Sleep apnea is easily diagnosed with an overnight sleep study. However, untreated sleep apnea can lead to potentially serious health complications such as heart disease and depression; it can also increase the risk of motor vehicle accidents from drowsy driving.
Here are some key points about sleep apnea:
- Around 1 in 5 adults have mild symptoms of obstructive sleep apnea (OSA), while 1 in 15 have moderate-to-severe symptoms.
- Approximately 18 million Americans have this condition; yet only 20 percent have been diagnosed and treated.
- Menopausal and postmenopausal women have an increased risk of OSA.
- Sleep apnea is an independent risk factor for hypertension (high blood pressure).
- While sleep apnea is more prevalent in those aged 50 and above, it can affect people of all ages, including children.
What is sleep apnea?
Sleep apnea is an involuntary pause in breathing that occurs during sleep, either from a blocked airway (obstructive) or a signaling problem in the brain (central). Most people with sleep apnea have OSA.
People with this disorder unknowingly stop breathing repeatedly throughout sleep. Once the airway is opened or the breathing signal is received, the person may snort, take a deep breath, or may awaken completely with a sensation of gasping, smothering, or choking.
Causes of sleep apnea
Various factors can contribute to the blocking or collapse of the airway:
Muscular changes - when people sleep, the muscles that keep the airway open along with the tongue relax, causing the airway to narrow. Under normal conditions, this relaxation does not prevent the flow of air in and out of the lungs.
Physical obstructions - when there is additional thickened tissue or excessive fat stores surrounding the airway. This blockage restricts the airflow, and any air that squeezes past can cause the loud snoring typically associated with OSA.
Brain function - in central sleep apnea (CSA) - the less common form of sleep apnea - the neurological controls for breathing are abnormal, causing the control and rhythm of breathing to malfunction. In most cases, CSA is associated with an underlying medical condition such as stroke or heart failure, recent ascent to high altitude or the use of pain relief medication.
When the airway becomes completely blocked, the snoring stops and there is no breathing (apnea) for a 10-20 second time period or until the brain senses the apnea and signals the muscles to tighten, returning the airflow.
Although this process continues hundreds of times throughout the night, the individual experiencing the apnea is not conscious of the problem.
Risk factors for sleep apnea include:
- supine (flat on back) sleeping
- chronic sinusitis
- large neck circumference
- recent weight gain
- large tonsils or adenoids
- Down syndrome
- family history of sleep apnea
- recessed chin or large overbite
Symptoms of sleep apnea
One of the most common symptoms of sleep apnea is snoring.
Episodes of apnea may be witnessed by another person. They may notice the person stop breathing, suddenly gasp or grunt, wake up, and then go back to sleep.
One of the most common symptoms of sleep apnea is daytime sleepiness. The patient with OSA may not be aware of their problem, if they woke up during the night their sleep will not be restful. Consequently, during the day they will feel unusually sleepy.
Additional symptoms include:
- restless sleep or insomnia
- difficulty concentrating
- loud snoring
- waking up several times a night to urinate
- awakening with a dry mouth or sore throat
- morning headache
- decreased libido and erectile dysfunction
- large neck circumference (greater than 17 inches for men, greater than 15 inches for women)
Sleep disorders have also been associated with a number of complications and other conditions. These include:
- motor vehicle accidents
- impaired cognition
- metabolic syndrome
- mood changes
- memory troubles
- chronic fatigue
- decreased quality of life
- increased mortality (death)
Tests and diagnosis of sleep apnea
Anyone who feels chronically tired or groggy during the day should consult a medical provider to determine both the exact cause and necessary steps to address the problem. Common questions they might ask include:
- What is your typical sleep schedule on weekdays and weekends?
- How long does it take you to fall asleep?
- Are you taking any medications to help you sleep?
- How much sleep do you think you get each night?
- Has anyone told you that you snore?
- Do you wake up with a feeling of panic or jolt awake?
- How do you feel when you wake up?
- Do you nod off easily when watching television or reading?
- Does anyone in your immediate family have a diagnosed sleep disorder?
- Describe your sleep environment.
Sleep apnea is diagnosed with a sleep study (nocturnal polysomnography) carried out at an overnight sleep laboratory. This records brain waves, eye and leg movements, oxygen levels, airflow, and heart rhythm during sleep. A physician who specializes in sleep disorders interprets the test.
For some individuals, Home Sleep Apnea Testing (HSAT) can be done in place of the laboratory study. The number of apnea episodes that occur every hour determines sleep apnea severity:
- Normal - 0-5 apnea episodes per hour.
- Mild sleep apnea - 5-15 apnea episodes per hour.
- Moderate sleep apnea - 16-30 apnea episodes per hour.
- Severe sleep apnea - 31+ episodes per hour.
Treatments for sleep apnea
One of the treatment options is CPAP therapy, where air is pushed through a mask to keep the airway open during sleep.
Sleep apnea is a common problem associated with decreased overall health and life-threatening complications such as motor vehicle accidents, difficulty concentrating, depression, heart attack, and stroke.
Depending on the cause and the level of apnea, there are different methods of treatment. The goal of treatment is to normalize breathing during sleep.
Normalizing breathing has the following effects on apnea:
- It eliminates daytime fatigue.
- It removes unwanted mental health changes from apnea or lack of sleep.
- It prevents cardiovascular changes caused by the excess strain of improper breathing.
Lifestyle modifications are essential to normalizing breathing, and they are critical first steps in treatment. They include:
- alcohol cessation
- smoking cessation
- weight loss
- side sleeping
Other treatment options include:
- Continuous positive airway pressure (CPAP) therapy - this is the frontline treatment for OSA. This keeps the airway open by gently providing a constant stream of positive pressure air through a mask.
- Surgery - there are various surgical procedures that can widen the airway. Surgery can be used to stiffen or shrink obstructing tissue, or remove excess tissue, or enlarged tonsils. Depending on the extent of the surgery, procedures can be carried out in a doctor's office or a hospital.
- Mandibular repositioning device (MRD) - this is a custom-made oral appliance suitable for individuals with mild or moderate sleep apnea. This mouthpiece holds the jaw in a forward position during sleep to expand the space behind the tongue. This helps keep the upper airway open, preventing apneas, and snoring.
Some people have trouble using CPAP and stop the treatment before achieving any lasting benefit. However, there are many measures that can be taken to make the equipment more comfortable and the adjustment period smooth. The mask and its settings can be adjusted, and adding moisture to the air as it flows through the mask can relieve nasal symptoms.
Side effects of a MRD may include jaw or tooth pain, and potential aggravation of temporomandibular joint disease.
The potential health implications of not treating sleep apnea far outweigh the cost or inconvenience associated with the diagnosis and treatment. Any individual with excessive daytime sleepiness or other symptoms of sleep apnea should promptly follow up with their doctor.