Make an Appointment
Talk to DoctorOverview
Sleep apnea is a sleep disorder that can be potentially severe, characterized by the intermittent cessation and resumption of breathing during sleep. If you snore loudly and continue to feel excessively tired despite getting a full night’s sleep, it could be a sign that you might be experiencing sleep apnea.
The consequent lack of oxygen triggers a survival reflex, that briefly wakes you up so that you can start breathing again. Your sleep pattern is disturbed even though that reflex keeps you alive. Because of this, it’s difficult to get a good night’s sleep and it may also have other negative effects, such as straining your heart, which may be fatal.
These are the forms of sleep apnea:
- Obstructive sleep apnea (OSA), which is the more prevalent type, which happens when the throat muscles relax and obstruct the passage of the air to the lungs.
- Central sleep apnea (CSA), which happens when improper signals from the brain are sent to the respiratory muscles.
- Treatment–emergent central sleep apnea, often referred to as complicated sleep apnea, this condition occurs when someone with OSA, as determined by a sleep study, converts to CSA while undergoing treatment for OSA.
Consult your doctor if you suspect that you may have sleep apnea. Treatment can help you feel better and may help you avoid consequences like heart disease.
Symptoms
It can be challenging to distinguish between obstructive and central sleep apneas since their symptoms sometimes overlap. Obstructive and central sleep apnea symptoms most frequently reported include:
- Sleep–related episodes in which you cease breathing, which would be noticed by someone else.
- Snoring loudly
- Gasping for air while sleeping
- Problems with concentration while awake.
- Being irritable.
- Having a dry mouth when you wake up.
- Having a headache in the morning.
- Alterations in mood such as anxiety and depression.
- Insomnia or problems of keeping a good sleep or staying asleep.
- Hypersomnia, which is an excessive amount of daytime sleepiness.
While loud snoring can be a warning sign of a potentially serious problem, it’s important to note that not all individuals with sleep apnea snore. If you are experiencing symptoms associated with sleep apnea such as persistent tiredness, sleepiness, or irritability, it is highly recommended to consult with your healthcare physician. It is crucial to discuss any sleep–related issues that impact your daily functioning with a medical professional.
Causes
Obstructive sleep apnea
When the muscles in the back of the throat relax, this kind of sleep apnea occurs. These muscles provide support for the tonsils, the soft palate, the uvula, the tongue, and the side walls of the throat.
Your airway narrows or shuts as you inhale when the muscles relax. You aren’t getting enough air, which might cause your blood’s oxygen level to drop. Your brain detects that you are having trouble breathing, quickly rousing you to allow you to reopen your airway. Usually, this revelation is so fleeting that you don’t recall it.
Snorting, choking, or gasping episodes may occur during sleep. This recurring pattern can happen anywhere from 5 to 30 times or even more per hour throughout the entire night, making it challenging to attain the rejuvenating and deep stages of sleep.
Central sleep apnea
When your brain fails to communicate with your breathing muscles, you get this less frequent type of sleep apnea. In other words, you briefly stop breathing without trying. Shortness of breath or trouble falling or staying asleep could cause you to wake up.
Risk factors
Anyone, even children, can be affected by sleep apnea. However, a few things make you more vulnerable.
Obstructive sleep apnea
The following factors raise the likelihood of developing this type of sleep apnea:
- Gender. Sleep apnea affects men two to three times more frequently than it does women. Women who are overweight or who have through menopause, however, run a higher risk.
- Old age. Older persons are substantially more likely to experience sleep apnea.
- Family history. A family history of sleep apnea may make you more susceptible.
- Race. Black, Hispanic or of Asian descent are prone to have this problem.
- Being overweight. OSA risk is significantly increased by obesity as the upper airway’s surrounding fat deposits may block breathing.
- Neck circumference. It’s possible that people with larger necks have narrower airways.
- Narrow airway. Perhaps you were born with a narrow throat. Adenoids or tonsils can potentially enlarge and obstruct the airway, especially in young children.
- Nasal congestion. You are more likely to develop obstructive sleep apnea if you have problems breathing via your nose, whether due to anatomical issues or allergies.
- Medical conditions. Among the illnesses that may raise the risk of obstructive sleep apnea include congestive heart failure, high blood pressure, and type 2 diabetes. Risk factors include having polycystic ovarian syndrome, hormonal issues, a history of stroke, and persistent lung conditions including asthma.
- Alcohol, sedatives or tranquilizers consumption. These medications and substance can make obstructive sleep apnea worse by loosening the muscles in your throat.
- Smoking. Obstructive sleep apnea is three times as common among smokers than it is in non–smokers. Smoking can make the upper airway more inflammatory and fluid–retained.
Central sleep apnea
The following are risk factors for this type of sleep apnea:
- Old age. The risk of central sleep apnea is increased in middle–aged and older persons.
- Gender. Men are more likely than women to experience central sleep apnea.
- Heart disease. Congestive cardiac failure raises the danger.
- Taking narcotic pain medications. Central sleep apnea is made more likely by opioid medications, especially long–acting ones like methadone.
- Stroke. The likelihood of developing central sleep apnea after a stroke rises.
Diagnosis
Your doctor may perform an assessment based on your symptoms and a sleep history, which you can provide with assistance from a bed partner or household member, if possible.
Most likely, a sleep problem clinic will be recommended to you. There, a sleep expert can assist you in deciding whether you need additional testing.
During sleep testing at a sleep center, your breathing and other bodily systems are frequently monitored overnight as part of an evaluation. There may also be a choice for at–home sleep testing. Testing for sleep apnea may involve:
- Nocturnal 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 throughout this test.
