What is Sleep Apnea and How to Treat It
Snoring is no fun for anyone; not the snorer or their partner. But did you know that snoring is sometimes caused by a more serious sleep disorder?
Sleep apnea can be detrimental to our health. So all that snoring you’ve been doing could be dangerous without even realizing it! Yet, by understanding the disorder and the risks it entails, we can figure out how to diagnose it, control it and treat it.
You might have heard of this disorder before, but what exactly is sleep apnea?
In a broad sense, it refers to the blockage of the throat during sleep. This is also the base cause of snoring, but what differentiates the two is that snorers continue to breathe (albeit loudly!)
Sleep apnea causes sufferers to stop breathing for short periods of time. The body notices the lack of oxygen and sends signals to the brain to wake the sleeper up, to breathe again.
These waking periods happen in short bursts and the sleeper is often unaware that they have woken up, even several times during the night.
Restricted oxygen to the body can be dangerous, especially when sufferers have no control while they’re unconscious. That’s why it’s important to understand the risk factors associated with this disease and how to treat it.
We will outline all the information you might need if you think that you are suffering from sleep apnea and the effects that it can have on your health.
COIVD-19 Update: It is unclear if there is an increased risk to people who have sleep apnea. A new study from the University of Warwick showed that there may be increase risk in the form of adverse outcomes from COVID-19. We will update this article as more research becomes available.
Types of Sleep Apnea
There are three different types of sleep apnea: obstructive, central, and complex. The latter is a combination of the first two. It’s not always easy to tell which type of sleep apnea you have because the symptoms and effects are the same in most cases. It is usually at the moment of diagnosis that it will become clear.
- Obstructive Sleep Apnea
This is the most common type of the disorder and is detrimental to physical and mental health. This type of sleep apnea happens when the muscles in the throat relax too much and cannot support a regular breathing pattern. These muscles, which support the jaw, tongue, and nasal passages, can also collapse, leading to a blockage in the throat.
The American Association of Oral and Maxillofacial Surgeons defines OSA by the number of times you stop breathing and how long these episodes last.
For a breathing issue to be classified as OSA, the patient needs to have at least 30 apneas in a seven-hour period. But, they also note that in severe cases, these episodes can last from 60-90 seconds and occur up to 500 times per night.
- Central Sleep Apnea
Where a blockage of the airways causes OSA, it’s the brain’s failure to send signals to the muscles in the throat and mouth which causes central sleep apnea. With these signals missing, the muscles fail to carry out the correct movements to help you breathe. Consequently, carbon dioxide builds up and there is a lack of oxygen in the blood. Usually, the body will notice these dangerous levels and trigger a response. This can mean that rather than just gasping, the sufferer will begin breathing rapidly. In the case of OSA, the person’s throat becomes blocked and the brain will react to the lack of normal movement. But a CSA sufferer’s brain won’t trigger a normal response when they stop breathing. The body relies on other signals in the latter case to resume breathing.
- Complex Sleep Apnea Syndrome
As mentioned, this type of sleep apnea is a combination of the first two. It’s caused by the collapse of throat muscles and the failure to send signals to those muscles to expand and contract. This type of sleep apnea is often detected when the patient receives treatment for OSA and the issue is still present.
What Causes Sleep Apnea?
The risk factors that lead to sleep apnea can be classified as naturally occurring factors and lifestyle decisions. Unfortunately, there will be no quick fix to change your DNA, but the changes that you make in your daily life can lessen the severity of sleep apnea.
It probably won’t be surprising to know that middle-aged, overweight men are most at risk of developing sleep apnea. That’s not to say that younger people, women, or those with a lower BMI can’t have the disorder. It means that certain factors can increase your disposition.
The Berger Henry ENT Specialist Group reports that 9% of middle-aged women are sufferers in the US, compared to 25% of middle-aged men.
It may surprise you to learn that, according to Berger Henry, African Americans are also more likely to be sufferers than Caucasians.
