Sleep Apnea Guide

Sleep Apnea is more common than you would think. Almost every one in five adults over 50 years of age is diagnosed with some form of sleep apnea, the intensity ranging from mild to severe. Certain underlying conditions also contribute to this condition. Unfortunately, not much is known about this medical state. Even if you suffer from sleep apnea, chances are you will not know about it. The reason is twofold. The first and primary reason is a lack of information. The second reason is that people suffering from sleep apnea are unaware that they suffer from any sleep disorder. They might even feel much rested the next morning and have no recollection of their apnea episode. This article will help you understand Sleep Apnea better by illuminating it’s finer points.

What is Sleep, Apnea?

Sleep apnea is a medical condition where a person repeatedly starts and stops breathing while asleep, leading to undue daytime sleepiness. In short, the person takes pauses in the breathing pattern and also has shallow overall breathing. The pause duration might range from a few seconds to minutes depending upon the severity of the condition. For this reason, sleep apnea is classified as a sleep disorder and is also known as “Sleep Apnoea.”

Types of Sleep Apnea

Sleep apnea is primarily of three types. These are listed below:

• Obstructive Sleep Apnea (OSA): OSA is the most common form of sleep apnea. It happens when the soft palate muscles found around the tongue base and the uvula loosen up obstructing the airways leading to disruption in the breathing pattern. It is characterized by a frequent collapse of the upper airways during sleep.
• Central Sleep Apnea (CSA): The type of sleep apnea that results due to the failure of the brain to send proper signals to the muscles in charge of your breathing is known as CSA. It is different from OSA in the respiratory drive department. In CSA, your body stops making an effort to breathe because of a lack of respiratory movements.
• Complex Sleep Apnea Syndrome (CSAS): CSAS is the type of sleep apnea that develops when a person already suffering from OSA ends up with CSA due to Continuous Positive Airway Pressure (CPAP) treatment. In other words, when a person exhibits repeated central apnea episodes of more than five times an hour when the obstructive sleep apnea element is extinguished by the positive airways pressure, he/she is known to suffer from CSAS.

Signs of Sleep Apnea

Knowing just the definition of sleep apnea is insufficient; you should also know how to identify the condition. It is only when you understand the common signs and symptoms exhibited by this condition that you can identify its manifestation. The signs of sleep apnea vary from major signs, which you absolutely cannot ignore to other more subtle signs. They are both listed below for your reference:

Major Signs

• Snoring both loud and chronic
• Repeated episodes of choking and snorting during Sleep
• Waking up gasping for breath
• Regular shortness of breath during Sleep
• Excessive daytime sleepiness
• Fatigue and feelings of being constantly tired
• Your bed partner complains of you snoring or is scared of the way you breathe while sleeping
• Insomnia and frequent waking at night
• Leg swelling or “Oedema.” This happens in extreme cases of sleep apnea.

Subtle Signs

• Waking up periodically with a dry mouth and a sore throat
• Disruptive Sleep with moments of anxiety and restlessness that doesn’t seem to go away
• A persistent unwillingness to fall asleep or feeling insecure about sleeping
• Waking up with headaches
• Making frequent bathroom trips at night
• Impotence and lack of sex drive
• Irritability and mood swings
• A marked decrease in levels of concentration and attention span
• Dip in productivity
• A general feeling of malaise

Sleep Apnea vs. Snoring

Sleep apnea and snoring have a complex relationship. One of the first major and common signs that your body gives you about suffering from sleep apnea is snoring. However, it can get difficult to understand if you are snoring because of sleep apnea or some other medical or lifestyle condition. Some points to help you differentiate between the two are:

• Asses how you feel during the day. Gauge if you are excessively sleepy, tired and overly fatigued. If you are then the chances are you are snoring because of sleep apnea. This is because normal snoring does not affect your Sleep even half as much as snoring caused by sleep apnea does.
• Rope in your better half or record your snoring during the night. If it is loud with periods of disturbance indicating a change in the breathing pattern, then you have sleep apnea.
• See if you have waking moments due to choking, gasping, and snoring during the night. Any snoring accompanied by these elements is a sign of sleep apnea.

