Sleep apnea is a common disorder in which you briefly stop breathing while you are asleep. According to the American Sleep Apnea Association, more than 12 million Americans suffer from sleep apnea. Being overweight is often the cause of sleep apnea. However, anyone can get sleep apnea -- even children.
People with sleep apnea stop breathing over and over again in their sleep. This causes harmful effects on your brain and heart and can cause depression and weight gain. There are three different types of sleep apnea.
Obstructive Sleep Apnea
Obstructive sleep apnea (OSA) occurs when something is blocking the airway. In the case of overweight people, it can mean that there is too much tissue around the neck and back of the throat. It can also occur when structures inside the nose and throat such as the tonsils or adenoids are enlarged. Most common causes of OSA:
- Being overweight
- Enlarged tonsils
- Enlarged adenoids (adenoids shrink the older you get so this is usually a problem unique to children)
- Genetic causes such as an inherited narrow airway or a large tongue. There are also certain genetic syndromes that make it more likely to get OSA such as Patau Syndrome (trisomy 13)
- Taking sedatives before bedtime
- Consuming alcoholic beverages
- Lung disease
- Nasal obstruction such as enlarged turbinates
Central Sleep Apnea
Central sleep apnea is different from OSA because there is no obstruction making it difficult to breathe. Instead your brain fails to send out the message to breathe at certain times when you are asleep. The most common cause of central sleep apnea is advanced heart failure, and stroke.
Mixed Sleep Apnea
As you might guess from the name mixed sleep apnea is a combination of obstructive and central sleep apnea.
Signs and Symptoms of Sleep Apnea
There are many possible signs and symptoms of sleep apnea. You may have some or all of them. Since you are asleep when signs of sleep apnea occur they are often reported by a spouse or other bedroom partner.
- Long periods or pauses in which you do not breathe while sleeping
- Snoring (learn how you can stop snoring)
- Gasping during sleep
- Restlessness during sleep
- Difficulty staying awake or being tired during the day
- Depression or mood swings
- Difficulty concentrating
- Memory loss
- Frequent headaches
Diagnosing Sleep Apnea
A polysomnogram (sleep study) can help diagnose sleep apnea. To undergo this test, you must go to a sleep center. Monitors will be put on you before you fall asleep including an oximeter (a monitor which is usually placed on your finger and measures the amount of oxygen in your blood), electrodes placed on your head which record your brain waves (EEG), electrodes placed on your chest which record the activity of your heart (EKG), electrodes placed on your jaw to record jaw clenching or teeth grinding, and electrodes placed on your legs which record the movement of your legs while sleeping (this is helpful in diagnosing restless leg syndrome). Most patients are asked to fall asleep on their back since this is the most likely position in which apnea will occur. It can be difficult to fall asleep during a sleep study but most patients do.
Treating Sleep Apnea Without Surgery
Non-surgical treatment often begins with losing weight. Discontinuing sedative medications can prove helpful in treating sleep apnea as can the use of a C-PAP, which stands for continuous positive airway pressure. It involves wearing a mask. There are many different types of masks but they all blow air into the nose or mouth to keep the airway open. If the patient has difficulty keeping their oximetry (blood oxygen levels) above 90 percent, supplemental oxygen can be added to their C-PAP. Humidification is often used because plain air can dry out the nose and mouth. Some people have difficulty tolerating C-PAP as it can be uncomfortable. Different mask types and sizes can be tried in order to make the C-PAP more comfortable.
C-PAP may be beneficial in treating central sleep apnea but in general the best treatment is to find the underlying cause of sleep apnea.
Surgical Treatment of Sleep Apnea
Tonsillectomy is beneficial if your tonsils are abnormally enlarged as is adenoidectomy in children. There are other surgical procedures that can be helpful in treating OSA like Uvulopalatopharyngoplasty (UPPP). In this procedure the uvula is removed as well as part of the soft palate. This gives more room for air to get to the lungs. Surgery to treat nasal obstruction may include reducing the size of enlarged turbinates or nasal sinus surgery.
Complications of Sleep Apnea
Many people have difficulty complying with non-surgical treatments for sleep apnea but it should be noted that sleep apnea is a deadly disease. The lack of oxygen flow to the blood and brain can cause the death of tissue. Sleep apnea can therefore lead to heart disease including heart attacks and heart failure. There is some evidence that sleep apnea can also cause strokes due to the lack of oxygen and tissue death in the brain. However, with treatment the prognosis of sleep apnea can be very good. Most people feel more rested and symptoms of depression and mood changes are relieved. With appropriate treatment some heart disease may be reversed.
American Family Physician. Obstructive Sleep Apnea. Accessed: November 28, 2009 from http://www.aafp.org/afp/991115ap/2279.html
American Sleep Apnea Association. Sleep Apnea Information. Accessed: November 28, 2009 from http://www.sleepapnea.org/info/index.html
Medline Plus. Central Sleep Apnea. Accessed: November 28, 2009 from http://www.nlm.nih.gov/medlineplus/ency/article/003997.htm