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
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.
- 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.
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
- 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
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:
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).
- The throat muscles and tongue relax more than is normal.
- The tonsils and adenoids
- 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.
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:
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
- 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.
Signs and symptoms of
The most common signs of sleep apnea are:
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
- Loud snoring
- Choking or gasping during sleep
- Fighting sleepiness during the day (even at work or while driving)
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:
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.
- 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
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
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.
in activities or habits
If a person has mild sleep apnea, some changes in daily activities or habits
may be all that are needed:
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.
- 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.
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
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:
- Dry or stuffy nose
- Irritation of the skin on the face
- Bloating of the stomach
- Sore eyes
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.
- 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.
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:
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.
Some people with sleep apnea may benefit from surgery. The type of surgery
depends on the cause of the sleep apnea.
Other possible surgeries for some people with sleep apnea include:
- 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.
Currently, there are no medicines for the treatment of sleep apnea.
- Rebuilding the lower jaw
- Surgery on the nose
- Surgery to treat obesity
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
- 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:
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.
- 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
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.
Source: U.S. National Heart, Lung and Blood Institute