CareMedic — Home Page
Schedule an Appointment
CareMedic — Home Page

Sleep Apnea—Sleep Apnea

Definition

Sleep apnea syndrome (sleep apnea syndrome), also known as sleep apnea or simply sleep apnea, is a potentially serious sleep disorder in which breathing repeatedly stops and starts. If you snore loudly and feel tired even after a full night’s sleep, you may have sleep apnea or sleep apnea syndrome

The main types of sleep apnea are:

  • Obstructive type, the most common form, which occurs when the muscles of the cervix (neck) relax
  • Central type, which occurs when your brain does not send signals correctly to the muscles that control breathing
  • Complex sleep apnea syndrome, which occurs when a person has both obstructive and central sleep apnea

If you think you might have sleep apnea, see your doctor. Treatment can relieve your symptoms and help prevent heart problems and other complications. At the clinics CarE MediC clinics, you can have your sleep monitored at home using a special portable device to investigate suspected sleep apnea.

Symptoms

The symptoms and signs of obstructive and central sleep apnea sometimes overlap, making it difficult to determine the type. The most common include:

  • Loud snoring
  • Episodes in which you stop breathing while sleeping (something that is usually reported by another person)
  • Trying to take a deeper breath while sleeping
  • Waking up with a dry mouth
  • Morning headache
  • Difficulty staying asleep (insomnia)
  • Excessive daytime sleepiness (sleepiness)
  • Difficulty concentrating during the day
  • Irritability

Causes

  • Obstructive sleep apnea:

This happens when the muscles at the back of your throat relax. These muscles support the soft palate—the triangular piece of tissue that hangs from the hard palate—the tonsils, the side walls of the throat, and the tongue.

When your muscles relax, your airway narrows or closes as you breathe in. You can’t get enough air, which can lower the oxygen level in your blood. Your brain senses your difficulty breathing and briefly wakes you up so you can reopen your airway. This awakening is usually so brief that you don’t remember it.

You may snore, choke, or wheeze. This pattern can repeat 5 to 30 times or more every hour, all night long, reducing your ability to achieve deep, restful sleep.

  • Central Sleep Apnea

This less common form of sleep apnea occurs when your brain does not send signals to your respiratory muscles. This means you make no effort to breathe for a short period of time. You may wake up feeling short of breath, or have trouble falling asleep or staying asleep.

Risk Factors

Sleep apnea can affect anyone, even children. However, certain factors increase the risk.

  • Obstructive sleep apnea

Factors that increase the risk of this form of sleep apnea include:

  1. Excess weight: Obesity significantly increases the risk of sleep apnea. Fat deposits around your upper airway can obstruct your breathing.
  2. Neck circumference: People with a larger neck circumference may have narrower airways.
  3. Airway narrowing: This may be hereditary. In addition, the tonsils or adenoids in that area can also enlarge and obstruct the airway (especially in children).
  4. Male gender: Men are two to three times more likely to have sleep apnea than women. However, women’s risk increases if they are overweight, as well as after menopause.
  5. Older Adults: Sleep apnea is much more common among older adults.
  6. Family history: Family members with a family history of sleep apnea may be at increased risk.
  7. Alcohol and sedatives: These substances relax the muscles in the throat and may worsen obstructive sleep apnea.
  8. Smoking: Smokers are three times more likely to develop obstructive sleep apnea than nonsmokers. Smoking can increase inflammation and fluid retention in the upper airway.
  9. Nasal congestion: If you have difficulty breathing through your nose—whether due to an anatomical problem or allergies—you are more likely to develop obstructive sleep apnea.
  • Central Sleep Apnea

Risk factors for this form of sleep apnea include:

  1. Older Adults: Middle-aged and older adults are at greater risk of central sleep apnea.
  2. Male: Central sleep apnea is more common in men than in women.
  3. Heart disorders: Congestive heart failure increases the risk of sleep apnea.
  4. Use of narcotic medications: Opioids, particularly long-acting ones such as methadone, increase the risk of central sleep apnea.
  5. Stroke: A history of stroke increases the risk of central sleep apnea or degenerative central sleep apnea.

