Do you snore loudly while sleeping and feel tired when you wake up? You may suffer from a potentially serious condition called sleep apnea. Experts estimate that around 22 million Americans have some kind of sleep apnea, and 80% of those with moderate to severe cases remain undiagnosed.
Unlike occasional insomnia, sleep apnea can result in more than just sleepiness. When left untreated, it can lead to life threatening conditions including high blood pressure, stroke, diabetes, Alzheimer’s disease, depression and even death.
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What Is Sleep Apnea?
Sleep apnea is a sleep disorder in which you repeatedly stop breathing while you are sleeping. Each time this happens, the brain wakes you up, usually just partially, so that you can breathe again. This constant waking up degrades the quality of your sleep and reduces the oxygenation of your blood, stressing your whole system.
Those suffering from severe sleep apnea may wake up hundreds of times a night, most often during the important rapid-eye-movement (REM) sleep cycle.
There are three types of sleep apnea: obstructive sleep apnea, central sleep apnea and complex sleep apnea.
Obstructive sleep apnea, or OSA, is when your tongue collapses against the soft palate, which is then pushed against the back of your throat during sleep. When this happens, the throat is partially blocked, making it difficult or impossible to breathe. OSA is the most common type of sleep apnea, accounting for around 65% of the cases.
Central sleep apnea (CSA) is less common and happens when the brain fails to transmit signals to your breathing muscles. The body simply stops breathing during sleep or breathes so shallowly that it cannot take in enough oxygen. Sometimes, periods of shallow breathing will be followed by overly deep breathing. Central sleep apnea often goes undiagnosed because it is typically not accompanied by loud snoring.
Complex sleep apnea is a combination of obstructive sleep apnea and central sleep apnea. After patients are treated for OSA, some of them will exhibit signs of CSA indicating that they have complex sleep apnea. Complex sleep apnea occurs in about 15% of the patients.
The most common signs of sleep apnea are: Loud snoring; Times during the night when your partner notices that you stopped breathing during sleep; Gasping for air when sleeping; Difficulty staying asleep; Waking up with a dry mouth; Waking up with a headache; Excessive daytime sleepiness; and Irritability.
Scientists are not sure what causes obstructive sleep apnea in some people and not others. Some researchers think that OSA is caused by a neurological issue in which a problem with the brain signals result in excessive relaxation of the tongue and soft palate.
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Causes and Symptoms of Sleep Apnea
Apnea is more common among those who are male, middle-aged, overweight, or sleep on their back, but is not limited to only people who fit this description.
Smoking, drinking alcohol and using sedatives or tranquilizers also increases risk.
Central sleep apnea frequently occurs in people who have other serious illnesses such as chronic heart failure, brainstem or upper spinal injuries, Parkinson’s disease, stroke, kidney failure and severe arthritis.
Users of certain drugs, including opiates can also experience CSA.
Sleep apnea also occurs among children, affecting between 1-4% of all children including infants. Pediatric sleep apnea is most common between the ages of two and eight but can occur at any age. It can cause mood problems, inattentiveness, hyperactivity and poor impulse control. Some children suffering from pediatric sleep apnea may be misdiagnosed as having attention deficit hyperactivity disorder (ADHD).
In children who have ADHD, pediatric sleep apnea worsens the symptoms. Having untreated pediatric sleep apnea increases the risk of having cardiovascular disease later in life, especially if the child is obese.
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Diagnosing and Treating Sleep Apnea
The most common sleep apnea treatment for moderate to severe cases of obstructive sleep apnea is the continuous positive airway pressure, or CPAP machine. The CPAP machine consists of a machine that pumps air to your nose all night through a tube connected to a mask. The mask of the sleep apnea machine is strapped to your head to keep it in place while you sleep. While the CPAP machine can be cumbersome and uncomfortable at first, with continued use and adjusting the fit of the mask, most people get used to it.
In addition to the regular CPAP machine, there are other sleep apnea machines including the auto-CPAP which automatically adjusts the pressure while you are sleeping and a BIPAP machine, which produces more pressure when you inhale than when you exhale.
If you have mild sleep apnea or if, after trying the CPAP machine, you just cannot get used to sleeping with it, another option is using an oral appliance. This is a sleep apnea mouth guard that brings the jaw forward during sleep to open up the throat. While less effective than the CPAP machine, oral appliances are more comfortable. Your dentist can fit you for the sleep apnea mouth guard and ensure that the fit continues to work for you.
Central sleep apnea can be treated using other mechanical sleep apnea devices. One such device is the adaptive servo-ventilation or ASV. The ASV learns your normal breathing pattern and stores it in a built-in computer. After you fall asleep, the machine uses pressure to restore your normal breathing pattern and prevent pauses in your breathing. Supplemental oxygen can also be used for central sleep apnea.
Since central sleep apnea is often caused by other health problems, sometimes treating the underlying problem can resolve the sleep apnea as well.
If none of these devices or treatments work on your sleep apnea, you can try surgery. Various types of surgical intervention can be used to correct the conditions that cause sleep apnea. These include:
- Tissue removal from the back of your mouth and top of your throat
- For children, removal of the tonsils or adenoids
- Tissue shrinkage using radiofrequency ablation for mild to moderate sleep apnea
- Jaw repositioning, or maxillomandibular advancement to enlarge the space behind the tongue and soft palate
- Implants in the soft palate
For severe cases of life-threatening sleep apnea, some may need a tracheostomy, in which a tube is inserted into your throat for breathing.
