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Sleep Apnea

What Is Sleep Apnea?

Sleep apnea is a common disorder in which you have one or more pauses in breathing or shallow breaths while you sleep.

Breathing pauses can last from a few seconds to minutes. They often occur 5 to 30 times or more an hour. Typically, normal breathing then starts again, sometimes with a loud snort or choking sound.

Sleep apnea usually is a chronic (ongoing) condition that disrupts your sleep 3 or more nights each week. You often move out of deep sleep and into light sleep when your breathing pauses or becomes shallow.

This results in poor sleep quality that makes you tired during the day. Sleep apnea is one of the leading causes of excessive daytime sleepiness.

Overview

Sleep apnea often goes undiagnosed. Doctors usually can’t detect the condition during routine office visits. Also, there are no blood tests for the condition.

Most people who have sleep apnea don’t know they have it because it only occurs during sleep. A family member and/or bed partner may first notice the signs of sleep apnea.

The most common type of sleep apnea is obstructive sleep apnea. This most often means that the airway has collapsed or is blocked during sleep. The blockage may cause shallow breathing or breathing pauses.

When you try to breathe, any air that squeezes past the blockage can cause loud snoring. Obstructive sleep apnea happens more often in people who are overweight, but it can affect anyone.

Central sleep apnea often occurs with obstructive sleep apnea, but it can occur alone. Snoring doesn’t typically happen with central sleep apnea.

This article mainly focuses on obstructive sleep apnea.

Outlook

Untreated sleep apnea can:

  • Increase the risk for high blood pressure, heart attack, stroke, obesity, and diabetes
  • Increase the risk for or worsen heart failure
  • Make irregular heartbeats more likely
  • Increase the chance of having work-related or driving accidents

What Causes Sleep Apnea?

When you’re awake, throat muscles help keep your airway stiff and open so air can flow into your lungs. When you sleep, these muscles are more relaxed. Normally, the relaxed throat muscles don’t stop your airway from staying open to allow air into your lungs.

But if you have obstructive sleep apnea, your airways can be blocked or narrowed during sleep because:

  • Your throat muscles and tongue relax more than normal.
  • Your tongue and tonsils (tissue masses in the back of your mouth) are large compared to the opening into your windpipe.
  • You’re overweight. The extra soft fat tissue can thicken the wall of the windpipe. This causes the inside opening to narrow and makes it harder to keep open.
  • The shape of your head and neck (bony structure) may cause a smaller airway size in the mouth and throat area.
  • The aging process limits the ability of brain signals to keep your throat muscles stiff during sleep. This makes it more likely that the airway will narrow or collapse.

Not enough air flows into your lungs when your airways are fully or partly blocked during sleep. This can cause loud snoring and a drop in your blood oxygen levels.

When the oxygen drops to dangerous levels, it triggers your brain to disturb your sleep. This helps tighten the upper airway muscles and open your windpipe. Normal breaths then start again, often with a loud snort or choking sound.

The frequent drops in oxygen levels and reduced sleep quality trigger the release of stress hormones. These compounds raise your heart rate and increase your risk for high blood pressure, heart attack, stroke, and irregular heartbeats. The hormones also raise the risk for or worsen heart failure.

Untreated sleep apnea also can lead to changes in how your body uses energy. These changes increase your risk for obesity and diabetes.

Who Is At Risk for Sleep Apnea?

It’s estimated that more than 12 million American adults have obstructive sleep apnea. More than half of the people who have this condition are overweight.

Sleep apnea is more common in men. One out of 25 middle-aged men and 1 out of 50 middle-aged women have sleep apnea.

Sleep apnea becomes more common as you get older. At least 1 out of 10 people over the age of 65 has sleep apnea. Women are much more likely to develop sleep apnea after menopause.

African Americans, Hispanics, and Pacific Islanders are more likely to develop sleep apnea than Caucasians.

If someone in your family has sleep apnea, you’re more likely to develop it.
People who have small airways in their noses, throats, or mouths also are more likely to have sleep apnea. Smaller airways may be due to the shape of these structures or allergies or other medical conditions that cause congestion in these areas.

Small children often have enlarged tonsil tissues in the throat. This can make them prone to developing sleep apnea.

