What is Sleep Apnea?
Obstructive sleep apnea is one of the most common sleep disorders where the upper airways become blocked, resulting in the sleeper not breathing for periods of time throughout the night. If you snore loudly and feel tired during the day, you may have sleep apnea.
The 3 Types of Sleep Apnea
There are 3 types of sleep apnea:
- Obstructive sleep apnea is when the throat muscles relax and block the airway.
- Central sleep apnea is when your brain isn't communicating with your muscles properly to allow proper airflow.
- Complex sleep apnea syndrome is a combination of the previous two conditions.
- Smoking. It causes inflammation and fluid retention in the upper airway.
- Genetics. A family history will increase the likelihood of having apneas.
- Age. Older people tend to be more prone to having apneas.
- Gender. Sleep apneas occurs more frequently in males.
- Weight. Being overweight increases the chances as there's more tissue to block the airway.
- Congestion. A deviated septum, allergies, or anything that will reduce the size of the airway can cause apneas.
You may not know if you have all of these symptoms, so you may need to ask your partner, or, if you sleep alone, you may need to use a sleep app that will record your snoring to see if you have all of these symptoms.
The most common symptoms are:
- Excessive daytime sleepiness (hypersomnia).
- Loud snoring.
- Waking up during the night or in the morning with a dry mouth (a sign of excessive snoring).
- Stopping breathing during the night.
- A headache in the morning.
SleepApnea.org has a Berlin questionnaire to help you determine if you have sleep apnea.
The risks of sleep apnea over the long term are serious and can be fatal.
- Heart issues including heart attacks, stroke, abnormal heartbeat, and if you have heart disease, low blood oxygen levels can lead to death.
- Type 2 diabetes, as sleep apnea increases your risk of insulin resistance.
- Liver issues are more common, including signs of scarring.
- Daytime fatigue.
- Lack of quality sleep can cause a long list of issues, including:
- less impulse control
- poor focus and memory
- reduced decision-making ability
- irritability that can affect relationships
- increased chance of obesity
- increased risk of driving accidents
How Sleep Apnea is Diagnosed
Sleep apnea is diagnosed with a sleep study, which can be done in a couple of different ways. A sleep clinic will give you an apparatus that you can wear at home for one night of sleep that will monitor your heart rate, blood oxygen levels, breathing patterns, brain and lung activity, as well as body movement. The next day you return the monitor and the sleep clinic will analyze the results to determine if you're a candidate for an overnight stay at the sleep clinic. If you are, you'll spend one night at the sleep clinic where they have a room that's set up similar to a hotel room. They will hook you up to their monitors and track your sleep throughout the night to see if you are having apneas.
Apnea is when you stop breathing for 10 seconds or longer. One of the main things the sleep study is looking to determine is the apnea-hypopnea index or AHI. Hypopnea is a constricted breath (between one-quarter and three-quarters) that lasts for 10 seconds or longer. The AHI is the number of apneas and hypopneas experienced per hour.
- AHI of 5-15: mild sleep apnea
- AHI of 15-30: moderate sleep apnea
- AHI of 30 or more: severe sleep apnea
If you have sleep apnea, your doctor might refer you to an ear, nose, and throat specialist to make sure there are no blockages in your throat or nose. You may also see a cardiologist (heart doctor) or neurologist (brain doctor) if you have central sleep apnea.
Treatments for Sleep Apnea
There are several different treatment options, depending on the nature and severity of their sleep apnea.
Continuous positive airway pressure (CPAP)
One of the most common therapies, this is for people with moderate to severe sleep apnea. It's a mask that you wear while you sleep that will supply pressure to keep your upper airways open, preventing apneas. Many sufferers of sleep apnea are initially unhappy that they'll need to use a CPAP machine to get good sleep, but once they acclimate to using it, they often report that they feel like a new person because they can get restful sleep. Their partners are happy as well because the machine eliminates snoring.
There are many different types of CPAP machines available. The smaller and more comfortable machines are often more expensive, but it's a good idea to try out different units until you find one that's comfortable.
If you start snoring again, talk to your doctors as the pressure settings on the CPAP may need to be changed to prevent the airway from being occluded (blocked).
Auto-CPAP and BPAP
An auto-CPAP is a machine that automatically adjusts the pressure while you sleep.
BPAP units supply more pressure when you inhale and less when you exhale.
Oral appliances are designed to keep your throat open by bringing your jaw forward and are often more comfortable than CPAP machines. These are available from dentists; you can find a dentist on the American Academy of Dental Sleep Medicine. After you start using it, you'll often need to follow up with your dentist to make sure that the fit is good and you're not experiencing symptoms of sleep apnea.
This is an option when all other options have failed. There are many different surgery options, including:
- Tissue removal. Your tonsils and adenoids are usually removed, and tissue from the top of your throat and back or your mouth is removed, getting rid of the tissue that's blocking your airway.
- Tissue shrinkage. This is less risky than removing tissue, as the process uses radiofrequency ablation (RFA), which is considered a safe option for patients with mild to moderate sleep apnea. It's also considered less risky as there's not much collateral damage to surrounding tissues. RFA involves giving off low-frequency radio waves (typically from 300 kHz to 1 MHz3), which scars and reduces the size of the tissue. This procedure is done on an outpatient basis and only takes a few minutes.
- Maxillomandibular advancement. This is a jaw surgery that moves your jaw forward, creating more space for you to breathe.
- Bariatric surgery. This is weight loss surgery that is occasionally used to open up air passages.
- Surgery for children. Children can snore and have sleep apnea. In these cases, it's usually due to enlarged tonsils, adenoids, or both. Surgically removing the tonsils and adenoids usually gets rid of any breathing restrictions.
What You Can Do to Prevent Sleep Apnea
Follow your doctor's advice as sleep apnea can be a very serious condition. But there are some things you can do to reduce sleep apnea:
- Sleep on your side. When you sleep on your back, your tongue tends to slide back and reduce the size of your airway. To prevent sleeping on your back, you can slide a pillow behind your back while you're on your side, or go as far as attaching a tennis or lacrosse ball to the back of a shirt or pajamas to make it uncomfortable when you go to your back. This can be effective for mild sleep apnea. For moderate to severe cases, it doesn't matter which position you sleep in.
- Avoid alcohol, sleeping pills, or any supplements that make you relaxed. These will make the muscles in the back of your throat relax and cause more apneas,
- Nasal decongestant. This can help keep airways open but isn't effective for moderate or severe sleep apnea.
- Exercise. This has helped some people with sleep apnea, even if they don't lose weight.
- Lose weight. Even a small weight loss may help prevent apneas. Around 70% of people with sleep apnea are overweight or obese.
- Playing wind instruments. There haven't been extensive studies to see if this is helpful, but it's not unrealistic that this could help stretch and open up airways.
- Acupuncture. There is one study that found that the number of respiratory events in the participants reduced significantly vs. a group that received sham acupuncture.