Obstructive sleep apnea
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Obstructive sleep apnea is the common respiratory condition linked to sleep. During sleep, it leads to recurrent interruptions of breathing. On average, individuals with this condition experience episodes where their breathing is obstructed for more than ten seconds at least five times per hour of sleep.
Obstructive sleep apnea is the most prevalent of the many forms of sleep apnea. This kind of sleep apnea happens when the muscles in your throat periodically relax and close off your airway. Snoring is an audible symptom of obstructive sleep apnea.
There are remedies for obstructive sleep apnea. Utilizing a device that employs positive pressure to keep your airway open while you sleep is one therapy option. Another choice is to use a mouthpiece to forward your lower jaw as you sleep. Surgery may also be a possibility.
Types of obstructive sleep apnea
According to the Apnea-Hypopnea Index (AHI), a measuring and classification system, obstructive sleep apnea can range from mild to severe. Your average number of apnea and hypopnea episodes per hour of sleep is measured by the AHI. Each type can be described as follows:
- Mild obstructive sleep apnea: AHI occurs between 5 to 15 times per hour.
- Moderate obstructive sleep apnea: AHI occurs between 15 to 30 times per hour.
- Severe obstructive sleep apnea: AHI occurs more than 30 times per hour.
Symptoms
Obstructive sleep apnea signs and symptoms include
- Snoring loudly
- Sudden awakenings that come with choking or gasping
- Seen instances of stopped breathing while sleeping
- Having a painful throat or dry mouth when you wake up
- Headache in the morning
- Oversleeping at day time
- Having trouble focusing during the day
- Mood swings like irritation or depression
- Elevated blood pressure
- Reduction in sex drive (libido)
If you or your partner encounter any of the subsequent symptoms, it is advisable to seek medical attention:
- Pauses in breathing when sleeping
- Snoring that is excessively loud and interferes with others’ or your sleep
- Gasping for breath or choking when awaken
- Being overly sleepy during the day, which could cause you to nod off while working, watching television, or even operating a vehicle.
Not all individuals who snore have obstructive sleep apnea, and snoring by itself does not always indicate an underlying issue that requires attention.
Immediate consultation with your doctor is highly recommended if you experience loud snoring, particularly when accompanied by intermittent periods of silence. When you have obstructive sleep apnea, your snoring typically gets louder when you sleep on your back and gets quieter when you sleep on your side.
If you are experiencing persistent feelings of tiredness, sleepiness, or irritability due to sleep-related problems, it is recommended to consult your doctor. Excessive daytime sleepiness could potentially be attributed to conditions such as narcolepsy or other underlying illnesses, and a medical evaluation can help determine the cause and provide appropriate guidance.
Causes
When the muscles in the back of your throat relax too much, it causes obstructive sleep apnea, which prevents normal breathing. The tongue, tonsils, uvula, and soft palate are all supported by these muscles.
Your airway narrows or closes as you breathe in when the muscles relax, making breathing difficult for ten seconds or longer. Your blood’s oxygen saturation may decrease as a result, and carbon dioxide levels may rise.
When your breathing becomes hindered, your brain detects it and momentarily wakes you up so you can reopen your airway. Usually, you don’t remember this awakening because it was so fleeting.
Upon awakening, you may notice brief episodes of breathlessness that rapidly resolve themselves, typically with just one or two deep breaths, accompanied by snorting, coughing, or gasping sounds. Throughout the night, this cycle may repeat itself anywhere from five to thirty times or even more per hour. These interruptions prevent you from achieving deep and restorative sleep, leading to daytime sleepiness.
Obstructive sleep apnea sufferers may not be aware of their disrupted sleep. Many individuals with this form of sleep apnea are unaware that they have not had a restful night’s sleep.
Risk factors
Obstructive sleep apnea can occur in anyone. However, some elements put you at higher danger, such as:
- Gender. Obstructive sleep apnea is typically twice or three times as common in men than in premenopausal women. After menopause, obstructive sleep apnea in women becomes more common.
