Everyone wants a good night’s sleep, but according to the American Thoracic Society 18 million Americans suffer from sleep apnea which causes;
- sleep deprivation
- depression
- the potential for respiratory disorders
- and certain heart conditions.(1)
The Department of Preventive Medicine reported that 93% of women and 82% of men with moderate to severe symptoms have not been clinically diagnosed.(2)
What is Sleep Apnea?
If your snoring sounds like a freight train or you experience long pauses between breaths while asleep, you just might have sleep apnea.
A potentially life-threatening disorder, sleep apnea or cessation of breathing occurs when someone stops breathing periodically while sleeping.
Some individuals actually stop breathing between 15 and 100 times a night, disrupting deep slumber and potentially causing respiratory, heart, and lung problems.
Who is At Risk?
Sleep apnea occurs most often in adults who are overweight or have large tonsils or adenoids.(3)
Adult males, postmenopausal females and adults over the age of 40 are also prone to develop sleep apnea.(4)
Surprisingly, apnea can also occur in newborns with underdeveloped lungs or children who have asthma or enlarged tonsils that block airways.(5,6)
Patients who have respiratory conditions like;
- chronic obstructive pulmonary disease (COPD),
- chronic bronchitis,
- or emphysema (breakdown of lung tissue)
are at a high risk of developing sleep apnea.
Other risk factors for developing sleep apnea include having a large tongue, a deviated septum, or a small jaw bone.(7)
At risk are also females with a neck circumference of 16 inches (40,5 centimeters) or more and males with a large neck measuring over 17 inches (over 43 centimeters) in circumference.(3)
People who have a family history of sleep apnea, suffer from gastroesophageal reflux (GERD), have a sinus condition, or allergies may also be predisposed to sleep apnea.
Common Types
There are basically three types of the disorder:
- obstructive,
- central and complex,
- a combination of the former two.
Obstructive Sleep Apnea (OSA)
During sleep, the muscles, that support the soft palate in the back of your throat, go slack.
Think of the soft palate as a bellows that extends from the uvula, the tonsils and the parallel walls of the throat to the tongue.
The soft palate expands and contracts to allow normal breathing.
However, when this muscle relaxes during sleep, the airway is constricted and obstructs air and oxygen from getting into the lungs.
Fortunately, the human brain can sense when airways are obstructed and automatically awakens sleep apnea sufferers so that they can reopen and clear closed airways.
Most sleep apnea victims cannot detect when they are awakened.
However, this pattern of repeated obstructed breathing and wakening can disrupt sleep patterns sufficiently to cause health issues.
OSA can also be hereditary, so it is not uncommon for whole families to suffer from breathing cessation.
Accumulating data, published in 2000 by Sleep Medicine Reviews Journal, suggest that approximately 40% of the variance in the apnea hypopnea index (AHI) may be explained by familial factors.(8)
Central Sleep Apnea (CSA)
Central sleep apnea can occur when the brain, part of the central nervous system, fails to prompt the soft palate muscles to contract and expand to control breathing.(9)
Individuals who are on medication for other ailments may develop central sleep apnea.
Certain prescription drugs sometimes interfere with the brain’s ability to receive and respond to certain neurological messages.(10)
If the brain fails to communicate with the soft palate muscles, airways become blocked and breathing ceases.
The brain, aware that normal breathing has stopped, sets off an “alarm” that abruptly awakens the individual and causes them to breathe before the brain and lungs lose too much oxygen.
Complex Sleep Apnea
Complex sleep apnea is a syndrome which occurs when an individual has a combination of obstructive and central sleep apnea.
Complex sleep apnea is a two-headed monster that can wreak havoc on an individual’s overall health.
Imagine the restless nights caused by loud snoring due to blocked airways punctuated by long periods of breathing cessation as the brain fights to signal normal breathing.
Chronic fatigue, sore throat, headaches, accelerated heartbeat, and high blood pressure may all plague an individual suffering from complex sleep apnea.
Due to its relative complexity, this syndrome requires prompt treatment to avoid aggravated and prolonged symptoms.
Untreated Sleep Apnea Causes Serious Health Issues
Sleep apnea often goes undiagnosed and can trigger other health conditions if left untreated.
Because certain well known diseases like high blood pressure, diabetes and depression are readily diagnosed as isolated health conditions, a doctor might not conclude that these common conditions are attributable to sleep apnea.
People who develop breathing cessation are at increased risk for;(11,12)
- stroke
- arrhythmia (irregular heartbeat)
- heart failure and attacks
- depression
- diabetes
- headaches
- and Attention Deficit/Hyperactivity Disorder (ADHD) in adults and children.
However, health care providers must be diligent in uncovering the root cause of common ailments and properly diagnosing sleep apnea.
Adults who suffer from sleep apnea and deprivation are more prone to accidents on the job, irrational thinking and mood swings, or an inability to perform well under stress.
Senior adults face an increased risk of accelerated aging and memory loss as circulatory systems and brain function decrease.
Sleep apnea patients may develop depression or suicidal thoughts as their health and mental well-being deteriorates due to a lack of sufficient oxygen through the lungs, heart and brain.
