Sleep Apnea: Symptoms and Treatment
Sleep apnea is a sleep disorder where your breathing stops and restarts again frequently throughout the night. It’s relatively common, with around 200,000 diagnosed cases per year. There are three different types of of the disorder, and cases can range from mild to severe. Those with milder cases can live with it for years without even realizing; however, it can prevent you from getting a restorative night’s sleep and leave you drowsy, irritable, and lethargic the next day. If you feel you may have some of the symptoms of the disorder, we encourage you to talk to your doctor to learn more.
Types of Sleep Apnea
OSA is the most common type and occurs when the muscles in the back of the throat block, or obstruct, your airway while you sleep. How does this happen? The muscles in the back of your throat control your soft palate, uvula, tonsils, and the sides of your throat and tongue. When these muscles relax, your airway narrows and eventually closes. When your brain senses it is no longer getting air, it rouses you awake to take a breath. These awakenings can be very brief, and many won’t remember even waking up to gasp for air. In milder cases, this can happen a few times a night, but in more severe cases it can happen repeatedly and prevent you from entering into REM sleep.
CSA occurs when your brain stops telling your muscles to breathe. Once your brain realizes it’s not getting oxygen, it tells your muscles to breathe again, and you typically wake up short of breath. Those with CSA have a harder time falling asleep and staying asleep.
This type is referred to as treatment-emergent because it occurs when someone with OSA develops CSA from the use of a continuous positive airway pressure (CPAP) machine.1 A CPAP machine delivers a constant flow of air through a facemask to your airway, preventing muscles in the back of your throat from relaxing and ensuring you receive a steady stream of air throughout the night. The change in air flow can trigger CSA behaviors such as breath-holding in combination with pre-exisisting OSA behaviors. To be diagnosed with this type, you must have a 50:50 ratio of OSA and CSA behaviors.
Who Is At Risk?
There are a variety of factors that can increase your risk of developing the disorder, and these risk factors can differ between OSA and CSA.
The precursors for OSA include:
Neck circumference: Individuals with thicker necks are at risk of having narrower airways.
Obesity: Being overweight increases your chance of fat depositing around your neck—resulting in a blocked airway.
Nasal Obstruction: Whether you have allergies or a deviated septum, any difficulty breathing through your nose can result in developing, or worsen existing, OSA.
The precursors for CSA include:
Heart disorder: Individuals with a heart disorder are at greater risk of developing CSA.
Stroke: If you have suffered a stroke, there is an increased chance you may develop CSA.
Additionally, both OSA and CSA are much more common in males, older adults, and those with a family history of the disorder.
Symptoms to Watch For
The first and most apparent symptom is waking up throughout the night to gasp for air.2 However, as we mentioned earlier, some individuals can live with the disorder for years without even realizing. So how can you tell if you have a sleep disorder if your symptoms are not repeatedly waking you? Other symptoms include having a sore throat upon awakening, loud snoring, headaches, excessive daytime fatigue, mood changes, difficulty paying attention, and restless sleep.
Diagnosing the Disorder
Meeting with a sleep specialist is the first step in establishing whether or not you have a sleep disorder. After you meet with a specialist, there are a variety of tests you can take to determine if you have the disorder. Usually, you can decide if you want to do these tests overnight at a sleep center, or in your own home.
The most common test is called a polysomnogram and is usually conducted at a sleep center. Patients are assigned to their own room for the night and hooked up to monitoring devices. A polysomnogram monitors your breathing patterns, body movement, blood oxygen levels, lung, heart, and brain activity while you sleep. A sleep specialist then analyzes these results. The devices involved include:
- EEG (electroencephalogram): Measures brain waves and activity
- EMG (elecromyogram): Records muscle activity such as leg movements, twitches, and teeth grinding.
- EOG (electro-oculogam): Records eye movements
- ECG (electrocardiogram): Monitors heart rate and rhythm
- Nasal Airflow Sensor: Records airflow through the nasal passsage
- Microphone: Records snoring
If you choose to do a simpler, in-home sleep test, your doctor will send you home with a testing kit meant to measure your heart rate, breathing patterns, airflow, and blood oxygen levels while you sleep. Your doctor will then look over your results and decide if further testing needs to be done.
There are a variety of treatments, ranging from lifestyle changes to surgery. If you are diagnosed with OSA, the first step is visiting an ear, nose, and throat doctor to find out if a blockage in your throat or airway is causing the disorder. For individuals diagnosed with CSA, a visit to a neurologist may be necessary to determine what is causing the disconnect between your brain and breathing muscles.
