Sleep Apnea
Concerned You May Have Sleep Apnea?
If you are concerned you may have sleep apnea, take our brief five question screening questionnaire, and learn what your options are.
Topics
| Causes of Obstructive Sleep Apnea | Who is at risk for sleep apnea? |
| Central Apnea | Diagnosis of Sleep Apnea |
| Sleep Apnea Symptoms | Treatment of Sleep Apnea |
| Sleep Apnea in Children |
The word “apnea” is a medical term
referring to a pause in breathing. Many
people who snore regularly will have a
few apneas, or breathing pauses,
throughout the night. However, the
disorder of sleep apnea occurs when
repetitive and recurrent apneas happen
during sleep.
Most people with sleep apnea stop breathing 10 to 60 times or more every hour. These breathing pauses usually last 10 to 20 seconds at a time before breathing resumes.
Causes of Obstructive Sleep Apnea
 |
Obstructed airway |
 |
Open airway |
Muscles in the back of our throats cause the air passage to close when we swallow. When we breathe, other muscles tighten up and prevent the air passage from closing. During sleep, all of the muscles in the back of the throat relax and the air passage becomes smaller than when we are awake.
For
those with a smaller air passage due to anatomical factors
such as enlarged tonsils, a big tongue, excessive fat tissue, or
a small or short jaw, the air passage may become narrowed
and relaxed enough during sleep that it will actually collapse
shut when the person takes a breath. This collapse of the air
passage causes obstructive apnea, the most common form
of sleep apnea. Even though the person’s chest and
diaphragm muscles are still working to breathe, no air can
flow through the closed air passage.
Whenever the air passage closes, powerful “alarm systems” are activated in the brain, causing it to shift from sleep to waking very briefly. This shift is sufficient for waking muscle tone to return to the air passage and the airway opens up again. As soon as the air starts to flow, the brain goes immediately back to sleep and the cycle repeats itself throughout the night. The awakening episodes are so brief that the sleeping person is usually unaware of them. Nonetheless, if this cycle repeats itself frequently throughout the night, it can cause enough disruption to sleep that the person may experience sleepiness during the day, a common symptom of sleep apnea.
Central Apnea: A Less Common Form of Sleep Apnea
A much less common form of sleep apnea is called central apnea. Normally during sleep, the brain sends a regular, repeating signal to all of the breathing muscles to take a breath. In central apnea, the brain’s signal to breathe pauses and as a result the sleeping person’s breathing also pauses.
Central apnea is most commonly seen in people:
- Taking medications that suppress the brain’s central breathing signal (narcotics, high doses of sleeping pills or sedatives, overdoses of some medications)
- With disorders causing significant muscle weakness
- With congestive heart failure
Individuals suffering from sleep apnea may be completely
unaware that they have this problem because their apneas
may not fully wake them up and/or the arousals are too brief
to be remembered. Often, family members and bed partners
are the ones who recognize the problem because they witness the episodes of loud snoring separated by silence
due to breathing pauses.
Common symptoms of sleep apnea are:
- Loud snoring with snorts or gasps
- Periods of not breathing (apneas) in sleep
- Significant daytime sleepiness, drowsiness or pervasive fatigue despite sufficient time spent sleeping
- Awakening feeling poorly rested in the morning
- Morning headaches, memory problems and attention problems
- Mood irritability
In children, symptoms of sleep apnea can be quite different and may include:
- Hyperactivity
- Poor school performance
- Tendency to sleep with the head and neck bent towards the back
- “Hard breathing” in sleep
- Returning to bed wetting after having been “dry” for a long time
- Restless or sweating during sleep
Who is at risk for sleep apnea?
In adults, certain physical features or body types can make a person more likely to have sleep apnea. Those with a small lower jaw, prominent overbite, obesity, significant weight gain in recent years, a short, large neck (over 18 inches in men and over 16 inches in women), nasal breathing obstruction and/or very crowded teeth often have a smaller air passage in the back of the throat.
Are you at risk of sleep apnea? Take our brief sleep apnea questionnaire to find out.
In children, large tonsils and prominent nasal allergies are the most common risk factors for sleep apnea. Obesity increases the risk for sleep apnea in children as well. People with Down’s Syndrome, facial deformities causing a small face or air passage, or disorders causing muscular weakness have an increased risk for both obstructive and central sleep apnea.
If you think you might have sleep apnea, begin by discussing
the possibility of sleep apnea with your doctor. Your doctor
should gather information about your sleep patterns, sleep
quality, family history of sleep apnea, weight gain and daytime
sleepiness.
An exam should be performed to determine features of the neck, nose and throat that may indicate a narrowing of the air passage. An overnight test in a sleep laboratory is usually necessary to make the diagnosis of sleep apnea.
The goal of treatment for obstructive sleep apnea is to keep the air passage open during sleep. Anything that causes muscles to be more relaxed during sleep or make it difficult to awaken can worsen sleep apnea.
For that reason, anyone with sleep apnea should avoid alcohol, sleeping pills, sedatives or narcotics for several hours before bedtime. In many cases, individuals who are overweight and have sleep apnea can completely resolve apnea through weight loss.
Surgery on the throat to remove excessive tissue (uvulopalatoplasty), tonsils and adenoids is not often performed in adults because the success rate for treating sleep apnea with surgery is not very high. In children, however, removal of the tonsils and adenoids is more effective, and is the most common treatment for sleep apnea. Consistent and effective treatment of nasal allergies is also necessary when treating apnea in children or adults.
An oral appliance or a type of “mouthpiece” is sometimes used to treat sleep apnea. The mouthpiece is worn during sleep to hold the lower jaw and tongue forward and away from the back of the throat to enlarge the air passage. The success of this treatment is unpredictable and people using oral appliances for apnea need to be re-tested periodically to determine the effectiveness of the therapy.
CPAP (constant positive airway pressure) is the most common
and the most effective way to control sleep apnea in the
vast majority of people who suffer from it. A CPAP device is
essentially a small air pump. During sleep, the person wears a
small mask or nostril piece connected to the CPAP machine
by thin, flexible tubing. A gentle flow of air is sent from the
machine through the nose to the back of the throat. This air
acts like an “air stent” to hold the air passage open during
sleep.
This device is usually very effective in preventing snoring
as well as controlling apnea in most people who use it.
Other types of positive airway pressure (PAP) machines
include auto-PAP, BiPAP (bilevel PAP) and ASV (adaptive
servoventilation) machines. These are used in a small
percentage of patients with sleep apnea for very specific
reasons. A sleep specialist can determine what type of
PAP machine is best.