Depression can exacerbate as sleep apnea victims spend most of their daytime hours making up for sleepless nights.
Hyperactive children may simply not be able to focus for a long period of time.
Childhood Sleep Apnea
Childhood sleep apnea can go undetected because children frequently take naps during the day.
A deviated septum, large tonsils or tongue, or small jaw bone might cause a toddler or kindergartner to develop sleep apnea.
Parents who suspect their child has breathing cessation should seek help from their pediatrician on pinpointing the exact cause.
- monitoring your child’s day and night time sleep patterns
- listening to their breathing while the child is asleep
- checking the pulse or heart rate
- and regular doctor visits can help pinpoint whether your child’s behavior is linked to sleep apnea
To avoid breathing problems in newborns and infants, doctors may prescribe continuous positive airway pressure (CPAP) using a small appliance in the nose that keeps airways open. CPAP is discussed in detail later in this article.
Parents should be aware that infants with or without sleep apnea should never be placed in the crib on their stomach to sleep.(13,14)
Face down, an infant’s airways could be blocked or the baby could spit up milk and choke.
Placing an infant on their back is the best way to help keep airways open and help prevent SIDS (sudden infant death syndrome).
Signs and Symptoms
Many people who suffer from sleep apnea are unaware of the problem.
Individuals may wake up tired with a headache or a sore throat. Others may snore loudly or repeatedly toss and turn while asleep.
Their spouse may notice loud snoring punctuated by long periods of breathing cessation, or choking or gasping sounds.
If your sleeping spouse inhales and holds their breath longer than normal before exhaling, then the underlying cause could be central sleep apnea.
Individuals may also suffer from insomnia and have difficulty staying asleep or experience excessive sleepiness during the day.
Sleep apnea sufferers may also fall asleep while driving, operating machinery or even in the middle of a conversation.
Other signs are;
- difficulty paying attention
- irritability
- mood swings
- forgetfulness
- and irrational thinking.(15)
Chronic sleep apnea sufferers should seek medical treatment as prolonged apnea can cause hypertension, stroke, congestive heart failure, or even death.
Common Treatments
Medical treatment for sleep apnea requires continuous monitoring and specially designed appliances that increase oxygen to the lungs and improve breathing.
Doctors also recommend lifestyle adjustments like;
√ smoking cessation,
√ weight loss,
√ low impact exercise,
√ and dietary changes
to facilitate better breathing and overall health.
Surgery may also be necessary to remove nasal obstructions, such as a deviated septum or adenoids, and clear blocked airways.
CPAP: The Most Effective Treatment
To counteract the adverse effects of sleep apnea, doctors prescribe continuous positive airway pressure (CPAP).
Essentially a two-part machine containing a motor on one side and a compressor on the other, a CPAP device lets patients breathe through a plastic mask that snugly fits over the mouth and nose, held securely onto the head with elastic straps.
The mask is connected to a flexible hose which feeds air from the machine through the mask.
Some CPAP machines have plastic pieces that fit snugly inside the patient’s nostrils.
The CPAP resembles a gas mask or space age contraption; but when worn properly, it is quite effective in regulating breathing.
A steady stream of air is pushed through the mask to keep airways open, thus preventing the soft palate and muscles inside the throat from collapsing.
As the patient inhales and exhales, their breathing becomes normal, snoring is eliminated, and air can flow freely through the nose and mouth to the lungs.
CPAP machines also have a memory card that records a patient’s rate of breathing while asleep, the amount of humidity in the room, and the number of hours a patient sleeps.
The pulmonologist will read data collected from the CPAP machine and adjust the device to help improve a patient’s lung capacity.
Nightly use of CPAP helps patients and their spouses get a good night’s sleep while keeping individuals from incurring chronic respiratory problems, hypertension and stroke.
CPAP Complications and Maintenance
Wearing a CPAP machine takes some getting used to. The steady stream of air blowing into the nostrils can be a bit disconcerting.
CPAP users also report feeling suffocated by the mask over their nose and mouth.
Nose pieces that fit inside the nostrils can also collapse and block airways.
Patients should not try to adjust the machine’s output level, but follow the respiratory therapist’s recommendation for machine settings and usage for the best results.
Sleep apnea victims on CPAP should also make sure that hoses, masks and water reservoirs are properly cleaned.
Hoses should be cleaned or replaced every 30 days to prevent contaminants from building up.
Masks can be cleaned once weekly with a vinegar and distilled water solution. Use the same vinegar solution to clean the water reservoir.
NEVER use ordinary tap water to clean CPAP components, as public tap water contains toxins that can contaminate equipment.
Purified or distilled water is best.
What You Can Do at Home
Aside from using a CPAP machine, sleep apnea victims can do several things at home to alleviate breathing problems:
√ Elevate the head with extra pillows to keep the soft palate from falling downward and obstructing airways.
√ Do not sleep on your back. Sleeping on the left or right side helps to keep the muscles in the throat from relaxing too much.
Sewing a tennis ball to your pajama tops helps you from sleeping on your back. If you should roll over, the tennis ball prompts you to turn onto your side.
