Sleep apnea
Sleep apnea is a common disorder in which you have one or more pauses in breathing or shallow breaths while you sleep.
This page contains
- Sleep apnea overview
- Sleep apnea types
- Risks of Untreated sleep apnea
- Other Names for Sleep Apnea
- Sleep Apnea causes
- Risk factor for developing Sleep Apnea
- Sleep Apnea signs and symptoms
- Sleep Apnea Diagnosis test
- Sleep Apnea Treatment
- Living With Sleep Apnea
- Family Members support for sleep apnea
Sleep apnea overview
Breathing
pauses can last from a few seconds to minutes. They often occur 5 to 30
times or more an hour. Typically, normal breathing then starts again,
sometimes with a loud snort or choking sound.
Sleep
apnea usually is a chronic (ongoing) condition that disrupts your sleep
3 or more nights each week. You often move out of deep sleep and into
light sleep when your breathing pauses or becomes shallow. This results
in poor sleep quality that makes you tired during the day. Sleep apnea
is one of the leading causes of excessive daytime sleepiness.
Sleep
apnea often goes undiagnosed. Doctors usually can't detect the
condition during routine office visits. Also, there are no blood tests
for the condition.
Most
people who have sleep apnea don't know they have it because it only
occurs during sleep. A family member and/or bed partner may first
notice the signs of sleep apnea.
Sleep apnea types
The
most common type of sleep apnea is obstructive sleep apnea. This most
often means that the airway has collapsed or is blocked during sleep.
The blockage may cause shallow breathing or breathing pauses.
When
you try to breathe, any air that squeezes past the blockage can cause
loud snoring. Obstructive sleep apnea happens more often in people who
are overweight, but it can affect anyone.
Central
sleep apnea is a less common type of sleep apnea. It happens when the
area of your brain that controls your breathing doesn't send the
correct signals to your breathing muscles. You make no effort to
breathe for brief periods.
Central
sleep apnea often occurs with obstructive sleep apnea, but it can occur
alone. Snoring doesn't typically happen with central sleep apnea.
Risks of Untreated sleep apnea
- Increase the risk for high blood pressure, heart attack, stroke, obesity, and diabetes
- Increase the risk for or worsen heart failure
- Make irregular heartbeats more likely
- Increase the chance of having work-related or driving accidents
Lifestyle changes, mouthpieces, surgery, and/or breathing devices can successfully treat sleep apnea in many people.
Other Names for Sleep Apnea
- Sleep-disordered breathing
- Cheyne-Stokes breathing
Sleep Apnea causes
When
you're awake, throat muscles help keep your airway stiff and open so
air can flow into your lungs. When you sleep, these muscles are more
relaxed. Normally, the relaxed throat muscles don't stop your airway
from staying open to allow air into your lungs.
But if you have obstructive sleep apnea, your airways can be blocked or narrowed during sleep because:
- Your throat muscles and tongue relax more than normal.
- Your tongue and tonsils (tissue masses in the back of your mouth) are large compared to the opening into your windpipe.
- You're
overweight. The extra soft fat tissue can thicken the wall of the
windpipe. This causes the inside opening to narrow and makes it harder
to keep open.
- The shape of your head and neck (bony structure) may cause a smaller airway size in the mouth and throat area.
- The
aging process limits the ability of brain signals to keep your throat
muscles stiff during sleep. This makes it more likely that the airway
will narrow or collapse.
- Not
enough air flows into your lungs when your airways are fully or partly
blocked during sleep. This can cause loud snoring and a drop in your
blood oxygen levels.
When
the oxygen drops to dangerous levels, it triggers your brain to disturb
your sleep. This helps tighten the upper airway muscles and open your
windpipe. Normal breaths then start again, often with a loud snort or
choking sound.
The
frequent drops in oxygen levels and reduced sleep quality trigger the
release of stress hormones. These compounds raise your heart rate and
increase your risk for high blood pressure, heart attack, stroke, and
irregular heartbeats. The hormones also raise the risk for or worsen
heart failure.
Untreated
sleep apnea also can lead to changes in how your body uses energy.
These changes increase your risk for obesity and diabetes.
Risk factor for developing Sleep Apnea
- It's
estimated that more than 12 million in American adults have obstructive
sleep apnea. More than half of the people who have this condition are
overweight.
- 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.
- Sleep
apnea becomes more common as you get older. At least 1 out of 10 people
over the age of 65 has sleep apnea. Women are much more likely to
develop sleep apnea after menopause.
- If someone in your family has sleep apnea, you're more likely to develop it.
- People
who have small airways in their noses, throats, or mouths also are more
likely to have sleep apnea. Smaller airways may be due to the shape of
these structures or allergies or other medical conditions that cause
congestion in these areas.
- Small children often have enlarged tonsil tissues in the throat. This can make them prone to developing sleep apnea.
- Other risk factors for sleep apnea include smoking, high blood pressure, and risk factors for stroke or heart failure.