- Old age. While the risk of obstructive sleep apnea rises with age, it seems to level off between the ages of 60 and 70.
- Having a history of sleep apnea in the family. A family history of obstructive sleep apnea may make you more susceptible.
- Asthma. The risk of obstructive sleep apnea has been linked to asthma, according to research.
- Being overweight. Obstructive sleep apnea patients tend to be overweight, but not always. Breathing difficulties may be caused by fat accumulation around the upper airway. Obstructive sleep apnea can also be brought on by medical diseases connected to fat, such as hypothyroidism and polycystic ovary syndrome.
- Narrowed airway. Your airways may be inherently narrow if so. Or your adenoids or tonsils could enlarge and obstruct your airway.
- Having nasal congestion for a long time. Regardless of the cause, obstructive sleep apnea is twice as common in people who have regular nighttime nasal congestion. Narrowed airways may be to blame for this.
- Increased blood pressure. People with hypertension frequently get obstructive sleep apnea.
- Smoking. Obstructive sleep apnea is more prevalent in smokers.
- Diabetes. People with diabetes may experience increased obstructive sleep apnea.
Diagnosis
Based on your symptoms, medical history, and a thorough examination, your doctor will evaluate the severity of your condition. They may recommend further testing by a sleep specialist. During the physical examination, your doctor will assess the back of your throat, mouth, and nose for any signs of excess tissue or abnormalities. They may also measure your blood pressure and evaluate the size of your waist and neck.
To accurately diagnose and assess your disorder, a sleep specialist may conduct additional tests. These tests could involve an overnight stay at a sleep center, where your breathing and other vital functions will be monitored during sleep. These comprehensive evaluations will help determine the nature and severity of your condition and aid in devising an appropriate treatment plan.
Tests
The following tests can identify obstructive sleep apnea:
- Polysomnography. Your heart, lungs, and brain activity, breathing patterns, arm and leg movements, and blood oxygen levels are all tracked by equipment as you sleep during this sleep study.
In a split-night sleep study, you might be observed the entire night or just a portion of it.
In a split-night sleep study, the first part of the night will be monitored. Staff members may wake you up and administer continuous positive airway pressure for the remainder of the night if you have been diagnosed with obstructive sleep apnea.
Other sleep disorders, such as narcolepsy or periodic limb movements (which induce jerky bouts of sleep during the day), that can cause excessive daytime sleepiness but call for different therapies, can also be found with the aid of this sleep study.
- Home sleep apnea testing. Your doctor may occasionally recommend an at-home polysomnography test for the detection of obstructive sleep apnea. Airflow, breathing patterns, blood oxygen levels, and potentially limb movements and snoring intensity are all typically measured during this examination.
Treatment
Lifestyle changes
Your doctor may suggest lifestyle modifications for obstructive sleep apnea in milder cases:
- Have a routine exercise
- Shedding off excess weight
- Stop smoking.
- Take antihistamines or nasal decongestants.
- Avoid sleeping lying on your back
- Steer clear of sedative pharmaceuticals like sleeping pills or anti-anxiety medications.
- If you do drink alcohol, do it in moderation. Avoid drinking in the hours before going to bed.
Your doctor may suggest further therapies if these steps don’t help you sleep better or if your apnea is moderate to severe. A few tools can aid in clearing a clogged airway. Other times, surgery can be required.
Therapies
- Positive airway pressure. Positive airway pressure may help people with obstructive sleep apnea. In this procedure, a machine applies air pressure to your nose or to the area around your mouth and nose while you sleep.
Positive airway pressure enhances your quality of life by lowering the frequency of respiratory episodes that take place while you sleep, cutting down on daytime tiredness, and more.
