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sleep apnea

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What causes sleep apnea?

Living with sleep apnea

Sleep apnea is a common disorder that can be very serious. In sleep apnea, a person's breathing stops or gets very shallow while he or she is sleeping. Each pause in breathing typically lasts 10 to 20 seconds or more. These pauses can occur 20 to 30 times or more an hour.

The most common type of sleep apnea is obstructive sleep apnea. During sleep, enough air cannot flow into the lungs through the mouth and nose even though a person tries to breathe. When this happens, the amount of oxygen in the blood may drop. Normal breaths then start again with a loud snort or choking sound.

When sleep is upset throughout the night, a person can be very sleepy during the day. With sleep apnea, sleep is not restful because:

These brief episodes of increased airway resistance (and breathing pauses) occur many times.
There may be many brief drops in the oxygen levels in the blood.
A person may move out of deep sleep and into light sleep several times during the night, resulting in poor sleep quality.

People with sleep apnea often have loud snoring. However, not everyone who snores has sleep apnea. Some people with sleep apnea don't know they snore.

Sleep apnea happens more often in people who are overweight, but even thin people can have it.
Most people don't know they have sleep apnea. They don't know that they are having problems breathing while they are sleeping.
A family member and/or bed partner may notice the signs of sleep apnea first.

Untreated sleep apnea can increase the chance of having high blood pressure and even a heart attack or stroke. Untreated sleep apnea can also increase the risk of diabetes and the risk for work-related accidents and driving accidents.

What causes sleep apnea?

Sleep apnea happens when enough air cannot move into the lungs while a person are sleeping. When a person is awake, and normally during sleep, the throat muscles keep the throat open and air flows into the lungs. In obstructive sleep apnea, however, the throat briefly collapses, causing pauses in breathing. With pauses in breathing, the oxygen level in the blood may drop. This happens if the following conditions occur:

The throat muscles and tongue relax more than is normal.
The tonsils and adenoids are large.
A person is overweight. The extra soft tissue in the throat makes it harder to keep the throat area open.
The shape of the head and neck (bony structure) results in somewhat smaller airway size in the mouth and throat area.

With the throat frequently fully or partly blocked during sleep, enough air cannot flow into the lungs, even though a person's efforts to breathe continue. Breathing may become hard and noisy and may even stop for short periods of time (apneas).

Central apnea is a rare type of sleep apnea that happens when the area of the brain that controls breathing doesn't send the correct signals to the breathing muscles. Then there is no effort to breathe at all for brief periods. Snoring does not typically occur in central apnea.

Who is at risk for obstructive sleep apnea?

Anyone can have obstructive sleep apnea.

It is estimated that more than 12 million Americans have obstructive sleep apnea. More than half the people who have sleep apnea are overweight, and most snore heavily.

Sleep apnea is more common in men. One out of 25 middle-aged men and 1 out of 50 middle-aged women have sleep apnea that causes them to be very sleepy during the day. Sleep apnea is more common in African Americans, Hispanics, and Pacific Islanders than in Caucasians. If a family member has sleep apnea, a person is more likely to develop it than someone without a family history of the condition.

Adults who are most likely to have sleep apnea:

Snore loudly.
Are overweight.
Have high blood pressure.
Have a decreased size of the airways in their nose, throat, or mouth. This can be caused by the shape of these structures or by medical conditions causing congestion in these areas, such as hay fever or other allergies.
Have a family history of sleep apnea.

Obstructive sleep apnea can also occur in children who snore. If a child snores, this should be discussed with the child's doctor or health care provider.

Signs and symptoms of sleep apnea

The most common signs of sleep apnea are:

Loud snoring
Choking or gasping during sleep
Fighting sleepiness during the day (even at work or while driving)

Family members may notice the symptoms before a sufferer does. Otherwise, a person would not likely be aware that he or she had problems breathing during asleep.

