Sleep apnea is a common
disorder that can be very serious.
In sleep apnea, your breathing stops or gets very shallow while
you are sleeping. Each pause typically lasts 10-20 seconds or more.
These pauses can occur 20 to 30 times or more an hour.
The most common type of sleep apnea is obstructive sleep apnea.
During sleep, enough air cannot flow into your lungs through your
mouth and nose even though you try to breathe. When this happens,
the amount of oxygen in your blood may drop. Normal breaths then
start again with a loud snort or choking sound.
Your sleep is not restful because:
These brief episodes of increased airway resistance (and breathing
pauses) occur many times
You may have many brief drops in your oxygen levels of the blood.
You move out of deep sleep and into light sleep several times
during the night, resulting in poor sleep quality.
When your sleep is upset throughout the night, you can be very
sleepy during the day.
People with sleep apnea often have loud snoring. However, not
everyone who snores has sleep apnea. Some people with sleep apnea
don't know they snore.
Sleep apnea happens more often in people who are overweight, but
even thin people can have it.
Most people don't know they have sleep apnea. They don't know
that they are having problems breathing while they are sleeping.
A family member and/or bed partner may notice the signs of sleep
apnea first.
Untreated sleep apnea can increase the chance of having high blood
pressure and even a heart attack or stroke. Untreated sleep apnea
can also increase the risk of diabetes and the risk for work-related
accidents and driving accidents.
Sleep apnea happens when enough air cannot move into
your lungs while you are sleeping.
When you are awake and normally during sleep, your throat muscles
keep your throat open and air flows into your lungs. However,
in obstructive sleep apnea, the throat briefly collapses, causing
pauses in your breathing. With pauses in breathing, your oxygen
level in your blood may drop. This happens when:
Your throat muscles and tongue relax more than is normal.
Your tonsils and adenoids are large.
You are overweight. The extra soft tissue in your throat makes
it harder to keep the throat area open.
The shape of your head and neck (bony structure) results in somewhat
smaller airway size in the mouth and throat area.
With the throat frequently fully or partly blocked during sleep,
enough air cannot flow into your lungs, even though efforts to
breathe continue. Your breathing may become hard and noisy and
may even stop for short periods of time (apneas).
Central apnea is a rare type of sleep apnea that happens when
the area of your brain that controls your breathing doesn't send
the correct signals to the breathing muscles. There is then no
effort to breathe at all for brief periods. Snoring does not typically
occur in central apnea.
Anyone can have obstructive sleep apnea.
It is estimated that more than 12 million Americans have obstructive
sleep apnea. More than half the people who have sleep apnea are
overweight, and most snore heavily.
Adults most likely to have sleep apnea:
Snore loudly
Are overweight
Have high blood pressure
Have decreased size of the airways in their nose, throat, or mouth.
This can be caused by the shape of these structures or by medical
conditions causing congestion in these areas, such as hay fever
or other allergies.
Have a family history of sleep apnea.
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 that causes
them to be very sleepy during the day. Sleep apnea is more common
in African Americans, Hispanics, and Pacific Islanders. If someone
in your family has sleep apnea, you are more likely to develop
sleep apnea than someone without a family history of the condition.
Obstructive sleep apnea can also occur in children who snore.
If your child snores, you should discuss it with your child's
doctor or health care provider.
The most common signs of sleep apnea are:
Loud snoring
Choking or gasping during sleep
Fighting sleepiness during the day (even at work or while driving)
Your family members may notice the symptoms before you do. You
will likely not otherwise be aware that you have problems breathing
while asleep.
Others signs of sleep apnea may include:
Morning headaches
Memory or learning problems
Feeling irritable
Not being able to concentrate on your work.
Mood swings or personality changes, perhaps feeling depressed
Dry throat upon awaking
Frequent urination at night.
Some of the ways to help doctors diagnose sleep apnea include:
A medical history that includes asking you and your family questions
about how you sleep and how you function during the day
Checking your mouth, nose, and throat for extra or large tissues,
for example tonsils, uvula (the tissue that hangs from the middle
of the back of the mouth), and soft palate (roof of your mouth
in the back of your throat)
A sleep recording of what happens with your breathing.
A sleep recording is a test that is often done in a sleep center
or sleep laboratory, which may be part of a hospital. You may
stay overnight in the sleep center, although sleep studies are
sometimes done in the home. The most common sleep recording used
to find out if you have sleep apnea is called a polysomnogram
(poly-SOM-no-gram) or PSG. This test records:
Brain activity
Eye movement
Muscle activity
Breathing and heart rate
How much air moves in and out of your lungs while you are sleeping
The percent of oxygen in your blood
A PSG is painless. You will go to sleep as usual. The staff at
the sleep center will monitor your sleep throughout the night.
The results of your PSG will be analyzed by a sleep medicine specialist
to see if you have sleep apnea, how severe it is, and what treatment
may be recommended.
In certain circumstances, the PSG can be done at home. A home
monitor can be used to record heart rate, how air moves in and
out of your lungs, the amount of oxygen in your blood, and your
breathing effort. For this test, a technician will come to your
home and help you apply the monitor you will wear overnight. You
will go to sleep as usual, and the technician will come back the
next morning to get the monitor and send the results to your doctor.
Once all your tests are completed, the sleep medicine
specialist will review the results and work with you and your
family to develop a treatment plan. In some cases, you may also
need to see another physician for evaluation of:
Lung problems (pulmonologist)
Problems with the brain or nerves (neurologist)
Heart or blood pressure problems (cardiology)
Ear, nose, or throat problems (ENT)
Psychologist or psychiatrist
Treatment is aimed at restoring regular nighttime breathing and
relieving symptoms such as very loud snoring and daytime sleepiness.
