- Sleep apnea is a common breathing disorder in which a person has one or more pauses in breathing or shallow breaths while asleep.
- Breathing pauses can last from a few seconds to minutes, and occur five to 30 times or more an hour. Typically, normal breathing then starts again, sometimes with a loud snort or choking sound.
- Sleep apnea is usually a chronic (ongoing) condition that disrupts your sleep 3 or more nights each week.
- Most people who have sleep apnea don't know they have it because it only occurs during sleep.
- The most common signs of sleep apnea are loud snoring and choking or gasping during sleep and being very sleepy during the day, also referred to as excessive daytime sleepiness.
- Obstructive sleep apnea (OSA) is the most common type of sleep apnea. This occurs when the airway has collapsed or is blocked during sleep. This may cause shallow breathing or breathing pauses. More than half of the people who have this condition are overweight.
- Central sleep apnea is a less common type of sleep apnea, which occurs when the area of the brain that controls breathing, the medulla oblongata, doesn't send the correct signals to the breathing muscles. People with central sleep apnea make no effort to breathe for brief periods. Central sleep apnea often occurs with obstructive sleep apnea, but it can occur alone. Snoring doesn't typically happen with central sleep apnea.
- Sleep apnea can increase the risk for or worsen some medical conditions, and increase the chance of having a work or driving-related accident.
- Sleep apnea treatment is aimed at restoring regular breathing during sleep and relieving symptoms. Treatment also may help other medical problems linked to sleep apnea.
- Lifestyle changes, mouthpieces, breathing devices, and/or surgery are used to treat sleep apnea. Continuous positive airway pressure (CPAP) is the most common treatment for moderate to severe sleep apnea.
- Family members can help a person who snores loudly or stops breathing during sleep by encouraging him or her to get medical help.
- Treatment may improve your overall health and happiness as well as your quality of sleep (and possibly your family's quality of sleep).
Untreated obstructive or central sleep apnea can:
- Increase the risk for high blood pressure, heart attack, stroke, obesity, and diabetes
- Increase the risk for or worsen heart failure
- Make irregular heartbeats more likely
- Increase the chance of having work-related or driving accidents
- Lifestyle changes, mouthpieces, surgery, and/or breathing devices can successfully treat sleep apnea in many people.
Causes of obstructive sleep apnea
When we are awake, our throat muscles help keep our airway stiff and open so air can flow into the lungs. During sleep, these muscles are more relaxed. Normally, the relaxed throat muscles don't stop the airway from staying open to allow air into the lungs. However, people obstructive sleep apnea have blocked or narrowed airways during sleep. This can occur for several reasons:
- The throat muscles and tongue relax more than normal
- The tongue and tonsils (tissue masses in the back of the mouth) are large compared to the opening into the windpipe
- Being overweight. The extra soft fat tissue can thicken the wall of the windpipe. This causes the inside opening to narrow and makes it harder to keep open
- The shape of the head and neck (bony structure) may cause a smaller airway size in the mouth and throat area
- The aging process limits the ability of brain signals to keep throat muscles stiff during sleep. This makes it more likely that the airway will narrow or collapse
When the oxygen drops to dangerous levels, it triggers the brain to disturb sleep, which helps tighten the upper airway muscles and open the windpipe. Normal breaths then start again, often with a loud snort or choking sound.
Untreated sleep apnea also can lead to changes in how the body uses energy. These changes increase the risk for obesity and diabetes.
Some adults with obstructive sleep apnea have an enlarged uvula, the tissue that hangs from the middle of the back of the mouth, or swelling in the roof of the mouth. Some children with obstructive sleep apnea have enlarged tonsils.
Signs and symptoms of obstructive sleep apnea
One of the most common signs of obstructive sleep apnea is loud and chronic (ongoing) snoring. Pauses may occur in the snoring. Choking or gasping may follow the pauses. Not everyone who snores has sleep apnea.
The snoring usually is loudest when the person with sleep apnea sleeps supine (on the back).Snoring may not happen every night. Over time, the snoring may happen more often and get louder.
Another common sign of sleep apnea is daytime fatigue at work or while driving. Patients with sleep apnea often find themselves rapidly falling asleep during the quiet moments of the day when they are not active.
Others signs and symptoms of sleep apnea may include:
- Morning headaches
- Memory or learning problems and not being able to concentrate
- Feeling irritable, depressed, or having mood swings or personality changes
- Urination at night
- A dry throat when you wake up
In children, sleep apnea can cause hyperactivity, poor school performance, and aggressiveness. Children who have sleep apnea also may have unusual sleeping positions, bedwetting, and may breathe through their mouths instead of their noses during the day.
