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Sleep Apnea

What is Sleep Apnea?

Sleep Apnea is a sleep disorder in which the patient experiences shallow breathing or pauses in breathing during sleep. These pauses can occur several times during sleep, leading to health complications and lifestyle hindrances such as excessive sleepiness during daytime.

What are the types of Sleep Apnea?

There are four types of sleep apnea:

  • Obstructive Sleep Apnea – Obstructive sleep apnea (OSA) is the most common form of this sleep disorder. Obstructive sleep apnea occurs when a patient’s throat closes when trying to inhale during sleep and the patient cannot suck air into their lungs. This happens because of a physical obstruction to the breathing process. Since muscles relax during sleep, the soft tissue of the pharynx relaxes and expands obstructing air flow in the upper respiratory tract. This reduces the amount of oxygen in the blood and forces the patient to wake up and take a deep breath. Men in the age group of 30 and 50 are chiefly affected by OSA. It is normal for people to experience mild OSA at some point in time in their lives; however chronic and severe OSA will require medical attention.
  • Central Sleep Apnea – Central sleep apnea or Cheyne-Stokes respiration is a relatively rare form of sleep apnea. It occurs when the region of the brain responsible for controlling the breathing muscles temporarily fails. It is different from OSA in that the patient experiences stop-start breathing due to a lack of effort to breathe.
  • Mixed Apnea – Mixed apnea is a combination of OSA and central sleep apnea. Chronic OSA can sometimes cause central sleep apnea. Although the cause is still unknown, weight-related, cardiovascular, and respiratory conditions can contribute to mixed sleep apnea.
  • Complex Sleep Apnea – Complex sleep apnea is a form of mixed sleep apnea. It is an unusual condition where a patient still experiences central sleep apnea even when the physical obstruction to breathing is removed.

What are the causes of Sleep Apnea?

Obstructive sleep apnea is caused when soft tissue in the airway relaxes. Changes in muscle tone increase in the soft tissue due to obesity, and the structure of the skull and face are the chief causes of OSA. Obese people are more at risk from OSA because they carry more muscle and tissue mass. More than 50% of those who have Down Syndrome suffer from OSA. Poor muscle tone, narrow nasopharynx, and a large tongue are common causes. Nasal congestion and alcohol consumption can also cause OSA. Enlarged tonsils and adenoids are the most common causes of obstructive sleep apnea in children. Obstructive sleep apnea can also occur as a part of the natural ageing process as the brain’s capacity to transmit instructions to the throat muscles to maintain rigidity decreases.

Central sleep apnea is usually a result of some medical condition. It is rarely found in healthy individuals. Since breathing is controlled by the brainstem, any medical condition involving that part of the brain can cause central sleep apnea. Cardiovascular conditions, neurodegenerative conditions such as Parkinson’s disease, advanced arthritis and encephalitis are some medical conditions that can cause central sleep apnea.

What are the symptoms/complications of sleep apnea?

Symptoms of sleep apnea can include:

  • Abnormal sleep patterns
  • Loud snoring
  • Frequent pauses during sleep due to breaks in breathing
  • Choking during sleep
  • Sudden awakenings to restart breathing
  • Waking up in a sweat
  • Daytime sleepiness
  • Falling asleep at inappropriate times
  • Irritableness
  • High blood pressure
  • Erectile dysfunction

Complications from sleep apnea can include inattentiveness at work, laziness and tiredness, risk of accidents, getting irritated easily, high blood pressure and erectile dysfunction. Sleep apnea can also increase the risk of congestive heart failure and stroke. It can lead to complications in the treatment processes for conditions such as atrial fibrillation. Children affected by sleep apnea can be hyperactive, high strung and aggressive, and prone to bed wetting. They may have unusual sleeping positions. Overall, a person suffering from sleep apnea experiences deterioration in the quality of life.

Diagnosis of Sleep Apnea

Diagnostic tests can determine if a patient suffers from sleep apnea, particularly if the patient is suffering from conditions such as high blood pressure, heart failure, and epilepsy. Physical examination for adults includes measuring for a wide neck, enlarged tonsils, and upper body obesity. In evaluating children, doctors check for enlarged adenoids and determine if the child has attention deficit issues.

Doctors use the patient medical and sleep history in diagnosing sleep apnea. Symptoms such as drowsiness, headaches, heartburn, and patient medications are evaluated in the diagnosis. If sleep apnea is ruled out, then the patient must be tested for other potential sleep disorders.

What types of treatments are available?

Treatments for sleep apnea include surgical and non-surgical treatments. Non-surgical treatments include medications, behavioral changes, dental appliances, and Continuous Positive Airway Pressure (CPAP):

  • Medication – Nasal steroid sprays have been found to be effective in controlling sleep apnea caused by nasal airway obstruction. Hypothyroidism treatment helps manage sleep apnea caused by the thyroid condition. 
  • Behavioral changes – Changes in lifestyle and behavior are often the only treatment required to treat sleep apnea, particularly the milder cases. Exercising to reduce fat and avoiding sleep positions that lead to increased snoring and apnea have been shown to be effective.
  • Dental appliances – Mild to moderate sleep apnea can be controlled by using dental appliances that hold the palate up and keep the airway free. The dental appliance should be fitted by a dentist so that it works properly.
  • Continuous positive airway pressure – Continuous positive airway pressure (CPAP) uses air pressure to ensure that the soft tissue does not sag during sleep. Pressurized air is delivered through a face mask. As the person breathes, gentle air pressure keeps the air passage open and prevents sleep apnea.

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