For mild cases, simple lifestyle changes and home remedies can be the cure. If your OSA is caused by nasal congestion, a daily allergy pill is recommended.3 Other lifestyle changes doctors suggest include:
- Sleeping on your side
- Exercising regularly
- Improving Sleep Hygiene
- Losing weight
- Investing in an adjustable bed
The best adjustable bed is one that lets you raise your head, effectively reducing snoring and symptoms of OSA. When you elevate your head, air can pass through your airways more easily than if you were lying down flat. Sleeping in an upright position greatly reduces the chances of your throat muscles relaxing and blocking your airway. A study conducted recently compared the relationship between OSA symptoms and head elevation and found there was a significant improvement in quality of sleep and oxygen flow through the airway, and less apnea behaviors throughout the night when sleeping with your head elevated.5
Positive Airway Pressure Device
If changes in your day-to-day aren’t the answer, your doctor will usually recommend a continuous positive airway pressure (CPAP) machine. As described earlier, a CPAP machine prevents your airway from closing while you sleep by delivering a continuous airflow through a facemask. A CPAP machine is a common and reliable treatment, but some people give up on using a facemask to sleep because they find it uncomfortable. Because many people feel sleeping with a CPAP facemask is awkward and cumbersome, companies have begun to create more comfortable mask options.
If you have difficulty adapting to a CPAP machine, you may decide to try an alternate bilevel positive airway pressure (BPAP) machine. This device may be easier to use because it delivers a steady flow of air while you breathe in, and less air while you breathe out.
In addition to positive airway pressure devices, some choose to utilize a dental device designed to keep your airway open while you sleep. If all other treatments fail, surgery is an option.6 Usually, doctors define the treatment as “failed” if, after a three month trial period, you haven’t noticed any improvements. It’s usually not until your doctor has ruled out all other treatments before they will suggest surgery.
There are three common types of surgery, these include:
Nasal Surgery: For OSA caused by nasal obstruction, a septoplasty and turbinate reduction are usually required. In this procedure, a surgeon will correct a deviated septum and minimize the size of your turbinates, creating a larger nasal cavity.
Uvulopalatopharyngoplasty (UPPP): UPPP is a prevalent and effective surgical method in treating this disorder.4 During this procedure, a surgeon will remove excess tissue around your soft palate and pharynx and even remove your tonsils and adenoids to enlarge your airway.
Mandibular Maxillomandibular Advancement Surgery: This procedure involves moving both your upper and lower jaw forward to increase the size of your airway. This surgery is usually not the first choice for doctors unless your OSA is clearly caused by an abnormality in your jaw.
Other less-common surgical procedures include nerve stimulation and implants. During nerve stimulation, a stimulator is inserted into your hypoglossal nerve, the nerve which controls your tongue movement, to keep your tongue in place and your airway open while you sleep. Implants are similar to nerve stimulation. The procedure involves implanting plastic rods into your soft palate to prevent it from relaxing and closing your airway. There is not much research on either one of these procedures, but they’re becoming more popular as doctors analyze how effective they are.
For severe cases, a tracheostomy may be necessary. During this procedure, a surgeon opens up your neck and inserts a plastic or metal tube into your trachea to create a whole new airway.
If Left Untreated
This sleep disorder can take away from your quality of life by preventing you from getting a good night’s rest, leaving you plagued with fatigue, irritability, headaches, and even hypersomnia, excessive daytime tiredness. A lack of sleep can lead to motor vehicle accidents and poor work performance, among other things.
Not only can it detract from your quality of life, but it can lead to issues such as Type 2 diabetes, metabolic syndrome, liver problems, high blood pressure, heart failure, stroke, ADHD, and depression. If you feel you may have some of the symptoms mentioned in this article, we encourage you to talk with your doctor about what you are experiencing.
Overview and Conclusion
Sleep apnea is a common sleep disorder when you frequently stop and start breathing throughout the night. Cases can range from mild to severe, regardless of the severity of your disorder, it can take away from your quality of life and prevent you from getting restorative sleep.
Even if you are not being roused awake, we encourage you to talk to your doctor about other symptoms you’re experiencing you may feel could be an indicator of the disorder.
Keeping a sleep journal is a great way to document your quality of sleep and keep track of any symptoms you are experiencing.