Are you one of the nearly 30 million adults in the U.S. suffering from sleep apnea? Would you even know? Getting a good night’s sleep is important in leading a healthy, productive life. Without it, our physical and emotional well-being suffers. That’s because when we cycle through the stages of sleep, our bodies go through a state of repair. Our cells regenerate giving us the ability to think clearly and retain information, and adequate rest provides energy to get through the next day, while decreasing the risk for illness or serious disease.
What Is Sleep Apnea?
Sleep apnea has proven to be a nightmare for some of those who experience it – either as a patient or someone sharing a bedroom with patient. The disorder is characterized by abnormal pauses in breathing while asleep. A person’s natural breathing rhythm may be interrupted hundreds of times throughout the night, lasting anywhere from 10 to 30 seconds or more. This deprives the body of much-needed oxygen. When those levels decrease, signals are interrupted and vital blood flow to the organs is affected, which strains the cardiovascular system.
As a result, the quality of sleep is poor. And patients are at an increased risk for developing respiratory and cardiovascular complications, as well as a host of other physical and emotional ailments in the short and long term. Serious complications can include irregular heart rhythms, high blood pressure, diabetes, stroke, heart attack, and even death if there are other chronic diseases or conditions at play.
Symptoms of Sleep Apnea
Unfortunately, getting the recommended seven to nine hours of shut eye every night is not as easy as turning out the lights and counting sheep. Especially if you have not been diagnosed with the disorder. However, if you experience any of these common sleep apnea symptoms, it may be time to seek medical advice:
- Feeling tired upon waking and sleepy through the day
- Headaches upon waking
- Episodes in which you stop breathing during sleep — which would be reported by another person
- Gasping for air during sleep
- Drowsy driving
- Awaking with a dry mouth
- Difficulty staying asleep (insomnia)
- Excessive daytime sleepiness (hypersomnia)
- Decreased interest in sex
- Difficulty paying attention while awake
- Irritability/mood changes
Types of Sleep Apnea
There are two main types of sleep apnea. Their risk factors and treatment options differ depending on which one a patient experiences. The most common form, with nearly 20 percent of the adult population diagnosed, according to the National Sleep Foundation, is obstructive sleep apnea or OSA. This happens when throat muscles supporting the soft palate relax for a variety of reasons. When they relax, the airway narrows or even closes as you inhale. However, people with OSA cannot take in enough air, which as mentioned, lowers the oxygen level in the blood.
Once the brain senses your inability to breathe, you’re startled awake in order to get oxygen into your lungs. Many don’t remember this occurring, but others recall choking, gasping, or snorting to inhale. Over time, this pattern impairs your ability to reach the deep, restful phases of sleep such as R.E.M.
Central sleep apnea (CSA) is the second form of the disorder and less common than OSA. Often, it is found people with other health conditions or comorbidities such as heart failure or stroke, or who sleep at very high levels of altitude. Opioid medications also are known to increase the risk of this form of apnea. When someone has CSA, the brain doesn't send proper signals to the appropriate muscles that control breathing.
The risk factors involved with both forms of sleep apnea include:
Obstructive sleep apnea
Overweight. Obesity greatly increases the risk of sleep apnea. Fat deposits around your upper airway can obstruct your breathing.
Large neck. Those with neck circumference greater than 16 inches for women and 17 inches for men likely have narrower airways.
A restricted airway. A narrow throat, particularly due to large tonsils or adenoids can block the airway in adults and especially children.
GERD is believed to be a contributing cause of obstructive sleep apnea.
Gender. Men are two to three times more likely to have sleep apnea; however, women increase their risk if they're overweight, and their risk also rises after menopause.
Age. While mostly common in adults over the age of 40, anyone can get it and the risk increases with age.
Genetics. Having family members with sleep apnea might increase your risk.
Substances. Using alcohol, sedatives, or tranquilizers relax the muscles in your throat, which can worsen obstructive sleep apnea.
