Sleep Apnea

If you find yourself waking up in the middle of the night gasping for air, you may suffer from sleep apnea. Read on to learn more about this sleep disorder, including its symptoms, risk factors, and how it is diagnosed and treated.

What is sleep apnea?

Sleep apnea is a sleep disorder that affects at least 2-4% of the population.[1] The actual percentage is likely higher as many patients are never diagnosed due to lack of awareness by the public and by health professionals.[2]  It is estimated that 22 million Americans suffer from sleep apnea, with 80% of those cases going undiagnosed.[3] 

Sleep apnea causes your breathing to stop and restart continually throughout the night. 

There are different types of sleep apnea. In obstructive sleep apnea, airflow to your upper airway becomes blocked repetitively during sleep. This can drastically reduce or completely cut off airflow. Central sleep apnea occurs when the brain does not send the correct signals to stimulate breathing. 

If it is not addressed, sleep apnea can lead to more serious disorders in the future.[4]

What are the symptoms of sleep apnea? 

Sleep apnea is diagnosed by sleep specialists. Here are some of the most common symptoms of sleep apnea:[1]

  • Stopping breathing during sleep.
  • Loud snoring.
  • Gasping for air while sleeping.
  • Extreme fatigue during the day.
  • Morning headaches
  • Feeling tired after sleeping.
  • Frequent urination during the night time.
  • Dry mouth when you wake up.
  • Headaches when you wake up.
  • Decrease in attention and concentration.
  • Impaired motor skills and memory.
  • Sexual dysfunction or low libido.
  • Irritability.

Symptoms of sleep apnea are often different between each individual. You may not experience all of the symptoms listed. If you experience some of these symptoms, it is important to tell your doctor about them.[4]

What are the causes of sleep apnea?

There are different causes of sleep apnea. You may be at higher risk due to age or lifestyle decisions. Certain medical conditions can put you at a higher risk of developing sleep apnea. These conditions include:[1] 

  • Obesity 
  • Congestive heart failure
  • Atrial fibrillation
  • Hypertension that does not respond to typical treatment5
  • Type 2 diabetes
  • Nocturnal dysrhythmias
  • Stroke6
  • Pulmonary hypertension

Keeping chronic conditions controlled with proper treatment and frequent doctor visits can help avoid developing sleep apnea. 

If you have sleep apnea, controlling these conditions can reduce the severity or totally resolve the condition.[1]

Who is at risk for sleep apnea?

Sleep apnea can affect many different people, including children. Certain characteristics can increase the risk of developing this chronic condition.[1]

The first major risk factor is an unhealthy lifestyle. Increased alcohol and/or tobacco consumption can lead to sleep apnea.[4]

Alcohol can cause the muscles in your upper airway to block your throat and can affect the way your brain sends signals to breathe while you sleep.[4]

Tobacco may lead to inflammation in your airway which can worsen your breathing. In general, unhealthy lifestyle habits like lack of exercise or poor diet can lead to obesity which can increase the risk of sleep apnea.[4]

While sleep apnea affects people of all ages, older adults are at a higher risk. Your brain changes as you age and can develop issues in controlling breathing while you sleep. As you age, fatty tissue can also accumulate near the neck and tongue, making the airway more narrow.[4]

A family history of sleep apnea can put you at a higher risk of developing this condition. Maintaining a healthy lifestyle is important in reducing your risk if you have a family history. Genes contributing to sleep apnea can be due to facial structure, obesity, inflammation, and more. [1] 

Sleep apnea risks

If left untreated, sleep apnea can lead to more serious disorders. The risk of developing certain conditions such as asthma, atrial fibrillation, and certain cancers is higher in patients with untreated sleep apnea.[4] 

The poor sleep quality associated with sleep apnea can lead to things like decreased attention, concentration, movement, and memory.[7] 

Children can develop learning disabilities if sleep apnea is left untreated.[4] Sleep apnea puts more stress on your heart, leading to things like heart attacks, heart failure, high blood pressure, or even stroke. 

