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
Tracheostomy
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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