Tobacco. Smokers are three times more likely to have OSA since doing so can increase the amount of inflammation and fluid retention in the upper airway.
Nasal congestion. Sinus issues can create difficulties breathing through your nose.
Central sleep apnea
- Age. Middle-aged and older people have a higher risk of central sleep apnea.
- Gender. Central sleep apnea is more common in men than it is in women.
- Cardiovascular disorders. Having congestive heart failure increases the risk.
- Narcotic pain medications. Opioid medications, especially long-acting ones such as methadone, increase the risk of central sleep apnea.
- Stroke. Having had a stroke increases your risk of central sleep apnea or treatment-emergent central sleep apnea.
Treating Sleep Apnea
For those with mild sleep apnea, the problem may resolve on its own with lifestyle changes that may have introduced the condition such as being overweight or smoking. Relief sometimes is found when an individual loses weight, stops drinking, avoids alcohol or sleeping pills (which contribute to relaxing the back of the throat muscles and obstruct the airway), or even by changing sleep positions and rolling from lying on the back to the side.
In more serious cases, however, medical intervention is needed. The first step is to schedule an appointment with your primary care provider. He or she may recommend a sleep apnea test in the home or in the sleep lab. During this sleep study, patients are hooked up to electrical transmitters while sleeping to record physical movement. Once the sleep specialist analyzes the data and the specific sleep disorder is determined, further tests may be ordered – particularly if OSA is suspected.
The most common treatment prescribed to aid in breathing assistance for OSA is the CPAP, otherwise known as the continuous positive airway pressure machine. Here, a mask is worn at night delivering a continuous flow of air into the nose or mouth. This air flow helps keep the airways open so that breathing is regular. Similar to CPAP is a device called known as BPAP or bi-level positive airway pressure. The difference here is air flow changes during the inhale and exhale process.
There are individuals who cannot use the CPAP. In this case, a minimally invasive device is implanted into the patient. This device, called Inspire, stimulates the upper airway via pulses administered by a small generator under the skin. Wires deliver mild pulses or stimulation as needed leading to the neck and lungs. A doctor can program the device from an external remote and the patient uses a remote to turn it on before bed and off in the morning. It’s a relatively new option for those who are unable or unwilling to use CPAP and who may not seek other treatment options such as dental devices or surgery to correct anatomical abnormalities or sinus obstructions.
Sleep apnea is a serious medical condition. Left untreated, complications can be serious and extend beyond a poor night’s sleep. Medical professionals have reported a shorter life expectancy in those with undiagnosed or untreated OSA That’s because patients later find themselves at an increased risk for auto accidents, heart disease, stroke, diabetes, depression, and hypertension. If you already have heart disease, multiple episodes of low blood oxygen (hypoxia or hypoxemia) during OSA can lead to sudden death from an irregular heartbeat or atrial fibrillation.
Of course, repeated awakenings with OSA plagues the sufferer with daytime fatigue, inability to concentrate, and irritability. As stated earlier, people with sleep apnea have an increased risk of motor vehicle and workplace accidents. In fact, one in 25 adults report falling asleep while driving in a given month. And, according to the National Highway Traffic Safety Administration, every year about 100,000 police-reported crashes related to drowsy driving.
Anyone with OSA may also suffer complications with medications and surgery. That’s because general anesthesia requires sedation and patients on their backs. Recovery is more difficult and surgery more complicated in patients with OSA. Loud snoring can keep anyone who sleeps near you from getting good rest. It's not uncommon for a partner to have to go to another room, or even to another floor of the house, to be able to sleep.
If you are experiencing any of these symptoms, or your partner is noticing sleep disturbances, talk to your doctor. He or she can schedule an appointment with the Sleep Center at UPMC , which has locations on both the east and west shores. Once you have a physician referral, you can schedule an appointment by calling 717-920-4325 or visit our sleep center.