Sleep Apnea: Symptoms and Treatment
Dr. Stuart F. Quan
Dr. Quan is the Clinical Director and Senior Physician in the Division of Sleep and Circadian Disorders at Brigham and Women’s Hospital and the Gerald E. McGinnis Professor of Sleep Medicine at Harvard Medical School. Dr. Quan focuses on the epidemiology of sleep, sleep disorders, and sleep-disordered breathing.
Sleep apnea is a sleep disorder where your breathing stops and restarts again frequently throughout the night. It’s relatively common, affecting around 1 in 4 adults. There are different types of sleep apnea, and cases can range from mild to severe. Some people 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 cause the oxygen levels in your blood to drop. This can increase your risk of developing high blood pressure, heart attack, stroke or diabetes.
Central Sleep Apnea, or CSA, is much less common than OSA. 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.
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.
Important risk factors 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.
- Face shape: The shape of a person’s face also increases OSA risk. For example, OSA is more common in those with wider and shorter facial dimensions.
Important risk factors for CSA include:
- Heart failure: Individuals with heart failure are at greater risk of developing CSA.
- Stroke: If you have suffered a stroke, there is an increased chance you may develop CSA.
Additionally, OSA is much more common in males, older adults, and those with a family history of the disorder. Other conditions where CSA is observed include certain neuromuscular disorders and assent to high altitude.
Symptoms to Watch For
Loud and disruptive snoring is the most common symptom of sleep apnea, especially OSA. In addition, many individuals will wake up during the night gasping for air. Since their sleep is disrupted, individuals with sleep apnea will frequently be tired and sleepy during the day. Other symptoms include having a sore throat upon awakening, headaches, mood changes, difficulty paying attention, and restless sleep. Having some of these symptoms should be a clue that you have sleep apnea.
Diagnosing the Disorder
Meeting with your primary care provider is the first step in establishing whether or not you have sleep apnea. She or he may refer you to a sleep specialist. Afterwards, there are a variety of tests you can take to determine if you have sleep apnea, but most commonly a sleep test is ordered which can be done in a sleep center or at 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. Alternatively, your doctor may order a home sleep test, which will measure your heart rate, breathing patterns, and 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 sleep apnea, your doctor will review treatment options with you.
For mild cases, simple lifestyle changes and home remedies can be the cure. If nasal congestion is contributing to OSA, a nasal spray or allergy pill may help. Other lifestyle changes doctors suggest include:
- Sleeping on your side
- Exercising regularly
- Improving sleep hygiene
- Losing weight
- Elevating the head while you sleep
Elevate the head
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.
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. A CPAP machine prevents your airway from closing while you sleep by delivering a continuous airflow through a mask covering either the nose or the nose and mouth. A CPAP machine is a common and reliable treatment, but some people give up on using a mask to sleep because they find it uncomfortable. Because many people feel sleeping with a CPAP mask 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 delivers a higher air pressure during inhalation and a lower pressure during exhalation. Some people find it more comfortable to use because air pressures may be lower.
In addition to positive airway pressure devices, some choose to utilize a special dental device designed to keep your airway open while you sleep by pulling your jaw and tongue forward. If all other treatments fail, surgery is an option. 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 in which nasal obstruction is an important contributing factor, a septoplasty and turbinate reduction may be helpful. In this procedure, a surgeon will correct a deviated septum and minimize the size of your turbinates, creating a larger nasal cavity. However, in most cases, nasal surgery by itself will not completely correct OSA and additional treatment is necessary.
- Uvulopalatopharyngoplasty (UPPP): 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. UPPP is only successful in a small number of individuals with OSA.
- 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 for OSA include nerve stimulation. 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.
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. Consequently, patients with severe OSA have an increased risk of death says Dr. Stuart Quan, a sleep medicine specialist at Brigham and Women’s Hospital and Harvard Medical School in Boston. 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 that 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.
This article is for informational purposes and should not replace advice from your doctor or other medical professional.