What Is Sleep Apnea And How Can You Get Relieved?
Sleep apnea is a common condition estimated to affect 22 million patients in the United States.
It is a sleep disorder in which the patient stops breathing for more than 10 seconds several times each hour. As a result of these respiratory interruptions, the amount of oxygen present in the patient’s blood decreases, disrupting the oxygenation of vital organs such as the brain and the heart.
In the following lines, you will find answers to everything that might bother you concerning sleep apnea.
What Is Sleep Apnea?
Sleep apnea is a condition in which breathing stops involuntarily for short periods repeatedly during sleep. Normally, air flows smoothly from the mouth and nose to the lungs without interruption. The intervals when breathing stops are called apnea episodes.
Snoring is a characteristic finding in the case of sleep apnea and is created when the air is forced to pass through the narrow space of the nasopharynx.
Types Of Sleep Apnea
There are 3 types of sleep apnea:
- Obstructive: is the most common type of apnea in which the air passage is narrower even to the point of approaching the obstruction.
- Central: there is no obstruction in the airway, but the brain does not send the signal to the respiratory muscles for respiration.
- Mixed: is a combination of obstructive and central sleep apnea.
What Are The Main Predisposing Factors?
The main predisposing factors for a person to experience sleep apnea are obesity (as estimated by body mass index), male gender, craniofacial abnormalities, anatomical obstructive causes in the upper airway (hypertrophic tonsils, anatomical abnormalities of the nose), the postmenopausal period for women, as well as the hereditary burden.
It is good to remember that sleep apnea is not just a disease of the obese. It can also occur in slender individuals, whose upper airway has anatomical features that predispose to its appearance.
What Are The Symptoms Of Sleep Apnea?
In addition to the predisposing somatometric data, patients with sleep apnea (SLE) have characteristic symptoms both day and night.
Daily Symptoms
- Sleepiness even during activities that please the patient and that until recently he performed with ease. The opportunity for spiritual work can be affected or social life limited by the risk of falling asleep when the patient is in the theater, at a restaurant with friends, or other social events. But it is much worse for the patient to realize that he is drowsy while driving and that he is a danger not only to themselves but also to the wider society.
- Daily fatigue for no apparent reason and despite adequate sleep.
- Emotional disorder (from simple melancholy to depression) without a clear cause related to interpersonal relationships or problems in the workplace.
- Sexual dysfunction without an underlying organic cause.
Nocturnal Symptoms
- Snoring. This symptom is not uncommon and does not mean that every person who snores (50–60% of people over 60) should be tested for sleep apnea (SLE). But it is important to investigate the snoring that years ago was tolerable and treatable by sleeping on its side and is now so intense that it disrupts his or his wife’s sleep or even forces couples to sleep in separate rooms.
- Observed breathing interruptions. They frighten the patient’s husband and force him to wake the sleeping person for fear that something bad will happen. Episodes often occur between episodes of intense snoring, but to observe them one must be in the same bedroom as the patient, which is not often the case with intense snoring.
- Sudden awakenings with a feeling of suffocation. These episodes represent awakenings from the central nervous system lifesaving for the patient to restore the blood gases and the stress of the vital organs from the hypoxemia.
- Sudden limb movements and restless sleep often disturb the bed partner.
- Frequent awakenings for urination disrupt the continuity of sleep.
- Waking up in the morning with a severe headache due to hypercapnia from the continuous episodes of night apnea, especially in REM sleep that prevails in the early morning hours.
What Causes Sleep Apnea?
Obstructive sleep apnea occurs more often in men, while obesity and age are their main causes. Weight loss can lead to significant improvement in symptoms. Conversely, sleeping in a supine position might worsen the apnea.
Beyond that, very important parameters that contribute decisively to the occurrence of this disease are the anatomical abnormalities that might be present in the upper airways.
What Anatomical Abnormalities Contribute To The Appearance Of Sleep Apnea?
The risk of sleep apnea increases in conditions that narrow the upper airway. Such are the following:
- Children with oversized tonsils or adenoids (meatballs).
- Large neck circumference, which is associated with increased fat deposition in the area and narrowing of the airway.
- An oversized tongue that blocks the passage of air.
- Micro-jaw or posterior jaw of the lower jaw.
- Narrow or flabby soft palate.
- Scoliosis of the nasal septum.
- Hypertrophic nasal passages or nasal polyps.
- Allergic rhinitis.
- Smoking.
How Is Sleep Apnea Diagnosed?
The diagnosis of sleep apnea begins with a complete history and physical examination. A patient who reports drowsiness during the day and snoring at sleep is a typical case.
