Apnea

 

apnea

 

Apnea!

What Is Apnea?

Sleep apnea (AP-ne-ah) is a common disorder in which you have one or more pauses in breathing or shallow breaths while you sleep.

Breathing pauses can last from a few seconds to minutes. They may occur 30 times or more an hour. Typically, normal breathing then starts again, sometimes with a loud snort or choking sound.

Sleep apnea usually is a chronic (ongoing) condition that disrupts your sleep. When your breathing pauses or becomes shallow, you’ll often move out of deep sleep and into a light sleep.

As a result, the quality of your sleep is poor, which makes you tired during the day. Sleep apnea is a leading cause of excessive daytime sleepiness.



What Causes Sleep Apnea?

When you sleep, all of the muscles in your body become more relaxed. This includes the muscles that help keep your throat open so air can flow into your lungs.

Normally, your throat remains open enough during sleep to let air pass by. Some people have a narrow throat. When the muscles in their upper throat relax during sleep, the tissues close in and block the airway. This stop in breathing is called apnea.

Loud snoring is a telltale symptom of OSA. Snoring is caused by air squeezing through the narrowed or blocked the airway.

Not everyone who snores has sleep apnea though.

Other factors also may increase your risk:

  • A lower jaw that is short compared to your upper jaw.
  • Certain shapes of the roof of your mouth (palate) or airway that cause it to collapse more easily.
  • Large neck or collar size (17 inches or more in men and 16 inches or more in women).
  • Large tongue, which may fall back and block the airway.
  • Obesity.
  • Large tonsils and adenoids that can block the airway.

Sleeping on your back can also cause your airway to become blocked or narrowed.

Central sleep apnea is another sleep disorder during which breathing can stop. It occurs when the brain temporarily stops sending signals to the muscles that control breathing.



Signs & Symptoms of Sleep Apnea?

Major Signs & Symptoms:

One of the most common signs of obstructive sleep apnea is loud and chronic (ongoing) snoring. Pauses may occur in the snoring. Choking or gasping may follow the pauses. The snoring usually is loudest when you sleep on your back; it might be less noisy when you turn on your side. You might not snore every night. Over time, however, the snoring can happen more often and get louder.

You're asleep when the snoring or gasping happens. You likely won't know that you're having problems breathing or be able to judge how severe the problem is. A family member or bed partner often will notice these problems before you do.

apnea

Not everyone who snores has sleep apnea.

Another common sign of sleep apnea is fighting sleepiness during the day, at work, or while driving. You may find yourself rapidly falling asleep during the quiet moments of the day when you're not active. Even if you don't have daytime sleepiness, talk with your doctor if you have problems breathing during sleep.



Other Signs & Symptoms:

Others signs and symptoms of sleep apnea include:

  • Morning headaches.
  • Memory or learning problems and not being able to concentrate.
  • Feeling irritable, depressed, or having mood swings or personality changes.
  • Waking up frequently to urinate.
  • Dry mouth or a sore throat when you wake up.

In children, sleep apnea can cause hyperactivity, poor school performance, and angry or hostile behavior. Children who have sleep apnea also may breathe through their mouths instead of their noses during the day.

If you have OSA, you usually begin snoring heavily soon after falling asleep.

  • The snoring often becomes very loud.
  • Snoring is interrupted by a long silent period while your breathing stops.
  • The silence is followed by a loud snort and gasp, as you attempt to breathe.
  • This pattern repeats throughout the night.
  • Most people with OSA do not know their breathing starts and stops during the night.
  • Usually, a sleep partner or other family members hear the loud snoring, gasping, and snorting.
  • Snoring can be loud enough to hear through walls.



People With Sleep Apnea May:

  • Wake up unrefreshed in the morning.
  • Feel sleepy or drowsy throughout the day.
  • Act grumpy, impatient, or irritable.
  • Be forgetful.
  • Fall asleep while working, reading, or watching TV.
  • Feel sleepy while driving or even fall asleep while driving.
  • Have hard-to-treat headaches.

apneaOther problems that may occur include:

  • Depression.
  • Hyperactive behavior, especially in children.
  • Difficult to treat high blood pressure.
  • Leg swelling (if apnea is severe).

How Is Sleep Apnea Diagnosed?