If you have mild sleep apnea, some changes in daily activities
or habits may be all that are needed:
Avoid alcohol, smoking, and medications that make you sleepy.
They will make it harder for your throat to stay open while you
sleep.
Lose weight if you are overweight. Even a little weight loss can
improve your symptoms.
Sleep on your side instead of your back. Sleeping on your side
may help keep your throat open.
People with moderate or severe sleep apnea will need to
make these changes as well. They also will need other treatments
such as:
Continuous Positive Airway Pressure (CPAP)
CPAP is the most common treatment for sleep apnea. For this treatment,
you will wear a mask over your nose during sleep that blows air
into your throat at a pressure level that is right for you. The
increased airway pressure acts to keep the throat open while you
sleep. The air pressure is adjusted so that it is just enough
to stop these airways from briefly getting too small during sleep.
Sleep apnea will return if CPAP is stopped or if it is not used
correctly. Usually, a technician comes to your home to bring the
CPAP equipment. The technician will set up the CPAP machine and
make adjustments based on your doctor's orders.
CPAP treatment may cause side effects in some people.
Some side effects are:
Dry or stuffy nose
Irritation of the skin on your face
Bloating of your stomach
Sore eyes
Headaches.
If you are having trouble with CPAP side effects, work
with your sleep medicine specialist and technician. Together you
can do things to reduce these side effects, such as:
Using a nasal spray to relieve a dry, stuffy, or runny nose
Adjusting the CPAP settings
Adjusting the size/fit of the mask
Adding moisture to the air as it flows through the mask
Using a CPAP machine that can automatically adjust the amount
of air pressure to the level that is required to keep the airway
open
Using a CPAP machine that will start with a low air pressure and
slowly increase the air pressure as you fall asleep.
People with severe sleep apnea symptoms generally feel much better
once they begin treatment with CPAP. When using CPAP, it is very
important that you follow up with your doctor. If you are having
side effects, talk to your doctor.
Mouthpiece
A mouthpiece (oral appliance) may be helpful in some people with
mild sleep apnea. Some doctors may also recommend this if you
snore loudly but do not have sleep apnea.
A custom-fit plastic mouthpiece will be made by a dentist or
orthodontist. An orthodontist is a specialist in correcting teeth
or jaw problems. The mouthpiece will adjust your lower jaw and
your tongue to help keep the airway in your throat open while
you are sleeping. Air can then flow easily into your lungs because
there is less resistance to breathing.
Possible side effects of the mouthpiece include damage
to your:
Teeth
Gums
Jaw
Follow up with your dentist or orthodontist to check for any side
effects and to be sure that your mouthpiece fits.
Surgery
Some people with sleep apnea may benefit from surgery.
The type of surgery depends on the cause of the sleep apnea:
Surgery to remove the tonsils and adenoids if they are blocking
the airway. This surgery is especially helpful for children.
Uvulopalatopharyngoplasty (UPPP) is a surgery that removes the
tonsils, uvula (the tissue that hangs from the middle of the back
of the roof of the mouth), and part of your soft palate (roof
of your mouth in the back of your throat). This surgery is only
effective for some people with sleep apnea.
Laser-assisted uvulopalatoplasty (LAUP) is a surgery that can
stop snoring but is probably not helpful in treating sleep apnea.
A laser device is used to remove the uvula and part of the soft
palate. Because the main symptom of sleep apnea-snoring-is stopped,
it is important to have a sleep study before having this surgery.
Tracheostomy is a surgery used in severe sleep apnea. A small
hole is made in the windpipe and a tube is inserted. Air will
flow through the tube and into the lungs. This surgery is very
successful but is needed only in patients not responding to all
other possible treatments.
Other possible surgeries for some people with sleep apnea
include:
Rebuilding the lower jaw
Surgery of the nose
Surgery to treat obesity.
Currently, there are no medications for the treatment of sleep
apnea.
Getting treatment for sleep apnea and following your doctor's
advice can help you and your family members.
Getting treatment for sleep apnea can help snoring and improve
your sleep.
Treating sleep apnea helps you feel rested during the day.
Many people will benefit by making changes, such as stopping smoking
and losing weight.
Some will need to wear a mask at night that will help keep the
throat open and improve breathing.
A few will need to have surgery to remove tonsils and adenoids,
part of the uvula (the tissue that hangs from the middle of the
back of the roof of the mouth), and/or the soft palate (roof of
your mouth in the back of your throat) that may block the airway.
Regular and ongoing follow up with your sleep medicine specialist
who will check if your treatment is working and if you are having
any side effects.
For Family and Friends, What Can You Do To Help?
Often, people with sleep apnea do not know they have it. They
are not aware that their breathing stops and starts many times
while they are sleeping.
Family members or bed partners are usually the first ones to
notice that the person snores and stops breathing while sleeping.
It is important for people with sleep apnea to get medical help.
They are at higher risk for car crashes and work-related accidents
and other medical problems due to their sleepiness.
People with sleep apnea may fall asleep during the day,
even when:
Driving a car
Working
Talking on the phone
Sleep apnea can be very serious. It is important that people with
sleep apnea see their doctor to treat and control this disorder.
Treatment may improve the person's overall health and happiness,
and the quality of sleep both for the person and the entire family.