Sleep apnea is a condition where airways narrow/close during sleep causing apneas, brief moments without breathing. These repeated interruptions result in poor sleep quality, leading to tiredness upon waking. Many people with obstructive sleep apnea are unaware they have it.
Some individuals have a less common condition called central sleep apnea. This occurs when the brain does not always send necessary signals to breathe during sleep, causing signs and symptoms similar to obstructive sleep apnea. Both types of sleep apnea share symptoms, diagnostic testing and management needs.
- Sleep apnea is a common condition that is becoming more widespread.
- About 15 to 35% of adults in Georgia may have sleep apnea. Your risk increases with age and weight.
- People with sleep apnea often experience daytime sleepiness, irritability, forgetfulness, lack of concentration, and decreased alertness due to disrupted sleep.
- Sleep apnea is associated with developing high blood pressure, stroke, coronary artery disease, congestive heart failure, cardiac rhythm disturbances and difficulty controlling blood sugar levels.
- Motor vehicle accidents are at least twice as likely to happen when people with sleep apnea are behind the wheel. When the disorder is treated, this increased risk disappears.
How Sleep Apnea Affects Your Body?
Sleep apnea occurs when the muscles and soft tissue at the back of the throat relax too much and collapse while you’re sleeping. This allows the soft tissues and the tongue to block your airway and your breathing. When the oxygen level in your blood starts to drop, your brain signals you to wake briefly and start breathing again. This cycle happens over and over throughout the night—often you don’t even realize it is happening.
Sleep apnea may negatively impact your health and well-being, including daytime sleepiness, forgetfulness, and irritability. People with sleep apnea often feel as if they haven’t slept at all, even if they sleep for the recommended seven to nine hours each night. This is because waking up so often prevents high-quality sleep. Sleep apnea-induced sleep deprivation can lead to difficulties with concentration, memory, mood, and mental clarity. Children with sleep apnea may display symptoms of hyperactivity instead of sleepiness.
There are serious potential consequences to undiagnosed or untreated sleep apnea. Besides making sleep difficult, it can lead to high blood pressure, heart disease, stroke, diabetes and result in early death.
Who Is at Risk?
Anything that narrows the airways results in more risk of having sleep apnea. You may inherit a naturally small throat, enlarged adenoids or tonsils. The most common risk factor is obesity because fatty tissue in your breathing passage reduces the space for air to pass through. This makes it easier for your breathing passage to collapse while you sleep. However, people who aren’t overweight can have sleep apnea.
Adult sleep apnea becomes more frequent as you age, starting in young adulthood until you are in your 60s and 70s. It has also been found that sleep apnea is two to three times more common for men than premenopausal women. Postmenopausal women have a similar risk for obstructive sleep apnea as men.
The Signs and Symptoms of Sleep Apnea
signs and symptoms of sleep apnea differ between individuals.The most common are:
- Snoring: Snoring is a common symptom of sleep apnea, but not all snorers have sleep apnea. Snoring can come and go throughout the night and is loud enough to disturb others sleeping nearby.
- Daytime sleepiness: If you aren’t getting high-quality sleep at night, you may doze off at work or even fall asleep behind the wheel.
- Pauses in breathing: People with sleep apnea wake up suddenly with jerking body movements after these breathing pauses, often gasping and choking. If you share a bed with someone, they may notice these noises and movements.
- Difficulties with memory and concentration
- Unusual moodiness or irritability
- Frequently waking up to urinate at night
- Morning headaches
- Dry mouth
How Sleep Apnea Is Diagnosed?
If you or a loved one suspect that you may have sleep apnea, your doctor will want to know about your sleep and health habits. They will ask about how much sleep you get, how long it takes to fall asleep and whether you sleepwalk or talk while asleep. Your medications will be reviewed for their effects on sleep. They may also ask about your family history, because sleep apnea runs in families. During a physical examination, they will look for anything making your upper airway narrower, such as enlarged tonsils or a pulled back jaw.
If your doctor thinks sleep apnea is likely, you may need a sleep study at home or at a sleep center. A sleep study monitors and records your breathing, heart rate and oxygen levels overnight. Regardless of if it is completed at home or in a sleep lab, this non-invasive test will use sensors attached to your head and body connected by long wires to a computer. The results, which may include measuring heart, lung, brain activity, breathing patterns, arm and leg movements and oxygen levels while asleep will help your doctor make a diagnosis of sleep apnea. A sleep study completed in a sleep center will provide your doctor with more information than can be collected while using a portable sleep apnea test at home.
Treating and Managing Sleep Apnea
How Sleep Apnea Is Treated
There are several ways to treat sleep apnea. No matter what treatment you choose, your doctor may want you to do a follow-up sleep study to make sure your sleep apnea is under control.
Continuous Positive Airway Pressure (CPAP): CPAP delivers air pressure to maintain open airways during sleep. You wear a mask that either fits into your nostrils, over your nose and/or over your mouth. Because CPAP works so well, it’s often the first treatment your healthcare provider will have you try. It should be used every night for the best treatment.
