Sleep Apnea

Sleep apnea represents a relatively common sleep disorder referring to breathing interruptions that occur following partial or complete blockage of the airway. Each breathing pause can last seconds or minutes during which the person’s brain and body does not receive the necessary amount of oxygen. In the unsuccessful attempt to breathe, the person may involuntarily snore and make other disturbing noises. Moreover, the body wakes up forcedly several times and the person may not even realize it. Generally, those suffering from sleep apnea experience the effects of a restless night in the morning and throughout the day, which mainly consist in tiredness, difficulties concentrating and sleepiness. The lack of oxygen can lead to negative consequences on the long term including heart disease and stroke, diabetes and high blood pressure as well as depression. Seeking medical attention and care becomes imperative if the episodes characterized by breathing cessation happen frequently and exceed 10 seconds. However, taking into consideration that the person in question is not aware of these episodes, the condition sometimes goes undiagnosed. In majority of cases, the partner or a close relative notices the concerning signs of sleep apnea. Diagnosis for this condition involves acquiring information regarding the patient’s medical history, performing physical examination and sleep study. The medical treatment consists of behavior therapy and surgery.


Types of Sleep Apnea

Specialists recognize there forms of sleep apnea, namely obstructive apnea, central apnea and complex sleep apnea, which practically represents a combination of the first two.

  • Obstructive sleep apnea (OSA) is more common in comparison to other forms of sleep apnea and occurs as a negative result of relaxed throat muscles and soft tissues that collapse blocking completely the airway. Following this abnormal blockage, the person begins to snore loudly as an effort to breathe.
  • Central sleep apnea (CSA) is less common and has a different cause. In a normal situation, the brain controls breathing by sending the necessary signals to the muscles. In people with central sleep apnea, the signals never reach the muscles because the brain fails to send them. The logical explanation behind this may refer to issues concerning the stability of the respiratory control center in the brainstem.
  • Complex sleep apnea syndrome, also called treatment-emergent apnea, combines the negative effects of both obstructive and central sleep apnea.


Risk Factors for Sleep Apnea

Any person, regardless of the age, can suffer from sleep apnea. However, specialists link several risk factors with this common sleep disorder. In terms of obstructive sleep apnea, these involve family history, age, excess weight, narrowed airway, neck circumference, nasal congestion and vicious habits like smoking and drinking. Apparently, obese people face higher chances of developing sleep apnea due to the presence of fat deposits surrounding the upper airway and obstructing breathing. Furthermore, most people with think necks have narrow airways while other people simply inherit a narrow throat. According to certain studies, elders are more likely to suffer from this serious condition, especially men. In what concerns women, the risk increases after menopause. In smokers, the upper airway indicates signs of fluid retention and inflammation, which obviously increases the likelihood of obstructive sleep apnea. Certain substances like sedatives and tranquilizers relax throat muscles leading to airway obstruction and implicitly, the inability to breathe.

When it comes to central sleep apnea, risk factors include age, history of stroke and heart disorders as well as the use of narcotic pain medications. Those who experienced a stroke in the past face a higher possibility of developing not only central sleep apnea but also treatment-emergent apnea. Congestive heart failure, especially in older and middle-aged people represents another danger associated with the alarming sleep disorder.


Signs and Symptoms of Sleep Apnea

Undoubtedly, the most obvious sign of sleep apnea is chronic snoring accompanied by chocking and gasping. At the beginning, the snoring is noisier only when the respective person sleeps in a certain position, namely on her back but in time, as the condition aggravates, it will inevitably become louder and more frequent. Unfortunately, the person cannot acknowledge the worrisome breathing problems or assess the severity of the problem because the condition always attacks when being unconscious. This causes a major delay in consulting a doctor and receiving the proper treatment. Apart from snoring, the individual suffering from sleep apnea also experiences abrupt awakenings that co-occur with dyspnea or shortness of breath, morning headaches, poor quality sleep or insomnia, difficulty concentrating and memory loss, attention problems, irritability and depression. Daytime sleepiness represents another symptom of sleep apnea that people struggle to fight, especially during moments of inactivity.

Sleep apnea can also occur in children meaning that parents need to pay maximum attention to possible signs, which refer to hostile behavior, poor school performance and hyperactivity. Moreover, a child suffering from this condition may start breathing though the mouth instead of breathing normally though the nose.


Diagnosis of Sleep Apnea

In order to establish an accurate diagnosis, doctors rely on information concerning the patient’s medical and family history as well as results of the physical examination and sleep study. A person who suspects the presence of sleep apnea will most likely contact her primary care doctor who will attentively evaluate the symptoms before sending the person in question to a sleep specialist, who may be a neurologist, pulmonologist, otolaryngologist or psychiatrist. The patient should take into account keeping a sleep diary because it will help him establish sleeping habits and patterns. The respective diary should contain details regarding the amount of sleep and the level of restfulness he managed to enjoy during each night, his state in the morning and throughout the day, the consumption of alcohol and caffeine as well as drugs and medications taken. This information will prove to be very useful for the doctor because it will enable him to determine the exact cause of the sleeping problems.