An ENT specialist will examine the head and neck to identify any aggravating factors associated with the onset of apnea. The exams that are conducted are:
- Nasal endoscopy. Using a rhinoscope connected to a special camera, the doctor can directly see the nasal passage and check for problems that block the passage of air.
- Laryngoscopy. The doctor uses a flexible nasopharynx-laryngoscope with a small diameter and sees with the help of special optical fibers the entire passage up to the vocal cords.
Other tests that are useful in diagnosing sleep apnea are:
- Sleep study. The test lasts overnight and the hypnotist measures the activity of various sleep-related organs.
- Cardiogram and encephalogram.
Sleep Apnea Therapy
The main goal in the treatment of sleep apnea is to ensure that the passage of air is not obstructed during sleep. Treatment methods include:
Weight Loss — Change Habits
Weight loss will be followed by fatigue and constant tiredness. The change of habits concerns the cessation of smoking, the restriction of alcohol, and hypnotics.
Nasal Decongestants
Nasal decongestants are usually effective in the mild form of the condition. They help treat nasal congestion and relieve snoring.
CPAP Treatment
CPAP treatment is especially useful in obstructive sleep apnea. CPAP is administered through a special mask during sleep. The mask provides positive pressure on the lungs and helps keep the passages open at night.
Surgical Approach
Depending on the height at which the airflow obstruction is located, there are the following options:
For the nose:
- Nasal septum plastic surgery.
- Functional rhinoplasty.
- Conchoplasty.
- Endoscopic nasal-paranasal surgery to remove nasal polyps.
For the pharynx:
- Tonsillectomy (adenotomy), for the treatment of hypertrophy of the tonsils and adenoids in children and adults.
- Snoring surgery, using radiofrequency, ultrasound, and laser, reshape the grape, soft palate, and pharyngeal walls to widen the airway.
Sleep Apnea Implant
An implant, which is placed under the chest and activates a nerve under the tongue, promises to provide a solution to those suffering from sleep apnea. This device is surgically inserted into the patient’s body and when it activates the nerve, it also opens the upper airway to facilitate breathing. The method shows encouraging results and a 70% reduction in symptoms.
Although the side effects are minimal, the scientists clarify that it is intended only for patients who do not show improvement with the usual treatment.
Frequently Asked Questions (FAQs)
How Common Is Sleep Apnea?
The answer depends on the definition that we will delimit. Using as the only criterion the number of apneas and hypopneas per hour (AHI), 24% of men and 9% of women exceed the upper limit of 5 episodes per bedtime. If in addition to the pathological index AHI is required the existence of daily symptoms (specifical drowsiness) then its frequency is estimated at 4% of men and 2% of women.
It should be noted that according to recent studies the above percentages rather underestimate the true frequency of the syndrome which is believed to be much higher.
Is It True That Sleep Apnea Is More Common In Men?
Indeed, it appears that the male population exhibits sleep apnea at least twice as often regardless of the definition we accept, but this is true for comparisons with premenopausal women. After menopause, the incidence in women increases significantly and almost all percentages reach those of men, as it is believed that the “protection” of sex hormones ceases to exist.
What Happens During Apnea Episodes That Makes Them Dangerous?
First, hemoglobin saturation decreases with consequently reduced oxygen supply to the major organs. Respiratory episodes trigger episodes of bradycardia or other arrhythmias. In addition, many respiratory episodes end with micro-awakenings of the brain, events that destroy the micro-architecture of sleep and lead to diurnal symptoms even on long-lasting sleep.
Can Sleep Apnea Kill You?
This is an extremely unlikely event. In sleep apnea the cessation of breathing is temporary and not permanent, so the chance of death is almost negligible. Nevertheless, it is a condition associated with potentially fatal conditions. Sleep apnea acts in a way as an “alarm clock” or an “alarm” that something is wrong with our body and of course, we should not ignore it under any circumstances.
Are There Patients With Other Diseases That We Should Look For More Persistently In Sleep Apnea?
Indeed, in patients with heart failure and severe reduction of the ejection fraction, ASD, and mostly associated with central episodes, is much more common. In obese patients with hypertension which is not adequately treated with medication or in cases of heart arrhythmias that we have gaps in the diagnostic approach, it is good to think about sleep apnea (ASD) that may be directly or indirectly related to these problems.
Can The Patient Be Safely Diagnosed Without A Multidisciplinary Sleep Study?
NO. The study is the only scientifically accepted and completely safe way to document the syndrome. It is done in special centers with special equipment and specialized medical staff.
Is Sleep Apnea A Curable Disease?
The syndrome is treatable in all cases, both in terms of the immediate consequences associated with the day and night symptoms, and in terms of its long-term adverse effects on the central nervous system, cardiovascular and endocrine system, and all the factors that shape the quality of that standard of living.
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