Complications

Sleep apnea is a serious medical condition. Complications may include:

  1. Fatigue during the day. The repeated awakenings associated with sleep apnea make it impossible to get proper, restful sleep, leading to severe daytime drowsiness, fatigue, and irritability.
  2. Difficulty concentrating and drowsiness while working, watching TV, or even while driving. People with sleep apnea are at increased risk of car accidents and workplace accidents.
  3. Children and adolescents with sleep apnea may perform poorly in school or have behavioral problems.
  4. High blood pressure or heart problems. The sudden drop in blood oxygen saturation that occurs during sleep apnea raises blood pressure and causes stiffness in the cardiovascular system. Obstructive sleep apnea increases the risk of high blood pressure (hypertension).
  5. Obstructive sleep apnea can also increase the risk of recurrent heart attacks, strokes, and arrhythmias, such as atrial fibrillation. If cardiovascular disease is already present, multiple episodes of low blood oxygen levels (hypoxia or hypoxemia) can lead to sudden death from an irregular heartbeat.
  6. Type 2 diabetes (T2DM). Sleep apnea increases the risk of developing insulin resistance and type 2 diabetes.
  7. Metabolic syndrome. This condition, which includes high blood pressure, abnormal cholesterol levels, high blood sugar, and an increased waist circumference, is associated with a higher risk of heart disease.
  8. Complications related to medications and surgery. Obstructive sleep apnea also raises concerns regarding certain medications and general anesthesia. People with sleep apnea may be more likely to experience complications after major surgery because they are prone to respiratory problems. Before surgery, tell your doctor about your sleep apnea and how it is being treated.
  9. Liver. People with sleep apnea are more likely to have abnormal liver function test results and are more likely to show signs of scarring (nonalcoholic fatty liver disease).
  10. Reduced sleep quality for partners as well. Loud snoring can deprive anyone sleeping near you of a good night’s rest. It’s not uncommon for your partner to have to sleep in another room—or even on another floor of the house.

Diagnosis

Your doctor can make an assessment based on your symptoms and signs, as well as a sleep history (usually provided by the person who sleeps with you).

You may be referred to a sleep center. There, a sleep specialist (usually a pulmonologist) can help you determine whether you need further evaluation. An evaluation often involves an overnight stay at a specialized sleep center to monitor both your breathing and other bodily functions. A home sleep study may also be an option. Tests to detect sleep apnea include:

  1. Overnight polysomnography: During this test, you are connected to equipment that monitors your heart, lungs, brain activity, breathing patterns, arm and leg movements, and blood oxygen levels while you sleep.
  2. At-home sleep apnea screening devices: Your doctor can provide simplified tests to be used at home to diagnose sleep apnea. These devices typically measure your heart rate, blood oxygen levels, airflow, and breathing patterns. Medical offices CarE MediC clinics provide this service.

If the results are abnormal, your doctor may be able to prescribe treatment without further investigation. However, portable monitoring devices do not detect all cases of sleep apnea, so your doctor may recommend a polysomnography test, even if your initial results are normal.

If you have obstructive sleep apnea, your doctor may refer you to an otolaryngologist to rule out a blockage in your nose or throat. An evaluation by a cardiologist or a neurologist may be necessary to investigate the causes of central sleep apnea.

Treatment

For milder cases of sleep apnea, your doctor may recommend only lifestyle changes, such as losing weight or quitting smoking. If you have nasal conditions, your doctor will recommend treatment for them. If these measures do not improve your signs and symptoms, or if your sleep apnea is moderate to severe, there are various other treatments available. Certain devices can help open a blocked airway, while in other cases, surgery may be necessary.

