Do you snore, or have a partner who does? Are you consistently sleepy during the day? I know it can be very annoying to try to sleep through loud snoring, but it may be more than just an inconvenience. Symptoms such as these can be an indication of a serious medical condition called Sleep Apnea. The complications of this illness can be life threatening, so perhaps it behooves us to learn more about it.
What is Sleep Apnea?
Sleep apnea is a serious sleep disorder that causes people to temporarily stop breathing multiple times throughout the night. It is the leading cause of daytime sleepiness, followed closely by narcolepsy, another major sleeping disorder. “Apnea” is from the Greek and means “without breath.” The interruptions of breathing associated with this disorder may occur as many as 400-500 times per night. No wonder people with this condition are sleepy during the day! Patients usually stop breathing for about 30 seconds, then awake with a start or a loud snort, and gradually fall back asleep.
There are two main types of sleep apnea: Obstructive sleep apnea (OSA) is the most common type, and is caused by part of the airway being closed off, usually the back of the throat. Central sleep apnea (CSA) occurs when the signals from the brain to the muscles that control breathing are disrupted. A combination of these two types is called complex sleep apnea. OSA is thought to affect anywhere from 1-10% of the adult population. The incidence of CSA is only about one-tenth of that. But these numbers may be deceiving. Many cases of sleep apnea are thought to go undiagnosed because people do not recognize that daytime sleepiness, the most common symptom of sleep apnea, is an indication of a medical condition. When apnea is diagnosed, it is often many years after the onset of symptoms. OSA can affect individuals of any age, but it is most often found in older adults, and is twice as common in males as in females. The highest risk group is middle-aged overweight men who use alcohol.
The socioeconomic consequences of sleep apnea are thought to be considerable. Needless to say, anybody who consistently does not sleep well at night cannot be nearly as productive as those who do get good sleep. Not only does sleep apnea make its victims tired from waking up so often, but the illness also keeps patients from spending enough time in the deeper stages of sleep that lead to rest and restoration of the body and its systems. Those who have sleep apnea are operating in a perpetual state of sleep deprivation. This is very damaging to both professional and interpersonal relationships, and can lead to even greater health problems down the road, as we will discuss in a moment. The potential for accidents is greatly increased as well. Studies have shown that sleepy drivers may be as dangerous on the road as those impaired by drugs or alcohol.
What Causes Sleep Apnea?
OSA occurs when the muscles near the back of the throat become abnormally relaxed during sleep. These muscles control the soft tissues of this region such as the tongue, tonsils, and the uvula (the triangular structure that hangs from the roof of your mouth). When you inhale while sleeping and these muscles are not working properly, the airway becomes blocked, and the oxygen levels in the blood temporarily drop. This sends a message to your brain, and results in a reflex that awakens you so that you can breathe normally. Patients often snort and gasp for breath for a few moments, and then go back to sleep. This can be a very brief process that may happen hundreds of times a night, and you may not even be aware of it. This is very disruptive to the sleep that the body needs to recharge its batteries every night. It can also be very disruptive to your partner!
CSA, a much less common condition, is caused by improper functioning of the neurons that control respiratory muscles. The reason these neurons malfunction is not well understood. It has something to do with the balance of carbon dioxide, a waste product of respiration, in the blood. When carbon dioxide levels are out of balance, the respiration rate is affected. While sleeping, CSA patients fluctuate between hyperventilating (respiration rates that are too high), and respiration rates that are too low (hypoventilation). This imbalance triggers the CSA symptoms and interrupts the sleep patterns of the patient. CSA is very common in people with cardiac disease.
What Are the Symptoms of Sleep Apnea?
Symptoms for OSA and CSA tend to overlap. A partner to observe sleep patterns is of great help. Some sleep apnea patients are aware of the problem, but some are not, and may even believe that they sleep well and don’t have a problem. Here is a list of the more common symptoms:
- Excessive daytime sleepiness (hypersomnia)
- Loud snoring: Often observed by the patient’s partner.
- Breathing cessation during sleep: The patient may be unaware of these, but his partner probably is not. Repeated episodes are common.
- Repeatedly waking up with a start, along with shortness of breath during these episodes.
- Never feeling rested after sleeping.
- Dry mouth or sore throat upon wakening.
