Sleep Apnea

Breathing pauses can last from a few seconds to minutes. They may occur 30 times or more an hour.

The most common type is obstructive sleep apnea. It causes your airway to collapse or become blocked during sleep. Normal breathing starts again with a snort or choking sound. People with sleep apnea often snore loudly. However, not everyone who snores has sleep apnea.

You are more at risk for sleep apnea if you are overweight, male, or have a family history or small airways. Children with enlarged tonsils may also get it.

Doctors diagnose sleep apnea based on medical and family histories, a physical exam, and sleep study results.

When your sleep is interrupted throughout the night, you can be drowsy during the day. People with sleep apnea are at higher risk for car crashes, work-related accidents, and other medical problems. If you have it, it is important to get treatment. Lifestyle changes, mouthpieces, surgery, and breathing devices can treat sleep apnea in many people.

Risk Factors

Obstructive sleep apnea is a common condition. About half of the people who have this condition are overweight.

Men are more likely than women to have sleep apnea. Although the condition can occur at any age, the risk increases as you get older.  A family history of sleep apnea also increases your risk for the condition.

People who have small airways in their noses, throats, or mouths are more likely to have sleep apnea. Small airways might be due to the shape of these structures or allergies or other conditions that cause congestion.

Small children might have enlarged tonsil tissues in their throats. Enlarged tonsil tissues raise a child’s risk for sleep apnea. Overweight children also might be at increased risk for sleep apnea.

About half of the people who have sleep apnea also have high blood pressure. Sleep apnea also is linked to smoking, metabolic syndrome, diabetes, and risk factors for stroke and heart failure.

Race and ethnicity might play a role in the risk of developing sleep apnea. However, more research is needed.

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 relax, which narrows your throat.

Normally, this narrowing doesn’t prevent air from flowing into and out of your lungs. But if you have sleep apnea, your airway can become partially or fully blocked because:

• Your throat muscles and tongue relax more than normal.
• Your tongue and tonsils are large compared with the opening into your windpipe.
• You’re overweight. The extra soft fat tissue can thicken the wall of the windpipe. This narrows the inside of the windpipe, which makes it harder to keep open.
• The shape of your head and neck  may cause a smaller airway size in the mouth and throat area.
• The aging process limits your brain signals’ ability to keep your throat muscles stiff during sleep. Thus, your airway is more likely to narrow or collapse.

Not enough air flows into your lungs if your airway is partially or fully blocked during sleep. As a result, loud snoring and a drop in your blood oxygen level can occur.

If the oxygen drops to a dangerous level, it triggers your brain to disturb your sleep. This helps tighten the upper airway muscles and open your windpipe. Normal breathing then starts again, often with a loud snort or choking sound.

Frequent drops in your blood oxygen level and reduced sleep quality can trigger the release of stress hormones. These hormones raise your heart rate and increase your risk for high blood pressure, heart attack, stroke, and arrhythmias (irregular heartbeats). The hormones also can raise your 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.

Symptoms

MAJOR SIGNS AND SYMPTOMS

One of the most common signs of obstructive sleep apnea is loud and chronic 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 might be less noisy when you turn on your side. You might not snore every night. Over time, however, the snoring can happen more often and get louder.

You’re asleep when the snoring or gasping happens. You likely won’t know that you’re having problems breathing or be able to judge how severe the problem is. A family member or bed partner often will 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. Even if you don’t have daytime sleepiness, talk with your doctor if you have problems breathing during sleep.

OTHER SIGNS AND SYMPTOMS

Others signs and symptoms of sleep apnea include:

• Morning headaches
• Memory or learning problems and not being able to concentrate
• Feeling irritable, depressed, or having mood swings or personality changes
• Waking up frequently to urinate
• Dry mouth or sore throat when you wake up

In children, sleep apnea can cause hyperactivity, poor school performance, and angry or hostile behavior. Children who have sleep apnea also may breathe through their mouths instead of their noses during the day.

Diagnosis

Doctors diagnose sleep apnea based on medical and family histories, a physical exam, and sleep study results. Your primary care doctor may evaluate your symptoms first. He or she will then decide whether you need to see a sleep specialist.

MEDICAL AND FAMILY HISTORIES

If you think you have a sleep problem, consider keeping a sleep diary for 1 to 2 weeks. Bring the diary with you to your next medical appointment.

