What is sleep apnea?

Did you know that sleep apnea is a common sleep disorder that can cause excessive snoring and daytime fatigue? If left untreated it can also lead to more serious health problems like heart disease. It is estimated that 5% of adults in the UK have undiagnosed sleep apnea, that is over 2.5 million people. In this post, we’ll discuss sleep apnea, the symptoms to look out for and how it’s treated. So if you’re curious about sleep apnea or want to learn more about it, keep reading.

There are three types of sleep apnea

• Obstructive
• Central
• Mixed (Complex Sleep Apnea Syndrome)

Obstructive sleep apnea (OSA) is the most common type and happens when there is a blockage in the airway. It is a condition characterised by pauses in breathing or shallow breaths during sleep. These pauses can last a few seconds to minutes and occur dozens, even hundreds of times throughout the night. They usually happen when the muscles supporting the soft tissues in the back of the throat such as your tongue and soft palate relax and collapse, temporarily blocking the airway. This can cause oxygen levels to drop and disrupt sleep. Typically, normal breathing then starts again with a loud snort or choking sound. People with obstructive sleep apnea often snore loudly and may choke or gasp during sleep.

Central sleep apnea is less common and happens when the airway is not blocked but the brain does not send signals to muscles that control breathing.

Mixed sleep apnea is a combination of both central and obstructive sleep apnea.

Symptoms of sleep apnea

Sleep apnea is a sleep disorder that causes pauses in breathing or shallow breaths while you sleep. Breathing pauses can last from a few seconds to minutes and cause sudden drops in blood oxygen levels. They may occur 30 times or more an hour. Sleep apnea usually is a chronic (ongoing) condition that disrupts your sleep. When your breathing pauses or becomes shallow, you’ll often move out of deep sleep and into a light sleep. As a result, your sleep quality is poor, making you tired during the day.

Daytime symptoms

• Daytime sleepiness and tiredness
• Morning headaches
• Difficulty concentrating
• Irritability
• Daytime fatigue
• Mood changes
• Memory problems
• Lack of energy
• Impaired judgment

Daytime symptoms can cause significant impairment in daytime functioning and quality of life. Daytime symptoms can also lead to social isolation and anxiety or depression. It can make it hard to stay awake while driving, working or watching television. You may find yourself falling asleep during these activities if you don’t get enough treatment for your sleep apnea. People with untreated sleep apnea are at higher risk for car accidents, work-related accidents and errors and industrial injuries. Tiredness can also lead to irritability and relationship problems.

Night time symptoms

• Loud snoring
• Snorting
• Dry mouth when you wake up

If you have trouble staying asleep at night because of frequent awakenings due to gasping or choking, it’s likely that your bed partner also has been affected by your snoring and restlessness.

Causes and risk factors of sleep apnea

It’s normal for the throat muscles and soft tissues in the mouth to relax and collapse somewhat while sleeping. For most people this doesn’t cause breathing problems.

In people with obstructive sleep apnea, the narrowed airway is the result of a number of factors, including:

• Large neck –  men with a collar size greater than roughly 43cm (17 inches) exerts more pressure on the throat muscles
• Large tonsils and adenoids – cause a narrower passage for breathing
• Menopause – changes in hormone levels can cause the throat muscles to relax more
• Family history – there could be a genetic link
• Obesity – excess weight around the stomach and neck leads to breathing problems
• Small lower jaw with an overbite – causes the throat to be abnormally narrow
• Nasal congestion e.g. nasal polyps or deviated septum
• Taking medicines with a sedative effect
• Age and sex – more commonly seen in males over 40 years of age

Diagnosis of sleep apnea

Sleep questionnaires

Take a look at the Epworth Sleepiness Scale test before you talk to your GP. It will help assess how likely it is that you fall asleep in everyday situations and also bear in mind not everyone with OSA actually feels sleepy all of the time. The test involves looking at eight situations and scoring each situation. Here are the situations and scales used:

Situations

• Sitting and reading
• Watching television
• Sitting inactive in a public place, e.g. theatre or meeting
• As a passenger in a car for an hour without a break
• Lying down in the afternoon, when circumstances permit
• Sitting and talking to someone
• Sitting quietly after lunch without alcohol
• In a car, while stopped for a few minutes in traffic

The scaling system:

0 = would never doze
1 = slight chance of dozing
2 = moderate chance of dozing
3 = high chance of dozing

If your results from this test show an increased risk this may lead your GP on different paths depending on how symptoms are experienced and treated. Some people find lifestyle changes work best while others need a referral to a sleep clinic and medical treatment.

