Sleep Apnea – OSA

Sleep apnea is a serious condition that affects more than 12 million Americans. It is as common as adult diabetes. Sleep apnea causes its sufferers to stop breathing several times during sleep, sometimes as often as hundreds of times per night. For those who have this condition, it can be extremely terrifying and debilitating. Not only does sleep apnea cause sufferers to lose sleep, it can also cause their partners to lose sleep as well.

Who Gets Sleep Apnea?

Even children are known to have sleep apnea, although it is more commonly seen in adults, especially those over 40 and those who are overweight. About 2% of all women have sleep apnea, while the condition affects about 4% of all men. The condition is more common in men under the 50 years, but after this age, it is equally common for both sexes.

Those who are obese are more prone to sleep apnea, with about 70% of obese people having the condition. Heart disease and stroke sufferers are very likely to have sleep apnea as well.

Types of Sleep Apnea

The three sleep apnea types are: obstructive sleep apnea, central sleep apnea and mixed sleep apnea.

Obstructive Sleep Apnea, OSA

This is the most common form of sleep apnea. Obstructive sleep apnea is caused when the soft tissues in the back of the throat relax too much during sleep, blocking the airways and restricting breathing.

There are four steps to obstructive sleep apnea: the airway becomes obstructed; the sufferer tries to breathe, but cannot; the level of oxygen in the blood decreases because of the lack of air; and the final step is when the brain signals the body the need to awaken and breathe. At this stage normal sleep is interrupted.

Obstructive Sleep Apnea Causes: There are many things that can cause obstructive sleep apnea. If a person has a deviated septum, he or she may be prone to the condition due to a narrowing of the air passages. In some cases, the filters in the nose, known as turbinates, can become swollen which will obstruct breathing.

A long palate and uvula, or even the tongue, can also fall back when relaxed, blocking the airway. The sides of the throat walls can also narrow and obstruct breathing. Most people who have obstructive sleep apnea have an airway that is narrower than others.

Central Sleep Apnea, CSA

Those who have central sleep apnea do not have a blockage of the airway, but rather, the brain does not give the signals to the muscles to allow the sleeper to breathe. There are many causes of central sleep apnea, but the most common seem to be heart, cerebrovascular or congenital diseases. Central sleep apnea can also occur in those who are taking certain medications, or live in high altitudes.

Central sleep apnea can occur in premature and full-term infants, and is characterized by lapses of breath that last longer than 20 seconds. Children who have central sleep apnea are required to have a sleep apnea monitor, which alerts the parents when these breathing lapses are taking place. Central sleep apnea is also common in adults, especially those with other medical conditions.

Mixed Sleep Apnea

Mixed sleep apnea is a combination of both CSA and OSA. The person may experience one or both kinds of apneas during the night.

Sleep Apnea Symptoms

There are some indicative symptoms of sleep apnea that will let a doctor know that you are suffering from the condition. The most defining symptom is the interruption of normal breathing during sleep by the feeling of suffocation.

Many people report being tired during the day, complain about headaches and may also be irritable and moody. People with sleep apnea also have a tendency to snore and typically snore more loudly than normal. Because they do not sleep well, people with apnea become sleep deprived and have difficulties concentrating during the daytime. Cognitive abilities become limited, and it may become difficult remembering simple things.

This can be extremely dangerous, especially when those affected are operating a motor vehicle or heavy machinery. Sleep apnea is often the cause of accidents in the workplace, due to the lack of ability to concentrate or remember critical information.

Sleep apnea can be mild, moderate or severe. Those who have this condition may be prone to other conditions, including high blood pressure, heart disease and a resistance to insulin. In extreme cases, sleep apnea can be fatal if left untreated.

Sleep Apnea Test

There are a number of sleep tests that a doctor may use to diagnose sleep apnea. The first test that a physician will perform is a thorough physical exam on you to rule out any other underlying health conditions.

Sleep Log

You will probably be required to start keeping a sleep journal or diary. You will record all of your symptoms, how often you are awakened at night, how often you stop breathing. Knowing how often sleep is interrupted by the need to sleep is only possible if you have a monitor or a partner who is watching you.