Oral Appliances: Oral appliances are dental devices that open your throat by bringing your jaw forward while you sleep. These devices are most effective in treating mild to moderate sleep apnea.
Surgery: If other treatment options are not right for you, you may be given surgical options. Sleep apnea surgery reduces the tissue in the back of your throat, pulls your tongue forward, and inserts a nerve stimulator to open your airway so you can breathe easier while sleeping. You may also be considered for surgery to remove tonsils or adenoids if they are blocking your airway.
Lifestyle Changes: Your doctor often will recommend that you make some lifestyle changes along with other treatments.
- Lose weight: Losing just 10% of your body weight can improve your sleep apnea. Sometimes losing weight may even cure sleep apnea.
- Avoid alcohol and sedatives: Your doctor may recommend that you stop drinking alcohol at least four hours before bed and avoid sedative medications such as sleeping pills.
- Quit smoking: This may improve your sleep apnea because cigarette smoke can cause inflammation that narrows your airways.
- Don’t sleep on your back: Sleeping on your back may make your sleep apnea worse. Use a pillow to force sleeping on your side.
Managing Sleep Apnea
If you have sleep apnea, you and your doctor will want to work together to determine lifestyle changes that you need to make to manage your condition. After you start treatment, you’ll feel more alert and less sleepy during the day. Your bed partner should notice reduced or eliminated snoring and gasping during the night.
It is important to use prescribed CPAP or oral appliance every time you sleep, but it may take you a while to adjust. If you are having a hard time getting used to your CPAP, or if you are still having symptoms after treatment, contact your doctor. There are many types of masks and it may take a couple of different tries to find the best fit for you.
If you use CPAP to treat sleep apnea, you need to regularly clean the device and replace the supplies. Many CPAP machines store information about how well they are working. Visit your doctor regularly to review the information on your CPAP machine to make sure it’s working well. If you use an oral appliance, keep it clean and follow up with a sleep specialist and a dentist as it may cause your teeth to shift.
A follow-up sleep test may be required post-surgery to assess the improvement of sleep apnea. A repeat sleep study may also be necessary with weight changes. Sleep apnea may return due to scar tissue or muscle relaxation, so ongoing monitoring of sleep symptoms is important.
Home Oxygen Therapy for Sleep Apnea
If a healthcare provider suspects you have sleep apnea, they’ll likely send you for a sleep test in a sleep laboratory to confirm the diagnosis, although it is sometimes possible to complete the study in your own home. Because OSA can cause your oxygen levels to drop while you sleep (a condition called hypoxemia or hypoxia), your healthcare provider may prescribe supplemental oxygen for you to use while you sleep. Oxygen therapy is often used for patients who are not somnolent (drowsy) or not compliant with CPAP.
Overnight oximetry is often used to monitor oxygen levels, and pulse rate is measured using a fingertip sensor. Hypoxemia is diagnosed if oxygen levels drop below 92% for over 5 minutes.
While the reasoning behind oxygen therapy may seem sound, it doesn’t improve the other symptoms of OSA, such as carbon dioxide retention and fragmented sleep.
That’s because obstructive sleep apnea is often due to the collapse of the tissues of the upper airway. If the throat is partially or completely closed, it doesn’t matter how much oxygen is delivered via a nasal cannula, it still may not reach the lungs.
CPAP and Oxygen concentrator
Because OSA is associated with high blood pressure, researchers have looked into the role of supplemental oxygen in addition to CPAP.
A study published in 2019 sought to establish the role of intermittent hypoxia (a state of low oxygen in the tissues) in the morning high blood pressure (hypertension) that’s common in people with OSA. They found that supplemental oxygen virtually eliminated the typical rise in morning blood pressure but didn’t address other symptoms of OSA, such as morning heart rate or daytime sleepiness.
They concluded that hypertension linked to OSA is the result of hypoxia and not sleep interruption.
Oxygen concentrator for Sleep Apnea with COPD
In some situations, using oxygen to treat sleep apnea may actually be dangerous. In people with only a chronic obstructive pulmonary disease (COPD), such as emphysema, oxygen has been shown to be beneficial. However, when COPD occurs alongside obstructive sleep apnea, a different picture emerges.
In this so-called “overlap syndrome,” the use of nighttime oxygen without CPAP or BIPAP therapy can actually cause your overnight breathing to get worse.
Your carbon dioxide levels may increase, which can cause morning headaches or confusion. Therefore, it is important that you treat your sleep apnea so that it’s safe to use oxygen for COPD.
Overlap syndrome makes it especially important for people with COPD to have a sleep test if sleep apnea is suspected.
Oxygen therapy may be added to CPAP or bilevel therapy if the oxygen levels remain low overnight for people whose lungs aren’t able to extract enough oxygen even when the airway is kept open.