Sleep Apnea signs and symptoms
Major Signs and Symptoms
- One
of the most common signs of obstructive sleep apnea is loud and chronic
(ongoing) snoring. Pauses may occur in the snoring. Choking or gasping
may follow the pauses.
- The
snoring usually is loudest when you sleep on your back; it may be less
noisy when you turn on your side. Snoring may not happen every night.
Over time, the snoring may happen more often and get louder.
- You're
asleep when the snoring or gasping occurs. You will likely not know
that you're having problems breathing or be able to judge how severe
the problem is. Your family members or bed partner will often notice
these problems before you do. Not everyone who snores has sleep apnea.
- Another
common sign of sleep apnea is fighting sleepiness during the day, at
work, or while driving. You may find yourself rapidly falling asleep
during the quiet moments of the day when you're not active.
Other Signs and Symptoms
- Morning headaches
- Memory or learning problems and not being able to concentrate
- Feeling irritable, depressed, or having mood swings or personality changes
Urination at night
- A dry throat when you wake up
- In
children, sleep apnea can cause hyperactivity, poor school performance,
and aggressiveness. Children who have sleep apnea also may have unusual
sleeping positions, bedwetting, and may breathe through their mouths
instead of their noses during the day.
Sleep Apnea Diagnosis test
Doctors
diagnose sleep apnea based on your medical and family histories, a
physical exam, and results from sleep studies. Usually, your primary
care doctor evaluates your symptoms first. He or she then decides
whether you need to see a sleep specialist.
These
specialists are doctors who diagnose and treat people with sleep
problems. Such doctors include lung, nerve, or ear, nose, and throat
specialists. Other types of doctors also can be sleep specialists.
Medical and Family Histories
Your
doctor will ask you and your family questions about how you sleep and
how you function during the day. To help your doctor, consider keeping
a sleep diary for 1 to 2 weeks. Write down how much you sleep each
night, as well as how sleepy you feel at various times during the day.
You can find a sample sleep diary in the National Heart, Lung, and Blood Institute's "Your Guide to Healthy Sleep."
Your
doctor also will want to know how loudly and often you snore or make
gasping or choking sounds during sleep. Often you're not aware of such
symptoms and must ask a family member or bed partner to report them.
If you're a parent of a child who may have sleep apnea, tell your child's doctor about your child's signs and symptoms.
Let your doctor know if anyone in your family has been diagnosed with sleep apnea or has had symptoms of the disorder.
Many people aren't aware of their symptoms and aren't diagnosed.
Physical Exam
Your
doctor will check your mouth, nose, and throat for extra or large
tissues. The tonsils often are enlarged in children with sleep apnea. A
physical exam and medical history may be all that's needed to diagnose
sleep apnea in children.
Adults
with the condition may have an enlarged uvula or soft palate. The uvula
is the tissue that hangs from the middle of the back of your mouth. The
soft palate is the roof of your mouth in the back of your throat.
Sleep Studies
A
sleep study is the most accurate test for diagnosing sleep apnea. It
captures what happens with your breathing while you sleep.
A
sleep study is often done in a sleep center or sleep lab, which may be
part of a hospital. You may stay overnight in the sleep center.
Polysomnogram
A polysomnogram (poly-SOM-no-gram), or PSG, is the most common study for diagnosing sleep apnea. This test records:
- Brain activity
- Eye movement and other muscle activity
- Breathing and heart rate
- How much air moves in and out of your lungs while you're sleeping
- The amount of oxygen in your blood
A
PSG is painless. You will go to sleep as usual, except you will have
sensors on your scalp, face, chest, limbs, and finger. The staff at the
sleep center will use the sensors to check on you throughout the night.
A
sleep specialist reviews the results of your PSG to see whether you
have sleep apnea and how severe it is. He or she will use the results
to plan your treatment.
Sleep Apnea Treatment
Goals of Treatment
- Restore regular breathing during sleep
- Relieve symptoms such as loud snoring and daytime sleepiness
- Treatment may help other medical problems linked to sleep apnea, such as high blood pressure.
- Treatment also can reduce your risk for heart disease, stroke, and diabetes.
Specific Types of Treatment
Lifestyle
changes, mouthpieces, breathing devices, and/or surgery are used to
treat sleep apnea. Currently, there are no medicines to treat sleep
apnea.
Lifestyle
changes and/or mouthpieces may be enough to relieve mild sleep apnea.
People who have moderate or severe sleep apnea also will need breathing
devices or surgery.
Lifestyle Changes
- Avoid alcohol and medicines that make you sleepy. They make it harder for your throat to stay open while you sleep.
- Lose weight if you're overweight or obese. Even a little weight loss can improve your symptoms.
- Sleep
on your side instead of your back to help keep your throat open. You
can sleep with special pillows or shirts that prevent you from sleeping
on your back.
- Keep
your nasal passages open at night with nose sprays or allergy
medicines, if needed. Talk to your doctor about whether these
treatments might help you.
- Stop smoking.
