Sleep Apnea

Symptoms, Treatments, Causes, and Cures

Snoring isn't something that most of us worry about. But loud snoring—especially when it's accompanied by daytime fatigue—may be a sign of sleep apnea, a common and potentially serious disorder in which breathing repeatedly stops and starts as you sleep. Untreated sleep apnea can be dangerous and detrimental to your health, so it’s important to see a doctor if you suspect that you or a loved one might have it. Read on to learn the warning signs of sleep apnea, how to distinguish it from normal snoring, the medical treatments available, and what you can do to help yourself.

What is sleep apnea?

Anatomy of a sleep apnea episode

As airflow stops during a sleep apnea episode, the oxygen level in your blood drops. Your brain responds by briefly disturbing your sleep enough to kick start breathing—which often resumes with a gasp or a choking sound. If you have obstructive sleep apnea, you probably won’t remember these awakenings. Most of the time, you’ll stir just enough to tighten your throat muscles and open your windpipe. In central sleep apnea, you may be conscious of your awakenings.

Sleep apnea affects the way you breathe when you’re sleeping. In untreated sleep apnea, breathing is briefly interrupted or becomes very shallow during sleep. These breathing pauses typically last between 10 to 20 seconds and can occur up to hundreds of times a night, jolting you out of your natural sleep rhythm. As a consequence, you spend more time in light sleep and less time in the deep, restorative sleep you need to be energetic, mentally sharp, and productive the next day.
The chronic sleep deprivation that comes with sleep apnea results in daytime sleepiness, slow reflexes, poor concentration, and an increased risk of accidents. Sleep apnea can also lead to serious health problems over time, including diabetes, high blood pressure, heart disease, stroke, and weight gain. But with treatment you can control the symptoms, get your sleep back on track, and start enjoying being refreshed and alert every day.

Types of sleep apnea

• Obstructive sleep apnea is the most common type of sleep apnea. It occurs when the soft tissue in the back of your throat relaxes during sleep and blocks the airway, often causing you to snore loudly.
• Central sleep apnea is a much less common type of sleep apnea that involves the central nervous system, occurring when the brain fails to signal the muscles that control breathing. People with central sleep apnea seldom snore.
• Complex sleep apnea is a combination of obstructive sleep apnea and central sleep apnea.

Sleep apnea signs and symptoms

It can be tough to identify sleep apnea on your own, since the most prominent symptoms only occur when you’re asleep. But you can get around this difficulty by asking a bed partner to observe your sleep habits, or by recording yourself during sleep. If pauses occur while you snore, and if choking or gasping follow the pauses, these are major signs that you have sleep apnea.

Major signs and symptoms of sleep apnea

• Loud and chronic snoring almost every night
• Choking, snorting, or gasping during sleep
• Pauses in breathing
• Waking up at night feeling short of breath
• Daytime sleepiness and fatigue, no matter how much time you spend in bed

Other warning signs and symptoms of sleep apnea

• Waking up with a dry mouth or sore throat
• Insomnia or nighttime awakenings
• Going to the bathroom frequently during the night
• Forgetfulness and difficulty concentrating
• Uncharacteristic moodiness, irritability, or depression
• Morning headaches
• Restless or fitful sleep
• Impotence

Signs and symptoms of sleep apnea in children

While obstructive sleep apnea can be common in children, it’s not always easy to recognize. In addition to continuous loud snoring, children with sleep apnea may adopt strange sleeping positions and suffer from bedwetting, excessive perspiration at night, or night terrors.
If you suspect your child may have sleep apnea, consult a pediatrician who specializes in sleep disorders. Once obstructive sleep apnea is diagnosed, surgery to remove the child’s tonsils or adenoids usually corrects the problem.

See a doctor immediately if you suspect sleep apnea

Sleep apnea can be a potentially serious disorder, so contact a doctor immediately if you spot the warning signs. An official diagnosis of sleep apnea may require seeing a sleep specialist and taking a home-based sleep test using a portable monitor, or an overnight stay at a sleep clinic.

Do you have sleep apnea?

These questions can help you and your physician figure out if you should be tested for sleep apnea.

