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Sleep apnea is a common sleep disorder characterized by brief interruptions of breathing during sleep. What worries is the possibility of suffocation during sleep apnea episode.

sleepapnea.jpgIt is important to know that person will not suffocate during these episodes, as some may think, although they could occur repeatedly throughout the night. People with sleep apnea partially awaken as they struggle to breathe, but in the morning they may not be aware of the disturbances.

Symptoms of sleep apnea

People who suffer from sleep apnea usually do not remember what happens during the night and most of the predominant symptoms are associated with excessive daytime sleepiness due to the low quality of the sleep they get during the night.

The most common symptoms are:

  • loud snoring
  • periods of not breathing (apnea)
  • waking up in the morning without feeling rested
  • abnormal daytime sleepiness, including falling asleep at inappropriate times
  • morning headaches
  • unrefreshing sleep
  • a dry mouth upon awakening
  • chest retraction during sleep in young children
  • high blood pressure
  • irritability
  • change in personality
  • depression
  • difficulty concentrating
  • excessive perspiring during sleep
  • heartburn
  • reduced libido
  • insomnia
  • frequent nocturnal urination  
  • restless sleep
  • nocturnal snorting, gasping, choking
  • recent and/or rapid weight gain
  • confusion upon awakening
  • limited attention
  • memory loss
  • poor judgment
  • lethargy

Additional symptoms that may be but are not necessarily associated with this disease:

  • hyperactive behavior, especially in children
  • high blood pressure
  • automatic behavior (performing actions by rote)
  • leg swelling (if severe)

Types of sleep apnea

There are two main types of sleep apnea:

  • obstructive sleep apnea

This is the most common form that occurs when throat muscles relax

  • central sleep apnea

This condition occurs when brain doesn't send proper signals to the muscles that control breathing.

Some researches have proven that some people have complex sleep apnea, which is a combination of both obstructive and central sleep apneas.

Causes of sleep apnea

Obstructive sleep apnea
There were several researches that tried to explain the exact mechanism of this condition and it is proven now that obstructive sleep apnea occurs when the muscles in the back of the throat relax. These muscles normally support the soft palate, tonsils and tongue. When these muscles relax and airway narrows or closes as s person breaths in, the breathing momentarily cuts off. How come that these people don’t suffocate? That’s because this stopping with breathing lowers the level of oxygen in blood. Of course, in that moment, the brain senses the inability to breath and briefly rouses a person from sleep so that he or she can reopen the airway.
This pattern can repeat itself 20 to 30 times or more each hour, all night long. The consequences are clear - these disruptions impair a person’s ability to reach those desired deep, restful phases of sleep, and he or she will probably feel sleepy during normal waking hours.

Central sleep apnea
Central sleep apnea occurs when the brain fails to transmit signals to breathing muscles. Some researches have came to the conclusion that a very common cause of central sleep apnea is a heart disease. 

Risk factors for developing sleep apnea

  • Excess weight
  • Neck circumference
  • High blood pressure (hypertension). 
  • A narrowed airway
  • Being male
  • Being older
  • A family history of sleep apnea
  • Use of alcohol, sedatives or tranquilizers. 
  • Smoking
  • Sex. Males are more likely to develop central sleep apnea
  • Heart disorders
  • Stroke or brain tumor
  • Neuromuscular disorders
  • High altitude

Diagnosis of sleep apnea

Patient’s and family history

Almost anyone who has obstructive sleep apnea is a snorer, so these pauses in breathing during sleep are commonly noticed by a bed partner. The patient also wakes in the morning feeling unrefreshed no matter how much he slept during the night.

The great majority of the patients also report excessive daytime sleepiness which is very common in sleep apnea. Other characteristic symptoms include hypertension, depression, trouble concentrating, and nocturnal awakenings.

Polysomnography

Polysomnography is definitely the most accurate diagnostic tool for sleep apnea today. It is usually done overnight in specialized sleep laboratories. Sleep recording systems which can perform polysomnography are being installed in the patient's home or hospital bed. This test monitors heart, lung and brain activity, breathing patterns, arm and leg movements, and blood oxygen levels while the patient is asleep.  

Oximetry

This is also a very modern technique which involves a small machine that monitors and records patient’s oxygen level while he or she is asleep. A small and simple sleeve is fitted painlessly over one of patient’s fingers to collect the information overnight at home. 

Portable cardio-respiratory testing

Sometimes the doctor may provide a patient with simplified tests to be used at home to diagnose sleep apnea. These tests usually involve oximetry, measurement of airflow and measurement of breathing patterns.

Complications of sleep apnea

Cardiovascular problems

Sudden drops in blood oxygen levels that occur during sleep apnea can easily increase blood pressure and put an extra pressure on the cardiovascular system. Studies have shown that most of the patients have hypertension.  In contrast to obstructive sleep apnea, central sleep apnea usually is the result of a heart disease. Obstructive sleep apnea greatly increases the risk of stroke.

Daytime fatigue

The repeated awakenings associated with sleep apnea make normal, restorative sleep literally impossible. That’s why the patients with sleep apnea often experience severe daytime drowsiness, fatigue and irritability. Children who suffer from this disorder may do poorly in school or have behavior problems.

Complications with medications and surgery

People with sleep apnea may be more likely to experience complications following a major surgery because they're prone to breathing problems, especially when sedated and lying on their backs. Before having a surgery, inform your doctor that you have sleep apnea. Undiagnosed sleep apnea is especially risky in this situation.

Sleep-deprived partners

This sleep disorder can make life a living hell for the patient’s bed partner. Loud snoring can even result in relationship break-ups.. 

Other problems

People with obstructive and central sleep apneas may also develop several other problems such as: memory problems, morning headaches, mood swings or feelings of depression, a need to urinate frequently at night, impotence and gastro-esophageal reflux disease.
Treatment of sleep apnea

Mild sleep apnea is usually treated by some behavioral changes. Losing weight and sleeping on the side are often recommended.

There are several treatments of sleep apnea including:

Therapies

Continuous positive airway pressure is a very good therapeutic machine that delivers air pressure through a mask placed over patient’s nose while asleep. Although this is very effective method of treating sleep apnea, some people find it cumbersome or uncomfortable. 

Wearing an oral appliance designed to keep the throat open is also a  very good method.

Surgery or other procedures

The goal of surgery for sleep apnea is to remove excess tissue from nose or throat that may be vibrating and causing the patient to snore. This parts of tissue can also blocking upper air passages and causing sleep apnea. Surgical options may include:

  • Uvulopalatopharyngoplasty (UPPP)

This is a very effective procedure, in which the doctor removes tissue from the mouth and the top of the throat. Patient’s tonsils and adenoids are usually removed as well. 

  • Maxillomandibular advancement

In this procedure, the upper and lower part of the patient’s jaw are moved forward. This enlarges the space behind the tongue and soft palate, making obstruction less likely.

  •  Tracheostomy

A tracheostomy is a surgical procedure where a small hole is cut in the neck and a tube with a valve is inserted into the hole. During the day the valve is closed so the person can speak.

Sometimes the nasal passages are the site of obstruction. It can be from a deviated septum, large nasal bones or a collapse of the nostril area, called the nasal valve. The radiofrequency procedure can effectively reduce the size of the turbinates.
Self-care tips

  1. Lose excess weight
  2. Avoid alcohol and medications such as tranquilizers and sleeping pills
  3. Sleep on your side or abdomen rather than on your back
  4. Keep your nasal passages open at night