Other risk factors for sleep apnea include smoking, high blood pressure, and risk factors for stroke or heart failure. What Are the Signs and Symptoms of Sleep Apnea?

Major Signs and Symptoms

One of the most common signs of obstructive sleep apnea is loud and chronic (ongoing) snoring. Pauses may occur in the snoring. Choking or gasping may follow the pauses.
The snoring usually is loudest when you sleep on your back; it may be less noisy when you turn on your side. Snoring may not happen every night. Over time, the snoring may happen more often and get louder.

You’re asleep when the snoring or gasping occurs. You will likely not know that you’re having problems breathing or be able to judge how severe the problem is. Your family members or bed partner will often notice these problems before you do.

Not everyone who snores has sleep apnea.

Another common sign of sleep apnea is fighting sleepiness during the day, at work, or while driving. You may find yourself rapidly falling asleep during the quiet moments of the day when you’re not active.

Other Signs and Symptoms

Others signs and symptoms of sleep apnea may include:

  • Morning headaches
  • Memory or learning problems and not being able to concentrate
  • Feeling irritable, depressed, or having mood swings or personality changes
  • Urination at night
  • A dry throat when you wake up

In children, sleep apnea can cause hyperactivity, poor school performance, and aggressiveness. Children who have sleep apnea also may have unusual sleeping positions, bedwetting, and may breathe through their mouths instead of their noses during the day.

How Is Sleep Apnea Diagnosed?

Doctors diagnose sleep apnea based on your medical and family histories, a physical exam, and results from sleep studies. Usually, your primary care doctor evaluates your symptoms first. He or she then decides whether you need to see a sleep specialist.

These specialists are doctors who diagnose and treat people with sleep problems. Such doctors include lung, nerve, or ear, nose, and throat specialists. Other types of doctors also can be sleep specialists.

Medical and Family Histories

Your doctor will ask you and your family questions about how you sleep and how you function during the day. To help your doctor, consider keeping a sleep diary for 1 to 2 weeks. Write down how much you sleep each night, as well as how sleepy you feel at various times during the day.

You can find a sample sleep diary in the National Heart, Lung, and Blood Institute’s“Your Guide to Healthy Sleep.”

Your doctor also will want to know how loudly and often you snore or make gasping or choking sounds during sleep. Often you’re not aware of such symptoms and must ask a family member or bed partner to report them.

If you’re a parent of a child who may have sleep apnea, tell your child’s doctor about your child’s signs and symptoms.

Let your doctor know if anyone in your family has been diagnosed with sleep apnea or has had symptoms of the disorder.

Many people aren’t aware of their symptoms and aren’t diagnosed.

Physical Exam

Your doctor will check your mouth, nose, and throat for extra or large tissues. The tonsils often are enlarged in children with sleep apnea. A physical exam and medical history may be all that’s needed to diagnose sleep apnea in children.

Adults with the condition may have an enlarged uvula or soft palate. The uvula is the tissue that hangs from the middle of the back of your mouth. The soft palate is the roof of your mouth in the back of your throat.

Sleep Studies

A sleep study is the most accurate test for diagnosing sleep apnea. It captures what happens with your breathing while you sleep.

A sleep study is often done in a sleep center or sleep lab, which may be part of a hospital. You may stay overnight in the sleep center.

Polysomnogram

A polysomnogram (poly-SOM-no-gram), or PSG, is the most common study for diagnosing sleep apnea. This test records:

  • Brain activity
  • Eye movement and other muscle activity
  • Breathing and heart rate
  • How much air moves in and out of your lungs while you’re sleeping
  • The amount of oxygen in your blood

A PSG is painless. You will go to sleep as usual, except you will have sensors on your scalp, face, chest, limbs, and finger. The staff at the sleep center will use the sensors to check on you throughout the night.

A sleep specialist reviews the results of your PSG to see whether you have sleep apnea and how severe it is. He or she will use the results to plan your treatment. How Is Sleep Apnea Treated?

Goals of Treatment

The goals of treating obstructive sleep apnea are to:

  • Restore regular breathing during sleep
  • Relieve symptoms such as loud snoring and daytime sleepiness

Treatment may help other medical problems linked to sleep apnea, such as high blood pressure. Treatment also can reduce your risk for heart disease, stroke, and diabetes.

