Sleep Apnea


 

Sleep apnea is a common sleep disorder characterized by brief interruptions of breathing during sleep.    The most common type of sleep apnea is obstructive sleep apnea, which occurs when the soft tissues in the throat relax and collapse into the airway blocking oxygen from reaching the lungs. Partial airway blockage often causes snoring, while full airway blockage may result in cessation of breathing, gasping, choking and then awakening. Individuals with severe sleep apnea can wake up many times during the night resulting in daytime sleepiness and fatigue. Central sleep apnea is caused by irregularities in the brain’s normal signals to breathe.  Many people with sleep apnea will have a combination of both types.

Sleep apnea can occur in anyone, but it is more likely to occur in men versus women, and in people who are overweight or obese. An estimated 25 million adult Americans suffer from this disorder.

For a person with sleep apnea, not enough air flows into the lungs while the person sleeps. Breathing may stop from 10 to 60 seconds at a time and this may occur repeatedly throughout the night. When not enough air flows into the lungs, the amount of oxygen in the blood decreases. The brain responds to the lack of oxygen by arousing the body from sleep so that normal breaths may start again. Upon awakening, the affected person may make a snorting, choking, or a gasping sound. Although individuals who have sleep apnea typically snore loudly and frequently, not everyone who snores has sleep apnea.  

The hallmark symptom of sleep apnea is excessive daytime sleepiness. Additional symptoms include restless sleep, loud snoring (with periods of silence followed by gasps), awakening with a dry mouth or sore throat, morning headaches, becoming drowsy or falling asleep while driving, trouble concentrating, irritability, forgetfulness, mood or behavior changes, anxiety, and depression.  Not everyone who has these symptoms will have sleep apnea, but it is recommended that people who are experiencing even a few of these symptoms visit their doctor for evaluation.

Although anyone can develop sleep apnea, persons with the following risk factors are more susceptible:

  • Obesity: Excess weight is the leading risk factor for obstructive sleep apnea. More than 50% of people with sleep apnea are overweight. Fat deposits around the upper airway obstruct the airway and impair breathing. However, not everyone who has sleep apnea is overweight; thin people can develop the disorder as well.
  • Diabetes: Sleep apnea is three times more common in individuals with diabetes.
  • High blood pressure: Nearly 50% of people with sleep apnea also have hypertension.
  • Anatomical features: Narrow throat; large neck, tongue, tonsils, and jaw
  • Nasal congestion: Sleep apnea occurs twice as often in those with nighttime nasal congestion.
  • Smoking and alcohol consumption

Sleep apnea is considered a serious medical condition. If left untreated, sleep apnea may precipitate certain adverse consequences such as:

  • Cardiovascular events: A sudden drop in blood oxygen levels during apneic episodes leads to an increase in blood pressure. Frequent drops in blood oxygen levels, with the associated hypertension, put a considerable strain on the cardiovascular system. As a result, individuals are at higher risk for stroke, transient ischemic attacks, coronary artery disease, irregular heartbeats, and heart failure. Persons with sleep apnea are 2 times more likely to have a stroke and 5 times more likely to have a cardiovascular event than persons without the disorder. Especially if there is underlying heart disease, sleep apnea could lead to sudden death.
  • Motor vehicle accidents: People with sleep apnea are twice as likely to have a traffic accident. Nearly 30% of accidents involving commercial truck drivers are caused by sleep-related factors.
  • Cancer: Patients with severe sleep apnea are 4 to 5 times more likely to develop cancer than those who do not have the sleep disorder.
  • Diabetes
  • Depression
  • Dementia

There is no cure for sleep apnea. However, there are several treatments that can successfully reduce or eliminate the apneic episodes that trigger the adverse consequences of the disorder. Most treatment regimens begin with lifestyle changes, such as losing weight, quitting smoking, and decreasing alcohol intake. Some individuals benefit from special pillows or devices that keep them from sleeping on their backs, or oral appliances that keep their airway open during sleep.  If conservative methods are inadequate, continuous positive airway pressure (CPAP) therapy is generally recommended.

CPAP therapy involves the use of a CPAP device, which pressurizes room air and then directs the pressurized air to the individual through tubing to a face or nasal mask. As the individual sleeps with the face or nasal mask on, the flow of pressurized air keeps the airway passages from closing. In addition to CPAP devices, there are also other devices that provide variable positive airway pressure (VPAP) and automatic positive airway pressure (APAP). Other treatments include nasal valves, upper airway stimulation with an implanted device, and surgery to remove tissue and widen the airway.  Some individuals may need a combination of therapies to successfully treat their sleep apnea.

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