Other physical factors that exacerbate sleep apnea, and can affect any demographic, are a large tongue or tonsils and a small jaw bone. But one of the major complaints with regards to our physical form is a deviated septum. Our septum stays central throughout childhood but will usually move slightly to the right as we get older. The ‘deviation’ comes from an extreme displacement due to genetics or physical pressure to the face.
Besides this, there are easy to treat health complaints that can trigger sleep apnea such as acid reflux, heartburn, and nasal obstruction due to allergies or sinus issues. It’s possible to keep all these complaints under control with over the counter medication.
Then there are the choices we make in our daily lives that can affect our health. We know that smoking, eating junk food, leading a sedentary lifestyle, and drinking alcohol in excess are all bad for us. But these choices also impact our breathing health. In this article, we outlined the ways that unhealthy lifestyle choices can provoke snoring. The same factors can bring on sleep apnea as the basic mechanics are the same as snoring.
Signs You May Be Suffering From Sleep Apnea
Symptoms of sleep apnea make it a difficult condition to diagnose because they are also symptoms of other disorders. Or we simply blame snoring, when snoring itself is a symptom rather than the cause. These are some of the common symptoms of sleep apnea. It may be worth consulting a specialist if you’re suffering from the majority of these problems.
- Snoring: the American Sleep Apnea Association reports that while not all snorers have sleep apnea, almost all sleep apnea sufferers snore. It’s common for people who are affected by sleep apnea to have prolonged, loud bouts of snoring. If your snoring is keeping up everyone in the house then it may be time to investigate.
- Gasping for air while you sleep: this is a tough one to know by yourself; usually, you would rely on a partner to spot this behavior. However, if you are aware that you sometimes end up choking on air in the middle of the night, this is a good indication that you’re suffering from sleep apnea.
- Dry mouth and headache upon waking: with all the gasping for air, sufferers will often wake up with a dry mouth. Likewise, people will develop headaches from the prolonged periods of oxygen deprivation.
- Tiredness throughout the day: even though it seems like you slept well, waking up several times each night is disruptive. You can also miss out on important sleep cycles. If you seem to be getting the recommended amount of shut-eye each night, but you feel tired throughout the day, this could be why.
- Cognitive complaints: including a reduction in attention span, concentration, and motor skills. Reduced cognitive abilities are a residual effect of tiredness.
- Mental health: lack of sleep can provoke the deterioration of mental health. In turn contributing to the onset of depression, anxiety, and even behavioral disorders.
While one or two of these symptoms may be the result of any number of disorders, a combination of them could point to sleep apnea. If you’re showing these specific symptoms, you should always consult a medical professional. Let them know the full extent of your complaints and they will be able to advise you on the next steps.
Overall Effects on Your Health
Health conditions that can be caused or worsened by sleep apnea are not to be taken lightly. Ranging from treatable conditions to lifelong diseases, sleep apnea is a dangerous disorder to leave untreated. Sleep apnea can contribute to the development of the following:
- Issues with the metabolism such as diabetes
- Heart diseases: atrial fibrillation, heart attacks, and heart failure. In fact, this John’s Hopkins study recently produced more evidence for a direct link between sleep apnea, metabolic and heart diseases.
- Blood disorders including high blood pressure, atherosclerosis, and stroke.
- Cancers of the pancreas, skin, and kidneys.
- Kidney and liver disease.
- Issues with the eyes such as glaucoma.
- Respiratory problems including asthma.
- Complications during pregnancy from gestational diabetes to high blood pressure.
- A weakened immune system; because the sufferer is tired all the time, the body finds it difficult to fight off bacteria. This means that there is a prevalence of cold, flu, and infections with sufferers.
As mentioned earlier, sleep apnea can affect our mental health and cognitive abilities too. While these issues are sleep apnea symptoms, we should consider the serious implications that they can have on our emotional and physical wellbeing.
