Photo from helpguide.org
Sleep apnea is a potentially dangerous sleep disease in which breathing regularly stops and begins. You may have sleep apnea if you snore loudly and feel fatigued even after a full night's sleep.
The following are the most common types of sleep apnea:
- Obstructive sleep apnea: The most frequent type is obstructive sleep apnea, which occurs when the throat muscles relax.
- Central sleep apnea: Central sleep apnea happens when your brain fails to deliver appropriate signals to the muscles that control your breathing.
- Complex sleep apnea: Complex sleep apnea syndrome, also known as treatment-emergent central sleep apnea, is characterized by the presence of both obstructive and central sleep apnea.
Consult your doctor if you suspect you have sleep apnea. Treatment can alleviate your symptoms and may aid in the prevention of heart issues and other complications.
WHAT ARE THE SYMPTOMS OF SLEEP APNEA?
The signs and symptoms of obstructive and central sleep apneas sometimes overlap, making it difficult to tell which type you have. The following are the most prevalent indications and symptoms of obstructive and central sleep apneas:
- Snoring loudly
- Episodes in which you stop breathing while sleeping — as recounted by another person
- During sleep, you may find yourself gasping for air.
- waking up with a dry tongue
- Headache in the morning
- Difficulties falling asleep (insomnia)
- Excessive drowsiness during the day (hypersomnia)
- Difficulty staying awake and paying attention
- Irritability
WHAT ARE THE CAUSES OF SLEEP APNEA?
Obstructive sleep apnea
When the muscles in the back of your throat relax, this happens. The soft palate, the triangular portion of tissue hanging from the soft palate (uvula), the tonsils, the side walls of the throat, and the tongue are all supported by these muscles.
When you relax your muscles, your airway narrows or closes when you breathe in. You aren't getting enough oxygen in your blood because you aren't getting enough air. Your brain detects your inability to breathe and momentarily wakes you up so you can reopen your airway. This awakening is frequently so fleeting that you are not aware of it.
You may sneeze, choke, or gasp. This rhythm can repeat itself five to thirty times or more every hour, all night, affecting your capacity to achieve deep, undisturbed sleep.
Central sleep apnea
This is a less frequent type of sleep apnea in which your brain fails to send signals to your breathing muscles. This means that for a little amount of time, you make no attempt to breathe. You may awaken with shortness of breath or have difficulty falling or staying asleep.
WHAT ARE THE RISK FACTORS FOR SLEEP APNEA
Anyone, including children, can suffer from sleep apnea. However, several circumstances raise your risk.
Obstructive sleep apnea
The following factors enhance the likelihood of this type of sleep apnea:
Extra weight: Obesity significantly raises the risk of sleep apnea. Fat deposits in the upper airway can restrict breathing.
Circumference of the neck: Airways may be narrower in people with broader necks.
A narrowed airway: You might have been born with a narrow throat. Tonsils and adenoids can also grow and restrict the airway, especially in children.
Being male: Men are two to three times more likely than women to suffer from sleep apnea. Women, on the other hand, tend to be at greater risk if they are overweight, and their risk looks to climb after menopause.
Nasal congestion: You are more likely to develop obstructive sleep apnea if you have trouble breathing through your nose, whether due to an anatomical condition or allergies.
Medical conditions: Some of the factors that may raise the risk of obstructive sleep apnea include congestive heart failure, high blood pressure, type 2 diabetes, and Parkinson's disease. Polycystic ovarian syndrome, hormonal abnormalities, a history of stroke, and chronic lung diseases such as asthma can all raise the risk.
Age: Sleep apnea is substantially more common in elderly people.
Family history: Having a family member who suffers from sleep apnea may raise your risk.
Use of sedatives, tranquilizers, or alcohol. These medications can cause obstructive sleep apnea by relaxing the muscles in your throat.
Smoking: Smokers are three times as likely than nonsmokers to experience obstructive sleep apnea. Smoking can cause an increase in inflammation and fluid retention in the upper airway.
Central sleep apnea
The following are risk factors for this type of sleep apnea:
- Ageing: People in their forties and fifties are more likely to suffer from central sleep apnea.
- Being male: Men are more likely than women to suffer from central sleep apnea.
- Heart problems: The danger is increased if you have congestive heart failure.