Continuous positive airway pressure, or CPAP, (SEE-pap), is the most popular kind. When receiving this treatment, your upper airway airways are kept open by the continuous, steady, and slightly elevated pressure of the air you are breathing. Snoring and obstructive sleep apnea are prevented by this air pressure.
Even though CPAP is the most effective and widely used treatment for obstructive sleep apnea, some people find the mask to be bulky, uncomfortable, or noisy. Although there are several mask designs for personal comfort, contemporary machines are smaller and less noisy than older ones.
Additionally, most people can adjust the mask to get a snug and comfortable fit with a little effort. To locate a mask that fits, you might need to try a few different kinds. There are several choices, including face masks, nasal pillows, and nasal masks.
Some machines feature additional adaptable pressure functions to increase comfort if you have trouble with pressure in particular. In addition to your CPAP machine, employing a humidifier may be beneficial.
Both continuous (fixed) and variable (autotitrating) pressures (APAP) can be used when administering CPAP. The pressure with fixed CPAP remains constant. If the machine detects increased airway resistance when autotitrating CPAP is being used, the pressure levels are changed.
Another form of positive airway pressure is called bilevel positive airway pressure (BPAP), which applies a fixed amount of pressure when you breathe in and a varied amount when you breathe out.
Because it has been well researched for obstructive sleep apnea and has been proven to be an effective treatment, CPAP is increasingly frequently utilized. However, BPAP or APAP might be worth a try for those who have trouble tolerating fixed CPAP.
If you experience problems, keep using your positive airway pressure device. To find out what modifications you can make to increase its comfort, consult your doctor.
Additionally, get in touch with your physician if you continue to snore despite therapy, if you start snoring again, or if your weight changes by 10% or more.
- Mouthpiece. Oral device offer an alternative for some persons with mild or moderate obstructive sleep apnea, even though positive airway pressure is frequently an effective treatment. It is also utilized by those who are unable to use CPAP due to severe sleep apnea. These tools could lessen your tiredness and raise your standard of living.
These tools are made to maintain an open throat. Some gadgets prevent snoring and obstructive sleep apnea by moving your lower jaw forward to keep your airway open. Your tongue is held in a different position by other devices.
If you and your doctor decide to investigate this possibility, you’ll need to have the fitting and ongoing treatment done by a dentist skilled in dental sleep medicine appliances. There are numerous gadgets available. To guarantee a successful outcome and that using the device doesn’t affect your teeth, close monitoring is required.
Surgery or other procedures
Surgery is often only undertaken if all other treatments have failed or are not an appropriate option for you. Surgical options could consist of:
- Surgical removal of tissue. During an uvulopalatopharyngoplasty (UPPP), your doctor will cut away tissue from the top of your throat and the back of your mouth. You might also have your tonsils and adenoids taken out. A general anesthesia is required for UPPP, which is frequently conducted in a hospital.
- Upper airway stimulation. People with moderate to severe obstructive sleep apnea who cannot tolerate CPAP or BPAP are approved to use this new gadget.
In the upper chest, a tiny, thin impulse generator called a hypoglossal nerve stimulator is implanted. The apparatus tracks your breathing patterns and, if necessary, activates the nerve that regulates tongue movement.
According to studies, upper airway stimulation significantly reduces the symptoms of obstructive sleep apnea and enhances quality of life.
- Maxillomandibular advancement. Your jaw’s upper and lower parts are separated from the rest of your facial bones during this treatment. This increases the area behind the tongue and soft palate, decreasing the likelihood of obstruction.
- Tracheostomy. If existing therapies haven’t worked for your severe, life-threatening obstructive sleep apnea, you might need this kind of surgery.
Your surgeon creates a hole in your neck during a tracheostomy and inserts a metal or plastic tube through which you breathe. Your lungs receive and expend air without having to go through the congested airway in your throat.
By widening or clearing airways, other surgical procedures, such as:
- Nasal surgery to remove polyps or align your deviated septum, which is the divider between your nostrils,
- Tonsil or adenoid surgical removal
