Sleep apnea is a potentially serious sleep disorder in which breathing repeatedly stops and starts. People with untreated sleep apnea stop breathing repeatedly during their sleep, sometimes hundreds of times during the night. If you snore loudly and feel tired even after a full night’s sleep, you might have sleep apnea.
It occurs in about 25% of men and nearly 10% of women. Sleep apnea can affect people of all ages, including babies and children and particularly people over the age of 50 and those who are overweight.
If it’s not treated, it can cause a number of health problems, including hypertension (high blood pressure), stroke, cardiomyopathy (enlargement of the muscle tissue of the heart), heart failure, diabetes and heart attacks.
The main types are:
• Obstructive sleep apnea (OSA), the more common form that occurs when throat muscles relax
• Central sleep apnea, which occurs when your brain doesn’t send proper signals to the muscles that control breathing
• Complex sleep apnea (CSA)syndrome, also known as treatment-emergent central sleep apnea, which occurs when someone has both obstructive sleep apnea and central sleep apnea
Signs & Symptoms –
Often the first signs are recognized not by the patient, but by the bed partner. Many of those affected have no sleep complaints. The most common signs and symptoms of includes:
• Daytime sleepiness or fatigue.
• Restlessness during sleep, frequent nighttime awakenings.
• Sudden awakenings with a sensation of gasping or choking.
• Dry mouth or sore throat upon awakening.
• Cognitive impairment, such as trouble concentrating, forgetfulness or irritability.
• Mood disturbances (depression or anxiety).
• Night sweats.
• Frequent nighttime urination.
• Sexual dysfunction.
People with central sleep apnea more often report recurrent awakenings or insomnia, although they may also experience a choking or gasping sensation upon awakening.
Symptoms in children may not be as obvious and include:
• Poor school performance.
• Sluggishness or sleepiness, often misinterpreted as laziness in the classroom.
• Daytime mouth breathing and swallowing difficulty.
• Inward movement of the ribcage when inhaling.
• Unusual sleeping positions, such as sleeping on the hands and knees, or with the neck hyper-extended.
• Excessive sweating at night.
• Learning and behavioral disorders (hyperactivity, attention deficits).
Obstructive sleep apnea occurs when the muscles in the back of your throat relax too much to allow normal breathing. These muscles support structures including the back of the roof of your mouth (soft palate), the triangular piece of tissue hanging from the soft palate (uvula), the tonsils and the tongue.
When the muscles relax, your airway narrows or closes as you breathe in, hampering your breathing for 10 seconds or longer. This can lower the level of oxygen in your blood and cause a buildup of carbon dioxide.
Your brain senses this impaired breathing and briefly rouses you from sleep so that you can reopen your airway. This awakening is usually so brief that you don’t remember it.
You can awaken with shortness of breath that corrects itself quickly, within one or two deep breaths. You might make a snorting, choking or gasping sound.This pattern can repeat itself five to 30 times or more each hour, all night long. These disruptions impair your ability to reach the deep, restful phases of sleep, and you’ll probably feel sleepy during your waking hours.
People with obstructive sleep apnea might not be aware of their interrupted sleep. Many people with this type of sleep apnea don’t realize they haven’t slept well all night.
Risk Factors –
Anyone can develop this kind of disease. However, certain factors put you at increased risk, including:
• Excess weight.
Most but not all people with obstructive sleep apnea are overweight. Fat deposits around the upper airway can obstruct breathing. Medical conditions that are associated with obesity, such as hypothyroidism and polycystic ovary syndrome, also can cause such problem.
• Older age.
The risk of obstructive sleep apnea increases as you age but appears to level off after your 60s and 70s.
• Narrowed airway.
You might inherit naturally narrow airways. Or your tonsils or adenoids might become enlarged and block your airway.
• High blood pressure (hypertension).
Obstructive sleep apnea is relatively common in people with hypertension.
• Chronic nasal congestion.
Obstructive sleep apnea occurs twice as often in those who have consistent nasal congestion at night, regardless of the cause. This may be due to narrowed airways.
People who smoke are more likely to have obstructive sleep apnea.
Obstructive sleep apnea might be more common in people with diabetes.
In general, men are twice or three times as likely as premenopausal women to have obstructive sleep apnea. The frequency of obstructive sleep apnea increases in women after menopause.
• A family history of sleep apnea.
Having family members with obstructive sleep apnea might increase your risk.
Research has found an association between asthma and the risk of obstructive sleep apnea.
This condition may increase the risk of the following –
• asthma symptoms
• atrial fibrillation
• chronic kidney disease
• ability to focus, memory problems, and other cognitive functions
• cardiovascular problems due to a reduced oxygen supply
• pregnancy complications
• eye disorders, such as glaucoma
• metabolic syndrome, including type 2 diabetes and hypertension
If your doctor determines that you have symptoms suggestive of such serious condition, you may be asked to have a sleep evaluation with a sleep specialist or may order an overnight sleep study to objectively evaluate for sleep apnea.
• Testing includes an overnight sleep study called a polysomnogram (PSG). A PSG is performed in a sleep laboratory under the direct supervision of a trained technologist. During the test, a variety of body functions, such as the electrical activity of the brain, eye movements, muscle activity, heart rate, breathing patterns, air flow, and blood oxygen levels are recorded at night during sleep. After the study is completed, the number of times breathing is impaired during sleep is tallied and the severity of the sleep apnea is graded.
• For adults, a Home Sleep Test (HST) can sometimes be performed instead. This is a modified type of sleep study that can be done in the comfort of home. It records fewer body functions than PSG.
Treatment aims to normalize breathing during sleep and address any underlying health problems. The options will depend on the cause and severity of symptoms.
▪︎ Lifestyle changes
Lifestyle modifications are essential to normalizing breathing and are critical first steps in treatment.
• following a heart-healthy diet
• developing healthy sleeping habits
• limiting alcohol consumption
• quitting smoking
• managing weight
• sleeping on the side
▪︎ Other options
Other treatment options include:
• Continuous positive airway pressure (CPAP) therapy
This is the main treatment for this problem. It keeps the airway open by gently providing a constant stream of positive pressure air through a mask.
A person can adjust the mask and its settings. Adding moisture to the air as it flows through the mask can relieve nasal symptoms.
Various surgical procedures can widen the airway in people with OSA. Surgery can stiffen or shrink obstructing tissue, or remove excess tissue or enlarged tonsils.
• Mandibular repositioning device (MRD)
This is a custom-made oral appliance suitable for individuals with mild or moderate OSA.The mouthpiece holds the jaw in a forward position during sleep to expand the space behind the tongue. This helps keep the upper airway open, preventing apnea and snoring.
Some drugs may help with CSA but should only be used after consultation with a sleep specialist. Examples include:
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