Questions for Sleep Apnea
1. Do you snore more than three nights a week?	Yes (2 points)  No
2. Is your snoring loud (can it be heard through a door or wall)?	Yes (2 points)  No
3. Has anyone ever told you that you briefly stop breathing or gasp when you are asleep?	Never  Occasionally (3 points)  Frequently (5 points)
4. What is your collar size?	Men:  Less than 17 inches  17 inches or greater (5 points) Women:  Less than 16 inches  16 inches or greater (5 points)
5. Have you had high blood pressure, or are you being treated for it?	Yes (2 points)  No
6. Do you ever doze or fall asleep during the day when you are not busy or active?	Yes (2 points)  No
7. Do you ever doze or fall asleep during the day when you are driving or stopped at a light?	Yes (2 points)  No
Click on Show Score to get the total and see what it means.

Score: 

Interpreting the score:

• 0 to 5: Low probability of sleep apnea. You’re sleep problems are more likely to be caused by something other than sleep apnea. Consult your doctor for a diagnosis.
• 6 to 8: It's uncertain whether you have sleep apnea. You and your doctor should decide the next step based on other pieces of your medical history.
• 9 +: You may have sleep apnea. You are a good candidate for a sleep study and should see your doctor immediately

This questionnaire is not intended to replace professional diagnosis.
Source: Harvard Health Publications

Is it just snoring or is it sleep apnea?

Not everyone who snores has sleep apnea, and not everyone who has sleep apnea snores. So how do you tell the difference between normal snoring and a more serious case of sleep apnea?
The biggest telltale sign is how you feel during the day. Normal snoring doesn’t interfere with the quality of your sleep as much as sleep apnea does, so you’re less likely to suffer from extreme fatigue and sleepiness during the day.
The following strategies can help you decipher the symptoms:

• Keep a sleep diary – Record how many hours you’re spending in bed, any nighttime awakenings, and whether you feel refreshed in the morning. Ask your sleep partner to keep track of your snoring, including how loud and frequent it is. Also ask him or her to note any gasping, choking, or other unusual sounds.
• Record yourself sleeping – Taking a video or audio recording of yourself while you sleep can be very informative and revealing. You can use a sound-activated audio recorder, a video camera, or software that turns your computer into a recorder.

Keep in mind that even if you don’t have sleep apnea, a snoring problem can get in the way of your bed partner’s rest and affect your own sleep quality and health. But there are plenty of tips and treatments that can help you stop snoring.

Sleep apnea causes and risk factors

Anyone can have sleep apnea—young, old, male, female, and even children. However, certain risk factors have been associated with obstructive and central sleep apnea.

Risk factors for obstructive sleep apnea

You have a higher risk for obstructive sleep apnea if you are (or have):

• Overweight
• Male
• Related to someone who has sleep apnea
• Over the age of 50
• Black, Hispanic, or a Pacific Islander
• A smoker
• High blood pressure
• A thick neck (neck circumference greater than 15.75 in or 40 cm)

Other physical attributes that put you at risk for obstructive sleep apnea include a deviated septum, receding chin, or enlarged tonsils or adenoids (the most common cause of sleep apnea in children). Your airway may be blocked or narrowed during sleep simply because your throat muscles tend to relax more than normal. Allergies or other medical conditions that cause nasal congestion and blockage can also contribute to sleep apnea.

Risk factors for central sleep apnea

Like obstructive sleep apnea, central sleep apnea is more common in males and people over the age of 65. However, unlike obstructive sleep apnea, central sleep apnea is often associated with serious illness, such as heart disease, stroke, neurological disease, or spinal or brainstem injury.

Self-help treatments for sleep apnea

While a diagnosis of sleep apnea can be scary, it is a treatable condition. In fact, there are many things you can do on your own to help, particularly for mild to moderate sleep apnea. Home remedies and lifestyle modifications can go a long way in reducing sleep apnea symptoms. However, they should not replace medical evaluation and treatment.

