What is Sleep Apnea?

Sleep apnea is a condition where momentary lapses in breathing occur due to the throat relaxing too much during sleep and blocking the airway. Those who have sleep apnea may not be aware they have the disorder as they usually feel like they slept through the night. Common symptoms are snoring (not everyone who snores has sleep apnea) or choking or waking gasping for air.

There are three primary forms of sleep apnea:

• Obstructive sleep apnea: The most common form of the sleep apnea results from the relaxation of the throat muscles, leading to air flow blockage. 
• Central sleep apnea: Central sleep apnea occurs when the brain fails to properly regulate respiratory muscle movement, causing the body to “forget” to breathe during sleep.
• Complex sleep apnea syndrome: This form of sleep apnea is a combination of the other two.

Sleep Apnea Symptoms

The most common symptom of sleep apnea happen during sleep so it is important to notice symptoms during wake times that could point to a sleep apnea diagnosis.

Obstructive and central sleep apnea have many of the same symptoms. Among the most frequent are:

• Holding one’s breath during sleep
• Waking suddenly from sleep, gasping for breath
• Insomnia
• Extensive sweating during sleep
• Morning headaches or dry mouth
• Excessive sleepiness or fatigue during the day
• Irritability
• Forgetfulness or difficulty concentrating
• Decreased sex drive or impotence

In addition to the symptoms above you may be able to determine if you need to see a sleep specialist by using the Epworth Sleepiness Scale or the Stop-BANG.

Diagnosis

A diagnosis can be made once a sleep specialist at Baptist Health takes a detailed sleep history, records your reported symptoms and a sleep study can be performed. Since pauses in breathing are central to the diagnosis of sleep apnea it is important to see a sleep specialist so you can have a study done in the sleep lab or at home. Polysomnography happens during the lab sleep study to monitor your breathing, heart and lungs, movements, brain waves for sleep stages and oxygen levels.

Your sleep specialist may also use the Epworth Sleepiness Scale and/or Stop-BANG assessments to aid in diagnosis.

Risk Factors and Causes of Sleep Apnea

While the cause of sleep apnea is typically from a loosening of the muscles surrounding the throat and soft pallet, there is not much you can do to prevent from developing sleep apnea. When the areas surrounding the throat and mouth (uvula, tonsils, tongue, etc.) relax too much, they close in on the airways and prevent breathing momentarily. Your brain senses the lapse in breathing and rouses you from sleep to open the airway.

Obstructive sleep apnea occurs when the soft muscles of the body’s throat cavity collapse during sleep, obstructing air movement in and out of the body. The blood’s reduced oxygen level triggers a reaction in the brain, which rouses the sleeper to resume normal breathing. These brief interruptions of sleep, which may occur two dozen or more times a night, are usually accompanied by gasping, snorting, or choking. 

A number of other factors, inherited and environmental, increase the risk of developing obstructive sleep apnea:

• Nasal congestion
• Being male
• Being older
• Obesity
• Smoking
• Use of alcohol or sedatives
• Related conditions of narrow airways and thick neck circumference
• A family history of sleep apnea

Central sleep apnea results from faulty communication between the brain and the body’s breathing muscles. This leads to regular episodes of breath stoppage, waking, and difficulty in sleeping for more than brief periods. Additional risk factors for central sleep apnea include:

• Being male
• Being older
• Heart disorders
• Stroke
• Using opioids or other narcotic medications

Prevention

While there is no way to prevent the muscles in your throat and mouth from relaxing too much, there are some risk factors that can help you determine your risk for sleep apnea and seek treatment earlier in the disorder for maximum symptom control.

You are more likely to have sleep apnea if you:

• Are a smoker.
• Are male.
• Have a neck circumference of more than 17 inches for men and more than 15 inches for women.
• Drink alcohol.
• Are overweight.
• Have a deviated septum or other nasal congestion issues.

Prognosis

Prognosis for those who have sleep apnea is positive. There are treatments that can alleviate symptoms and lead to better sleep, including, dental appliances, therapies and CPAP machines. In rare cases surgery may be required to treat sleep apnea but are determined on a case by case basis. Most patients are able to continue enjoying their normal activities and find once they are better able to sleep with treatment they have a higher quality of life.

Effects of Snoring and Sleep Apnea 

Snoring results from the partial collapse of the upper airway as the muscles that normally keep the airway open relax during sleep. These collapsed tissues interfere with airflow and vibrate generating the noise we call snoring.

Snoring:

• Worsens with age, as these muscles become more flaccid
• Worsens with significant weight gains that result in fat deposits in the upper airway
• Worsens with fatigue, as the muscles may relax further
• Worsens with alcohol and some sleeping pills and analgesics
• Can result in daytime fatigue
• Causes sleep deprivation for your bed partner

Sleep apnea is serious and occurs when the airway collapses completely until enough effort is made breathing to overcome the resistance of the closed-off airway. The smaller or more swollen the airway, the more severe the apnea. Thirty million Americans have obstructive sleep apnea.

Patients with sleep apnea are:

• Two times more likely to have hypertension
• Three times more likely to have a heart attack
• Four times more likely to have a stroke
• Five times more likely to be involved in a car accident

Untreated sleep apnea may worsen:

• Diabetes mellitus, in patients with hypertension
• Open angle glaucoma
• Congestive heart failure

In addition, unrecognized obstructive sleep apnea can complicate recovery after surgery.

Treatments for Sleep Apnea

There are a variety of options for treating sleep apnea, ranging from lifestyle changes to more serious forms of medical intervention. These include:

Therapies

• Continuous positive airway pressure (CPAP): CPAP is a three-part device, including a mask, hose, and flow generator, that improves nighttime breathing by increasing the air pressure entering the throat cavity.
• CPAP alternatives: Alternative technologies, including auto-CPAP and bilevel positive airway pressure (BPAP), are available for sleep-apnea patients who are uncomfortable with the standard CPAP device. 
• Oral appliances: There are other, less complicated devices for opening the throat cavity during sleep but they may not be as medically effective as CPAP.

Surgery

• Tissue removal or shrinkage: Surgical procedures exist for reducing oral and throat tissues, utilizing surgical incisions or radiofrequency energy.
• Jaw repositioning: The jaw is moved forward surgically relative to other bones in the face, decreasing the possibility of an obstructed airway.
• Nerve stimulation: An electronic device is inserted to increase tongue movement. 
• Implants: Plastic rods are inserted in the soft palate. 
• Tracheostomy: A tracheostomy is the surgical creation of an alternative breathing passage, typically through a metal tube in the neck. This is the most extreme form of surgery, and is only used in those situations where sleep apnea has become life-threatening.

Lifestyle changes

• Smoking cessation
• Weight loss through exercise and diet
• New sleeping position (side or stomach rather than back)
• No alcohol, tranquilizers, or sleeping pills before bedtime

Appointments can be made to speak with any of our physicians by calling the sleep center, however you may need a referral to have a study or other tests performed, which can be obtained from your primary care physician.

Learn More About Obstructive Sleep Apnea from Baptist Health

Obstructive sleep apnea can be conquered. Start by scheduling an appointment with a Baptist Health primary care or sleep specialist today.