Obstructive Sleep Apnea

• Sleep apnea affects millions of men, women and children
• Apart from greatly affecting sleep, obstructive sleep apnea is linked to many other diseases and health problems

Overview of Obstructive Sleep Apnea

Video courtesy of Harvard Health Publications, Harvard Medical School. The special health report,

Improving Sleep: A guide to a good night’s rest, prepared in consultation with medical editor

Lawrence Epstein, M.D., is available at the following link:
http://www.health.harvard.edu/special_health_reports/improving-sleep-a-guide-to-a-good-nights-rest.html

Sleep apnea occurs when the airway becomes partially or fully blocked during sleep. This stops air successfully reaching the lungs, and the patient wakes up gasping for breath. It can be scary to watch someone stop breathing or struggle for breath while they sleep, but most people with sleep apnea don’t actually know that they have it. People with severe apnea can stop breathing hundreds of times every night.

Symptoms of Obstructive Sleep Apnea

These include:

• Frequent silences during sleep due to breaks in breathing (apnea)
• Choking or gasping during sleep to get air into the lungs
• Loud snoring
• Sudden awakenings to restart breathing or waking up in a sweat
• Daytime sleepiness and feeling unrefreshed by a night’s sleep, including falling asleep at inappropriate times

These symptoms are often noticed first by a parent or bed partner.

Causes of Obstructive Sleep Apnea

There are a number of factors that increase the risk of obstructive sleep apnea:

• Being overweight or obese (although 50% of people with sleep apnea are not obese)
• Large tonsils or adenoids
• Other distinctive physical attributes (deviated septum, shape of head and neck, receding chin, enlarged tongue)
• Nasal congestion or blockage (from cold, sinusitis, allergies, smoking, etc.)
• Throat muscles and tongue relax more than normal during sleep (possibly due to alcohol, sedatives or age)

When you inhale, air passes through your nose and mouth, flowing past soft-tissue structures in your throat such as the soft palate, uvula, tonsils, and tongue. While you are awake, the muscles surrounding your throat contract when you breathe which helps keep the airway open.

There are multiple reasons why the airway can become blocked during sleep. Sometimes, when the throat muscles relax during sleep, the soft tissue structures can collapse and block the airway. Sometimes the airway itself may be smaller than usual because of large tonsils or a small jaw. Gaining extra body weight can also cause the airway to become blocked when the heavier throat tissues fall into the airway.

“Apnea” basically means “no breathing”, while “Hypopnea” basically means “reduced airflow”. As there is no breathing during an apnea, oxygen in the blood falls and carbon dioxide rises. When this occurs, the individual must briefly wake up to activate the airway muscles and open the airway. This generally occurs with a loud gasp or snore as breathing resumes. This routine may be repeated many times throughout the night, destroying the person’s natural sleep patterns. Their sleep is described as fragmented and light.

Despite the fact that the person has been in bed all night long, and they may not recall waking up even once during that time, they will probably feel exhausted all day long. Sometimes people with sleep apnea wake up with headaches.

Consequences of Not Treating Obstructive Sleep Apnea

Sleep apnea has serious health consequences and can even be life-threatening. The main effects of sleep apnea are sleep deprivation and oxygen deprivation.

Sleep deprivation - Sleep deprivation hurts the person with sleep apnea and the bed partner. Frequent waking, whether remembered or not, causes fitful sleep and prohibits therapeutic rest. A bed partner may lose an hour or more of sleep each night from sleeping next to a person with sleep apnea. Along with the apnea episodes, side effects like excessive sweating and a frequent need to urinate disrupt sleep.

Often, a person with sleep apnea will wake up feeling like they have not slept or have difficulty staying awake during the day. Some trickle-down effects of sleep deprivation include a compromised immune system, poor mental and emotional health, irritability, and an increased likelihood of vehicular or workplace accidents.

Oxygen deprivation - When your airway is blocked, air and oxygen cannot get into the lungs and your brain does not get enough oxygen. Serious problems can result from the oxygen deprivation of sleep apnea, including heart disease, high blood pressure, sexual dysfunction, and learning/memory problems.

Treatment for Obstructive Sleep Apnea

As obstructive sleep apnea is a common and well-understood disease, treatments exist that can relieve most, if not all, of the symptoms.

Continuous Positive Airway Pressure (CPAP)

CPAP is the most widely recommended treatment for moderate to severe obstructive sleep apnea. CPAP entails wearing a mask-like device while you sleep, which provides pressurized air to prevent the airway from collapsing. Most CPAP units are the size of a tissue box and many now come with a built-in humidifier for comfort.

While CPAP works very well in preventing apnea symptoms, many people find the apparatus uncomfortable and difficult to use. Luckily, recent advancements to CPAP technology have made these once cumbersome devices lighter, quieter and much more comfortable. Recent refinements include options such as:

• “Bilevel PAP,” which switches from higher to lower air pressure during exhalation, making breathing easier for some,
• “AutoPAP”, which uses an internal regulator that adjusts pressure rather than remaining at one fixed setting.

Different types of masks are available and can make using the device more comfortable. When used correctly, CPAP is very effective in treating OSA. Unfortunately, many people don’t receive proper coaching and guidance for using these breathing devices, and give up on them too quickly.

Dental appliances, oral devices, and lower jaw adjustment devices

Most dental devices are acrylic and fit inside your mouth, much like an athletic mouth guard or orthodontic appliance. They reposition your lower jaw. Two common types of oral devices are the Mandibular Repositioning Device and the Tongue Retaining Device. These devices open your airway by bringing your lower jaw or your tongue forward during sleep.

While oral devices are less cumbersome than CPAP and relatively simple to use, they are only effective for mild to moderate sleep apnea. There are also a number of potential side effects from using this type of treatment – soreness; damage to/permanent change in position of the jaw, teeth, and mouth; saliva build-up; and nausea. It is very important to get fitted by a dentist that specializes in sleep apnea, and to see the dentist on a regular basis for any dental problems that may occur.

Surgery as treatment

Surgery can increase the size of your airway. 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 may be an effective option for some, and can even provide permanent relief from symptoms. However, any surgery carries risks of surgical complications and infections, and in some rare cases, symptoms can become worse after surgery. If you have exhausted other apnea treatment options, you may want to discuss surgical options with your doctor or sleep specialist.

It can be very worrying to see someone who has sleep apnea events. If you, or someone that you know, has signs of sleep apnea, then definitely speak to your doctor. Sleep apnea is easily diagnosed and treated. Sufferers are often astounded by the quality of sleep that they have been missing and the difference treatment makes to their lives.