Reasons for Developing Sleep Apnea

Sleep apnea is caused by a cluster of causes. It is a sleep disorder that stems from a restricted airway passage that leads to abnormal airway flow when you are asleep. The predominant causes of developing this condition are:

• Muscular Change: Your muscles relax while you sleep. The muscles around the throat, neck, your tongue, and all the other muscles responsible for keeping your airways open also relax while you sleep. Generally, this muscle relaxation does not pose any problems, but in some people, especially those falling in the risk category, these relaxed muscles lead to airway obstruction, causing breathing problems while you are asleep developing into sleep apnea.
• Physical Hindrance: Sometimes, there are obstructions like fatty tissue layers and stores along the airway passage. This narrows the passage and does not allow for optimal airflow. It is also responsible for snoring. A physical obstruction causes OSA.
• Brain function: Your breathing pattern and rhythm are governed by neurological controls. When the brain does not transmit appropriate signals for this neurological control to function properly, it causes uneven breathing patterns with periods when you do not breathe. This is the main cause of CSA. CSA is also associated with other medical conditions like heart failure, stroke, high altitudes, and certain medications.

People Who Can Develop Sleep Apnea

Sleep Apnea is one sleeping disorder that can strike anyone. However, the older you get, the higher your risk of developing sleep apnea. You are generally more susceptible to sleep apnea if you are:

• Overweight and Obese
• Of the male gender
• Have a family history of sleep apnea
• Smoke
• Suffer from high blood pressure
• Are over 50 years of age
• Ethnicity matters. Black, Hispanic and Asians are more prone to developing sleep apnea
• Have a neck circumference larger than 15.75 inches or 40 cm.
• Suffer from allergies and frequent nasal congestions. These can cause the airways to inflame periodically and obstruct your airways leading to sleep apnea.
• Physical factors like:
  • Receding Chin
  • Enlarged Tonsils
  • Enlarged Adenoids
  • Deviated Septum
  • Large tongue
  • Naturally narrow palate or airways

When to Schedule Doctor’s Visit?

Sleep apnea can be a serious condition if left untreated. However, initial treatments can include a holistic and lifestyle approach, as discussed in the earlier section. When you feel like you can no longer cope with the condition or if your sleep apnea is getting worse night by night and shows no sign of improvement, then it may be time to make a friendly visit to your doctor.

It is not necessary that you have to take the wait and watch approach. Sleep apnea can have debilitating effects on your daily life. If, at any point, you feel that your condition is taking over your life, seek professional help.

Diagnosing Sleep Apnea

One common question that people suffering from sleep apnea have is how exactly do the doctors diagnose this condition? Some ways that your doctor will be able to judge whether or not you suffer from sleep apnea are:

Verbal Methods

• A detailed questionnaire asking you to list your lifestyle pattern and medical history. These might include:
  • Age
  • Weight
  • Smoking habits
  • Allergy issues
  • If you suffer from any pre-existing respiratory disorders like COPD and chronically inflamed airway passages
• Questions about your sleeping behavior which will include :
  • Your sleep schedule
  • Nighttime waking frequency and duration
  • Incidences of choking
  • Sleeping position
  • Instances of waking up gasping for breath
  • Daytime napping and sleepiness

Non – Verbal Methods

• Head and neck examination to check for physical factors
• Polysomnogram: This requires you to stay overnight in a sleep clinic or a hospital. Polysomnogram is also known as a sleep study. During the night, your Sleep is monitored, and various tests are conducted on it. These tests include:
  • Electroencephalogram (EEG): This test works by attaching an electrode to your scalp. This then monitors your brain wave in all the three conditions namely:
    • Before Sleep
    • During Sleep
    • After Sleep

The brain wave help establish the sleeping pattern and help pinpoint the sleep apnea moments.