- Using narcotic pain relievers: Opioid drugs, particularly long-acting opioids like methadone, raise the risk of central sleep apnea.
- Stroke: A stroke raises your chances of developing central sleep apnea or treatment-emergent central sleep apnea.
WHAT ARE THE COMPLICATIONS OF SLEEP APNEA?
Sleep apnea is a potentially fatal medical condition. Complications can include the following:
- Daytime exhaustion: The frequent awakenings caused by sleep apnea make normal, restorative sleep impossible, resulting in significant daytime sleepiness, weariness, and irritability.
You may find it difficult to concentrate and fall asleep at work, while watching TV, or even while driving. People who suffer from sleep apnea are more likely to be involved in car accidents and occupational mishaps.
You may also be irritable, moody, or depressed. Children and adolescents who suffer sleep apnea may struggle in school or have behavioral issues.
- Metabolic syndrome (MS): Excessive blood pressure, abnormal cholesterol levels, high blood sugar, and an enlarged waist circumference are all symptoms of this ailment, which has been related to an increased risk of heart disease.
- Medication and surgical complications: Certain drugs and general anesthesia might cause obstructive sleep apnea. People who have sleep apnea are more likely to have issues after major surgery because they have breathing problems, especially when sedated and laying on their backs.
Inform your doctor about your sleep apnea and how it is being treated before undergoing surgery.
- Heart problems or high blood pressure: Sudden reductions in blood oxygen levels caused by sleep apnea raise blood pressure and put a load on the cardiovascular system. Obstructive sleep apnea raises your chances of developing high blood pressure (hypertension).
Obstructive sleep apnea may also increase your chances of having another heart attack, having a stroke, or having abnormal heartbeats such as atrial fibrillation. Multiple episodes of low blood oxygen (hypoxia or hypoxemia) might lead to sudden death from an irregular heartbeat if you have heart disease.
- Diabetes type 2: Sleep apnea raises your chances of developing insulin resistance and type 2 diabetes.
- Liver problems: Sleep apnea patients are more likely to have abnormal liver function tests, and their livers are more likely to show symptoms of scarring (nonalcoholic fatty liver disease).
- Sleep-deprived partners: Snoring can prevent anyone sleeping nearby from enjoying a good night's sleep. It's fairly uncommon for a partner to have to sleep in another room, or even on a different floor of the house.
HOW IS SLEEP APNEA DIAGNOSED?
Your doctor may conduct an evaluation based on your indications and symptoms as well as a sleep history, which you can complete with the assistance of someone who shares your bed or household, if possible.
You will almost certainly be referred to a sleep disorder facility. There, a sleep specialist can assist you in determining whether you require further evaluation.
An evaluation frequently entails nightly monitoring of your breathing and other physiological systems while sleeping at a sleep clinic. Home sleep testing may also be an option. The following tests are used to detect sleep apnea:
- Nocturnal polysomnography: You are linked up to equipment that measures your heart, lung, and brain activity, breathing patterns, arm and leg movements, and blood oxygen levels while you sleep throughout this test.
- Sleep tests at home: To diagnose sleep apnea, your doctor may prescribe simple tests that you can perform at home. These tests often take your heart rate, blood oxygen level, airflow, and breathing patterns into account.
If the results are abnormal, your doctor may be able to recommend a therapy without requiring additional testing. However, because portable monitoring equipment do not detect all types of sleep apnea, your doctor may still recommend polysomnography even if your initial results are normal.
If you have obstructive sleep apnea, your doctor may recommend you to an ear, nose, and throat specialist to rule out any obstructions in your nose or throat. To investigate for causes of central sleep apnea, a doctor who specializes in the heart (cardiologist) or a specialist who specializes in the nerve system (neurologist) may be required.
WHAT ARE THE TREATMENTS FOR SLEEP APNEA?
For milder cases of sleep apnea, your doctor may just suggest lifestyle changes like decreasing weight or quitting smoking. If you have nasal allergies, your doctor will advise you on how to treat them.
If these methods do not help your symptoms, or if your apnea is moderate to severe, there are a variety of alternative therapies available.
Certain gadgets can aid in the opening of a clogged airway. In some circumstances, surgery may be required.