Others signs of sleep apnea may include:

Morning headaches
Memory or learning problems
Feeling irritable
Not being able to concentrate on work
Mood swings or personality changes; perhaps feeling depressed
Dry throat upon wakening
Frequent urination at night

Diagnosis of sleep apnea

A doctor will do a physical exam and take a medical history that includes asking a person and family members questions about how the individual sleeps and functions during the day. As part of the exam, the doctor will check the patient's mouth, nose, and throat for extra or large tissues; for example, tonsils, uvula (the tissue that hangs from the middle of the back of the mouth), and soft palate (the roof of the mouth in the back of the throat).

A doctor may order a sleep recording of what happens with a person's breathing while he or she is sleep. A sleep recording is a test that is often done in a sleep center or sleep laboratory, which may be part of a hospital. An individual may stay overnight in the sleep center, although sleep studies are sometimes done in the home. The most common sleep recording used to find out if a person haa sleep apnea is called a polysomnogram, or PSG. This test records:

Brain activity
Eye movement
Muscle activity
Breathing and heart rate
How much air moves in and out of the lungs during periods of sleep
The percentage of oxygen in the blood

A PSG is painless. A person goes to sleep as usual. The staff at the sleep center will monitor his or her sleep throughout the night. The results of the PSG will be analyzed by a sleep medicine specialist to see if an individual has sleep apnea, how severe it is, and what treatment may be recommended.

In certain circumstances, the PSG can be done at home. A home monitor can be used to record a person's heart rate, how air moves in and out of the lungs, the amount of oxygen in the blood, and the person's breathing effort. For this test, a technician will come to the person's home and help him or her apply the monitor that will be worn overnight. The person will go to sleep as usual, and the technician will come back the next morning to get the monitor and send the results to the doctor.

Once all the tests are completed, the sleep medicine specialist will review the results and work with the person and his or her family to develop a treatment plan. In some cases, the patient may also need to see another physician for evaluation of:

Lung problems (treated by a pulmonologist)
Problems with the brain or nerves (treated by a neurologist)
Heart or blood pressure problems (treated by a cardiologist)
Ear, nose, or throat problems (treated by an ENT specialist)
Mental health, such as anxiety or depression (treated by a psychologist or psychiatrist)

Treatment of sleep apnea

Treatment is aimed at restoring regular nighttime breathing and relieving symptoms such as very loud snoring and daytime sleepiness. Treatment will also help associated medical problems, such as high blood pressure, and reduce the risk for heart attack and stroke.

Changes in activities or habits

If a person has mild sleep apnea, some changes in daily activities or habits may be all that are needed:

Avoiding alcohol, smoking, and medicines that cause sleepiness. They make it harder for the throat to stay open during sleep.
Losing weight if a person isoverweight. Even a little weight loss can improve the symptoms.
Sleeping on the side instead of the back. Sleeping on the side may help keep the throat open.

People with moderate or severe sleep apnea will need to make these changes as well. They also will need other treatments, such as the following.

Continuous positive airway pressure

Continuous positive airway pressure (CPAP) is the most common treatment for sleep apnea. For this treatment, the patient wears a mask over his or her nose during sleep. The mask blows air into the throat at a pressure level that is right for the individual. The increased airway pressure keeps the throat open during sleep. The air pressure is adjusted so that it is just enough to stop the airways from briefly getting too small during sleep.

Treating sleep apnea may help a person stop snoring. Stopping snoring does not mean that an individual no longer has sleep apnea or that he or she can stop using CPAP.

Sleep apnea will return if CPAP is stopped or if it is not used correctly. Usually, a technician comes to the individual's home to bring the CPAP equipment. The technician will set up the CPAP machine and make adjustments based on the doctor's orders.

CPAP treatment may cause side effects in some people. Some side effects are:

Dry or stuffy nose
Irritation of the skin on the face
Bloating of the stomach
Sore eyes
Headaches

A person having trouble with CPAP side effects, work with his or her sleep medicine specialist and technician. Together things can be done to reduce these side effects, such as:

Using a nasal spray to relieve a dry, stuffy, or runny nose.
Adjusting the CPAP settings.
Adjusting the size/fit of the mask.
Adding moisture to the air as it flows through the mask.
Using a CPAP machine that can automatically adjust the amount of air pressure to the level that is required to keep the airway open.
Using a CPAP machine that will start with a low air pressure and slowly increase the air pressure as a person falls asleep.

