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:
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.
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:
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:
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:
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:
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.
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:
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:
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:
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:
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.
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:
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.
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.
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.