What Is Sleep Apnea?

Sleep apnea is a serious medical condition that causes a person to stop breathing for brief periods of time while sleeping. Sleep apnea reduces the amount of oxygen in your body and may be experienced as gasping, a loud snort, or choking while sleeping.

The periodic stoppage of breathing can lead to serious medical problems, such as hypertension or high blood pressure, stroke, or heart conditions. There are 3 different types of sleep apnea: obstructive sleep apnea (most common), central sleep apnea (CSA), and treatment-emergent central sleep apnea (mixed/complex sleep apnea).

During an apneic event, the brain recognizes that breathing has stopped and will cause the body to wake itself up to start breathing again. This survival response hinders a person from getting deep restorative sleep, which can lead to daytime drowsiness and other health problems. Sleep apnea is becoming a more common condition and tends to affect more males than females.

Although loud snoring can be a tell-tale sign of sleep apnea, it does not always indicate the condition. If your healthcare provider suspects sleep apnea, an at-home or in-lab sleep study may be recommended.

Although sleep apnea can lead to more serious health issues, there are several effective treatment options for those suffering from the condition. The earlier the condition is diagnosed and treated, the better the treatment outcomes. Sleep apnea is considered a manageable condition.

Signs and Symptoms

There are several symptoms of sleep apnea. Many of the symptoms overlap between the types of sleep apnea. Symptoms include:

• Snoring loudly
• Apneic episodes (periods of time where you stop breathing while sleeping)
• Gasping for air while sleeping
• Choking sensation while sleeping
• Unusual breathing patterns while sleeping
• Morning headache
• Daytime drowsiness
• Waking with dry mouth
• Insomnia
• Waking up repeatedly in the middle of the night
• Difficulty with attention and focus
• Memory issues
• Irritability
• Mood changes (anxiety or depression)
• Night sweats
• Feeling restless at night

Causes

There are several potential causes for sleep apnea. Research has found that sleep apnea tends to run in families, so if someone in your family has the condition, you may have a greater risk of developing it. The causes of sleep apnea are also dependent on which type of sleep apnea you have. There are 3 main types: obstructive sleep apnea (most common), central sleep apnea (CSA), and treatment-emergent central sleep apnea (complex sleep apnea).

Obstructive Sleep Apnea (OSA)

OSA is the most common form of sleep apnea, and it occurs when the muscles in the back of your throat relax, causing your airway to narrow and close when you breathe in. OSA causes apneic episodes, which happen when the airway is obstructed, and your brain recognizes that breathing has stopped. The brain then forces the body to wake up to start breathing again. In an apneic episode, a person may gasp, snort, or experience a choking sensation while sleeping. Usually, the awakening time is so brief, a person does not remember that they woke up.

Central Sleep Apnea (CSA)

CSA occurs when the brain fails to send signals to your breathing muscles while sleeping. It causes a person to not make any effort to breathe for a short period of time. A person may awaken and experience shortness of breath or have difficulty falling asleep or staying asleep.

Treatment-Emergent Central Sleep Apnea (Mixed/Complex Sleep Apnea)

A less common form of sleep apnea, complex sleep apnea, develops after a person has started treatment for sleep apnea. Complex sleep apnea is when a person develops CSA after starting treatment for obstructive sleep apnea.

Risk Factors

Sleep apnea can affect both males and females at any age. However, it is more common in males and tends to occur more often over the age of 50. Risk factors may vary depending on what type of sleep apnea you have.

OSA

• Obesity
• Narrowed airway (can be due to having inherited a narrow throat or having enlarged or swollen tonsils or adenoids)
• Neck circumference (thicker necks may lead to narrower airways)
• Family history
• Being male
• Being over the age of 50
• Women who are overweight and have already gone through menopause
• Smoking (3 times greater of a risk than non-smokers; smoking can cause inflammation and fluid retention in upper airways)
• Nasal congestion
• Substances that relax the muscles in the throat (alcohol, sedatives, or tranquilizers)
• Certain medical conditions (congestive heart failure, high blood pressure, type 2 diabetes, PCOS, hormonal disorders, chronic lung diseases, such as asthma, or prior stroke)

Types of Sleep Apnea

There are 3 main types of sleep apnea: obstructive sleep apnea (OSA), central sleep apnea (CSA), and mixed/complex sleep apnea. Each type has an overlap of symptoms with each other.

Obstructive Sleep Apnea

OSA is the most common form of sleep apnea, and it occurs when the muscles in the back of your throat relax, causing your airway to narrow and close when you breathe in. OSA causes apneic episodes, which happen when the airway is obstructed, and your brain recognizes that breathing has stopped. The brain then forces the body to wake up to start breathing again. In an apneic episode, a person may gasp, snort, or experience a choking sensation while sleeping. Usually, the awakening time is so brief, a person does not remember that they woke up.

