Sleep Apnea: Types, Causes, Risk Factors, Diagnosis and Treatment Options | Sleep Disorders

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Sleep Apnea: Types, Causes, Risk Factors, Diagnosis and Treatment Options

Written by Jeff Behar, MS, MBA

Sleep apnea is a common sleeping disorder n which you have one or more pauses in breathing or shallow breaths while man_with_sleep_apnea_snoring_and_keeping_wife_up you sleep. Breathing pauses typically occur 5 to 30 times or more an hour, with each one lasting from a few seconds to a few minutes. Sleep apnea occurs when airways become blocked or restricted.

The restriction causes blood oxygen levels to drops to dangerous levels which triggers the brain to tighten the upper airway muscles and open the windpipe. Typically, normal breathing then starts again, sometimes with a loud snort or choking sound. This automatic action disrupts REM (or restorative) sleep. This disruption of REM sleep results in poor sleep quality for those with sleep apnea. Sleep apnea is one of the leading causes of excessive daytime sleepiness.

The Effects of Obstructive Sleep Apnea

When you have obstructive sleep apnea not enough air flows into your lungs because the 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 causes the body to tighten the upper airway muscles and open your windpipe. Normal breaths then start again, often with a loud snort or choking sound.

It is the frequent drops in oxygen levels and reduced sleep quality trigger the release of stress hormones. Stress hormones raise your heart rate and increase your risk for high blood pressure, heart attack, stroke, and can increase the risk for heart failure. Untreated sleep apnea can ultimately lead to changes in how your body uses energy. These changes increase your risk for obesity, and diabetes.

Because obstructive sleep apnea is a leading cause of daytime sleepiness obstructive sleep apnea can also increase the risk for work-related and driving accidents. The combination of all these health effects has shown to decrease the average life span of an untreated obstructive sleep apnea patient by 20 years when compared to the life span of the rest of the population.

Types of Sleep Apnea

Obstructive Sleep Apnea

The most common type of sleep apnea is obstructive sleep apnea. People with obstructive sleep apnea often have their airway collapsed or a blocked airway during sleep. The blockage may cause shallow breathing or breathing pauses. Obstructive sleep apnea happens more often in people who are overweight, but it can affect anyone. When you try to breathe, any air that squeezes past the blockage can cause loud snoring.

Central Sleep Apnea

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.

Obstructive Sleep Apnea Statistics

It is estimated that obstructive sleep apnea (OSA) affects anywhere from 2-26 percent of the general population (more than 12 million American adults)

Approximately 80 percent of men and 93 percent of women with moderate to severe sleep apnea are unaware they have sleep apnea.

Causes of Obstructive Sleep Apnea

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. When your throat muscles and tongue relax more than normal they can block or restrict the airway.

Shape of your head and neck. The shape of your head and neck (bony structure) may cause a smaller airway size in the mouth and throat area.

Your tongue and tonsils (tissue masses in the back of your mouth) are large compared to the opening into your windpipe. This can cause airway blockage.

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 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 collapses.

Obstructive Sleep Apnea Signs /Obstructive Sleep Apnea 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. Note: Not everyone who snores has obstructive sleep apnea.
Another common sign of obstructive sleep apnea is fighting sleepiness during the day, at work, or while driving.

Other Obstructive Sleep Apnea Signs and Symptoms

Others signs and symptoms of obstructive sleep apnea may include:

Feeling irritable, depressed, or having mood swings or personality changes
Urination at night
A dry throat when you wake up
Morning headaches
Memory or learning problems and not being able to concentrate

In children, obstructive sleep apnea can cause:

Hyperactivity
Aggressiveness
Breathing through their mouths instead of their noses during the day
Poor school performance
Unusual sleeping positions
Bedwetting

Obstructive Sleep Apnea Risk Factors

Weight. More than half of the people who have sleep apnea are overweight.
Hormones. Women are much more likely to develop sleep apnea after menopause.
Race. African Americans, Hispanics, and Pacific Islanders are more likely to develop obstructive sleep apnea than Caucasians.
Hereditary. If someone in your family has sleep apnea, you're more likely to develop it.
Body Structure. People who have small airways in their noses, throats, or mouths also are more likely to have obstructive 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.
Gender. Obstructive 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.
Age. Obstructive sleep apnea becomes more common as you get older. At least 1 out of 10 people over the age of 65 has sleep apnea.
Smoking. Cigarette smoking increases the risk for obstructive sleep apnea, which appears to resolve with smoking cessation.