Home sleep tests. Your doctor may give you streamlined tests that you may perform at home to identify sleep apnea. During these examinations, your blood oxygen level, airflow, and breathing patterns are typically measured. If central sleep apnea is suspected, your doctor is more likely to advise polysomnography at a sleep lab rather than a home sleep test.
If the results are abnormal, your doctor might be able to recommend a therapy without conducting any additional tests. Sometimes portable monitoring tools fail to detect sleep apnea. So even if your initial results are within the normal range, your doctor can still advise polysomnography.
Your doctor may suggest that you see an ear, nose, and throat specialist if you have obstructive sleep apnea in order to rule out a blockage in your throat or nose. To determine the reasons of central sleep apnea, a patient may need to be evaluated by a cardiologist (a physician who specializes in the heart) or a neurologist (a physician who specializes in the neurological system).
Treatment
For mild cases of sleep apnea, your doctor may recommend lifestyle changes such as smoking cessation or weight loss. Adjusting your sleeping position may also be suggested. If nasal allergies are a contributing factor, allergy medication might be recommended.
In cases where the above measures are ineffective or if you have mild to severe sleep apnea, there are several alternative therapies available. Certain tools can assist in clearing a blocked airway, while in other situations, surgical intervention may be necessary.
Therapies for OSA
- Continuous Positive Airway Pressure (CPAP). Use of a device that produces air pressure through a mask while you sleep may be beneficial if you have moderate to severe obstructive sleep apnea. The air pressure provided by CPAP is just enough to keep the upper airway passages open and avoid apnea and snoring. It is slightly higher than the air pressure in the room.
CPAP is the most widely used and effective treatment for sleep apnea, but some people find it inconvenient or uncomfortable. To find a comfortable mask, test out a few different kinds and speak with your health care practitioner.
- Other airway pressure devices. You might be able to utilize an alternative airway pressure device if using a CPAP machine continues to be a problem for you. This device automatically changes the pressure while you’re sleeping (auto–CPAP). There are also devices that deliver bilevel positive airway pressure (BPAP). With these, your pressure increases during inhalation and decreases during exhalation.
- Oral appliances. Another option is to wear an oral appliance designed to keep your airway open during sleep. While oral appliances can be more user–friendly, continuous positive airway pressure (CPAP) therapy is generally more consistently effective. Some oral appliances are specifically designed to bring your jaw forward and help open your throat, which can provide relief for mild obstructive sleep apnea and snoring.
Your dentist may have a range of devices available, and it may be necessary to try out different options before finding the most suitable one for you. Once you have found the right fit, it is important to regularly follow up with your dentist to ensure the appliance still fits properly and to evaluate the effectiveness of symptom management, especially beyond the initial year.
Surgery for OSA
In cases where alternative treatments have failed, surgery may be a possibility for those with OSA. Prior to considering surgery, it is usually advised to try out other treatments for at least three months. But for a tiny percentage of patients with certain jaw structural issues, surgery is a good initial step.
Possible surgical options include:
- Tissue removal. A surgeon will remove tissue from the top of your throat and the back of your mouth during this treatment (uvulopalatopharyngoplasty). In most cases, your tonsils and adenoids are also removed.
This kind of surgery may be effective in preventing throat tissues from vibrating and snoring. It isn’t regarded as a trustworthy treatment for obstructive sleep apnea and is less effective than CPAP.
For those who cannot tolerate CPAP or oral appliances, radiofrequency ablation (removal of tissues with radiofrequency energy) may be an alternative.
- Tissue shrinkage. Another choice is to use radiofrequency ablation to reduce the tissue in the back of the mouth and the throat. If you have mild to moderate sleep apnea, this technique might be done. According to one study, these results are comparable to those of tissue removal but come with lower surgical risks.
- Jaw repositioning. The jaw is advanced relative to the other face bones during this treatment. This increases the area behind the tongue and soft palate, decreasing the likelihood of obstruction. The term “maxillomandibular advancement” refers to this surgery.
- Implants. Following local anesthesia, soft rods, typically composed of polyester or plastic, are surgically placed into the soft palate. To find out how effectively implants function, more study is required.
- Nerve stimulation. Surgery is required to place a tongue–movement–controlling stimulator into the hypoglossal nerve. Increased stimulation aids in keeping the tongue in a posture that maintains an open airway. More study is required.
- Creating a new air passageway, known as tracheostomy. If alternative therapies haven’t worked for your severe, life–threatening sleep apnea, you might need this kind of surgery. Your surgeon creates a hole in your neck and installs a metal or plastic tube, which you breathe through.
Throughout the day, you cover the opening. However, you leave it open at night so that air can enter and exit your lungs without having to go via the closed airway in your throat.
By opening up or widening airways, several surgical procedures could help treat sleep apnea and lessen snoring which includes tonsil or adenoid surgical removal and bariatric surgery (surgery performed for weight loss).
Therapies for CSA
- Treatment for associated medical problems. Treating cardiac or neuromuscular issues, which are potential causes of central sleep apnea, may be helpful. Additionally, supplementary oxygen, CPAP, BPAP, and adaptive servo–ventilation (ASV) may be utilized as treatments for CSA.
- Medicine changes. You might be given acetazolamide or another medication to assist control your breathing. Your healthcare physician may adjust your medications if drugs like opioids are making your CSA worse.
- Supplemental oxygen. If you have central sleep apnea, using more oxygen while you sleep may be beneficial. Devices that supply oxygen to your lungs come in a variety of types.
- Adaptive Servo–Ventilation (ASV). This more contemporary airflow device that has been approved learns your regular breathing pattern and keeps the data in an integrated computer. The device employs pressure to control your breathing pattern after you nod off and avoid breathing pauses.
Some persons with treatment–emergent central sleep apnea may be able to benefit from ASV. For those with severe heart failure with predominate central sleep apnea are not advised to use ASV.