People with severe sleep apnea symptoms generally feel much better once they begin treatment with CPAP. When using CPAP, it is very important that a person follows up with his or her doctor. Any side effects should be brought to the doctor's attention.

Mouthpiece

A mouthpiece (oral appliance) may be helpful in some people with mild sleep apnea. Some doctors may also recommend this if a person snores loudly but does not have sleep apnea.

A custom-fit plastic mouthpiece will be made by a dentist or orthodontist. An orthodontist is a specialist in correcting teeth or jaw problems. The mouthpiece will adjust a person's lower jaw and tongue to help keep the airway in the throat open during sleep. Air can then flow easily into the lungs because there is less resistance to breathing.

Possible side effects of the mouthpiece include damage to a person's:

Teeth
Gums
Jaw

A patient should follow up with his or her dentist or orthodontist to check for any side effects and to be sure that the mouthpiece fits.

Surgery

Some people with sleep apnea may benefit from surgery. The type of surgery depends on the cause of the sleep apnea.

Surgery may be done to remove the tonsils and adenoids if they are blocking the airway. This surgery is especially helpful for children. Uvulopalatopharyngoplasty (UPPP) is a surgery that removes the tonsils, uvula (the tissue that hangs from the middle of the back of the roof of the mouth), and part of your soft palate. This surgery is only effective for some people with sleep apnea.

Laser-assisted uvulopalatoplasty (LAUP) is a surgery that can stop snoring but is probably not helpful in treating sleep apnea. A laser device is used to remove the uvula and part of the soft palate. Because this surgery stops the main symptom of sleep apnea (snoring), it is important to have a sleep study first.

Tracheostomy is a surgery used in severe sleep apnea. A small hole is made in the windpipe and a tube is inserted. Air will flow through the tube and into the lungs. This surgery is very successful but is needed only in patients not responding to all other possible treatments.

Other possible surgeries for some people with sleep apnea include:

Rebuilding the lower jaw
Surgery on the nose
Surgery to treat obesity

Currently, there are no medicines for the treatment of sleep apnea.

Living with sleep apnea

Getting treatment for sleep apnea and following a doctor's advice can help a sufferer and his or her family members.

Getting treatment for sleep apnea can help snoring and can improve sleep.
Treating sleep apnea helps a person feel rested during the day.
Many people will benefit by making healthy changes, such as stopping smoking and losing weight.
Some people will need to wear a mask at night to help keep the throat open and improve breathing.
A few people will need to have surgery to remove tonsils and adenoids, part of the uvula, and/or the soft palate that may block the airway.
Regular and ongoing followup is needed; a sleep medicine specialist will check whether a person's treatment is working and whether he or she is having any side effects.

What family can do to help

Often, people with sleep apnea do not know they have it. They are not aware that their breathing stops and starts many times while they are sleeping. Family members or bed partners are usually the first ones to notice that the person snores and stops breathing while sleeping.

There are many things family members can do to help a loved one who has sleep apnea, including:

Letting the person know if he or she snores loudly during sleep or has breathing stops and starts
Encouraging the person to get medical help
Helping the person follow the doctor's treatment plan, including continuous positive airway pressure (CPAP)
Making sure the person puts on the CPAP mask before falling asleep
Providing emotional support
Helping with insurance paperwork

Sleep apnea can be very serious. People with sleep apnea are at higher risk for car crashes, work-related accidents, and other medical problems due to their sleepiness. It is important that people with sleep apnea see their doctor to treat and control this disorder.

Treatment may improve a person's overall health and happiness as well as the quality of sleep for both the person and the entire family.

Related category

• HEALTH AND DISEASE

Source: U.S. National Heart, Lung and Blood Institute

Also on this site:

Encyclopedia of Alternative Energy & Sustainable Living
Encyclopedia of History

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