Specific Types of Treatment

Lifestyle changes, mouthpieces, breathing devices, and/or surgery are used to treat sleep apnea. Currently, there are no medicines to treat sleep apnea.

If you have sleep apnea, talk to your doctor or sleep specialist about the treatment options that are most appropriate for your specific condition.

Lifestyle changes and/or mouthpieces may be enough to relieve mild sleep apnea. People who have moderate or severe sleep apnea may need breathing devices or surgery.

Lifestyle Changes

If you have mild sleep apnea, some changes in daily activities or habits may be all that you need.

  • Avoid alcohol and medicines that make you sleepy. They make it harder for your throat to stay open while you sleep.
  • Lose weight if you’re overweight or obese. Even a little weight loss can improve your symptoms.
  • Sleep on your side instead of your back to help keep your throat open. You can sleep with special pillows or shirts that prevent you from sleeping on your back.
  • Keep your nasal passages open at night with nose sprays or allergy medicines, if needed. Talk to your doctor about whether these treatments might help you.
  • Stop smoking.

Mouthpiece

A mouthpiece, sometimes called an oral appliance, may help some people who have mild sleep apnea. Your doctor also may recommend a mouthpiece if you snore loudly but don’t have sleep apnea.

A dentist or orthodontist can make a custom-fit plastic mouthpiece for treating sleep apnea. (An orthodontist specializes in correcting teeth or jaw problems.) The mouthpiece will adjust your lower jaw and your tongue to help keep your airways open while you sleep.

If you use a mouthpiece, it’s important that you check with your doctor about discomfort or pain while using the device. You may need periodic office visits so your doctor can adjust your mouthpiece to fit better.

Breathing Devices

Continuous positive airway pressure (CPAP) is the most common treatment for moderate to severe sleep apnea in adults. A CPAP machine uses a mask that fits over your mouth and nose, or just over your nose. The machine gently blows air into your throat.

The air presses on the wall of your airway. The air pressure is adjusted so that it’s just enough to stop the airways from becoming narrowed or blocked during sleep.

Treating sleep apnea may help you stop snoring. But stopping snoring doesn’t mean that you no longer have sleep apnea or can stop using CPAP. Sleep apnea will return if CPAP is stopped or not used correctly.

Usually, a technician will come to your home to bring the CPAP equipment. The technician will set up the CPAP machine and adjust it based on your doctor’s orders. After the initial setup, you may need to have the CPAP adjusted on occasion for the best results.
CPAP treatment may cause side effects in some people. These side effects include a dry or stuffy nose, irritated skin on your face, sore eyes, and headaches. If your CPAP isn’t properly adjusted, you may get stomach bloating and discomfort while wearing the mask.
If you’re having trouble with CPAP side effects, work with your sleep specialist, his or her nursing staff, and the CPAP technician. Together, you can take steps to reduce these side effects. These steps include adjusting the CPAP settings or the size/fit of the mask, or adding moisture to the air as it flows through the mask. A nasal spray may relieve a dry, stuffy, or runny nose.

There are many different kinds of CPAP machines and masks. Be sure to tell your doctor if you’re not happy with the type you’re using. He or she may suggest switching to a different kind that may work better for you.

People who have severe sleep apnea symptoms generally feel much better once they begin treatment with CPAP.

Surgery

Some people who have sleep apnea may benefit from surgery. The type of surgery and how well it works depend on the cause of the sleep apnea.

Surgery is done to widen breathing passages. It usually involves removing, shrinking, or stiffening excess tissue in the mouth and throat or resetting the lower jaw.

Surgery to shrink or stiffen excess tissue in the mouth or throat is done in a doctor’s office or a hospital. Shrinking tissue may involve small shots or other treatments to the tissue. A series of such treatments may be needed to shrink the excess tissue. To stiffen excess tissue, the doctor makes a small cut in the tissue and inserts a small piece of stiff plastic.
Surgery to remove excess tissue is only done in a hospital. You’re given medicine that makes you sleep during the surgery. After surgery, you may have throat pain that lasts for 1 to 2 weeks.

Surgery to remove the tonsils, if they’re blocking the airway, may be very helpful for some children. Your child’s doctor may suggest waiting some time to see whether these tissues shrink on their own. This is common as small children grow.

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