√ Lose belly fat. Sleep apnea may be caused by excessive weight gain, especially belly fat.
Belly fat rests heavily on the lungs, causing airways to constrict and limit breathing.
√ Go to bed at the same time each night to train your body to fully relax.
√ Avoid drinking too much caffeine before bedtime. Drinking coffee, tea, alcohol and other stimulating beverages keeps the body awake and too alert to fall asleep easily.
√ Seek treatment for restless leg syndrome. Involuntary leg movement can awaken even the soundest sleeper and cause disruptive sleep patterns.
√ Avoid exercising right before bed and give yourself plenty of time to relax.
Other Treatments
Treatments also include oral appliances worn inside the mouth that open airways and help fill the lungs with oxygen.(16)
An oral surgeon or dentist will custom fit an individual with sleep apnea with a plastic device that either repositions the jaw or prevents the tongue from blocking airways.
Patients who are not overweight or only have a mild case of apnea may fare better using an oral appliance than those with severe obstructive and complex sleep apnea.
Surgical means of treating breathing cessation due to enlarged tonsils or adenoids involves removal of the offending gland.
Decades ago, children routinely had their tonsils removed at a certain age.
However, this trend seems to have lessened, which could account for more cases of childhood sleep apnea.
Authors of Patient Information Series J.A. Rowley, C. McGowen, S. Lareau, B. Fahy, and C. Garvey assert that surgically removing tissue from the airways is not as effective as using continuous positive airway pressure, or CPAP.(17)
Certainly, CPAP is much less invasive and treatments can be adjusted to suit a sleep apnea patient’s changing needs.
How To Determine If You Have Sleep Apnea?
To diagnose sleep apnea, a physician will schedule a sleep test, or polysomnogram, to monitor breathing cessation.
Testing is usually held at a sleep center from late evening through early morning hours.
During the sleep test, you will be hooked up to machines that monitor heart rate, oxygen level, the rate at which your breathing stops within an hour, and whether the apnea is obstructive, central or combined.
Your doctor will read test results and prescribe CPAP with or without oxygen therapy to help improve sleep patterns and breathing and eliminate loud snoring.
The Next Step
If you suspect that loud snoring, morning fatigue and daytime sleepiness are a result of sleep apnea, see your primary care physician.
A physician can recommend a pulmonologist or respiratory specialist to assess your condition and sleep habits.
Make sure that your primary care physician is familiar with all of your health issues, such as;
- hypertension
- or high blood pressure
- depression
- or an irregular heartbeat
Let your doctor know if you suffer from mood swings, headaches or restless leg syndrome.
You want to keep your doctor informed so that he can make the proper diagnosis and investigate whether or not common health conditions are attributable to sleep apnea.
Once properly diagnosed, your primary care physician may refer you to a pulmonologist or respiratory specialist to address your nighttime sleep issues and accompanying illnesses.
The specialist will determine what steps you should take to correct breathing cessation while asleep.
Try to make recommended adjustments to your lifestyle, such as losing weight or cutting out caffeine.
If the specialist recommends a polysomnogram or sleep test, go ahead and invest the time to get a professional analysis.
The pulmonologist may either determine that continuous positive air pressure (CPAP) is a viable solution for your sleep apnea or recommend surgery to remove physical airway obstructions.
Conclusion: Don’t Ignore the Symptoms
Be proactive in pinpointing the nature of your sleeplessness.
Remember, if you’re over 40, are overweight, suffer from insomnia, snore loudly or have long periods of breathing cessation, you might have sleep apnea.
The quicker you seek treatment, the greater the chance you’ll finally get a good night’s sleep and better overall health.
Researches and references
(1)http://www.thoracic.org/patients/lung-disease-week/2013/sleep-disorders-week/general-info.php
(2)http://www.ncbi.nlm.nih.gov/pubmed/9406321
(3)http://www.ncbi.nlm.nih.gov/pubmed/12746251
(4)http://www.ncbi.nlm.nih.gov/pubmed/12734134
(5)http://childrensnational.org/choose-childrens/conditions-and-treatments/airway-lungs/infant-apnea
(6)http://www.ncbi.nlm.nih.gov/pubmed/24138363
(7)http://www.ncbi.nlm.nih.gov/pubmed/26608151
(8)http://www.ncbi.nlm.nih.gov/pubmed/12531037/
(9)http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2287191/
(10)http://www.ncbi.nlm.nih.gov/pubmed/2171388/
(11)http://healthysleep.med.harvard.edu/sleep-apnea/living-with-osa/health-consequences
(12)http://www.webmd.com/sleep-disorders/excessive-sleepiness-10/10-results-sleep-loss
(13)https://sleepfoundation.org/sleep-disorders-problems/sudden-infant-death-syndrome-and-sleep
(14)https://www.nichd.nih.gov/publications/pubs/documents/sids_qa-508-rev.pdf
(15)http://www.nhlbi.nih.gov/health/health-topics/topics/sleepapnea/signs
(16)https://www.sleepassociation.org/list-oral-appliances-treating-sleep-apnea/
(17)https://www.thoracic.org/patients/patient-resources/resources/obstructive-sleep-apnea-in-adults.pdf
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