- Cognitive issues
The combination of exhaustion and low levels of oxygen in the bloodstream can lead to impaired cognitive functions. Actions that are usually second nature to us become complicated. This includes a decrease in concentration, attention span, motor abilities, spatial awareness, and even language. Sleep apnea has also been linked to dementia. Psychology Today reports that one study showed a positive correlation between severe sleep apnea and the onset of dementia.
These statistics reported by Sleep Disorders Guide show that sleep apnea sufferers are six times more likely to die in a car accident.
This is because sufferers are not only tired, but they have reduced motor function which is absolutely essential to judge space and speed. A controversy broke last year as Donald Trump decided to remove mandatory sleep apnea screening for truck and train drivers. The proposal was already controversial, but it aimed to reduce the number of accidents amongst professional drivers. It followed a high profile incident in which a train driver suffering from the disorder crashed and killed over 100 people. While the final word on economic implications is out, it’s clear that sleep apnea is a dangerous disorder that should not be left untreated.
How Can You Prevent Sleep Apnea?
If you know that you are at risk, but have not already developed the disorder, you may want to think about how you can nip it in the bud. Or perhaps you have sleep apnea but are unable to pursue treatment yet, so you want to try and improve the severity of it.
We’ve discussed some of the risk factors that increase your chances of developing the disorder, and some of those are not possible to alter. However, with some lifestyle changes, you can reduce the risk of sleep apnea, even if you are in an at-risk group.
Lead a Healthy Lifestyle
Obstructive sleep apnea can be improved by reducing external factors that contribute to the blockage of the throat. For example, smoking, drinking alcohol, and weight gain. We detail how these choices affect your snoring here, and the effects are the same for sleep apnea.
Adopt the Correct Sleeping Posture
In addition to this, there are steps you can take at bedtime to ensure that you reduce the risk of developing sleep apnea. By adopting a sleeping position that keeps your airways open, you can help tackle obstructive sleep apnea. Caused by a blockage in your own muscles, ensure that you keep the throat as clear as possible. The best position is lying on your side or front with your chin tilted forward. You can train your body to stop shifting onto your back using a full body pillow. Put it behind you so that when you roll over, it’s in the way and you return to your side. You can also use anti-snoring pillows which claim to keep your head in the right position to open your throat.
Get a Good Night’s Rest
Another bedtime habit you can try is getting the recommended amount of sleep. Unfortunately, those with sleep apnea will always have disrupted sleep and will be constantly fatigued. But getting an inadequate amount of sleep every night will be even worse. Few hours of sleep leads to tiredness in itself, but combine this with constantly waking up and the body won’t be able to get any restorative rest.
How to Get a Definitive Diagnosis
The first place to start with sleep apnea is assessing the symptoms. If you find that you’re exhibiting the majority of complaints outlined in the ‘Symptoms’ section, then you should consider sleep apnea as a potential cause. Especially if you are suffering from fatigue but seem to be getting the recommended amount of sleep. Having a bedmate will also help to identify symptoms such as pauses while breathing and gasping for air. It might be tempting to dismiss snoring as an inconvenience, but you should definitely see a specialist in case it’s indicative of sleep apnea.
Once you, or your doctor, suspect that you may have a case of sleep apnea, there are a number of procedures to get a medical diagnosis.
This sleep study is usually conducted at a specialist clinic within a hospital or sleep study center. You will sleep over at the clinic where your brain activity will be monitored electronically. Then a professional will analyse your blood oxygen levels, heart rate, brain waves, breathing and movement to determine a diagnosis.
Regarded as less accurate than a polysomnography test, you can take an Oximetry test at home. A small probe which clips onto the finger or earlobe measures your blood oxygen levels. The probe uses light wavelengths which are sent to a machine to measure the absorbance of oxygen in the blood.