Doctors diagnose sleep apnea based on medical and family histories, a physical exam, and sleep study results. Your primary care doctor may evaluate your symptoms first. He or she will then decide whether you need to see a sleep specialist.

Sleep specialists are doctors who diagnose and treat people who have sleep problems. Examples of such doctors include lung and nerve specialists and ear, nose, and throat specialists. Other types of doctors also can be sleep specialists.



Medical and Family Histories:

If you think you have a sleep problem, consider keeping a sleep diary for 1 to 2 weeks. Bring the diary with you to your next medical appointment.

Write down when you go to sleep, wake up, and take naps. Also write down how much you sleep each night, how alert and rested you feel in the morning, and how sleepy you feel at various times during the day. This information can help your doctor figure out whether you have a sleep disorder.

At your appointment, your doctor will ask you questions about how you sleep and how you function during the day. Your doctor also will want to know how loudly and often you snore or make gasping or choking sounds during sleep. Often you're not aware of such symptoms and must ask a family member or bed partner to report them.


Let your doctor know if anyone in your family has been diagnosed with sleep apnea or has had symptoms of the disorder. Many people aren't aware of their symptoms and aren't diagnosed. If you're a parent of a child who may have sleep apnea, tell your child's doctor about your child's signs and symptoms.


Exams and Tests:

1. Physical Exam:

  • Your doctor will check your mouth, nose, and throat for extra or large tissues.
  • Children who have sleep apnea might have enlarged tonsils.
  • Doctors may need only a physical exam and medical history to diagnose sleep apnea in children.
  • Adults who have sleep apnea may have an enlarged uvula (U-vu-luh) or soft palate.
  • The uvula is the tissue that hangs from the middle of the back of your mouth.
  • The soft palate is the roof of your mouth in the back of your throat.

2. Sleep Studies:

  • Sleep studies are tests that measure how well you sleep and how your body responds to sleep problems.
  • These tests can help your doctor find out whether you have a sleep disorder and how severe it is.
  • Sleep studies are the most accurate tests for diagnosing sleep apnea.

There are different kinds of sleep studies. If your doctor thinks you have sleep apnea, he or she may recommend a polysomnogram (poly-SOM-no-gram; also called a PSG) or a home-based portable monitor.



3. Polysomnogram:

  • A PSG is the most common sleep study for diagnosing sleep apnea.
  • This study records brain activity, eye movements, heart rate, and blood pressure.
  • A PSG also records the amount of oxygen in your blood, air movement through your nose while you breathe, snoring, and chest movements.
  • The chest movements show whether you're making an effort to breathe.
  • PSGs often are done at sleep centers or sleep labs.
  • The test is painless. You'll go to sleep as usual, except you'll have sensors attached to your scalp, face, chest, limbs, and a finger.
  • The staff at the sleep center will use the sensors to check on you throughout the night.
  • A sleep specialist will review the results of your PSG to see whether you have sleep apnea and how severe it is.
  • He or she will use the results to plan your treatment.

Your doctor also may use a PSG to find the best setting for you on a CPAP (continuous positive airway pressure) machine. CPAP is the most common treatment for sleep apnea. A CPAP machine uses mild air pressure to keep your airway open while you sleep.


If your doctor thinks that you have sleep apnea, he or she may schedule a split-night sleep study. During the first half of the night, your sleep will be checked without a CPAP machine. This will show whether you have sleep apnea and how severe it is.

If the PSG shows that you have sleep apnea, you’ll use a CPAP machine during the second half of the split-night study. The staff at the sleep center will adjust the flow of air from the CPAP machine to find the setting that works best for you.


Home-Based Portable Monitor:

Your doctor may recommend a home-based sleep test with a portable monitor. The portable monitor will record some of the same information as a PSG.

For example, it may record:

  • The amount of oxygen in your blood.
  • Air movement through your nose while you breathe.
  • Your heart rate.
  • Chest movements that show whether you're making an effort to breathe.

A sleep specialist may use the results from a home-based sleep test to help diagnose sleep apnea. He or she also may use the results to decide whether you need a full PSG study in a sleep center.


Treatment:

Treatment helps keep your airway open while you sleep so your breathing does not stop.