Diagnosis of obstructive sleep apnea
Obstructive sleep apnea often goes undiagnosed. Doctors usually can't detect the condition during routine office visits, and there are no blood tests for the condition. Most people who have sleep apnea don't know they have it because it only occurs during sleep. A family member and/or bed partner may first notice the signs of sleep apnea.
Doctors diagnose sleep apnea based on medical and family histories, a physical exam, and results from sleep studies.
A sleep study is the most accurate test for diagnosing sleep apnea. A patient may stay overnight in a sleep center or sleep lab and have his or her breathing monitored during sleep.
A polysomnogram (PSG) is the most common study for diagnosing sleep apnea. This test records:
- Brain activity
- Eye movement and other muscle activity
- Breathing and heart rate
- How much air moves in and out of your lungs while you're sleeping
- The amount of oxygen in your blood
A polysomnogram is painless procedure during which a patient goes to sleep in a sleep center and the staff use sensors to monitor brain and body activity during sleep. A sleep specialist can then review the results of the polysomnogram to diagnose sleep apnea.
Treatment of sleep apnea
Treating sleep apnea may help reduce the prevalence of other medical problems linked to sleep apnea, such as high blood pressure. Treatment also can reduce the risk for heart disease, stroke, and diabetes.
Lifestyle changes, mouthpieces, breathing devices, and/or surgery are used to treat sleep apnea. Currently, there are no medicines to treat sleep apnea.
Changes in daily activities or habits may improve breathing for patients with mild obstructive sleep apnea:
- Avoid alcohol and medicines that induce drowsiness: they make it harder for the throat to stay open during sleep
- Lose weight if you're overweight or obese
- Sleep on your side instead of your back or use special pilllows to to help keep your throat open
- Stop smoking
A mouthpiece, sometimes called an oral appliance, may help some people who have mild sleep apnea. A dentist or orthodontist can make a custom-fit plastic mouthpiece for treating sleep apnea. The mouthpiece will adjust the lower jaw and tongue to help keep the airways open during sleep. Proper fit of the mouthpiece is important, and a doctor should be contacted if there is any pain or discomfort.
Continuous positive airway pressure (CPAP) is the most common treatment for moderate to severe sleep apnea in adults. A CPAP machine uses a mask that fits over the mouth and nose, or just over the nose and gently blows air into the throat. The air presses on the wall of your airway. The air pressure is adjusted so that it's just enough to stop the airways from becoming narrowed or blocked during sleep.
CPAP treatment may cause side effects in some people. These side effects include a dry or stuffy nose, irritated skin on your face, sore eyes, and headaches. There are many different kinds of CPAP machines and masks. Be sure to tell your doctor if you're not happy with the type you're using. He or she may suggest switching to a different kind that may work better for you.
Some people who have sleep apnea may benefit from surgery. The type of surgery and how well it works depend on the cause of the sleep apnea. Surgery is done to widen breathing passages. It usually involves removing, shrinking, or stiffening excess tissue in the mouth and throat or resetting the lower jaw.
Surgery to shrink or stiffen excess tissue in the mouth or throat is done in a doctor's office or a hospital. Shrinking tissue may involve small shots or other treatments to the tissue. A series of such treatments may be needed to shrink the excess tissue.To stiffen excess tissue, the doctor makes a small cut in the tissue and inserts a small piece of stiff plastic.
Ongoing health care needs
- Follow up with your doctor regularly to make sure your treatment is working. Tell him or her if the treatment is causing side effects that you can't handle. This ongoing care is especially important if you're getting continuous positive airway pressure (CPAP) treatment. It may take a while before you adjust to using CPAP.
- Try not to gain weight. Weight gain can worsen sleep apnea and require adjustments to your CPAP device. In contrast, weight loss may relieve your sleep apnea.
- Until your sleep apnea is properly treated, know the dangers of driving or operating heavy machinery while sleepy.
- If you're having any type of surgery that requires medicine to put you to sleep, let your surgeon and doctors know you have sleep apnea. They might have to take extra steps to make sure your airway stays open during the surgery.
How Can Family Members Help?
Often, people with sleep apnea don't know they have it. They're not aware that their breathing stops and starts many times while they're sleeping. Family members or bed partners usually are the first to notice signs of sleep apnea.
Family members can do many things to help a loved one who has sleep apnea.
- Let the person know if he or she snores loudly during sleep or has breathing stops and starts.
- Encourage the person to get medical help.
- Help the person follow the doctor's treatment plan, including CPAP.
- Provide emotional support.
Reference: The National Institute of Neurological Disorders and Stroke (NINDS)