Sleep Apnea

Apnea is a Greek word that means "without breath." Sleep apnea is a condition in which breathing briefly stops repeatedly through the night as a person sleeps.

These pauses last at least 10 seconds. They may happen hundreds of times during the night. A person with sleep apnea is only rarely aware of having difficulty breathing. It is usually recognized as a problem by others who witness the pauses in the breath.

Sleep apnea disturbs a person's sleep. A person with sleep apnea may moved from deep sleep to light sleep several times during the night. Levels of oxygen in the blood fall from the pauses in breathing. People with sleep apnea often snore loudly during sleep. (Not all people who snore, however, have sleep apnea.)

There are three types of sleep apnea:

  • Central sleep apnea happens because the muscles that cause the lungs to fill with air don't move. The brain isn't sending the proper signals to the muscles that control breathing.
  • Obstructive sleep apnea happens because something physical blocks the airflow even as a person's body works to breathe. This is the most common form. An estimated one out of every five Americans has this type of sleep apnea.
  • Mixed sleep apnea is when a person moves between central sleep apnea and obstructive sleep apnea during an event of apnea.
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Symptoms

A person with sleep apnea may be unaware that a problem exists. Usually a family member or sleeping partner is the first to recognize the problem.

Common signs of sleep apnea include:

  • Loud snoring. Not all people who snore, however, have sleep apnea. People with central sleep apnea may not snore.
  • Choking or gasping during sleep
  • Sleepiness or being tired during the day. An adult or teen suffering from long-standing severe sleep apnea may fall asleep for short periods of time during the course of daily activities if given a chance to rest.

A person with sleep apnea may also have:

  • A dry throat on waking
  • A hard time concentrating
  • Problems with memory or learning
  • A loss of interest in sex
  • A need to go to the bathroom often during the night
  • Acid reflux
  • An increased heart rate
  • Irritability
  • Mood swings or personality changes, including feeling depressed
  • Morning headaches
  • Night sweats

Children who have sleep apnea may be extremely sleepy during the day. In some cases, toddlers or young children will behave as if they are hyper or overtired. Children with sleep apnea may be thin and show signs of a failure to thrive (slowed growth). This happens because the child's body burns calories at a high rate to get enough air into the lungs. If there is a blockage in the throat due to swollen tonsils or adenoids, the child may not be able to smell properly. Food doesn't taste as good to them and may even be difficult to swallow.

Causes and Risk Factors

Sleep apnea affects more than 12 million Americans, according to the National Institutes of Health. It affects men, women, older people and children alike.

Some factors, however, make getting sleep apnea more likely. These include:

  • Being male. Men are twice as likely to get sleep apnea as women.
  • Being older. Obstructive sleep apnea is two to three times more likely in older adults aged 65 or older.
  • Being overweight. The extra soft tissue in the throat makes it harder to keep the throat open during sleep.
  • Having a family member who has sleep apnea.
  • Having a thick neck. A person whose neck is more than 17 inches around has a greater risk of developing sleep apnea.
  • Smoking. It may cause inflammation and fluid retention of the throat and upper airways.

Several things can cause sleep apnea, including:

  • Overly relaxed muscle tone in the throat that causes the walls of the airway to collapse
  • Structural problems of the head, throat and nasal passages
  • Heart disease, which is the most common cause of central sleep apnea. People with atrial fibrillation or heart failure have a greater risk of central sleep apnea.
  • Neuromuscular disorders. These include amyotrophic lateral sclerosis (Lou Gehrig's disease), spinal cord injuries or muscular dystrophy. Each of these conditions can affect how the brain controls breathing.
  • Stroke or brain tumor. These conditions can disturb the brain's ability to regulate breathing.
  • Excessive drinking of alcohol or use of sedatives or tranquilizers. These may relax the muscles of the throat too much, interfering with normal breathing and sleep.
  • Having Down Syndrome. A little more than half the people who have Down Syndrome also have sleep apnea. A person with Down Syndrome may have a more relaxed muscle tone than other people and a relatively narrow nose and throat and large tongue.
  • Colds, infections or allergies that cause nasal congestion or swelling of the throat or tonsils. Some viruses such as Epstein-Barr can cause the lymph glands to swell. Sleep apnea due to these types of blockages usually only lasts a short period of time.
  • Enlarged tonsils and adenoids. Children with obstructive sleep apnea usually have this problem. It can be corrected with a tonsillectomy and adenoidectomy.
  • High altitude, if you aren't accustomed to it. This usually goes away as the body adapts to the higher altitude or if you move to a lower altitude.
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Diagnosis

Many people live for years or decades with sleep apnea, unaware that they have it. Often a family member or sleeping partner brings it to their attention.

To diagnose sleep apnea, a doctor will take a medical history and do a physical exam. He or she will check the mouth, nose and throat for extra or large tissues.

The doctor may order several tests to be done while you sleep, including:

  • Measuring the oxygen in your blood (oximetry). This is done by putting a small sleeve over a finger while you sleep.
  • A polysomnogram. It records brain eye and muscle activity as well as breathing and heart rates. It measures the amount of oxygen in your blood and how much air moves in and out of your lungs while you sleep.

This painless test can be done in a sleep laboratory or center or at home using a home monitor. When the test is done at home, a technician comes to your house and helps you apply a monitor that you will wear overnight. The technician will return in the morning to get the monitor and send the results to your doctor.

You may be referred to a specialist in lung problems (pulmonologist), the brain or nerves (neurologist), heart and blood pressure problems (cardiologist) or ear, nose and throat problems (otolaryngologists) for additional evaluation.

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Treatments

Treatment for sleep apnea is designed to restore regular nighttime breathing, relieve loud snoring and address daytime sleepiness.

Treatment also targets complications of sleep apnea such as high blood pressure and higher risks for heart attack and stroke. The interruption of normal sleep can lead to accidents at home, on the job or while driving. It can disturb healing and immune responses. In children, it can interfere with normal growth.

Treatment for sleep apnea varies depending on the cause of the problem, your medical history and how severe the condition is. Treatment generally falls into these categories:

  • Lifestyle changes
  • Devices to change the position of the jaw, tongue and soft tissues of the mouth and throat.
  • Pressurized air machines
  • Surgery

People with sleep apnea need to take special care when having surgery or undergoing dental procedures. Anesthesia and drugs used to relieve pain and depress consciousness stay in the body for hours or even days after surgery. Even these small amounts can make sleep apnea worse.

Dental, mouth or throat surgery can cause swelling in the lining or the mouth and throat also making sleep apnea worse.

Be sure your doctors, dentist and surgeons are aware that you have sleep apnea. You will need to be closely monitored after surgery.