Sleep apnea can affect your eyes, can lead to diabetes, and can cause pregnancy complications.[4] Obstructive sleep apnea is associated with a higher risk of hypertension,[4] stroke,[6] and to a lesser extent coronary artery disease.[8] 

Sleep apnea can affect your eyes, can lead to diabetes, and can cause pregnancy complications.[4] Obstructive sleep apnea is associated with a higher risk of hypertension,[4] stroke,[6] and to a lesser extent coronary artery disease.[8] However, it is unclear if sleep apnea actually contributes to the development or causes these conditions. 

It is also possible that patients with poorer overall health, including these cardiac conditions, are more likely to have sleep apnea. Regardless, it is important to take note of the signs and symptoms of sleep apnea and treat the condition if necessary.[4]

How to determine a sleep apnea diagnosis

Sleep apnea has to be diagnosed by a doctor. If you believe you are experiencing sleep apnea, your doctor can perform some tests. Your doctor will likely have you perform a sleep study. 

A sleep study is useful at monitoring your sleep patterns. The doctor will assess your sleep study, take your medical history, and do a physical exam to determine whether you have sleep apnea.

Your doctor may want you to wear a home monitor that observes your sleep patterns or may have you do the sleep study in a sleep treatment facility. 

If you have a high risk for complications from sleep apnea and are having many symptoms at night, it is recommended that you do sleep testing. This includes patients who are obese, have heart failure, coronary artery disease, history of stroke, or significant rapid or slow heart beats.[1] 

A sleep study for sleep apnea may include monitoring for things like blood oxygen levels, how fast you are breathing, brain-wave activity, your leg movements, and how many partial inhalation incidences (also called apnea and hypopnea incidence) you experience per hour. These monitoring parameters can help your doctor determine whether you have sleep apnea, what kind of sleep apnea you have, and how severe your sleep apnea is. 

How to treat sleep apnea

There are a range of treatments for sleep apnea. It can be managed using different methods. 

Treatments range from basic behavior changes to invasive surgery. Here are the most common sleep apnea solutions. 

Continuous Positive Airway Pressure (CPAP)

CPAP therapy is recommended as a first line treatment for mild sleep apnea, moderate sleep apnea, and severe sleep apnea.[9] 

A CPAP machine supplies positive airway pressure through a nasal, oral, or oral + nasal mask during sleep. If you are given a CPAP machine, you should be educated about how it works, how to care for it, and how to maintain the equipment. This helps your airway remain open, so you breathe better. This sleep apnea machine can also improve sleepiness and quality of life.[9]

Lifestyle Changes

You can help reduce your risk of sleep apnea, manage or treat sleep apnea, by making healthy lifestyle decisions.[7] 

Weight loss can drastically improve sleep apnea. Adopting a healthy diet can help you lose weight, improve sleep apnea, and reduce your risk for developing other chronic disorders.

Exercise can help you lose weight and also improve other chronic heart conditions as well. And reducing alcohol and tobacco usage has been shown to have a direct impact on improving symptoms associated with sleep apnea.

Your sleep position can also affect how your airway functions while you sleep. Positional therapy helps you stay in the optimal sleep position to keep your airways open and help you breathe. Positional therapy can utilize pillows, alarms, tennis balls, or even a sleep apnea pillow to help you stay in the correct position. 

Mouth and facial muscle therapy may benefit patients suffering from sleep apnea. Orofacial therapy helps strengthen the muscles controlling the lips, tongue, soft palate, and face. This therapy trains your muscles to be in more optimal positions to keep the airway open. 