Lifestyle changes may help relieve symptoms in people with mild sleep apnea, such as:

  • Avoid alcohol or medicines that make you sleepy before bedtime. They can make symptoms worse.
  • Avoid sleeping on your back.
  • Lose excess weight.
  • Continuous positive airway pressure (CPAP) devices work best to treat obstructive sleep apnea in most people.

sleep-apnea-treatment

  • You wear a mask over your nose while you sleep.
  • The mask is connected by a hose to a small machine that sits at the side of your bed.
  • The machine pumps air under pressure through the hose and mask and into your airway while you sleep. This helps keep your airway open.
  • It can take some time to get used to sleeping with CPAP therapy.
  • Good follow-up and support from a sleep center can help you overcome any problems using CPAP.
  • Dental devices may help some people.
  • You wear them in your mouth while you sleep to keep your jaw forward and the airway open.
  • Other treatments may be available, but there is less evidence that they work.
  • It is best to talk with a doctor who specializes in sleep problems before trying them.
  • Surgery may be an option for some people.
  • It is often a last resort if other treatments did not work and you have severe symptoms.

Surgery may be used to:

dental-device-sleep-apnea

  • Remove extra tissue at the back of the throat.
  • Correct problems with the structures in the face.
  • Create an opening in the windpipe to bypass the blocked airway if there are physical problems.
  • Remove the tonsils and adenoids.
  • Surgery may not completely cure obstructive sleep apnea and may have long-term side effects.

Outlook (Prognosis):

If not treated, sleep apnea may cause:

  • Anxiety and depression.
  • Loss of interest in sex.
  • Poor performance at work or school.

Daytime sleepiness because of sleep apnea can increase the risk of:

  • Motor vehicle accidents from driving while sleepy.
  • Industrial accidents from falling asleep on the job.
  • In most cases, treatment completely relieves symptoms and problems from sleep apnea.

apnea


Living With Sleep Apnea:

Sleep apnea can be very serious. However, following an effective treatment plan often can improve your quality of life quite a bit. Treatment can improve your sleep and relieve daytime sleepiness.

Treatment also might lower your risk for high blood pressure, heart disease, and other health problems linked to sleep apnea. Treatment may improve your overall health and happiness as well as your quality of sleep (and possibly your family's quality of sleep).



Ongoing Health Care Needs:

Follow up with your doctor regularly to make sure your treatment is working. Tell him or her if the treatment is causing bothersome side effects. Ongoing care is important if you're getting CPAP (continuous positive airway pressure) treatment. It may take a while before you adjust to using CPAP.

If you aren't comfortable with your CPAP device, or if it doesn't seem to be working, let your doctor know. You may need to switch to a different device or mask. Or, you may need treatment to relieve CPAP side effects.

Try not to gain weight. Weight gain can worsen sleep apnea and require adjustments to your CPAP device. In contrast, weight loss may relieve your sleep apnea. Until your sleep apnea is properly treated, know the dangers of driving or operating heavy machinery while sleepy.

If you're having any type of surgery that requires medicine to put you to sleep, let your surgeon and doctors know you have sleep apnea. They might have to take extra steps to make sure your airway stays open during the surgery. If you're using a mouthpiece to treat your sleep apnea, you may need to have routine checkups with your dentist.


How Can Family Members Help?

Often, people who have sleep apnea don't know they have it. They're not aware that their breathing stops and starts many times while they're sleeping. Family members or bed partners usually are the first to notice signs of sleep apnea.

Family members can do many things to help a loved one who has sleep apnea.

  • Let the person know if he or she snores loudly during sleep or has breathing stops and starts.
  • Encourage the person to get medical help.
  • Help the person follow the doctor's treatment plan, including CPAP treatment.
  • Provide emotional support.

Possible Complications:

Untreated obstructive sleep apnea may lead to or worsen heart disease, including:

  • Heart Arrhythmias.
  • Heart failure.
  • Heart attack.
  • High blood pressure.
  • Stroke.



When to Contact a Medical Professional?

Call your provider if:

  • You feel very tired and sleepy during the day.
  • You or your family notice symptoms of obstructive sleep apnea.
  • Symptoms do not improve with treatment, or new symptoms develop.

Alternative Names:

Sleep apnea - obstructive - adults Apnea - obstructive sleep apnea syndrome - adults Sleep-disordered breathing - adults; OSA - adults


Resource:

Basner RC. Obstructive sleep apnea. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 100.NIH.


  



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