Central Sleep Apnea

CSA occurs when the brain fails to send signals to your breathing muscles while sleeping. It causes a person to not make any effort to breathe for a short period of time. A person may awaken and experience shortness of breath or have difficulty falling asleep or staying asleep.

Mixed Sleep Apnea

A less common form of sleep apnea, complex sleep apnea, develops after a person has started treatment for sleep apnea. Complex sleep apnea is when a person develops CSA after starting treatment for obstructive sleep apnea.

Diagnosis

Diagnosing sleep apnea typically happens after an evaluation by your primary care provider based on symptoms and sleep history. If sleep apnea is suspected, your provider will likely recommend completing testing at a sleep lab or doing an at-home sleep study.

Nocturnal Polysomnography

This study is conducted overnight in a sleep lab. During the study, a person is hooked up to various monitors and devices that will be measuring and assessing heart rate, lung activity, brain activity, breathing patterns, arm and leg movement, and oxygen saturation levels while sleeping.

Home Sleep Tests

At-home tests are sometimes recommended over polysomnography tests when CNS is not suspected, or if the patient prefers to try it at home versus going to a lab and being monitored. At-home sleep tests are simplified versions of the lab tests and typically measure heart rate, blood oxygen saturation, breathing patterns, airflow, and body movement and body positions. Often, if an at-home sleep test does not indicate sleep apnea, a sleep lab test will still be recommended.

Treatment Options

There are various treatment options for sleep apnea. The recommended treatment approach will depend on the type of sleep apnea and the severity of it. Generally, if treated, the prognosis for sleep apnea symptoms is good. Treatments that are used consistently tend to be effective and help to manage symptoms.

In some cases, if symptoms are considered mild, a healthcare provider may first recommend lifestyle changes that would focus on weight loss, reducing stress, and decreasing any allergy symptoms. Additionally, your doctor may advise different medication management.

CPAP Therapy

A CPAP (continuous positive airway pressure) device is one of the more common treatment options for those suffering with sleep apnea, especially for more moderate to severe cases. A CPAP device delivers air through a mask that allows the airway to stay open while sleeping and helps to decrease the number of apneic episodes and snoring.

Some people find wearing the mask to be uncomfortable and may give up on using the CPAP altogether. It is important to speak with your provider so you can choose from various options of CPAP devices and find the one that best fits your needs.

Oral Appliances

OSA occurs when the muscles of the throat, mouth, jaw, or neck relax and push downward against the windpipe, decreasing airflow and oxygen to the body. Oral appliances work to keep the soft tissue from collapsing against the windpipe and blocking airflow and are recommended for mild to moderate cases. Special mouthpieces help to keep the jaw or tongue in place so that they are not pressing against the windpipe. It is important to consult with a dentist or sleep specialist when considering oral appliances. Specialists will be able to customize the fit to your mouth and jaw, to ensure there will not be any complications or changes in your bite from wearing the oral appliance. Oral appliances can be effective in reducing symptoms and people tend to find them less cumbersome than the CPAP machines.

Surgery

Typically, surgery would not be recommended unless all other treatment measures have failed. However, for a small number of people with certain structural jaw issues, surgery may be the first option. There are different types of surgery, depending on the root cause of symptoms.

Somnoplasty

The procedure uses radiofrequency technology to decrease soft tissue around the upper parts of the windpipe.

Tonsillectomy/Adenoidectomy

This treatment is most helpful for children with OSA. The surgery removes the tonsils and adenoids, which widens the airway, allowing more air to pass through. More specifically, it removes the soft tissue that may be blocking the airway.

Uvulopalatopharyngoplasty (UPPP)

This surgery removes the uvula, which is the teardrop-shaped soft tissue that hangs down at the back of the throat. Additionally, it removes soft tissue from the soft palate and pharynx. This surgery helps to widen the airway.

Jaw Surgery

There are different types of jaw surgeries that can slightly change the position of the jaw, making it harder for soft tissue to press against the windpipe. Jaw surgery can be helpful for people with structural jaw issues, such as micrognathia.

Nasal Surgery

One form of nasal surgery, known as septoplasty, helps to straighten the soft tissue in the nose, making it easier for air to travel through the nose and nasal passages.

Nerve Stimulator

This surgery inserts a nerve stimulator that helps to keep the tongue in position and allows the airway to remain open while sleeping. This is a newer treatment method, and more research is needed.

Learn More about Sleep Apnea

Sleep apnea is a treatable medical condition. If left untreated, sleep apnea can lead to life-threatening conditions, such as cardiovascular disease, high blood pressure, stroke, or type 2 diabetes. It is important to consult with your healthcare provider if you suspect you may have sleep apnea. Call the Baptist Health sleep center today.