• Electro Oculogram (EOM): EOM also requires attaching electrodes to your body. One electrode is attached at one cm above the outer corner of your right eye and another at one cm below the outer corner of your left eye. This then records your eye movements whenever they move away from the center. The eye movement helps in understanding your sleep phases and REM cycles.
• Electromyogram (EMG): This measures muscle activity. Two electrodes are attached to the chin, one above and one below. Another two electrodes are attached to each shin. They then monitor and record your muscle activity to ascertain when they are optimally relaxed, indicating deep Sleep.
• Electrocardiogram (EKG or ECG): The ECG measures both your heart rate and your heart rhythm. A 12 K EKG helps in determining whether you have heart disease or not. ECGs can also detect long term Blood Pressure issues. Monitoring your heart rate and rhythm allows the doctor to rule out these two possibilities and helps in identifying any other abnormal cardiac movement in your body during Sleep.
• Pulse Oximetry Test (POT): This test checks the oxygen levels in your body during Sleep. A small device is known as the “Pulse Oximeter” is attached to a thing area like your fingertip or ear lobe. This device then flashed LED light into your bloodstream to ascertain your oxygen levels. The normal oxygen saturation level is 95 to 100%. This decreases when you suffer a sleep apnea episode. This is monitored by the doctor, and results interpreted accordingly.
• Arterial Blood Gas Analysis (ABG): ABG involves testing the blood from your arteries to ascertain the following levels:
  • Oxygen partial pressure
  • Carbon Dioxide partial pressure
  • Oxygen level
  • Oxygen saturation level
  • Bicarbonate level

This test is very important for your doctor to understand if you need or require oxygen in your body. It also helps provide information about the acidic content of your body, which is helpful to determine if you also suffer from acid reflux while asleep.

Sleep Apnea Treatment Methods

The basic cause of sleep apnea is difficulty breathing because of restricted airflow in the airway passage. Medical treatment methods focus on removing the cause of this constriction. These include:

• Weight Loss: If you are obese, the first step is to shed those extra kilos. This will automatically decrease the fatty layer on the tissues under your mouth and uvula, which are responsible for airway passage constriction. If lifestyle changes do not help in weight loss, you can even consider surgical means for this.
• Decongestants: Decongestants for the nasal passage are especially helpful to relieve snoring. They are most effective in mild cases of sleep apnea and help by reducing nasal inflammation and blockage. This opens up the passage for better airflow.
• CPAP: It involves continuous flow of positive airflow into your airways to keep them propped and open through the night. This airflow is administered through a face mask, which you have to wear through the night. You might even have to place a dental device to keep your jaw positioned right. CPAP is the first treatment practice for obstructive sleep apnea and is known to be extremely effective.
• Bilevel Positive Airflow Pressure (BPAP): BPAP machines are a little more complex than the CPAP face mask. BPAP machine administers positive airflow whose pressure automatically adjusts as per your breathing pattern. Hence the airflow pressure is high when you inhale and low when you exhale. This treatment method is used for treating OSA when CPAP fails.
• Surgery: There are two types of surgeries that are used for sleep apnea. These are:
  • Uvulopalatopharyngoplasty (UPPP): It is quite a mouthful and also the most common surgery performed to relieve OSA. In UPPP, the extra layer of tissues from the back of your throat is removed. This eases up your snoring and improves the breathing levels. However, UPPP is not known to remove sleep apnea completely, and it has several complications attached to it as well.
  • Tracheotomy: This type is way more complicated and invasive than the UPPP. Tracheotomy involves making a puncture in your windpipe. This puncture is then used as an opening to the windpipe bypassing the throat obstruction. Because of the highly invasive nature of this procedure and the severe complications that can arise, this surgery is used as a last resort to treat sleep apnea.
  • Other surgical procedures can also be used to help sleep apnea. These involve face surgery, tonsil, and adenoid removal surgery. These types of surgeries are especially helpful in treating sleep apnea in children.

