Sleep Apnea

Sleep apnea is a serious sleep disorder in which breathing repeatedly stops and starts during sleep. There are two main types: obstructive sleep apnea (OSA), where the throat muscles relax and block the airway, and central sleep apnea, where the brain doesn't send proper signals to control breathing.

Sleep apnea can cause loud snoring, daytime fatigue, and serious health problems if left untreated. It's more common than many people realize and often goes undiagnosed. Treatment can significantly improve quality of life and reduce health risks.

Sleep apnea symptoms may include:

During Sleep:

• Loud snoring: Often very loud
• Episodes of stopped breathing: Observed by others
• Gasping or choking: During sleep
• Restless sleep: Tossing and turning
• Frequent awakenings: May not remember
• Night sweats: Excessive sweating

During Day:

• Excessive daytime sleepiness: Feeling very tired
• Morning headache: Frequent headaches
• Difficulty concentrating: Trouble focusing
• Irritability or mood changes: Emotional changes
• Dry mouth or sore throat: Upon waking
• Decreased libido: Reduced sex drive

You may not be aware of your symptoms. A bed partner often notices the snoring and breathing pauses first.

Seek emergency care if:

• Breathing completely stops for extended period
• Severe difficulty breathing
• Chest pain
• Severe symptoms

Managing sleep apnea involves:

1. Use CPAP or Other Treatment (if prescribed):

   • Use consistently every night
   • Keep equipment clean
   • Adjust mask for comfort
   • Report problems to doctor
   • Don't stop using without doctor approval

2. Lifestyle Changes:

   • Lose weight: If overweight (most important for many)
   • Exercise regularly: Helps with weight and sleep
   • Avoid alcohol: Especially before bed
   • Don't smoke: Smoking worsens sleep apnea
   • Sleep position: Sleep on side, not back

3. Sleep Hygiene:

   • Regular sleep schedule
   • Adequate sleep time
   • Comfortable sleep environment
   • Avoid screens before bed
   • Relaxation techniques

4. Avoid Sedatives:

   • Sleeping pills can worsen apnea
   • Some medications relax throat muscles
   • Discuss with doctor

5. Nasal Issues:

   • Treat allergies
   • Use nasal sprays if needed
   • Keep nasal passages clear

6. Regular Monitoring:

   • Follow-up appointments
   • Adjust treatment as needed
   • Monitor for improvement
   • Report symptoms

• Breathing completely stops
• Severe difficulty breathing
• Chest pain
• Severe symptoms

• Symptoms of sleep apnea
• Loud snoring with breathing pauses
• Excessive daytime sleepiness
• Partner observes breathing stops
• Questions about treatment
• Need to adjust CPAP
• Symptoms not improving

• Using treatment as prescribed
• Following lifestyle changes
• Symptoms well-controlled
• Regular follow-up scheduled

Diagnosing sleep apnea involves:

1. Medical History and Physical Exam:

   • Symptoms assessment
   • Sleep history
   • Physical examination
   • Check for risk factors

2. Sleep Study (Polysomnography):

   • In-lab: Overnight study in sleep center
   • Monitors: Breathing, oxygen levels, heart rate, brain waves
   • Determines severity
   • May be needed for diagnosis

3. Home Sleep Test:

   • Simpler test done at home
   • Monitors breathing, oxygen, heart rate
   • May be used for screening
   • Less comprehensive than in-lab

4. Additional Tests (if needed):

   • Blood tests
   • Thyroid function
   • Other tests

Severity Levels (based on apnea-hypopnea index):

• Mild: 5-15 events per hour
• Moderate: 15-30 events per hour
• Severe: More than 30 events per hour

Treatment aims to keep airway open during sleep:

1. CPAP (Continuous Positive Airway Pressure):

   • Most common treatment
   • Machine delivers air pressure through mask
   • Keeps airway open
   • Very effective when used consistently
   • Takes time to adjust

2. Other Positive Airway Pressure Devices:

   • BiPAP: Different pressure for inhale/exhale
   • APAP: Auto-adjusting pressure
   • Alternative to CPAP

3. Oral Appliances:

   • Dental devices
   • Reposition jaw or tongue
   • For mild to moderate cases
   • Fitted by dentist

4. Lifestyle Changes:

   • Weight loss (if overweight)
   • Exercise
   • Avoid alcohol before bed
   • Sleep on side
   • Don't smoke

5. Surgery (in some cases):

   • Remove tissue blocking airway
   • Reposition jaw
   • Implant devices
   • Usually last resort

6. Positional Therapy:

   • Devices to keep you on side
   • For positional sleep apnea
   • May help some people

Prevent or reduce sleep apnea by:

• Maintain Healthy Weight: Excess weight is major risk factor
• Exercise Regularly: Helps with weight and sleep
• Don't Smoke: Smoking worsens sleep apnea
• Limit Alcohol: Especially before bed
• Sleep on Side: Not on back
• Treat Nasal Issues: Allergies, congestion
• Get Adequate Sleep: Regular schedule
• Avoid Sedatives: Can worsen apnea

In obstructive sleep apnea:

1. Throat Muscles Relax: During sleep
2. Airway Narrows or Closes: Blocks breathing
3. Breathing Stops: For 10 seconds or more
4. Oxygen Drops: Blood oxygen decreases
5. Brain Awakens: To restart breathing
6. Cycle Repeats: Throughout night
7. Poor Sleep Quality: Despite being "asleep"

Risk Factors:

• Excess weight: Major risk factor
• Neck circumference: Larger necks at higher risk
• Narrowed airway: Anatomical factors
• Age: More common in older adults
• Sex: More common in men
• Family history: Genetic component
• Alcohol and sedatives: Relax throat muscles
• Smoking: Increases risk
• Nasal congestion: Can contribute

• More common with age
• May have other health conditions
• May need different treatment approach
• Higher risk of complications

• More common in men
• Often undiagnosed
• Should be screened if symptoms
• Treatment important

• Risk increases after menopause
• May have different symptoms
• Often underdiagnosed
• Should be aware of symptoms

• Excess weight is major risk factor
• Weight loss can significantly improve or cure
• Should be primary focus for many
• Combined with other treatments

If Untreated, Sleep Apnea Can Lead To:

• High blood pressure
• Heart disease
• Stroke
• Type 2 diabetes
• Metabolic syndrome
• Liver problems
• Complications with medications and surgery
• Daytime fatigue and accidents

For many people, especially if related to weight, significant weight loss can cure or greatly improve sleep apnea. For others, treatment can effectively manage it, though it may not be "cured."

It depends. If weight loss cures it, you may not need CPAP. For many people, CPAP is needed long-term. However, it significantly improves quality of life and health.

Severe untreated sleep apnea can be dangerous and increase risk of serious health problems. However, with proper treatment, risks are greatly reduced.

Not all snoring is sleep apnea, but loud, frequent snoring, especially with breathing pauses, may indicate sleep apnea. If you're concerned, see a doctor.

Yes. Children can have sleep apnea, often due to enlarged tonsils or adenoids. Symptoms may be different (bedwetting, hyperactivity, poor school performance). Treatment is important.