Obstructive Sleep Apnea Diagnosis

Obstructive Sleep apnea often goes undiagnosed. It is estimated that around 80 percent of men and 93 percent of women with moderate to severe obstructive sleep apnea are unaware they have sleep apnea. Doctors usually can't detect obstructive sleep apnea during routine office visits.

More alarming still is that the estimated average life span of an untreated obstructive sleep apnea patient is 20 years shorter than the average life span of the rest of the population. This is why diagnosis is very important.

Usually, your primary care doctor evaluates your obstructive sleep apnea symptoms first. Your doctor will diagnose obstructive sleep apnea based on your medical and family histories, a physical exam, and results from sleep studies. The doctor then decides whether you need to see a sleep specialist. Sleep specialists are doctors who diagnose and treat people with sleep problems. Sleep specialists include doctors who are 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. 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.

Physical Exam for Obstructive Sleep Apnea

Your doctor will check your mouth, nose, and throat for extra or large tissues. A physical exam and medical history may be all that's needed to diagnose obstructive sleep apnea.

Sleep Studies

A sleep study is the most accurate test for diagnosing obstructive 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. During a sleep study a polysomnogram (poly-SOM-no-gram), or PSG, is often used to diagnose obstructive sleep apnea. The polysomnogram records:

Brain 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
Eye movement and other muscle activity

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 mouthpieces

Obstructive Sleep Apnea Treatment

Currently, there are no medicines to treat obstructive sleep apnea, however there are other treatment options for people with obstructive sleep apnea. Obstructive sleep apnea treatment typically includes one or more of the following:

Lifestyle changes
Mouthpieces
Breathing devices, and/or
Surgery

The goals of treating obstructive sleep apnea are to restore regular breathing during sleep and to relieve symptoms such as snoring and daytime sleepiness. Treatment may help other medical problems linked to obstructive sleep apnea, such as high blood pressure. Obstructive sleep apnea treatment also can reduce your risk for heart attack, stroke, and diabetes and may extend your life possibly up to twenty years.

Obstructive Sleep Apnea Lifestyle Changes

If you have mild obstructive sleep apnea, some changes in daily activities or habits may be all that you need. These might include:

Losing weight if you're overweight or obese. Even a little weight loss can improve your symptoms.
Sleeping 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, or nasal strips, if needed.
Avoiding alcohol and medicines that make you sleepy. They make it harder for your throat to stay open while you sleep.
Quitting smoking.

Sleep Apnea Mouthpiece

A mouthpiece, sometimes called an oral appliance, may help some people who have mild sleep apnea. The mouthpiece will adjust your lower jaw and your tongue to help keep your airways open while you sleep. There are also some fairly good mouthpieces that can now be bought in drug stores or over the internet that can be customized in the home. These mouthpieces models while not fully custom have been shown to work for mild sleep apnea can can be hundreds of dollars cheaper than the custom fit mouth pieces that can be purchased from a dentist or orthodontist.

cpap

Obstructive Sleep Apnea Breathing Devices

Continuous positive airway pressure (CPAP) is the most common treatment for moderate to severe obstructive sleep apnea in adults. A CPAP machine uses a mask that fits over your mouth and nose, or just over your nose and gently blows air into your throat. People who have severe obstructive sleep apnea symptoms generally feel much better once they begin treatment with CPAP.

Obstructive Sleep Apnea Surgery

Some people who have obstructive sleep apnea may benefit from surgery. There are different surgical potions depending on the issue. This may include;

Surgery 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 remove excess tissue. Thus 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 shrink or stiffen excess tissue in the mouth or throat. This is typically 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 the tonsils. If the tonsils are blocking the airway, surgery 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.