Therapies
- Continuous positive airway pressure (CPAP): If you have moderate to severe sleep apnea, a machine that supplies air pressure through a mask while you sleep may be beneficial. The air pressure provided by CPAP (SEE-pap) is slightly higher than that of the surrounding air and is just enough to keep your upper airway passages open, preventing apnea and snoring.
Although CPAP is the most frequent and reliable technique of treating sleep apnea, it can be difficult or uncomfortable for some people. Some people abandon the CPAP machine, but most people learn to adjust the tension of the straps on the mask to get a comfortable and secure fit with practice.
To locate a comfortable mask, you may need to try on many different types. If you encounter troubles with your CPAP machine, don't stop using it. Consult your doctor to determine what modifications might be done to improve your comfort.
Additionally, if you are still snoring or if you begin snoring again despite treatment, consult your doctor. If your weight changes, the CPAP machine's pressure settings may need to be modified.
- Oral appliances: Wearing an oral appliance designed to keep your neck open is another possibility. Although CPAP is more reliable than oral equipment, oral appliances may be easier to use. Some are intended to open your throat by pushing your jaw forward, which can help with snoring and moderate obstructive sleep apnea.
Your dentist can provide you with a variety of equipment. You may need to experiment with many gadgets before settling on one that works for you.
Once you've found the proper fit, you'll need to see your dentist frequently during the first year and then on a regular basis thereafter to check that the fit is still good and to reassess your indications and symptoms.
- Other airway pressure devices: If using a CPAP machine proves to be an issue for you, you may be able to utilize a different type of airway pressure device that regulates the pressure automatically while you sleep (auto-CPAP). There are also units that provide bilevel positive airway pressure (BPAP). These give more pressure when inhaling and less pressure when exhaling.
- Treatment for related medical issues: Heart or neuromuscular diseases are possible causes of central sleep apnea, and addressing such conditions may assist.
- Supplemental oxygen: If you have central sleep apnea, using supplementary oxygen while sleeping may assist. There are various types of oxygen available, as well as technologies that transport oxygen to your lungs.
- Adaptive servo-ventilation (ASV): This newly certified airflow device learns your typical breathing pattern and stores it in a built-in computer. After you fall asleep, the machine applies pressure to regulate your breathing rhythm and prevent breathing pauses.
In certain cases, ASV appears to be more effective than other forms of positive airway pressure in treating complicated sleep apnea. However, it may not be a good option for patients who have severe central sleep apnea and advanced heart failure.
Surgery
Surgery is normally reserved for when all other therapies have failed. Before considering surgery, other therapy options should be tried for at least three months. However, it is a good first option for a small percentage of people who have particular jaw structure abnormalities.
Surgical alternatives could include:
- Tissue removal: Your doctor will remove tissue from the back of your mouth and the top of your throat during this operation (uvulopalatopharyngoplasty). Tonsils and adenoids are frequently removed as well.
This procedure may be effective in preventing throat tissues from vibrating and producing snoring. It is less effective than CPAP and is not regarded as a dependable treatment for obstructive sleep apnea.
If you can't tolerate CPAP or oral appliances, radiofrequency radiation may be used to remove tissues in the back of your throat (radiofrequency ablation).
- Repositioning of the jaw: During this treatment, your jaw is separated from the rest of your face bones. This increases the space behind the tongue and soft palate, decreasing the likelihood of obstruction. This is referred to as maxillomandibular advancement.
- Implants: After a local anesthesia has been administered, soft rods, often made of polyester or plastic, are surgically placed into the soft palate. More research is needed to establish the effectiveness of implants.
- Tissue shrinkage: Another option is to use radiofrequency ablation to shrink the tissue at the back of your mouth and throat. For mild to moderate sleep apnea, this technique may be used. According to one study, this had similar results to tissue removal but with fewer surgical risks.
- Stimulation of the nerves: This necessitates surgery in order to implant a stimulator for the nerve that regulates tongue movement (hypoglossal nerve). The increased stimulation aids in keeping the tongue in a position that allows the airway to remain open. More investigation is required.
- Establishing a new airway (tracheostomy): If other therapies have failed and you have severe, life-threatening sleep apnea, you may require this type of surgery. During this treatment, your surgeon makes an incision in your neck and implants a metal or plastic tube through which you will breathe.
During the day, you cover the opening. At night, however, you remove it to allow air to pass into and out of your lungs, bypassing the blocked air passage in your throat.