Write down when you go to sleep, wake up, and take naps. Also write down how much you sleep each night, how alert and rested you feel in the morning, and how sleepy you feel at various times during the day. This information can help your doctor figure out whether you have a sleep disorder.

At your appointment, your doctor will ask you questions about how you sleep and how you function during the day.

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.

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.

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.

PHYSICAL EXAM

Your doctor will check your mouth, nose, and throat for extra or large tissues. Children who have sleep apnea might have enlarged tonsils. Doctors may need only a physical exam and medical history to diagnose sleep apnea in children.

Adults who have sleep apnea 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

Sleep studies are tests that measure how well you sleep and how your body responds to sleep problems. These tests can help your doctor find out whether you have a sleep disorder and how severe it is. Sleep studies are the most accurate tests for diagnosing sleep apnea.

There are different kinds of sleep studies. If your doctor thinks you have sleep apnea, he or she may recommend a polysomnogram (PSG) or a home-based portable monitor.

Polysomnogram

A PSG is the most common sleep study for diagnosing sleep apnea. This study records brain activity, eye movements, heart rate, and blood pressure.

If your doctor thinks that you have sleep apnea, he or she may schedule a split-night sleep study. During the first half of the night, your sleep will be checked without a CPAP machine. This will show whether you have sleep apnea and how severe it is.

If the PSG shows that you have sleep apnea, you’ll use a CPAP machine during the second half of the split-night study. The staff at the sleep center will adjust the flow of air from the CPAP machine to find the setting that works best for you.

Home-Based Portable Monitor

Your doctor may recommend a home-based sleep test with a portable monitor. The portable monitor will record some of the same information as a PSG.

Treatment

Sleep apnea is treated with lifestyle changes, mouthpieces, breathing devices, and surgery. Medicines typically aren’t used to treat the condition.

Treatment may improve other medical problems linked to sleep apnea, such as high blood pressure. Treatment also can reduce your risk for heart disease, stroke, and diabetes.

Lifestyle changes and/or mouthpieces may relieve mild sleep apnea. People who have moderate or severe sleep apnea may need breathing devices or surgery.

If treatment and enough sleep don’t relieve your daytime sleepiness, your doctor will consider other treatment options.

LIFESTYLE CHANGES

If you have mild sleep apnea, some changes in daily activities or habits might be all the treatment you need.

• 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 nasal sprays or allergy medicines, if needed. Talk with your doctor about whether these treatments might help you.
• If you smoke, quit. Talk with your doctor about programs and products that can help you quit smoking.

MOUTHPIECES

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. The mouthpiece will adjust your lower jaw and your tongue to help keep your airways open while you sleep.

BREATHING DEVICES

CPAP (continuous positive airway pressure) 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 pressure from the air helps keep your airway open while you sleep.

Treating sleep apnea may help you stop snoring. But not snoring doesn’t mean that you no longer have sleep apnea or can stop using CPAP. Your sleep apnea will return if you stop using your CPAP machine or don’t use it correctly.

CPAP treatment may cause side effects in some people. These side effects include a dry or stuffy nose, irritated skin on your face, dry mouth, and headaches. If your CPAP isn’t adjusted properly, 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 the side effects.

People who have severe sleep apnea symptoms generally feel much better once they begin treatment with CPAP.

SURGERY

Some people who have sleep apnea might 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 shrinking, stiffening, or removing excess tissue in the mouth and throat or resetting the lower jaw.

Surgery to shrink or stiffen excess tissue is done in a doctor’s office or a hospital. Shrinking tissue may involve small shots or other treatments to the tissue. You may need a series of treatments to shrink the excess tissue. To stiffen excess tissue, the doctor makes a small cut in the tissue and inserts a piece of stiff plastic.

Surgery to remove the tonsils, if they’re blocking the airway, might be 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.

Recovery

Sleep apnea can be very serious. However, following an effective treatment plan often can improve your quality of life quite a bit.

Treatment can improve your sleep and relieve daytime sleepiness. Treatment also might lower your risk for 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 bothersome side effects.

Ongoing care is important if you’re getting CPAP (continuous positive airway pressure) treatment. It may take a while before you adjust to using CPAP.

If you aren’t comfortable with your CPAP device, or if 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.

If you’re using a mouthpiece to treat your sleep apnea, you may need to have routine checkups with your dentist.

HOW CAN FAMILY MEMBERS HELP?

Often, people who have 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 treatment.
• Provide emotional support.