If you are snoring heavily, experiencing morning fatigue and daytime sleepiness you may have sleep apnea. “Apnea” comes from the Word “apnos” in Greek, which means “without breathing”. Sleep apnea is much more frequent in men and worsens by aging. The frequency of sleep apnea also increases in postmenopausal women.
There are two types of sleep apnea:
- Obstructive sleep apnea (OSA): The more common of the two forms of apnea, it is caused by a blockage of the airway, usually when the soft tissue in the back of the throat collapses during sleep.
- Central sleep apnea: Unlike OSA, the airway is not blocked, but the brain fails to signal the muscles to breathe, due to instability in the respiratory control center.
- Sleepiness or lack of energy during the day and while driving
- Loud snoring
- Witnessed episodes of breath pauses or apnea during sleep
- Restless sleep
- Occasionally waking up with a choking or gasping sensation
- Recurrent awakenings or insomnia
- Waking up with a very sore or dry throat
- Morning headaches
- Forgetfulness, mood changes, and a decreased interest in sex
Effects of sleep apnea
If left untreated, sleep apnea can result in a growing number of health problems, including:
- Problems of the heart and blood circulation:
- High blood pressure
- Heart failure
- Irregular heart beats
- Heart attacks
- Poor performance in everyday activities, such as at work and school, motor vehicle crashes, and academic underachievement in children and adolescents.
- Worsening of Attention Deficit Hyperactivity Disorder (ADHD)
Causes of sleep apnea
- Obstructive sleep apnea is due to upper airway narrowing or collapse, resulting in lower amounts of oxygen in the blood, which causes the heart to work harder. It also causes disruption of the natural sleep cycle, which makes people feel poorly rested despite adequate time in bed. Apnea patients may experience 30 to 300 such events per night.
- Central sleep apnea is infrequent and it is due to interruption of brain activity to send proper signals to muscles of respiration. Consequently, decrease of blood oxygen and increase of blood cabondioxide results in awakenings.
Obstructive sleep apnea
- Male gender
- Being overweight
- Being over age 40
- Having a large neck size (43 cms or greater in men and 40 cms or greater in women)
- Having large tonsils, a large tongue, or a small jaw bone
- Having a family history of sleep apnea
- Gastroesophageal reflux disease
- Nasal obstruction due to a deviated septum, allergies, or sinus problems
- Regular use of alcohol, sedatives, sleeping pills
- Brain tumors
- Generalized muscle diseases
- Neurologic disorders affecting the brainstem and spine
- High altitude
Evaluation and Diagnosis
If you have symptoms of sleep apnea, your doctor may ask you to have a sleep apnea test, called a polysomnogram. This may be done in a sleep disorder center or even at home. A polysomnogram -or sleep study- is a multiple-component test that electronically transmits and records specific physical activities while you sleep. The recordings are analyzed by a qualified sleep specialist to determine whether or not you have sleep apnea or another type of sleep disorder. If sleep apnea is determined, you may be asked to do further sleep testing in order to determine the best treatment option.
On the night of your sleep study if you are in a sleep center lab, you will be assigned to a private bedroom in the sleep center or hospital. Near the bedroom will be a central monitoring area, where the technicians monitor sleeping patients. You will be hooked up to equipment that may look uncomfortable. However, most people fall asleep with little difficulty. During a sleep study, surface electrodes will be put on your face and scalp and will send recorded electrical signals to the measuring equipment. These signals, which are generated by your brain and muscle activity, are then recorded digitally. Belts will be placed around your chest and abdomen to measure your breathing. A bandage-like oximeter probe will be put on your finger to measure the amount of oxygen in your blood. The equipment will also record EEG (electroencephalogram) to measure and record brain wave activity, EMG (electromyogram) to record muscle activity, EOG (electro-oculogram) to record eye movements, ECG (electrocardiogram) to record heart rate and rhythm, nasal airflow sensor to record airflow, snore microphone to record snoring activity.
- Lose weight if you are overweighed.
- Avoid alcohol, tranquilizers, sleeping pills, and antihistamines before bedtime.
- Sleep on your side rather than your back.
- Seek medical advice if you have nasal stuffiness
Treatment of OSA
Sleep apnea is not a self-limiting disorder. In some patients, significant weight loss can improve snoring and OSA. Decision of treatment depends on the degree and level(s) of upper airway narrowing. In some cases, more than one procedure may be necessary. Treatment options are:
1. PAP (Positive Airway Pressure) devices: They open the airway with a small amount of positive pressure. This pressure is delivered via a nasal mask worn during sleep. This treatment is currently the initial treatment of choice for patients with OSA. There are diffrent types of PAP devices:
- CPAP (continuous positive airway pressure
- biPAP (bilevel positive airway pressure)
- aPAP (automatic positive airway pressure)
2. Surgery: The aim of surgery in OSA is to remove excess tissues to open the airway. In addition, the remaining tissue stiffens as it heals, thereby minimizing tissue vibration and collaps.
- Pharyngoplasty: Uvula, soft palate and tissues sorrounding tonsils are rehaped using different techniques. Tonsillectomy is commonly performed in these perocedures. Healing and tissue stiffening occurs within 6 weeks following surgery. CLICK HERE to watch pharygoplasty videos.
- Radiofrequency (RF) ablation: Commonly performed to facilitate the effect of other surgical procedures in OSA. Nasal turbinates, soft palate and tongue base are main targets of RF tissue reduction.
- Surgery of the tongue base: There are surgical options either to reduce the volume or change the position of the tongue.
- Other assistive operations: Septoplasty, endoscopic sinus surgery, tonsillectomy, adenoidectomy
- Maxillary and mandibular advancement surgery: Surgery to correct certain facial problems or throat obstructions that contribute to sleep apnea.
- Tracheotomy: Rarely performed when other treatment options fail to releive life-threatening OSA. The windpipe is surgically opened through the neck, by-passing the obstruction sites.
3. Oral appliances: A custom-fit oral appliance, which repositions the lower jaw forward, may also be considered for certain patients with snoring and mild OSA. This should be fitted by an otolaryngologist, dentist, or oral surgeon with expertise in sleep dentistry.4. Hypoglossal nerve stimulators: For people unable to use a PAP device, an implanted device is available. This device consists of a small pulse generator placed under the skin in the upper chest. A wire leading up to the neck, delivers mild stimulation to nerves that control airway muscles, keeping them open. The device can be programmed from an external remote. The success rate of these implants to releive OSA are similar to other surgical options. Limiting MRI examination is a major drawback.
Treatment of central apnea
- Treatment of causing disorders: heart, nervous system, muscles.
- Oxygen support
- PAP devices