- Morning headache: Due to low oxygen levels.
- Disorientation upon wakening: Also due to low oxygen levels.
- Profuse sweating during sleep (hyperhidrosis)
- Frequent urination at night
Some secondary symptoms may include:
- Rapid weight gain
- Personality changes
- Difficulty concentrating
- Reduced libido
What Are the Possible Complications of Sleep Apnea?
Sleep apnea is a major problem in its own right, but it can also lead to serious complications which may include:
- Cardiovascular problems: Sleep apnea patients can develop life-threatening conditions due mainly to consistent drops in the levels of blood oxygen (hypoxia or hypoxemia) while sleeping. Hypertension is the most common, and this increases the risk of heart disease and stroke. If an individual with sleep apnea has a co-existing heart condition, oxygen deprivation can lead to heart failure and sudden death. Even if high blood pressure is not caused by sleep apnea in a given individual, the risk for stroke is still increased just because of the presence of sleep apnea.
- Surgical complications: Any major surgery is risky, but that risk can be significantly increased by sleep apnea. Patients with sleep apnea are more likely to have complications and a tougher recovery from surgery due to breathing problems. Anesthesia is more of a challenge with sleep apnea patients because they are sedated and lying on their backs. If you must have surgery, be absolutely sure to inform the doctor of your sleep apnea.
What Are the Risk Factors for Sleep Apnea?
Sleep apnea may strike anyone, but if certain factors are present, your risk is increased:
- Obesity: Overweight people may have excess fat deposits in the area of their airways that can obstruct breathing.
- Narrow airway: Some folks are born with a naturally narrow throat, or some may have unusually large tonsils or adenoids. Any of these factors can increase the risk of sleep apnea.
- Gender: Men are twice as likely to get sleep apnea as women. The risk for ladies rises after menopause and if they are overweight.
- Neck size: An unusually large or thick neck can increase risk by narrowing the airway. If your neck circumference is over 17 inches, you are at a higher risk.
- Smoking: Smokers greatly increase their risk of sleep apnea. This is due to increased inflammation and fluid retention in the airway. The good news is that if you quit smoking, your risk will return to normal.
- Alcohol or tranquilizer use: Use of these substances causes the muscles of the throat to relax and shrink the airway during sleep.
- Age: Those over the age of 65 have 2-3 times greater risk than younger folks.
- Hypertension: If you have high blood pressure, your risk is also increased.
- Family history: If you have a family member with sleep apnea, your risk is slightly increased for getting it yourself.
The following factors only apply to CSA:
- Gender: Men are likely to get CSA than women.
- Neuromuscular disorders: Certain conditions can increase risk by affecting the breathing functions of the central nervous system. These include: muscular dystrophy, amyotrophic lateral sclerosis (Lou Gehrig’s disease), and spinal chord injuries.
- Strokes or brain tumors: These can interfere with the brain’s ability to control breathing functions.
- Heart conditions: Atrial fibrillation (irregular heartbeat) or congestive heart failure can interfere with normal breathing and increase risk for CSA.
- High altitude: Sleeping at an altitude that is higher than you are normally used to can increase risk.
What Treatments Are Available for Sleep Apnea?
The most successful treatment for most people who suffer from sleep apnea is called continuous positive airway pressure (CPAP). This is a machine that delivers air pressure into your airway as you sleep. It involves the use of a mask on your face, and the principle behind it is that if the air pressure in your body can be manipulated so that it is slightly greater than the surrounding air outside your body, the airway will more easily stay open. Most patients find considerable improvements in their symptoms by using CPAP, or SEE-pap, as it is affectionately called by some. They snore less and sleep more soundly. Their partners love it too!
The best thing about SEE-pap is that it is non-invasive and has no known side effects. Some patients have a bit of a hard time getting used to sleeping with it on, but this most often can be handled by trying different types of masks until you find one that you like. The tension of the mask can also be adjusted to your liking. Some folks also prefer to use a humidifier along with the SEE-pap.
Another non-invasive option is to wear an oral appliance that is designed to keep your throat and airway open while you sleep. These are not generally as effective as SEE-pap, but some people prefer them, and they are much more economical if you must purchase out of pocket. There are numerous types available. This is usually an item that can be purchased from your dentist.