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Sleep apnea is a potentially serious breathing disorder that affects more than 18 million Americans. If you have sleep apnea, your body stops breathing when you sleep, and you need to wake up to breathe again—creating a cycle of waking and sleeping that can impact health in significant ways. You may wake up gasping for breath, or you might stir from sleep so briefly you don’t notice waking up. Some people with severe sleep apnea may stop breathing more than 30 times in an hour of sleep.
Stopping breathing in the nighttime may sound serious, and it is. For most people, sleep apnea doesn’t stop your breathing long enough to put you at risk of immediate harm—but over the long term, sleep apnea can lead to other serious problems, including heart disease, memory lapses, and impotence. And being tired from poor sleep can get in the way of your work or your home life, or even put you at risk for a serious accident.
There are two basic types of sleep apnea:
Many people with central sleep apnea suffer from obstructive sleep apnea as well. Having both types at once is known as mixed sleep apnea, or complex sleep apnea syndrome. Complex sleep apnea is, in fact, more common than central sleep apnea on its own. According to one study of 223 people with sleep apnea:
Regardless what type you have, sleep apnea affects the quality of your sleep and can leave you tired in the morning.
There are two types of sleep apnea that have different causes, but similar effects.
Obstructive sleep apnea is caused by an airway that closes up or gets blocked so that air can’t get through. If you have obstructive sleep apnea, the muscles in the back of your throat relax while you sleep, allowing your tongue, your uvula, and your soft palate to relax. One of these parts may slide back and block the airway, or the sides of your windpipe may simply close in, which makes it harder for air to get through.
Central sleep apnea is caused when your brain fails to send a signal to the muscles you use to breathe. Central sleep apnea is often caused by a problem with the brainstem, and it is most common in people who suffer from advanced heart failure, or have had a stroke.
Because obstructive and central sleep apnea occur for different reasons, they have different risk factors, for the most part. A few of the risk factors are things you can control, although others are not.
Factors that raise your risk of both obstructive and central sleep apnea include:
Controllable risk factors for obstructive sleep apnea include:
Risk factors you can’t control for obstructive sleep apnea include:
Controllable risk factors for central sleep apnea include:
The uncontrollable risk factors for central sleep apnea are mostly other medical conditions. These include:
You may call your doctor for an appointment because you have had trouble with snoring, being tired in the daytime, or nighttime breathing problems such as waking up gasping for air, or the possibility of sleep apnea may come up in a regular appointment.
At the doctor’s visit, your doctor will likely ask you questions about your symptoms including:
Your doctor may diagnose your condition based on this interview, or he or she may refer you to a sleep disorder center for further testing.
At the sleep disorder center, you may be evaluated by a sleep specialist, who might ask you to stay overnight for an evaluation, or to take equipment home with you to monitor your sleep in your own bed.
If you are diagnosed with sleep apnea, you may also need to visit an ear, nose, and throat doctor (otolaryngologist) to make sure there isn’t something in the way of your air passages. If you have central sleep apnea, you may need to visit a heart doctor (cardiologist) or a doctor who treats the brain and nervous system (neurologist) to check for specific causes of apnea.
One of the major signs of sleep apnea is snoring. Not everyone who snores has sleep apnea, and not everyone with sleep apnea snores, but loud snoring can be a warning sign of sleep apnea, especially if it’s loud enough to wake you up, or to wake up your spouse or significant other. Snoring is also common in people with central sleep apnea, although it may not be as common or as loud.
Being overtired during the day is another symptom of sleep apnea and other sleep disorders. This may lead to drowsiness, distraction, or having a hard time concentrating or paying attention.
Other symptoms of sleep apnea include:
If you have central sleep apnea, you may also wake up gasping for breath or feeling like you can’t breathe.
Sleep apnea may stop your breathing for a minute or longer, but for most people, apnea does not stop breathing long enough to cause immediate harm. However, long-term sleep apnea can lead to serious medical problems, including:
In addition, sleep apnea can cause serious loss of sleep for you and your significant other, leading to:
Untreated sleep apnea can shorten our lifespan and increase your risk of death before age 50. Fortunately, treatment can reduce or eliminate the added risk.
Treatment for sleep apnea may be hard to get used to. A CPAP device maybe uncomfortable or irritating when you sleep. But proper treatment can improve your health and your sleep. Tell your doctor if your CPAP or other treatments cause side effects. And if it stays uncomfortable after you’ve been using it for a while, try adjusting the straps or trying on different masks that may be easier to use.
If you need surgery or anesthesia, tell the surgeon and the anesthesiologist that you have sleep apnea, so they can take extra precautions to keep your airway open and keep you breathing while you’re unconscious.
Also tell close friends and family about your condition. They may be able to help you keep your treatments on track or offer emotional support.
Here are some additional tips for living with sleep apnea:
Many doctors don’t realize the seriousness of sleep apnea, and most patients with this condition are never diagnosed. By some estimates, up to 93% of all people with sleep apnea don’t know they have it. Fortunately, awareness of this condition is improving.
An overnight sleep study is too expensive and time-consuming to use in routine screening, but several questionnaires and screening tools are available to help your doctor check your risk of sleep apnea and other sleep disorders, and to find out whether you should have further testing. Some of these screening tools rely on questions alone, while others require a physical examination, including body measurements such as the size of your tongue and the size and shape of your neck.
Screening is especially important before surgery or anesthesia, when you may not be able to wake up and move if you stop breathing. Fortunately, there are screening questionnaires that are specifically designed to screen patients for sleep apnea before surgery.
You can also screen yourself at home with questionnaires provided by the American Sleep Apnea Association at http://sleepapnea.org/treat/test-yourself.html
No self-test can substitute for a diagnosis by a doctor, but these tests are a good starting point.
Not all causes of sleep apnea are under your control, but if you are concerned about sleep apnea, there are things you can do to lower your risk. Specifically:
For some people with mild sleep apnea, treatment may consist of lifestyle changes alone. If your apnea is caused by a treatable medical condition, then the first step is to treat the underlying cause. If these measures aren’t enough, then the next step is likely to be a device to help you breathe at night.
The most common treatment for sleep apnea is continuous positive airway pressure (CPAP). This treatment involves strapping a mask that is attached to a hose with an air pump at the other end. You put the mask on before you sleep, and the pump delivers air through the hose at a slightly higher pressure than the air around you. This increased air pressure helps you keep your airways open, so that you can breathe evenly through the night.
CPAP can seem uncomfortable or annoying at first, but most people who stick with it get better sleep and feel more rested in the day. Many people get used to the mask over time, or can make it more comfortable by adjusting the straps or finding a more comfortable air mask.
If you can’t get used to CPAP, there are other devices that may help. Many of these devices are based on the same principle as CPAP, but with slight adjustments. They include:
If you’ve tried devices and lifestyle changes but you still can’t get the relief you need, then there are surgical interventions available as well. These include:
There isn’t a lot of research yet on alternative or complementary treatments for sleep apnea. Some studies have found acupuncture to be helpful, when used together with standard treatments. Talk with your doctor before trying any alternative or complementary treatment
Sleep apnea can lead to serious health problems, but up to 93% of people who have this condition are not diagnosed. Talk to your doctor if:
When you go to see your doctor, it’s good to have a list of the questions you’d like to have answered. Take a moment to write down some of the things you want to know. Your questions for your doctor might include some of these:
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