- Other Home Tests
When it’s not convenient or possible to get to a sleep center, you can get results using a home test. These tests should always be obtained from a trained specialist who will be able to accurately interpret the readings. Your heart rate, blood oxygen levels and breathing patterns can be monitored with home testing kits.
There is some controversy surrounding home tests because of the potential inaccuracy of the results. On one hand, these tests are cheaper and more convenient as they fit your schedule. You don’t have to leave your home and sleep in a center, making the experience more natural. But carrying out such tests in an uncontrolled environment can cause the results to be skewed by external factors. If the patient doesn’t use the equipment correctly, then the findings may not reflect the exact situation. Likewise, if the machine is disconnected during sleep, there is no one to reconnect it.
Treatments for Sleep Apnea
Once you have a definitive diagnosis of sleep apnea, you will need to start considering treatments. You will need to decide the best course of action with a medical professional, but it is useful to know what these procedures entail. Especially if your doctor hasn’t discussed all the possible options with you.
- Lifestyle Changes
As previously mentioned, lifestyle changes can be a preventative measure in the onset of sleep apnea. In the case of obstructive sleep apnea, keeping your airways open and unobstructed is crucial. Check out which measures you can take in your daily life to reduce the risk of sleep apnea, by reading the ’How can you prevent sleep apnea’ section of this article.
The most common and effective treatment for less severe cases is continuous positive airway pressure (CPAP). A CPAP device includes a sleep apnea mask that you wear over your nose and mouth, which is hooked up to a machine. The machine sends air through the mask at a pressure that is strong enough to keep your airways open. You can use CPAP at your home.
CPAP requires you to wear a mask during sleep, which stays hooked up to a machine by a tube, and is noisy! For these reasons, patients can find it difficult to get comfortable with this treatment. It’s best to see a doctor when you’re having problems since you should never just abandon your treatment. As recently as last year, New Zealand-based Fisher & Paykel Healthcare introduced a CPAP machine that they hope will eliminate the discomfort that patients can feel. It offers more size adjustments than existing machines and fits to your body.
Based on CPAP devices, there are some variations that offer extra features. Bilevel positive airway pressure (BiPAP) and Adaptive servo-ventilation (ASV) machines are better for central sleep apnea sufferers because they encourage regular breathing patterns rather than relying on the sleeper.
However, CNN recently reported on study findings that suggest that CPAP machines may not reduce the risk of heart disease.
Professionals previously thought that using a CPAP machine would reduce the risk of having a heart problem. But this larger-scale study showed no significant improvement in those using a CPAP machine and the prevention of heart diseases such as heart attack and stroke. It should be noted that CPAP machines are helpful in getting a restful night’s sleep and as such can help combat daytime fatigue and its associated effects.
- Other Breathing Devices
Some people can find the CPAP is difficult to sleep with due to it being bulky. Fortunately, there are alternative breathing devices that are less cumbersome. One example is the expiratory positive airway pressure (EPAP) device. These disposable gadgets are worn over the nose to facilitate air moving in and restrict air going out of the nostril. This creates pressure in the airways to keep them dilated.
- Oral Devices
For a non-severe case of obstructive sleep apnea, dental appliances can be a solution. They fit around your mouth and teeth to keep your tongue in place, and your mouth and jaw open. Usually, it’s a gum shield or fits around your head. That way, any obstructions to the throat will not be severe enough to cause these breathing blackouts. You can obtain these devices from a dentist but it’s important that a specialist follows up on this treatment, since dental devices can have side effects. Manipulating the mouth and jaw can cause pain, damage, and nausea.
This type of treatment includes inserting small rods into the soft palate to make it more rigid and therefore stop it from collapsing. The rods are inserted with a syringe under local anesthetic. It can be an effective treatment when it’s certain that the sufferer has obstructive sleep apnea. The jury is still out on whether this is a long-term solution as some of these rods have been known to move from the palate and it targets such a specific area.