Epworth Sleep Scale

A sleep test that physicians use to tell if a person has sleep apnea is the Epworth Sleepiness Scale, which is a subjective method of diagnosis. This is a test that is actually done by you, and it measures just how sleepy you are. When taking this test, you will rate on a scale of zero to three how likely you are to fall asleep while performing certain activities. The scale measurements are as follows:

  • Zero – not very likely to fall asleep
  • One – there is a slight possibility of the person falling asleep
  • Two – the chance that the person will fall asleep is moderate
  • Three – the person is highly likely to fall asleep

Some of the activities that are measured with the Epworth Sleepiness Scale includes the likelihood of falling asleep while: watching television, sitting down and reading a book or magazine, sitting in a public place, sitting in a car for long periods of time as a passenger, sitting down and having a conversation and lying down and relaxing in the afternoon.

Polysomnography

Polysomnography is a sleep study where the person suffering from sleep apnea is studied during sleep, their physical and physiological activities are evaluated and recorded. Some of the things that will be monitored while the person is sleeping include:

  • Frequency of breathing difficulty
  • Brain waves
  • Eye movements
  • Oral and nasal flow
  • Loudness of snoring
  • Blood oxygen levels
  • Chest and abdominal movement
  • Muscle activity

Sleep Latency Test

A multiple sleep latency test is a test that measures how sleepy you are by measuring how quickly you fall asleep during the daytime. It is performed immediately following an overnight sleep study, because the sleep doctor will have a base line for how well you actually slept the night before.

The test is done over four to five 20-minute naps in a two hour period. You are told to try to fall asleep, and if you fall asleep in under five minutes, this is considered to be excessive sleepiness and an indicative sign of sleep apnea or other sleep disorder. The faster your ability to fall asleep during the day, the greater the sleep deprivation.

Maintenance of Wakefulness Test

In this test that also measures daytime sleepiness; you are instructed to try to stay awake. This is done over four, 40-minute sessions that are two hours apart from each other. If you do not fall asleep in all of the tests, you are probably not prone to being sleepy during the daytime.

Sleep Apnea Treatment

There are a number of treatments for sleep apnea, ranging from simple behavioral changes to the use of sleep apnea equipment to more drastic step of surgery if other treatments are unsuccessful. Some of the most popular non-surgical forms of treatment for obstructive sleep apnea include:

Behavioral Changes

There are many small behavioral changes that sufferers of sleep apnea can make that will help treat their condition. The simplest change is to sleep in a different position. Sleep apnea often occurs when the person is sleeping flat on their back, by shifting the sleeping position to the side; it is more difficult for the airway passage to close, alleviating the primary symptom.

Because sleep apnea is often seen in obese people, it is important to make dietary changes, and to get more exercise. Losing weight is a very effective treatment for this condition.

It is also important to make sure that your environment is optimal for a good night’s sleep, what is known as sleep hygiene. There should be little to no light in the room, as well as little to no noise. You should not eat or exercise before going to bed, nor should you read or watch television while in bed.

Another way to treat sleep apnea is by quitting smoking. Obviously, this is something that greatly affects the breathing, and plays a role in sleep apnea. Quitting smoking has been shown to reduce symptoms.

It is also recommended that people with sleep apnea do not drink alcoholic beverages before going to sleep, alcohol can cause the muscles to over-relax, which in turn can lead to breathing obstructions.

Dental Appliances

Many people use dental appliances to treat sleep apnea, and these appliances are effective about 75% of the time. A dental appliance is worn at night while you are sleeping, and holds the jaw and tongue forward, and the palate up, so it does not fall backward and block the air passage.

Dental appliances are a very effective alternative to surgical procedures. These devices must be worn every night, and because they must be a perfect fit with the person’s teeth, they are often fitted by a dentist or an oral surgeon.

CPAP Equipment

A CPAP mask is the most popular form of non-surgical treatment for sleep apnea, and involves the use of a face or nasal mask that delivers air to the person wearing it. Used in 1981 for the first time by Australian Dr. Colin Sullivan, CPAP devices keep the palate, tissues and the nose open, making it possible for the person to breathe properly.