- Breathing
Devices - Continuous positive airway pressure (CPAP) is the most
common treatment for moderate to severe sleep apnea in adults. A CPAP
machine uses a mask that fits over your mouth and nose, or just over
your nose. The machine gently blows air into your throat. The air
presses on the wall of your airway. The air pressure is adjusted so
that it's just enough to stop the airways from becoming narrowed or
blocked during sleep.
- Mouthpiece
- A mouthpiece, sometimes called an oral appliance, may help some
people who have mild sleep apnea. Your doctor also may recommend a
mouthpiece if you snore loudly but don't have sleep apnea.
A
dentist or orthodontist can make a custom-fit plastic mouthpiece for
treating sleep apnea. (An orthodontist specializes in correcting teeth
or jaw problems.) The mouthpiece will adjust your lower jaw and your
tongue to help keep your airways open while you sleep. If you use a
mouthpiece, it's important that you check with your doctor about
discomfort or pain while using the device. You may need periodic office
visits so your doctor can adjust your mouthpiece to fit better.
Treating
sleep apnea may help you stop snoring. But stopping snoring doesn't
mean that you no longer have sleep apnea or can stop using CPAP. Sleep
apnea will return if CPAP is stopped or not used correctly.
Usually,
a technician will come to your home to bring the CPAP equipment. The
technician will set up the CPAP machine and adjust it based on your
doctor's orders. After the initial setup, you may need to have the CPAP
adjusted on occasion for the best results.
CPAP
treatment may cause side effects in some people. These side effects
include a dry or stuffy nose, irritated skin on your face, sore eyes,
and headaches. If your CPAP isn't properly adjusted, you may get
stomach bloating and discomfort while wearing the mask.
If
you're having trouble with CPAP side effects, work with your sleep
specialist, his or her nursing staff, and the CPAP technician.
Together, you can take steps to reduce these side effects. These steps
include adjusting the CPAP settings or the size/fit of the mask, or
adding moisture to the air as it flows through the mask. A nasal spray
may relieve a dry, stuffy, or runny nose.
There
are many different kinds of CPAP machines and masks. Be sure to tell
your doctor if you're not happy with the type you're using. He or she
may suggest switching to a different kind that may work better for you.
People who have severe sleep apnea symptoms generally feel much better once they begin treatment with CPAP.
Surgery
Some
people who have sleep apnea may benefit from surgery. The type of
surgery and how well it works depend on the cause of the sleep apnea.
Surgery
is done to widen breathing passages. It usually involves removing,
shrinking, or stiffening excess tissue in the mouth and throat or
resetting the lower jaw.
Surgery
to shrink or stiffen excess tissue in the mouth or throat is done in a
doctor's office or a hospital. Shrinking tissue may involve small shots
or other treatments to the tissue. A series of such treatments may be
needed to shrink the excess tissue. To stiffen excess tissue, the
doctor makes a small cut in the tissue and inserts a small piece of
stiff plastic.
Surgery
to remove excess tissue is only done in a hospital. You're given
medicine that makes you sleep during the surgery. After surgery, you
may have throat pain that lasts for 1 to 2 weeks.
Surgery
to remove the tonsils, if they're blocking the airway, may be very
helpful for some children. Your child's doctor may suggest waiting some
time to see whether these tissues shrink on their own. This is common
as small children grow.
Living With Sleep Apnea
- Obstructive
sleep apnea can be very serious. However, following an effective
treatment plan can often improve your quality of life quite a bit.
- Treatment
can improve your sleep and relieve daytime tiredness. It also may make
you less likely to develop high blood pressure, heart disease, and
other health problems linked to sleep apnea.
- Treatment
may improve your overall health and happiness as well as your quality
of sleep (and possibly your family's quality of sleep).
- Ongoing
Health Care Needs - Follow up with your doctor regularly to make sure
your treatment is working. Tell him or her if the treatment is causing
side effects that you can't handle.
This
ongoing care is especially important if you're getting continuous
positive airway pressure (CPAP) treatment. It may take a while before
you adjust to using CPAP.
If
you aren't comfortable with your CPAP device or it doesn't seem to be
working, let your doctor know. You may need to switch to a different
device or mask. Or, you may need treatment to relieve CPAP side
effects.
Try
not to gain weight. Weight gain can worsen sleep apnea and require
adjustments to your CPAP device. In contrast, weight loss may relieve
your sleep apnea.
Until your sleep apnea is properly treated, know the dangers of driving or operating heavy machinery while sleepy.
If
you're having any type of surgery that requires medicine to put you to
sleep, let your surgeon and doctors know you have sleep apnea. They
might have to take extra steps to make sure your airway stays open
during the surgery.
Family Members support for sleep apnea
Often,
people with sleep apnea don't know they have it. They're not aware that
their breathing stops and starts many times while they're sleeping.
Family members or bed partners usually are the first to notice signs of
sleep apnea.
- Family members can do many things to help a loved one who has sleep apnea.
- Let the person know if he or she snores loudly during sleep or has breathing stops and starts.
- Encourage the person to get medical help.
- Help the person follow the doctor's treatment plan, including CPAP.
- Provide emotional support.
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