Lifestyle changes that can help sleep apnea

• Lose weight. People who are overweight have extra tissue in the back of their throat, which can fall down over the airway and block the flow of air into the lungs while they sleep. Even a small amount of weight loss can open up your throat and improve sleep apnea symptoms.
• Quit smoking. Smoking is believed to contribute to sleep apnea by increasing inflammation and fluid retention in your throat and upper airway.
• Avoid alcohol, sleeping pills, and sedatives, especially before bedtime, because they relax the muscles in the throat and interfere with breathing.
• Exercise regularly. As well as helping you to lose weight, starting and sticking to an exercise program can have a major effect on the duration and quality of your sleep. Aerobic and resistance training can help reduce sleep apnea symptoms, while yoga is also good for strengthening the muscles in your airways and improving breathing.
• Avoid caffeine and heavy meals within two hours of going to bed.
• Maintain regular sleep hours. Sticking to a steady sleep schedule will help you relax and sleep better. Apnea episodes decrease when you get plenty of sleep.

Bedtime tips for preventing sleep apnea

• Sleep on your side. Avoid sleeping on your back, as gravity makes it more likely for your tongue and soft tissues to drop and obstruct your airway. Some people only experience sleep apnea when sleeping on their back.
• The tennis ball trick. In order to keep yourself from rolling onto your back while you sleep, sew a tennis ball into a pocket on the back of your pajama top. Or wedge a pillow stuffed with tennis balls behind your back.
• Prop your head up. Elevate the head of your bed by four to six inches, or elevate your body from the waist up by using a foam wedge. You can also use a special cervical pillow.
• Open your nasal passages. Try to keep your nasal passages open at night using a nasal dilator, saline spray, breathing strips, or a neti pot.
• Tighten the muscles that keep the mouth closed. Try chewing gum or holding a pen or a pencil between your teeth for about 10 minutes before bedtime, or until your jaw starts to ache.

Alternative remedies for preventing sleep apnea

• Singing can increase muscle control in the throat and soft palate, reducing snoring and sleep apnea caused by lax muscles.
• Playing the didgeridoo (native Australian wind instrument) can strengthen the soft palate and throat, reducing daytime sleepiness and snoring in people with moderate sleep apnea.

Throat exercises to reduce sleep apnea

Throat and tongue exercises may reduce the severity of sleep apnea by strengthening the muscles in the airway, making them less likely to collapse. It may take several weeks before you start to notice the benefits.
Try these exercises:

• Press your tongue flat against the floor of your mouth and brush top and sides with a toothbrush. Repeat brushing movement five times, three times a day.
• Press the length of your tongue tothe roof of your mouth and hold for three minutes a day.
• Place a finger into one side of your mouth. Hold the finger against your cheek while pulling the cheek muscle in at same time. Repeat 10 times, rest, and then alternate sides. Repeat this sequence three times.
• Purse your lips as if to kiss. Hold your lips tightly together and move them up and to the right, then up and to the left 10 times. Repeat this sequence three times.
• Place your lips on a balloon. Take a deep breath through your nose then blow out through your mouth to inflate the balloon as much as possible. Repeat this five times without removing balloon from your mouth.
• Gargle with water for five minutes, twice a day.
• Lightly hold your tongue between your teeth. Swallow five times. Repeat this five times a day.

Sleep apnea treatment

If your sleep apnea is moderate to severe, or you’ve tried self-help strategies and lifestyle changes without success, it’s important to follow up with a sleep doctor who can evaluate your symptoms and help you find an effective treatment. Treatment for sleep apnea has come a long way in recent times, so take some time to explore the new options. Even if you were unhappy with sleep apnea treatment in the past, chances are you can find something that works and feels comfortable to you.
Treatments for central and complex sleep apnea usually include:

• Treating the underlying medical condition causing the apnea, such as a heart or neuromuscular disorder
• Using supplemental oxygen while you sleep
• Using breathing devices that will also manage obstructive sleep apnea

Medications are only available to treat the sleepiness associated with sleep apnea, not the apnea itself, so they should only be used in conjunction with other proven sleep apnea treatments.

CPAP for sleep apnea

Source: Harvard Health Blog

Continuous Positive Airflow Pressure (CPAP) is the most common treatment for moderate to severe obstructive sleep apnea. The CPAP device is a mask-like machine that covers your nose and mouth, providing a constant stream of air that keeps your breathing passages open while you sleep. Most CPAP devices are the size of a tissue box. In many cases, you’ll experience immediate symptom relief and a huge boost in your mental and physical energy.
If you’ve given up on sleep apnea machines in the past because of discomfort, you owe it to yourself to give them a second look. CPAP technology is constantly being updated and improved, and the new CPAP devices are lighter, quieter, and more comfortable. So make sure your sleep apnea device is up to date.