Oral Appliances (Sleep apnea mouth guard)

Oral appliances are things like custom retainers or sleep apnea mouthguards that keep your jaw in an optimal position. These devices enlarge your upper airway in order to provide adequate airflow.[7]

Repositioning your jaw while you sleep can help keep your airway open. While CPAP is still preferred, oral appliances are indicated for mild or moderate sleep apnea who cannot or do not want to use CPAP.[9] If you have severe sleep apnea, an oral appliance may not be as effective as other sleep apnea solutions.[1]

Sleep Apnea Surgery

Surgery for sleep apnea includes reconstructing your upper airway to help you breathe better.[7] 

Patients who have sleep apnea fixable by surgery may have large tonsils or other upper airway abnormalities. Surgery can include removing the tonsils, moving the jaw to enlarge the airway, or a tracheostomy to create a trach tube to help you breathe.[4]

Another sleep apnea surgery places an implant that senses your breathing patterns and stimulates your muscles to open airways during sleep. Nerve stimulators can also be placed during surgery to control tongue movement to keep the airway open. Surgery may be considered when other, less invasive sleep apnea treatments have failed.[4] 

Bariatric Surgery

Bariatric surgery includes procedures like the lap band or gastric bypass. These surgeries promote major weight loss in patients who have not lost weight using normal methods. This is an add-on therapy to traditional sleep apnea treatments and is invasive.[1] One particular study showed that while bariatric surgery decreases BMI and weight, symptoms of sleep apnea that required treatment were still present.[7]

Sleep apnea can recur at a rate of up to 40% in patients who have received bariatric surgery, meaning follow up is very important.[1]

Medication and Oxygen Therapy

There are no widely effective medications for sleep apnea.[1] However, medications can be effective when used to treat endocrine disorders that contribute to sleep apnea (e.g. thyroid disorders). Oxygen use is not recommended as a first line treatment for sleep apnea.[1]

Conclusion

Overall, there are many options for the effective treatment of sleep apnea. You can choose to improve your sleep apnea and overall health by making healthy lifestyle decisions. In addition to lifestyle changes, sleep apnea devices can be used to improve your sleep. 

If you believe you’re experiencing sleep apnea symptoms, it is important to talk to your doctor about a diagnosis. 

All patients with sleep apnea should seek continuous, long-term management for this chronic disorder.[1] Long-term management is important to avoid complications from sleep apnea. If you are treated and successfully eliminate sleep apnea, you should continue to be monitored and look for return of symptoms.[1]

References

  1. Epstein LJ, Kristo D, Strollo PJ Jr, Friedman N, Malhotra A, Patil SP, Ramar K, Rogers R,  Schwab RJ, Weaver EM, Weinstein MD; Adult Obstructive Sleep Apnea Task Force of the American Academy of Sleep Medicine. Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med. 2009 Jun 15;5(3):263-76. PMCID:PMC2699173
  2. What is sleep apnea? (n.d.). Retreived August 3, 2019, https://www.sleepapnea.org/learn/sleep-apnea/
  3. Sleep Apnea Information for Clinicians. (n.d.). Retrieved August 5, 2019, from https://www.sleepapnea.org/learn/sleep-apnea-information-clinicians/
  4. Sleep Apnea. (n.d.). Retrieved July 26, 2019, from https://www.nhlbi.nih.gov/health-topics/sleep-apnea 
  5. Peppard PE, Young T, Palta M, Skatrud J. Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med2000;58:811-7.
  6. Arzt M, Young T, Finn L, Skatrud JB, Bradley JD. Association of sleep-disordered breathing and the occurrence of stroke. Am J Respir Crit Care Med2005;172:1447-51.
  7. Greenstone M, Hack M. Obstructive sleep apnoea. BMJ. 2014 Jun 17;348:g3745.doi: 10.1136/bmj.g3745
  8. Gottlieb DJ, Yenokyan G, Newman AB, O’Connor GT, Punjabi NM, Quan SF, et al. A prospective study of obstructive sleep apnea and incident coronary artery disease and heart failure: the Sleep Heart Health Study. Circulation 2010;122:352-60.
  9. Patil SP, Ayappa IA, Caples SM, Kimoff RJ, Patel SR, Harrod CG. Treatment of Adult Obstructive Sleep Apnea with Positive Airway Pressure: An American Academy of Sleep Medicine Clinical Practice Guideline. J Clin Sleep Med. 2019 Feb 15;15(2):335-343. doi: 10.5664/jcsm.7640