CONDITIONS

What Is Sleep Apnea

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:

  • Obstructive sleep apnea is by far the most common type. In obstructive sleep apnea, your breathing stops because something gets in the way, like your tongue or your soft palate, or the muscles in your throat relax and let your windpipe close up so that air can’t get through.
  • Central sleep apnea is much less common; in central sleep apnea, your brain fails to send an important signal, and the muscles in your airways just “forget” to breathe.

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:

  • 188 people, or about 84%, had obstructive sleep apnea
  • 34 people, or 15%, had complex sleep apnea syndrome
  • Only 1 patient, less than ½%, had central sleep apnea alone

Regardless what type you have, sleep apnea affects the quality of your sleep and can leave you tired in the morning.

What Causes Sleep Apnea

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.

Risk Factors For Sleep Apnea

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:

  • Your sex. Both types of apnea are more common in men than in women.
  • Your age. Sleep apnea in general is more common after age 60. Central sleep apnea is more common after 65.

Controllable risk factors for obstructive sleep apnea include:

  • Your weight. Not everyone with sleep apnea is overweight, but fat deposits near your upper airway can increase your risk.
  • Smoking. If you smoke, you are three times as likely to have sleep apnea. Quitting now can lower your risk!
  • Drugs that relax your muscles, such as alcohol, sedatives, or tranquilizers.
  • Nasal congestion. Obstructive sleep apnea is more likely if it’s hard for you to breathe through your nose.
  • Swollen tonsils or adenoids, which can reduce the space at the top of your windpipe and make it harder for air to get through.

Risk factors you can’t control for obstructive sleep apnea include:

  • Your race. Sleep apnea before age 35 is more common in African Americans.
  • Your family history. You may have a greater risk if someone in your family has sleep apnea.
  • The size of your neck and your windpipe. If your windpipe is thinner than usual, it may be harder for air to get through. If you have a thicker than usual neck, then you may have a thinner than usual airway.

Controllable risk factors for central sleep apnea include:

  • Living at a high altitude, where there is less oxygen in the air
  • Using opioid medications
  • Treatment for obstructive sleep apnea using continuous positive airway pressure (CPAP). Unfortunately, the main treatment for obstructive sleep apnea is also a significant cause of central sleep apnea. This may be a reason why complex sleep apnea is more than 30 times as common as central sleep apnea alone.

The uncontrollable risk factors for central sleep apnea are mostly other medical conditions. These include:

  • Congestive heart failure
  • Atrial fibrillation
  • Stroke
  • Brain tumor

Diagnosing Sleep Apnea

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:

  • How long you’ve been having problems with your breathing or your sleep
  • How severe the problem seems to you
  • How much your spouse or significant other notices the problem
  • Whether anything triggers or worsens your symptoms

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.

Symptoms of Sleep 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:

  • Waking up in the middle of the night
  • Waking in the morning with dry mouth, sore throat, or headache
  • Stopping breathing in the night, which might be noticed by someone else in the room

If you have central sleep apnea, you may also wake up gasping for breath or feeling like you can’t breathe.

Prognosis

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:

  • Heart disease, especially on the right side of your heart, which can eventually lead to complete heart failure
  • High blood pressure
  • Liver problems
  • Impotence
  • Overweight or obesity
  • Memory loss

In addition, sleep apnea can cause serious loss of sleep for you and your significant other, leading to:

  • Distraction
  • Mood changes
  • Lost productivity
  • Risk of serious or even deadly accidents

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.

Living With Sleep Apnea

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:

  • Until you know your treatment is working, be careful when driving or operating heavy machinery, as drowsiness can lead to serious accidents.
  • Try to lose weight or keep your weight the same, as excess fat can make your sleep apnea worse.
  • Avoid alcohol and sedatives in the evening.
  • Don’t smoke. If you need help quitting, ask your doctor.

Screening

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.

Prevention

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:

  • Don’t smoke. Smoking triples your risk of sleep apnea and can lead to other serious health problems. Quitting now can help reduce your risk. If it’s hard for you to quit smoking, ask your doctor for help.
  • Exercise and keep a healthy weight. Being overweight can affect your airways and increase your risk of sleep apnea.
  • Avoid using alcohol or sedatives just before bed. Drugs that relax your muscles may make it harder for the same muscles to keep your airway open.

Medication And Treatment

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:

  • Bilevel positive airway pressure (BPAP), which gives more pressure when you breath in and less when you breathe out
  • Adaptive servo-ventilation (ASV), which learns your breathing pattern and uses air pressure to keep your breathing in rhythm without interruption.
  • Oral appliances that you put in your mouth before you sleep. These appliances help you keep your airway open by adjusting the position of your jaw, like a retainer. Oral appliances aren’t always as effective as CPAP, and you will need to have the fit checked by a dentist every year—twice in the first year—but they work without electricity, and you don’t need to be connected to a large machine.
  • Expiratory positive airway pressure (EPAP). These are small valves that you put over your nostrils before you go to sleep. The valves let you breathe in freely, but require more pressure when you breathe out. This uses the force of your own breath to fill your air passages up with air, to keep the airway open without electric power.

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:

  • Jaw repositioning to move your lower jaw forward and make more room for you to breathe.
  • Surgery to remove or repair tissue that’s in the way, such as removing tonsils and adenoids or fixing a deviated septum.
  • Plastic implants in the soft palate, if you can’t tolerate CPAP.
  • Tracheostomy if you suffer from severe, life-threatening sleep apnea. This operation puts a new breathing hole in your neck, and it is usually done only as a last resort.

Complementary and Alternative Treatment

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

When To Contact A Doctor

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:

  • You snore loud enough to wake you up or wake up other people in the house
  • You wake up gasping for breath
  • Your spouse or significant other notices that you stop breathing while you are asleep
  • You feel tired or drowsy during the day, or you fall asleep when you don’t intend to

Questions For A Doctor

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:

  • What do you think is interrupting my sleep?
  • What treatments do you recommend?
  • [If you need CPAP or another medical device] Is there anything I can do to make it easier to adapt to sleeping with this device on?
  • What can I do in my day-to-day life to improve my condition?
  • Is there anything else I should know about sleep apnea?
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