What is sleep apnea ?
Sleep apnea is a serious sleep disorder that happens when a person’s breathing is interrupted during sleep. People with untreated sleep apnea stop breathing repeatedly during their sleep, sometimes hundreds of times during the night. If it’s not treated, sleep apnea 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. Untreated sleep apnea can also be responsible for job impairment, work-related accidents and motor vehicle crashes, as well as underachievement in school in children and adolescents.
What are the types of sleep apnea ?
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Obstructive sleep apnea is the more common of the two. Obstructive sleep apnea occurs as repetitive episodes of complete or partial upper airway blockage during sleep. During an apnea episode, the diaphragm and chest muscles work harder as the pressure increases to open the airway. Breathing usually resumes with a loud gasp or body jerk.
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In Central sleep apnea, the airway is not blocked but the brain fails to signal the muscles to breathe due to instability in the respiratory control center. Central apnea is related to the function of the central nervous system.
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Mixed/complex sleep apnea - combination of both obstructive events and central events.
Who does sleep apnea affect ?
Sleep apnea can happen to anyone, ranging from infants and children to older adults.
Obstructive sleep apnea is more common in certain circumstances and groups of people:
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Before age 50, it’s more common in men and people assigned male at birth (AMAB). After age 50, it affects women and people assigned female at birth (AFAB) at the same rate.
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People are more likely to develop it as they get older.
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Having excess weight or obesity strongly increases the risk of developing it.
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It’s more common in people who are Black, Hispanic or of Asian descent.
Central sleep apnea is most common in certain groups of people:
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People who take opioid pain medications.
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Adults over 60 years old.
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People with heart conditions such as atrial fibrillation or congestive heart failure.
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For some people using CPAP or who have obstructive sleep apnea, this can trigger the development of central events knowns as treatment-emergent central sleep apnea.
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When people live at high altitudes, this can cause central apneas to occur.
What are the symptoms of sleep apnea?
The most common signs and symptoms of OSA include:
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Snoring
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Daytime sleepiness or fatigue.
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Restlessness during sleep, frequent night time awakenings.
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Sudden awakenings with a sensation of gasping or choking.
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Dry mouth or sore throat upon awakening.
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Cognitive impairment, such as trouble concentrating, forgetfulness or irritability.
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Mood disturbances (depression or anxiety).
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Night sweats.
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Frequent night time urination.
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Sexual dysfunction.
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Headache
Sleep apnea in children
Sleep apnea in children can happen in slightly different ways. The symptoms of sleep apnea in children include:
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Hyperactivity or trouble focusing or performing poorly in school. This can look like symptoms of attention-deficit/hyperactivity disorder (ADHD).
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Loud snoring.
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Bedwetting.
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Frequent arm or leg movements while asleep.
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Sleeping in unusual positions or sleeping with their neck extended.
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Reflux (heartburn) or night sweats.
How is sleep apnea diagnosed ?
If your doctor determines that you have symptoms suggestive of sleep apnea, 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.
How is sleep apnea treated, and is there a cure ?
There are many approaches to treating sleep apnea, depending on the specific type of sleep apnea and how severe it is. While none of these is a cure, they can help prevent apnea events or reduce how often they happen or how severe they are.
Many treatments should be a part of your daily (or nightly) routine. That can ultimately reduce or even eliminate sleep apnea’s effects on your life for as long as you use these treatments.
Possible treatments include:
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Conservative (nonmedical) treatments.
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Positive airway pressure and adaptive ventilation devices.
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Oral appliances (mouthpieces).
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Nerve stimulators.
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Surgery.
Medications (central sleep apnea only
Conservative treatments
Weight loss
Position changes while sleeping and sleep aid items
Nasal sprays, adhesive strips
Treating the underlying condition
Medication changes
Positive airway pressure (PAP) and adaptive ventilation
Positive airway pressure is a method that uses a specialized device to increase the air pressure inside of your airway while you inhale. This method can treat obstructive, central and mixed sleep apneas.
Pushing pressurized air down your windpipe keeps it open so you can breathe. These devices push air through a hose that attaches to a special mask you wear on your face while you sleep. Masks can cover your nose, mouth or both.
The best-known PAP device is the Continuous Positive Airway Pressure (CPAP) machine.​
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Oral devices
Obstructive sleep apnea happens when soft tissue in your head or neck, especially around your mouth and jaw, press downward on your windpipe. Special mouthpiece devices can help hold your jaw and tongue in a position that keeps pressure off your windpipe.
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Nerve stimulators
The hypoglossal nerve is what controls your tongue’s movements. A nerve stimulator attached to this nerve can stimulate it, pushing your tongue slightly forward when you breathe while you’re sleeping. That keeps your tongue from relaxing and pressing backward on your windpipe while you sleep, which is one of the ways that obstructive sleep apnea happens.
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A similar kind of nerve stimulation is also possible with central sleep apnea. This type of stimulation affects the phrenic nerves. This pair of nerves connect your spinal cord to the diaphragm, a layer of muscle underneath your lungs that controls your ability to inhale and exhale. Stimulating the phrenic nerve causes those muscles to flex, helping you breathe.
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Surgery
Somnoplasty
Complications of sleep apnea ?
If left untreated, sleep apnea can result in a number of health problems including:
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Daytime fatigue
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High blood pressure or heart problems
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Type 2 diabetes
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Metabolic syndrome (high blood pressure, abnormal cholesterol levels, high blood sugar and obesity is linked to a higher risk of heart disease.)
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Complications with medicines, anesthesia and surgery
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Stroke, memory loss, Alzheimer's disease
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Arrhythmias, cardiomyopathy, heart failure, heart attack
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Depression, anxiety
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Gastro-esophageal reflux disease (GERD)