Sleep clinic

At a sleep clinic a sleep specialist consultant and other staff, such as nurses and technicians will carry out a detailed assessment of you. They will:

• Take your height
• Take your weight
• Take your blood pressure
• Take your neck circumference (size)
• Measure your jaw size and position
• Discuss your medical history
• Discuss the quality and duration of your sleep
• Ask about family history
• Ask about your symptoms and how long you’ve had them
• Ask about the effect on your work and ability to concentrate and drive
• Ask if you smoke
• Ask for feedback from a family member

Once all the information is gathered you will be invited for a sleep study. A sleep study, also called a polysomnogram, is a test used to diagnose sleep disorders. It monitors what’s happening in your brain, heart, lungs and muscles while you sleep. The sleep sensors will be placed on your scalp, face and eyelids. These sensors record how you breathe during sleep as well as other important measurements such as heart rate or oxygen levels to help the healthcare team better understand how your body behaves during sleep.

One of the tests doctors use is the Apnea-Hypopnea Index (AHI), which calculates the average number of apneas (breathing stops) and hypopneas (shallow breathing) you experience each hour during sleep.

Sleep apnea treatment options

Lifestyle changes

The good news is that there are lifestyle changes that can help to reduce the symptoms of sleep apnea and promote better overall health. One of the most important changes is weight loss, if you are overweight. Excess weight can put pressure on the airway and make it more difficult to breathe during sleep.

Additionally, it is important to avoid drinking alcohol before bed and smoking. Both of these habits can exacerbate sleep apnea symptoms. Alcohol can relax the muscles in the throat, making it more likely for the airway to become blocked. Smoking can inflame the upper airway and make it more difficult to breathe.

Finally, sleep position can also play a role in sleep apnea. Sleeping on your back can allow the tongue and soft palate to collapse and block the airway. Sleeping on your side can help to prevent this from happening.

Making these changes can be difficult, but they can make a big difference in your quality of sleep and overall health. Talk to your doctor about what lifestyle changes would be best for you.

The goal of the treatment of OSA is to make sure airflow isn’t obstructed during sleep. If lifestyle changes are not enough the following treatment methods available are:

Continuous positive airway pressure (CPAP) machine

CPAP stands for continuous positive airway pressure. CPAP is a treatment that uses mild air pressure to keep your breathing passages open. The CPAP machine usually consists of three parts:

• A machine that blows air into a tube
• A mask or nasal interface that fits over your nose
• Straps that hold the mask in place

The CPAP machine pumps air through the tubing into the mask at a constant steady pressure. The positive pressure keeps your upper airway passages from collapsing, the air pressure is mild and is adjusted to your specific needs. A properly fitted CPAP mask forms an air seal with your face and prevents leaks. If you have a leaky CPAP mask, it can be uncomfortable and make the CPAP less effective in treating sleep apnea. You will be fully trained on how to use the CPAP machine to prevent these problems. A CPAP machine is about the size of a small lunchbox and runs quietly throughout the night. It is available for home use. Some can even be portable enough to take with you on trips.

CPAP therapy usually requires patience and consistency while using the machine every night. After starting CPAP therapy, people with sleep apnea often report feeling less sleepy during the day, having more energy and stamina and enjoying better moods and improved concentration. In addition to improving quality of life, CPAP therapy has been shown to reduce high blood pressure, improve heart health and decrease the risk of stroke.

Mandibular advancement

Another treatment option is a MAD, or Mandibular Advancement Device, an oral appliance that is worn during sleep to treat sleep apnea. The appliance holds the lower jaw in a forward position, thereby opening up the airway and allowing air to flow more freely. MADs are custom-fitted to each patient, they can be adjusted to provide different levels of jaw advancement. MADs are one of the most effective treatments for mild to moderate sleep apnea and can be a great alternative to CPAP therapy. They are also relatively small and portable, making them easy to take with you when you travel. If you are looking for an effective way to treat your sleep apnea, a MAD may be right for you. A dentist trained in dental sleep medicine will fit a MAD device for you.

Complications of untreated sleep apnea

People with untreated OSA are at increased risk for medical conditions. Sleep apnea is strongly linked to the following conditions:

• Heart disease
• Stroke
• High blood pressure (hypertension)
• Atrial fibrillation
• Heart failure
• Type 2 diabetes
• Heart attack
• Mood change or depression

Sleep apnea is different to regular snoring and can be a serious condition that affects your health. If you think you may have sleep apnea, speak to your healthcare professional for medical advice on how to treat it. There are many different treatment options available and a treatment plan that combines lifestyle changes with other therapies is often the most effective.

Sources

• Causes – NIH
• Sleep Foundation
• Sleep Apnea – NHS
• Obstructive sleep – BLF