Sleep Apnea

Overview

Sleep apnea is a sleep disorder characterized by repeated episodes of stopped or reduced breathing during sleep. There are two main types of sleep apnea: obstructive sleep apnea (OSA) and central sleep apnea (CSA). Obstructive sleep apnea occurs when throat muscles relax and block the airway, while central sleep apnea happens when the brain doesn't send proper signals to the muscles that control breathing. Symptoms of sleep apnea include excessive daytime sleepiness, loud snoring, observed episodes of stopped breathing during sleep, waking during the night gasping or choking, and morning headaches. If you think you might have sleep apnea, consult your health care provider for proper diagnosis and treatment.

Understanding the disease

Symptoms

The symptoms of sleep apnea include:

1. Observed episodes of not breathing during sleep.
2. Sudden awakenings with shortness of breath.
3. Not being able to stay asleep, known as insomnia.
4. Excessive daytime sleepiness, known as hypersomnia.
5. Trouble focusing.
6. Mood changes.
7. Morning headaches.
8. Snoring. Sleep apnea can be either central or obstructive. Central sleep apnea is characterized by a lack of breathing effort during sleep, while obstructive sleep apnea is caused by a physical blockage of the airway. Snoring is more prominent in obstructive sleep apnea, but it can also occur in central sleep apnea. If you suspect you have sleep apnea, consult your healthcare provider for proper evaluation and treatment.

Risk Factors

The risk factors for developing sleep apnea include:

1. Excess weight: Obesity is a common risk factor for obstructive sleep apnea. Fat deposits around the upper airway can obstruct breathing.
2. Narrowed airway: A naturally narrow airway can be inherited or caused by enlarged tonsils and adenoids.
3. Older age: The risk of obstructive sleep apnea increases with age, but it tends to plateau after the 60s and 70s.
4. High blood pressure (hypertension): Obstructive sleep apnea is relatively common in people with hypertension.
5. Down syndrome, birth defects in the skull or face, cerebral palsy, sickle cell disease, neuromuscular disease, or a history of low birth weight.
6. Family history of obstructive sleep apnea. Note that central sleep apnea has different risk factors, such as being older, male, having heart disorders, using narcotic pain medicines, or having had a stroke.

Development

Sleep apnea develops when the normal breathing process during sleep is disrupted, causing repeated pauses in breathing or shallow breathing. The two main types of sleep apnea are obstructive sleep apnea (OSA) and central sleep apnea (CSA). Obstructive sleep apnea (OSA) occurs when the muscles in the back of the throat relax, blocking the flow of air into the lungs. This is the more common form of sleep apnea and is often associated with loud snoring and excessive daytime sleepiness. Central sleep apnea (CSA) occurs when the brain doesn't send proper signals to the muscles that control breathing. This less common form of sleep apnea is typically not associated with snoring, and people with CSA may wake up with shortness of breath. Treatment-emergent central sleep apnea, also known as complex sleep apnea, happens when someone with obstructive sleep apnea (diagnosed with a sleep study) converts to central sleep apnea during therapy for OSA. In summary, sleep apnea develops due to the collapse of upper airway muscles (in OSA) or the failure of the brain to send proper signals to breathe (in CSA).

Assessment and Diagnosis

Triage

You should see a doctor if you or your partner notice symptoms of sleep apnea, such as loud snoring, episodes of stopped breathing during sleep, gasping or choking, sudden awakenings with shortness of breath, difficulty staying asleep, excessive daytime sleepiness, trouble focusing, mood changes, or morning headaches. If you experience shortness of breath that awakens you from sleep or pauses in your breathing during sleep, consult a medical professional as soon as possible.

Diagnosis

To diagnose sleep apnea, your health care provider will typically start with a consultation and evaluation based on your symptoms and sleep history. A sleep specialist may also be consulted to further evaluate your condition. The evaluation may involve an overnight monitoring of your breathing and other body functions during sleep testing at a sleep center or through home sleep testing. The tests used to detect sleep apnea include nocturnal polysomnography and polysomnography, which monitor heart, lung and brain activity, breathing patterns, arm and leg movements, and blood oxygen levels during sleep. If you are diagnosed with sleep apnea, a sleep specialist will determine the appropriate treatment plan for you.

Management and Treatment

Complications

Sleep apnea, both obstructive and central, can lead to various complications. Some potential complications of sleep apnea include:

1. Daytime fatigue and sleepiness: People with sleep apnea often experience severe daytime drowsiness, fatigue, and irritability due to a lack of restorative sleep at night.
2. Difficulty concentrating: The excessive daytime sleepiness can make it challenging to focus and may cause individuals to fall asleep in inappropriate situations, such as at work, while watching TV, or even while driving.
3. Cardiovascular problems: Sudden drops in blood oxygen levels during sleep apnea can increase blood pressure and strain the cardiovascular system, potentially increasing the risk of heart disease.
4. Fatigue: Central sleep apnea's repeated awakenings make restorative sleep impossible, causing severe fatigue, daytime drowsiness, and irritability.
5. Attention or behavior problems: Children and young people with central sleep apnea might struggle in school and commonly have attention or behavior problems.
6. Heart disease: People with obstructive sleep apnea may develop high blood pressure, increasing the risk of heart disease.
7. Stroke: Having had a stroke increases the risk of central sleep apnea.
8. Eye problems: Some research has found a connection between sleep apnea and certain eye conditions, such as glaucoma.
9. Relationship disruptions: Loud snoring can disrupt the sleep of those around the individual, potentially leading to strained relationships.
10. Memory problems, morning headaches, mood swings, and depression: People with sleep apnea may experience these issues, as well as a need to urinate frequently during the night.
11. Increased risk of severe COVID-19: Individuals with sleep apnea may be at higher risk for developing a severe form of COVID-19 and may require hospital treatment. It is essential to address sleep apnea to avoid or minimize these potential complications.

Home Remedies

It is important to consult a healthcare professional for proper diagnosis and treatment of sleep apnea. Sleep apnea is a serious condition that requires medical attention and may involve the use of devices such as continuous positive airway pressure (CPAP) machines or other treatments recommended by a healthcare provider.

Treatment

Treatments for obstructive sleep apnea include devices that use positive pressure to keep the airway open during sleep, such as CPAP machines, and mouthpieces that thrust the lower jaw forward during sleep. In some cases, surgery might be an option. For central sleep apnea, treatments involve managing underlying conditions, using breathing assistance devices, or using supplemental oxygen. Treatment-emergent central sleep apnea, which occurs in some people with obstructive sleep apnea using CPAP, might be treated with a different type of positive airway pressure therapy or other approaches.

Preparing for medical consultation

To prepare for an appointment for sleep apnea, you should:

1. Make a list of your symptoms, including any that may seem unrelated to the reason for the appointment and when they began.
2. Gather information about your personal and family history, including any history of sleep disorders.
3. Bring a list of all medicines, vitamins, or supplements you take, including doses.
4. If possible, bring a family member or friend along to help you remember the information you receive.
5. If you suspect sleep apnea, keep a sleep diary before your appointment, recording your sleep patterns, daily routine, naps, and how you feel during the day.
6. Prepare questions to ask your doctor, such as the most likely cause of your symptoms, what tests you need, whether you need to go to a sleep clinic, and the available treatments. By gathering this information and being prepared with your questions, you can make the most of your appointment and work with your healthcare professional to manage your sleep apnea effectively.