Sleep Apnea Overview

Sleep apnea is classified into two types. There is obstructive sleep apnea and there is central sleep apnea. Obstructive sleep apnea is the most common and occurs when the upper airway becomes blocked continuously during sleep. This can reduce or completely block the airflow.  Central sleep apnea is when the brain isn’t sending the needed signals for the body to breath during sleep. This can lower oxygen levels which can lead to many negative symptoms.

Some of the common symptoms can include daytime tiredness, loud snoring, anxiety, dry mouth, and more. Sleep apnea is is usually diagnosed with the use of a sleep test that can be done in the home or over night in a sleep center.

Most common treatments are the use of a CPAP machine and/or lifestyle changes. There are some alternative methods that are still being validated. Sometimes surgery is an option, but is usually viewed as a last resort because it is not as successful and there are risks involved. If untreated sleep apnea can lead to lots of major health issues. 

To learn in more about this condition in detail choose one of the options below.

Symptoms

Excessive daytime sleepiness (hypersomnia): Feeling sleepy almost every day, even with a good sleep schedule, can be a sign of sleep apnea. taking this test here should give you an indication if you may be suffering from sleep apnea

Loud snoring: Loud snoring isn’t a for sure way to know if you have sleep apnea, but it is a pretty good indicator.

Episodes in which you stop breathing during sleep: You probably wouldn’t recognize this yourself, but someone that sleeps in the same room as you would. This can often sound like choking or gasping for air. It might even wake you up, but you wouldn’t have any memory it happening in most cases.

Awakening with a dry mouth: This would be a sign of you breathing through your mouth because you aren’t getting enough air through normal breathing

Morning headache: This is reported more by women then men, but morning headaches are a common symptom.

Difficulty staying asleep: If you are experiencing sleep apnea episodes, you are probably being woken up throughout the night. You might think it is just stress or something else, because the episodes are happening while you are asleep making you unaware of them. If you wake up multiple times throughout each night, getting a sleep test is a good idea. 

Difficulty paying attention while awake: Your body might try to self relax if you aren’t getting the proper sleep at night. If you find you are having trouble focusing or paying attention, make sure to talk to your doctor.

Irritability: Wake up on the wrong side of the bed? Getting poor sleep can make people cranky. Especially if you have been dealing with it for months or years untreated.

Anxiety: Lots of people who suffer from sleep apnea reported feeling very anxious in the mornings. The lack of oxygen can have a negative effect on the brain causing a person to feel anxious. The person usually starts to feel better as the day goes on and they breathe in a normal amount of oxygen.

Causes and risk factors:

Obesity is a common cause of sleep apnea in adults. People with this condition have increased fat deposits in their necks that can block the upper airway. People who have unhealthy diets and don’t exercise are also at risk. Eating better and exercising limits your chance to develop sleep apnea.

Heart or kidney failure: Sleep apnea is commonly found in people who have advanced heart or kidney failure. These patients may have fluid build-up in their neck, which can obstruct the upper airway and cause sleep apnea.

Large tonsils or tongue may contribute to sleep apnea, because they narrow the upper airway.

Being older: Although sleep apnea can occur at any age, the risk for sleep apnea increases as you get older. Normal age-related changes in how the brain controls breathing during sleep partially explain the increased risk as you get older. Another possible reason is that as we age, more fatty tissue builds up in the neck and the tongue.

Narrowed Airway: Genetically you might have been born with a narrow airway. This can make it harder for your body to breath when you sleep. This can be more common with people who have a thicker neck. Children are also more likely to have this issue than adults.

Being Male: Both types of sleep apnea is more common in men than it is in women. That gap between men and women decreases with age.

Heart disorders: Having congestive heart failure increases the risk.

Alcohol: Excessive alcohol consumption can contribute to sleep apnea. For obstructive sleep apnea, alcohol relaxes the muscles in the mouth and throat. This can narrow or close off the upper airway preventing air from coming in. For central sleep apnea, alcohol can also affect what signals the brain sends to control sleep or the muscles involved in breathing.

Using narcotic pain medications: Opioid medications, especially long-acting ones such as methadone, increase the risk of central sleep apnea.

Stroke: Having had a stroke increases your risk of central sleep apnea or treatment-emergent central sleep apnea.

Family history: can also play a part as a risk factor for sleep apnea. . Some of the gene related to sleep apnea are associated with the structural development of the face and skull and with how the brain controls sleep and breathing during sleep. Some genes are also associated with obesity and inflammation.

Race: In the United States, sleep apnea is more common among blacks, Hispanics, and Native Americans than among whites. 

