What you should know about sleep apnea

Obstructive sleep apnea is a common disorder that causes people to stop breathing during sleep, and, according to the National Sleep Foundation, it affects more than 18 million American adults. The disorder is characterized by a person experiencing one or more pauses in breathing or shallow breaths while sleeping, according to the National Heart, Lung, and Blood Institute. The length of breathing pauses vary from a few seconds to minutes, and may occur 30 times or more an hour. Individuals typically begin to breathe normally after pauses, which usually is identified with a loud snort or choking sound, according to the National Heart, Lung, and Blood Institute. Sleep apnea tends to be a chronic condition and causes individuals to routinely move out of a deep sleep and into a light sleep.

Causes of sleep apnea

According to the Mayo Clinic, obstructive sleep apnea occurs when the muscles in the back of the throat relax. These muscles support the soft palate, the uvula, the tonsils, as well as the side walls of throat and the tongue.

As the muscles relax, an individual’s airway narrows or closes while breathing in, and is unable to inhale enough oxygen. This occurrence may lower the level of oxygen in the blood, the Mayo Clinic reports.

The brain senses the inability to breathe and briefly wakes the individual from sleep to reopen the airway. People usually do not remember the awakening as it is typically brief, according to the Mayo Clinic.

According to the National Heart, Lung, and Blood Institute, there are several ways a person’s airway can become partially or fully blocked during sleep,

The throat muscles and tongue relax more than normal.

The tongue and tonsils are large compared with the opening into the windpipe.

An individual is overweight, and the extra soft fat tissue can thicken the wall of the windpipe thereby narrowing the inside of the windpipe, which makes it harder to keep open.

The shape of a person’s head and neck may create a smaller airway size in the mouth and throat area.

The aging process tends to limit the brain’s ability to keep the throat muscles still during sleep.

Sleep apnea symptoms

Individuals with obstructive sleep apnea are generally unaware that they have the disorder and that their sleep is interrupted. Most people are alerted to the possibility of having sleep apnea from a family member or a loved one.

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A common sign of sleep apnea is a loud and ongoing snore, according to the National Heart, Lung, and Blood Institute. The snoring tends to be the loudest when sleeping on one’s back, and the snoring may become less noisy when sleeping on one’s side.

However, not everyone who snores has sleep apnea. Additionally, individuals who have sleep apnea tend to suffer from excessive daytime sleepiness.

According to the National Heart, Lung and Blood Institute, other signs and symptoms of sleep apnea include:

morning headaches;

memory, learning and concentration problems;

feeling irritable, depressed, or having mood swings or personality changes;

waking up frequently to urinate; and

dry mouth or sore throat when waking up.

The Mayo Clinic advises that people consult with a medical professional if they experience, or if a partner notices:

snoring that is loud enough to disturb the sleep of others or yourself;

shortness of breath, gasping for air or choking that awakens an individual from sleep;

intermittent pauses in breathing during sleep; and

excessive daytime drowsiness, which may cause an individual to fall asleep while at work, watching television or driving.

Diagnosing sleep apnea

About 80% of moderate and severe obstructive sleep apnea cases go undiagnosed, according to the American Sleep Apnea Association. Routine doctor’s office visits do not typically help identify the condition and blood tests are ineffective in diagnosing sleep apnea.

A primary care physician may make an evaluation based on the signs and symptoms a patient presents with, however an individual will likely receive a referral to a sleep disorder center where a sleep specialist can decide if the individual needs further evaluation.

Most evaluations often involve overnight monitoring of a person’s breathing and other bodily functions during sleep. Home sleep tests may also be an option. According to the Mayo Clinic, tests to help detect sleep apnea may include:

nocturnal polysomnography – a test in which a patient is connected to equipment that monitors the heart, lung and brain activity, breathing patterns, arm and leg movements, and blood oxygen levels while they sleep.

home sleep tests – which usually involve measuring a person’s heart rate, blood oxygen level, airflow and breathing patterns.

If results from the home sleep test are abnormal, a doctor may prescribe a therapy without further testing. However, not all portable monitoring devices detect all cases of sleep apnea. In that instance, a doctor may still recommend a polysomnography even if the initial results from home are normal.

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A doctor will likely refer a patient who has tested positive for sleep apnea to visit an ear, nose and throat specialist to rule out any possible blockage in the nose or throat. Further, a person diagnosed with sleep apnea may receive a referral to see a cardiologist or neurologist to look for possible causes of sleep apnea.

Sleep apnea treatment

A physician may recommend lifestyle changes in the case of mild occurrences of sleep apnea, including weight loss or quitting smoking. Additionally, if a person has nasal allergies, a doctor will likely recommend treatment for the specific allergies. However, if these measures do not improve the symptoms or if the apnea is moderate to severe, there are other treatments available.

According to the American Academy of Sleep Medicine, treatment options might include:

a CPAP machine that uses a steady stream of air to keep the airway open throughout the night to help the person breathe;

a device that fits in a person’s mouth over their teeth while they sleep. The device may resemble a sports mouth guard or an orthodontic retainer and helps prevent the airway from collapsing by holding the tongue in position or by sliding the jaw forward so a person can breathe while sleeping; and

a variety of surgical therapies. The most common surgical options include reducing or eliminating the extra tissue in the throat that collapses and blocks the airway during sleep. More complex procedures can adjust the bone structures in the jaw, nose and facial bones. Weight loss surgery may also be an option. However, surgical therapies are not as effective in treating sleep apnea.

CPAP is considered the frontline treatment for obstructive sleep apnea and is recommended for all cases, according to the America Academy of Sleep Medicine.

Additional information can be found on these websites:

http://www.mayoclinic.org/diseases-conditions/sleep-apnea/basics/definition/con-20020286

https://www.nhlbi.nih.gov/health/health-topics/topics/sleepapnea

https://www.sleepapnea.org/learn/sleep-apnea-information-clinicians/

http://www.sleepeducation.org/essentials-in-sleep/sleep-apnea

https://sleepfoundation.org/sleep-disorders-problems/sleep-apnea