There is a range of surgeries that correct sleep apnea and a specialist will advise a specific procedure based on which type you have. Unfortunately, there is no one surefire cure.
- Nasal surgery: a corrective procedure for a deviated septum.
- Uvulopalatopharyngoplasty: this involved removing tissues at the back of the mouth and throat to create more space in the airways.
- Maxillomandibular Advancement Surgery: the jaw is brought forward in this corrective procedure to help create space at the back of the mouth. It’s thought to be the most effective solution for obstructive sleep apnea.
- Tracheostomy: This is a last resort surgery in the case that all other treatments have failed and the sleep apnea is becoming life-threatening. In this invasive procedure, the doctor makes an opening in the neck through which they insert a tube. The tube stays closed throughout the day and the patient breathes as normal. It’s then uncovered at night so that air can pass directly into the airway safely.
The Chicago Tribune reported on a breakthrough treatment combining surgery and a monitoring device. A small machine, similar to a pacemaker, is inserted into the chest and then stimulates the muscles integral to breathing. This type of machine could be an important step in the treatment of central sleep apnea.
Self-help options should never take the place of seeing a doctor, but sometimes a diagnosis can take a long time, and the treatment can take even longer. So you may want to look into alternatives, at least in the meantime. These suggestions are not meant to replace seeing a specialist, but they can help you deal with the situation while it persists.
- Lifestyle changes
This advice keeps cropping up, but making adjustments to your daily routine really can help you! Even if these changes don’t cure your sleep apnea, you will feel a lot better for making positive decisions. Aside from the obvious, reducing smoking and alcohol, exercising, and eating healthily, the following measures target sleep apnea specifically:
- Sleep devices: targeted with snorers in mind, the same blockage issue causes sleep apnea, so they can help improve your breathing. Look into nasal strips or mouth guards.
- Anti-snoring pillows: again, they are designed to treat snoring but will be sure to improve a case of obstructive sleep apnea.
- Sleeping in the correct position: sleeping on your front or side will help you to keep your airways open and air flowing freely.
- Throat exercises
The New York Times reported on a study that suggested that throat exercises could relieve sleep apnea. They concluded that these exercises could at least be a cheap therapy for sufferers. While they may not be a definitive cure, they could help you to speed up your recovery and complement the treatment process. The Sleep Foundation suggests these three throat exercises and Livestrong offers these alternatives.
A controversial alternative therapy is sometimes sought out in the form of medicinal marijuana. Sleep Apnea Treatment Centers of America reports that clinical trials yielded results of a 32% reduction in sleep apnea sufferers who used medicinal marijuana. The NIH has funded further research due to these promising results. While medical marijuana is only permitted for certain health conditions, it is legal for recreational use in eight states. You should only use it on the advice of a medical professional.
Living With the Disorder
Whether you have a sleep apnea diagnosis or suspect you may have it, it’s important to know how to cope. Firstly, make yourself aware of the risk factors; the ‘Overall effects on your health’ section of this article is a good start. But further to that, you might want to consult a specialist. When you know what the disease can lead to, you will be motivated to get a diagnosis and start treatment.
Once you’re sure that you have the disorder, keep an eye on it. Sleep apnea rarely improves on its own so you’ll need to monitor it. Perhaps it’s not causing too much stress at the moment, but it could be more severe than you realize. Or it could become serious without you knowing.
Finally, take preventative measures and try out the alternative therapies we mentioned. Doing this won’t cure your sleep apnea but it can lessen the detrimental effects on your health. It could possibly speed up the recovery process if you’re having treatment with a specialist.
All in all, sleep apnea is a tough disorder to overcome. It is difficult to diagnose, and treatment can be trial and error. Further to that, it can be fatal when left unchecked. If you suspect that you may be suffering from any type of sleep apnea, be sure to see a specialist right away. They will know how to determine the best course of action for your individual case. The good news is that you can seek professional treatment for sleep apnea and improve it with measures you can take at home.