CPAP without the mask

One of the newest treatment options for sleep apnea is an alternative form of CPAP called Provent, a device that fits over the nostrils and is smaller and less intrusive than the traditional CPAP machine. If you haven't been able to adjust to the CPAP mask, ask your doctor about Provent. Keep in mind that Provent, however, is more expensive than regular CPAP machines, and it doesn't work for everyone.

CPAP tips and troubleshooting

Having trouble with your new sleep apnea device? It can take some time to get accustomed to sleeping while wearing a CPAP device. It’s natural to miss sleeping the “old way,” but there are things you can to do make the adjustment easier.

• Make sure your CPAP device fits correctly. A correct fit makes a huge difference. Make sure the straps are not too tight or too loose and that the mask seals completely over your nose and mouth. Schedule regular appointments with your doctor to check the fit and evaluate your treatment progress.
• Ease into it. Start by using your CPAP device for short periods during the day. Use the “ramp” setting to gradually increase air pressure. It’s normal to need several months to get used to sleeping this way.
• Upgrade your CPAP device with customized options. Customize the mask, tubing and straps, to find the right fit. Ask your doctor about soft pads to reduce skin irritation, nasal pillows for nose discomfort, and chinstraps to keep your mouth closed and reduce throat irritation.
• Use a humidifier to decrease dryness and skin irritation. Try a special face moisturizer for dry skin. Many CPAP devices now come with a built-in humidifier.
• Try a saline nasal spray or a nasal decongestant for nasal congestion.
• Keep your mask, tubing and headgear clean. To ensure maximum comfort and benefit, replace CPAP and humidifier filters regularly and keep the unit clean.
• Mask the sound of the CPAP machine. If the sound of the CPAP machine bothers you, place it beneath the bed to reduce the noise. You can also try using a sound machine or white noise machine to help you sleep.

Other breathing devices for sleep apnea

In addition to CPAP, there are other adjustable airway pressure devices that a sleep specialist may recommend for sleep apnea treatment:

• Bilevel positive airway pressure (BPAP) devices can be used for those who are unable to adapt to using CPAP, or for central sleep apnea sufferers who need assistance for a weak breathing pattern. This device automatically adjusts the pressure while you're sleeping, providing more pressure when you inhale, less when you exhale. Some BPAP devices also automatically deliver a breath if it detects you haven't taken one for a certain number of seconds.
• Adaptive servo-ventilation (ASV) devices can be used for treating central sleep apnea as well as obstructive sleep apnea. The ASV device stores information about your normal breathing pattern and automatically uses airflow pressure to prevent pauses in your breathing while you’re asleep.

Dental devices and surgery for sleep apnea

If you’ve tried CPAP and self-help tips and your sleep apnea persists, you may benefit from a dental device or surgical treatment.

Dental devices for sleep apnea

Most dental devices are acrylic and fit inside your mouth, much like an athletic mouth guard. Others fit around your head and chin to adjust the position of your lower jaw. Two common oral devices are themandibular repositioning device and the tongue retaining device. These devices open your airway by bringing your lower jaw or your tongue forward during sleep.
Dental devices are only effective for mild-to-moderate sleep apnea. There are also a number of troubling side effects from using this type of treatment, including soreness, saliva build-up, nausea, and damage or permanent change in position of the jaw, teeth, and mouth.
It is very important to get fitted by a dentist specializing in sleep apnea, and to see the dentist on a regular basis for any dental problems that may occur. You may also need to periodically have your dentist adjust the mouthpiece to fit better.

Surgery as treatment for sleep apnea

If you have exhausted other apnea treatment options, you may want to discuss surgical options with your doctor or sleep specialist. Surgery can increase the size of your airway, thus reducing your episodes of sleep apnea.
The surgeon may remove tonsils, adenoids, or excess tissue at the back of the throat or inside the nose. Or the surgeon may reconstruct the jaw to enlarge the upper airway. Surgery carries risks of complications and infections, and in some rare cases, symptoms can become worse after surgery.

Resource: helpguide.org