The CPAP machine sends humidified, heated air to the mask, which needs to be worn air-tight to the face in order to prevent any of the pressurized air leaking out. CPAP equipment is very effective in treating sleep apnea; however, the mask must be worn every night.

Sleep Apnea Drugs

There are many sleep medications that physicians may prescribe to people with this condition. Sleep apnea is different in each person; any use of medication to treat sleep apnea must be tailored to the specific symptoms of the individual to work effectively.

Many people who suffer from sleep apnea are prescribed nasal decongestants, like neosynephrine and oxymetazoline, which can help to reduce nasal swelling which can be a factor in obstructive sleep apnea. In many cases, sleep apnea may be brought on by sinusitis or other sinus conditions, so these medications may be a huge help in treating the cause of sleep apnea.

Some of the other types of sleep medicine that are often used to treat obstructive sleep apnea include selective serotonin reuptake inhibitors (SSRIs), theophylline (Theo-Dur, Respbid, Slo-Bid, Theo-24, Theolair, Uniphyl, Slo-Phyllin), acetazolamide (Diamox), tricyclic antidepressants and medroxyprogesterone (Provera, Amen, Cycrin).

Sleep Apnea Surgery

Although many of these surgical procedures are often very effective in the treatment of this condition, just like with any surgery, these procedures do not come without their risks, which can include infection, scarring, pain and time missed from work.

Some of the more common surgical procedures used to treat obstructive sleep apnea include nasal airway surgery, palate implants, tongue reduction, tracheostomy, maxillomandibular advancement, and bariatric surgery. Some people even have two or more of these surgeries in combination to treat severe cases of obstructive sleep apnea.

Nasal Airway Surgery

This is a procedure that eases such symptoms as septal deviation, nasal polyps, and swelling of the turbinates. Any type of nasal obstruction makes using the CPAP equipment extremely difficult. This is the most successful type of surgical procedure for sleep apnea and works to improve the effectiveness of the CPAP machine.

Tongue Reduction Surgery

Because in some cases the apnea is caused by the tongue falling back and blocking the air passage, this type of procedure is often necessary to prevent this obstruction. Surgical procedures that will reduce the size of the back of the tongue can reduce the chances of sleep apnea in this situation.

Tongue reduction is typically done under general anesthesia, and when combined with other surgical procedures for obstructive sleep apnea, can be 70% effective in the treatment of the condition.

Palate Implants

This is a procedure that is used to stiffen the palate, making it less prone to fall back when relaxed, thereby not blocking the airways. Palate implants also prevent the palate from vibrating during sleep, which is the main cause of snoring.
This type of procedure is often successful with people with mild cases of obstructive sleep apnea, although many people also require other forms of surgery, especially if they have other health conditions that are attributed to the apnea.

Tracheostomy

This is a surgical procedure that is performed under general anesthesia, and it is used to bypass the air passage that is narrowed. A tube is inserted into the lower neck directly into the trachea, and due to its severity is a procedure of last resort.
A tracheostomy is usually only performed on those who have severe cases of apnea and morbidly obese people, both of which have few other treatment options. This is a procedure that can be temporary, and the tube can be removed. This is a treatment that is nearly 100% effective in all people.

Maxillomandibular Advancement

This surgery moves the person’s jaw and upper teeth forward, which in turn pulls the base of the tongue forward, thereby increasing the ability for the person to breathe properly, because the airway is no longer restricted. The bones are cut, moved, and realigned, and because it involves the teeth, must be performed by an oral surgeon. Generally, this procedure has a success rate as high as 90%.

Bariatric Surgery

Often, sleep apnea is prevalent in those who are extremely overweight. Obese people with apnea often need to undergo bariatric surgery in order to be able to lose the weight. Once a person has had bariatric surgery and has lost weight, they should notice a difference in their apnea symptoms.

Other Surgical Procedures

There are other types of surgical procedures used to effectively treat sleep apnea. These procedures include genioglossus advancement, uvulopalatopharyngoplasty (UPPP), and hyoid suspension.

Sleep apnea can be caused by a number of medical conditions that need to be correctly diagnosed and treated, and if left untreated, can also lead to a number of other conditions that can even be fatal. If you think that you may have obstructive sleep apnea, make an appointment today to see your doctor, and start getting the sleep you need.

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