Apart from these medical treatments, there are certain holistic approaches that you can take as well, which may not eliminate the problem but will help in easing the symptoms and coping with the situation. These are discussed in the next section.

Dealing with Sleep Apnea

It can be difficult dealing with any of the three types of sleep apnea. Sleep apnea tends to make you anxious and restless. Just thinking that there are periods of your Sleep when you involuntarily stop breathing makes a person agitated enough to start avoiding Sleep altogether. This will, in turn, worsen the situation since troubled Sleep will exacerbate sleep apnea.

The best ways to deal with sleep apnea apart from or while undergoing medical treatment for it is:

• Holistic treatment like meditation to deal with the stress and anxiety of having sleep apnea.
• Talking to friends and family about your condition helps immensely in coping with the situation
• Taking external help through support groups which help you in realizing that you are not the only one suffering through this condition. It will also give you insight into how other people manage their conditions.
• Propping an extra pillow under your head seems to help a lot of people in avoiding choking and incessant snoring. Alternatively, you can elevate the head of your bed by wedging something under the mattress or even under the bed. Research confirms that head elevation helps with sleep apnea.
• Try sleeping on your side. The preferred side for alleviating sleep apnea symptoms is the left side.
• Trying to get adequate sleep by practicing good sleep techniques, lifestyle changes, or even medication.
• Having a positive approach to the whole scenario. Remember, you can overcome anything as long as you overcome it in your mind first.
• Invest in a humidifier for your bedroom. This will keep the air in your room moist and decrease congestion, thereby easing your breathing pattern.

Complications of Sleep Apnea

Sleep apnea is classified as a sleeping disorder. Anything that affects your sleep quality and quantity has both physical and mental impact on your health. Apart from the sleep perspective, sleep apnea also causes breathing issues. This also leads to certain problems. All of these problems are listed below:

• A decrease in concentration and cognitive functions
• Increased behavioral issues including mood swings, irritability, and depression
• Metabolic changes and syndromes
• Hypertension
• Increased chances of heart attacks and stroke
• Chronic and severe fatigue
• Dry cracked and chapped lips
• Lower quality of life
• Type2 Diabetes
• Liver function problems
• Relationship issues due to loud snoring and other sleep disturbances
• Increased risk of Glaucoma which might result in vision impairment and blindness
• Increased chances of developing adult asthma
• Gastroesophageal Reflux Disease (GERD)

FAQ Section

What is the most common cause of Sleep Apnea?

In an average adult, the most common cause of sleep apnea is noticed to be excessive weight or obesity, particularly associated with the soft tissue making up your mouth and throat. When you sleep, both your tongue and throat muscles tend to relax. At this point, a fatty layer of soft tissue in the mouth and throat can obstruct the airway passages leading to sleep apnea.

Is it possible to Cure Sleep Apnea?

Sleep apnea can be cured. CPAP and other oral tools can be used to ease and eliminate the condition. They can be a remedial intervention and a cure.  However, the easiest cure is to reduce your weight either naturally or through surgery. But bear in mind that surgical weight loss will result in certain side effects, which are best avoided if possible.

Can thin people also develop Sleep Apnea?

Skinny people can suffer from sleep apnea. The chances of sleep apnea developing in skinny people are slim. The relationship is that overweight people generally have sleep apnea, but not everyone with sleep apnea is overweight. Thin people can end up having a fatty tissue lining in their throat and mouth, which leads to sleep apnea.

Is Sleep Apnea synonymous with snoring?

It is not necessary for a person who snores to suffer from sleep apnea. However, if you do suffer from sleep apnea, you will snore.

Conclusion

Sleep Apnea can be potentially life-threatening. It has episodes where you stop breathing and have to sometime wake briefly for a split second to resume breathing. These awakenings are accompanied by breath gasping, chortling, and choking. On the good side, sleep apnea is manageable and can be easily cured, sometimes only requiring some basic lifestyle changes.