In terms of medical and family history, the doctor will ask questions about the frequency of snoring as well as other noises during sleep. Obviously, the person herself is not able to give the needed answers because nobody can know what happens during sleep and for this reason, discussing with the bed partner or a family member is more efficient. Nevertheless, the patient can inform the doctor about cases of sleep apnea in the family. The physical examination consists in checking the patient’s mouth, throat and nose for large tissues. Children suffering from this condition have enlarged tonsils while adults have an enlarged soft palate or uvula.

After discussing with the patient and performing the physical examination, the doctor will continue with a sleep study, which represents a test that measures the quality of sleep and the body response to sleep issues. This probably represents the most reliable method of diagnosing sleep apnea because it allows doctors to determine the presence or absence of the condition as well as its severity. Furthermore, doctors have the possibility to choose between an overnight sleep study performed in a lab and home sleep tests.

  • The first option is more common for this type of situation and requires the patient to spend the night in a sleep center with sensors connected to different parts of the body, including chest, limbs and face. The sensors have the purpose to record heartbeat and blood pressure, brain activity and breathing, eye and chest movements. The latter indicates if the patient puts more effort than necessary into breathing properly. This method is painless but expensive. After reviewing the results of the test, a sleep specialist will determine the severity of the condition and plan the most efficient treatment.
  • Even though performing the sleep study in a fully equipped lab provides the most accurate results, taking into consideration the patient’s symptoms and circumstances, the specialist may recommend the second option, namely the home sleep test. However, the patient should not have other serious medical conditions like neuromuscular and pulmonary diseases or congestive heart failure. This study consists in using a portable monitor that will record a part of the necessary information for establishing a diagnosis of sleep apnea. For instance, in this case, the specialist will be able to analyze the heart rate, chest movements and blood pressure. In comparison to the in-lab overnight sleep study, this method is more affordable and the patient has the responsibility to prepare the testing equipment.


Non-Surgical Treatments for Sleep Apnea

Even though behavioral changes are the simplest treatment methods, patients sometimes encounter difficulties in following them. As mentioned above, the condition often occurs when maintaining the same position throughout the night, usually on the back meaning that in order to reduce the symptoms and improve the quality of sleep the person needs to change her sleeping position. This may prove to be a challenging mission because nobody can control his body while being asleep. Another factor that contributes significantly to sleep apnea is obesity. Consequently, the only solution in this case is adopting a healthier lifestyle and a more balanced diet that promotes weight loss. Once again, this mission is quite challenging because for some patients exercising seems almost impossible because of the constant tiredness and the lack of energy. They inevitably end up in a vicious circle because increased tiredness impedes exercising which encourages weight gain thus worsening the condition.  Furthermore, doctors recommend common and simple practices that can improve sleep that involve diminishing the light and noise in the room, avoiding distractions in bed, such as watching TV and reading, keeping work responsibilities and tasks outside of the room and practicing both physical and mental relaxation techniques before falling asleep.

In terms of medication, specialists are still trying to find something that could fight symptoms of sleep apnea but considering the main cause of the condition, which refers to the narrowing or blockage of the airway, this objective becomes hard to accomplish. Nevertheless, doctors recommend steroid sprays and topical nasal decongestants for those patients with nasal obstruction and swelling. Thyroid replacement therapy represents a solution for people with obstructive sleep apnea caused by a low production of thyroid hormone. Obese people with sleep apnea can benefit from medication if they do not succeed to lose weight though exercise.

Dental appliances are suitable for patients with mild or moderate forms of obstructive sleep apnea. They impede airway closure by holding the jaw and the tongue forward. A dental appliance is small and portable. Doctors may combine them with other forms of treatment, such as continuous positive airway pressure (CPAP) and nasal surgery. The main disadvantage of dental appliances is that, in time, the person may experience joint pain when eating and has to contact a dentist or an oral surgeon to adjust the appliance.


Surgical Treatments for Sleep Apnea

Doctors benefit from various surgical options for treating sleep apnea. Therefore, in order to make a decision, they must consider the patient’s specific anatomy as well as the severity of the condition. Most people choose surgery because it is faster and more convenient in comparison to other treatment methods like losing weight or wearing a dental appliance every night, for instance. Generally, surgeries are safe but doctors warn that every intervention comes along with risks. Most surgeries force patients to abstain from normal activities or work for approximately two weeks because of the pain. Potential risks involve problems swallowing, scar tissue, infection, bleeding, anesthesia risks and unexpected surgical complications. All surgical treatments for sleep apnea revolve around the problematic areas including the neck, jaw, nose, tongue and palate. Surgical options for sleep apnea refer to nasal airway surgery, upper airway stimulation therapy, hyoid suspension, palatal implants, tongue repositioning or reduction and tracheostomy, among others. In certain cases, surgeons perform these procedures together.

Surprisingly, after evaluating all the options in terms of treatment for sleep apnea, some people do not show excitement or interest when it comes to choosing one allowing the condition to degenerate and lead to medical complications. These complications include decreased attentiveness at home and productivity at the workplace, high blood pressure, heart attacks and strokes and most importantly, of all, death. Patients need to realize the consequences that may appear in the absence of treatment and take action as soon as possible.

Last updated on December 3rd, 2018

Chris Riley

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