  1. Continuous Positive Airway Pressure (CPAP): If you have moderate to severe sleep apnea, you may benefit from using a machine that delivers air pressure through a mask while you sleep. With CPAP, the air pressure is higher than ambient pressure and is sufficient to keep the upper airways open, preventing apnea and snoring.

    Although CPAP is the most common and reliable method for treating sleep apnea, some people find it difficult or uncomfortable. Some people give up on the CPAP machine, but with practice and getting used to it, most people learn to adjust the tension of the mask straps to achieve a comfortable and secure fit.

    You may need to try more than one type of mask to find one that’s comfortable. Don’t stop using your CPAP machine if you’re having problems. Contact your doctor to see what adjustments can be made to improve your comfort.

    In addition, contact your doctor if you continue to snore or start snoring again, despite treatment. If your weight changes, you may need to adjust the pressure on your CPAP machine.
  2. Other airway pressure devices: If you use a CPAP and it continues to be a problem for you, you may be able to use a different type of airway pressure device that automatically adjusts the pressure while you sleep (auto-CPAP). There are also devices that provide positive airway pressure (BPAP). These deliver higher pressure when you inhale and lower pressure when you exhale.
  3. Oral devices: Another option is to use an oral device designed to keep your throat open. CPAP is more effective than oral devices, but the latter may be easier to use. Some are designed to open your throat by moving your jaw forward, which can sometimes relieve snoring and mild obstructive sleep apnea.
  4. Surgery: Surgery is usually an option after other treatments have failed. Generally, it is recommended to try other treatments for at least three months before considering surgery. However, for a small number of people with certain jaw structure problems, it is a good first option.

    Surgical options may include:
  • Tissue removal. During this procedure, your doctor removes tissue from the back of your mouth and the upper part of your throat. Your tonsils and adenoids are usually removed as well.
  • Tissue shrinkage. Another option is to shrink the tissue at the back of your mouth and the back of your throat using radiofrequency energy. This procedure can be used for mild to moderate sleep apnea.
  • Jaw repositioning. In this procedure, your jaw is moved forward relative to the rest of your facial bones. This increases the space behind the tongue and soft palate, making obstruction less likely.
  • Implants. Plastic rods are surgically implanted in the soft palate after local anesthesia. More research is needed to determine how well the implants work.
  • Nerve stimulation. This requires surgery to implant a stimulator for the nerve that controls tongue movement (hypoglossal nerve). The increased stimulation helps keep the tongue in a position that keeps the airway open.
  • Creation of a new airway (tracheostomy). In very specific cases, this type of surgery may be necessary if other treatments have failed and there is severe, life-threatening sleep apnea.
  • Other types of surgery may help reduce snoring and treat sleep apnea by clearing or widening the airways, such as surgery to remove enlarged tonsils or adenoids and bariatric surgery for weight loss.

    5. Lifestyle changes: In some cases, self-care can be a way to manage obstructive sleep apnea and possibly central sleep apnea. Try these tips:
  • Lose excess weight. Even a small amount of weight loss can help relieve the narrowing of your throat. In some cases, sleep apnea can be resolved by returning to a healthy weight, but it may recur if you regain the weight.
  • Exercise. Regular exercise can help relieve the symptoms of obstructive sleep apnea, even without weight loss. Try to engage in 30 minutes of moderate-intensity exercise, such as brisk walking, most days of the week.
  • Avoid alcohol and certain medications, such as sedatives and sleeping pills. These relax the muscles at the back of your throat, interfering with your breathing.
  • Sleep on your side or on your stomach, not on your back. Sleeping on your back can cause your tongue and the soft palate at the back of your throat to relax, resulting in airway obstruction. There are also commercially available devices that vibrate when you roll onto your back while sleeping.
  • Don’t smoke. If you’re a smoker, look for ways to help you quit.

When to See a Doctor

Loud snoring may indicate a potentially serious problem, but not in everyone who has sleep apnea. Talk to your doctor if you have signs or symptoms of sleep apnea. Ask about any sleep problems that leave you feeling tired, sleepy, and irritable during the day.