Premature Birth: Babies born before 37 weeks of pregnancy: have a higher risk for breathing problems during sleep. In most cases, the risk decreases as the brain matures.

Smoking: Smoking can cause inflammation in the upper airway, affecting breathing.

Nasal congestion: If you have difficulty breathing through your nose you’re more likely to develop obstructive sleep apnea.

Doctors and Testing

Any kind of doctor can write a prescription for a test or do an exam to see if you are at risk for sleep apnea. Below are the most common types:

Primary Care: Your primary care doctor can do an exam and order a sleep study if needed. This can be internal medicine, family medicine, geriatric, or pediatrician. Not only can they order tests, but they can also write prescriptions for CPAP and other things as well. This is a good place to start if you are unsure of your symptoms.

ENT (OTO): An Ear Nose and Throat (ENT) is a specialist that can treat sleep apnea. This would be a good choice if you think a narrow airway, nasal congestion, or allergies are the root cause.

Pulmonologist: Another specialist that can treat sleep apnea. These are lung specialists who are perfect for making sure your body is getting enough oxygen.

Sleep Medicine: These doctors obviously specialize is sleep disorders. Sometimes they can be hard to find. You might also find out that some ENTs and Pulminologists are dual board certfied in sleep medicine but they dont advertise it as much, especially in larger practices.

Types of tests

Polysomnogram (PSG): This test is performed overnight in a hospital or a sleep center. You will be hooked up to some equipment that can monitor your vital signs, heart rate, blood oxygen levels, and breathing patterns. It may sound scary, but it really isn’t. In most places they give you a private room and the atmosphere is a lot like a hotel room. 

Home sleep tests: This is a simplified version of the PSG. It tests for similar things. This is where the sleep center will give you a small device to take home with you or mail it to you. It is fairly easy to use. These tests are significantly cheaper than doing it at a facility. The results aren’t as accurate (at home tests tend to have slightly lower results), but still accurate enough to make a diagnosis. 

CPAP Titration Test: If you are diagnosed with a sleep disorder, this test is usally recommended to make sure CPAP treatment will work for you. This will be done overnight in a facility. A tech will fit you in with a mask and CPAP machine. As you sleep at night a tech will monitor you remotely and adjust the settings to see what is best for you. If they notice the mask you are wearing isn’t working they may slide in to try a different mask on you. If you are found to be a good candidate for treatment (it is almost alway yes) then this test will tell them what settings they need to set your machine to.

Treatments

Breathing Devices: Breathing devices are the most common treatment for sleep apnea to help people sleep at night. A CPAP machine is the most common breathing device people use. There is a wide selection of CPAPs with different functions and features, but they are all meant to help a person breathe better at night giving them a better sleep. They are often effective with a high success rate.

Lifestyle Changes: Besides breathing devices, the other best treatment is making healthy lifestyle changes. This can include quitting smoking, exercising more often, eating healthier, proper vitamin intake, and in general keep good cardio health. In severe cases of sleep apnea life style changes may on be enough, but it could greatly help make it better.

Mouthpieces: These are oral appliances that are usually customer fit that a person would wear while they sleep. There are two types of these. The first is Mandibular re positioning mouthpieces. These are devices that cover the upper and lower teeth and hold the jaw in a position that prevents it from blocking the upper airway.  The other is Tongue retaining devices. These are mouthpieces that hold the tongue in a forward position to prevent it from blocking the upper airway. This type of treatment is very specific to the individual and depends on the root cause of the sleep apnea and the severity of it to determine how effective it is. 

Surgery: Surgery is can be considered if the sleep apnea is severe and all other treatments are not working. It is usually considered a last resort because the success rate isn’t as high as CPAP treatment and there can be some negative side effects. But if needed, this is a option. Removing the tounsels is the most common and least invasive surgery. This helps make more room in the airway and one less thing to block it. Jaw surgery is also considered to make room in the upper airway. Tracheostomy is the other common surgery to make a hole through the front of your neck into your trachea, or windpipe. A breathing tube, called a trach tube, is placed through the hole and directly into your windpipe to help you breathe.

Implants: This is a fairly new treatment but it is FDA approved. Some devices treat both obstructive and central sleep apnea. You must have surgery to place an implant in your body. The device senses breathing patterns and delivers mild stimulation to certain muscles that open the airways during sleep. This can be seen as something better than CPAP because there is no mask or tube needed to attach allowing a person to sleep more naturally. More research is needed to determine how effective the implant is in treating central sleep apnea. Also The long term effects still need to be researched. It is highly recommended that if CPAP treatment is working for you, you should stick with the CPAP. If you fill out this 2 question questionnaire on this website ___________ They will only recommend their treatment if CPAP is just not helping you.