What is Sleep Apnea? 

The Greek word "apnea" means "without breath."

Sleep apnea is very common, almost as common in adults as diabetes or asthma. According to the National Institutes of Health it affects more than twelve million Americans.  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 in breathing typically lasts 10 to 20 seconds or more.  These pauses can occur 20 to 30 times or more an hour.

There are three types of apnea:

Obstructive Sleep Apnea (OSA), the most common, is caused by a narrowing of the airway, usually when the soft tissue in the back of the throat collapses during sleep. When this happens, the amount of oxygen in your blood may drop. Normal breathing then starts again with a loud snort or choking sound.

In Central Sleep Apnea, the airway does not collapse but the brain fails to signal the muscles to breathe.

Mixed Apnea, as the name implies, is a combination of OSA and Central Sleep Apnea.

• These brief episodes of increased airway resistance (and breathing pauses) occur many times.
• You may have many brief drops in the oxygen levels in your blood.
• You move out of deep sleep and into light sleep several times during the night, resulting in poor sleep quality.

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. 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.

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 for work-related accidents and driving accidents.

What are the Complications of Sleep Apnea?

Untreated, sleep apnea may contribute to:

• High blood pressure
• Cardiovascular diseases
• Diabetes
• Memory problems
• Weight gain
• Impotency
• Headaches
• Stroke

Other reasons treatment is important:

• Twenty three percent of the morbidity of heart disease could possibly be eliminated if sleep apnea were treated
• Sleep apnea is responsible for increased job impairment and job-related injuries
• Untreated sleep apnea patients have 4-10 times as many motor vehicles accidents as the general population, accounting 4% of all traffic fatalities

Fortunately, sleep apnea can be diagnosed and treated. Several treatment options exist, and research into additional options continues.

What are my Risk Factors for Sleep Apnea?

Risk factors include: 

• Being male
• Being overweight
• Being over the age of forty
• Having a family history of sleep apnea
  

Sleep apnea can, however, occur in anyone at any age, even children. Yet, because of the lack of awareness by the public and healthcare professionals, the vast majority of cases remain undiagnosed and therefore untreated. This is despite the fact that this serious disorder can have significant consequences .

Less than 5% of all OSA patients are receiving treatment at the present time.

What Are the Signs and Symptoms of Sleep Apnea?

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. Otherwise, you will likely not be aware that you have problems breathing while you are asleep.

Other 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 when you wake up
• Frequent urination at night

I snore; does this mean I have sleep apnea?

Snoring is a sound made in the upper airway of your throat when you sleep. The muscles of the throat relax, partially blocking the airway causing the tissue in the back of your throat to vibrate. About one-half of all people that snore have Obstructive Sleep Apnea (OSA). OSA occurs when the tissue either completely blocks the airway causing a complete blockage of airflow. Partial blockage can also occur causing a drastic decrease in the effectiveness of you breathing. When this happens your body wakes up. It can happen so quickly that you aren’t even aware of it. This disrupts the overall sleep process. It can occur hundreds of times a night. Many people, even though they feel as though they’ve slept well feel tired during the day, even after a nap.

Almost everyone is likely to snore at one time or another in their life. It has been found that all age groups snore. The estimates of snoring vary widely based on how it is defined. Chronic snoring has been found in about 24% of adult women and 40% of adult men. The incidence of snoring increases in both men and women as they age.

Snoring is more common in people who are overweight and also appears to run in families. Your likelihood of snoring may also increase if you:

• Are pregnant 
• Drink alcohol
• Use of muscle relaxers
• Use drugs
• Smoke

How is Sleep Apnea Diagnosed?

Your doctor will do a physical exam and take a medical history that includes asking you and your family questions about how you sleep and how you function during the day. As part of the exam, your doctor will check 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 (the roof of your mouth in the back of your throat).

Your doctor may order an overnight sleep study to determine what happens with your breathing while you sleep.  A sleep study is a test that is often done in a sleep center or sleep laboratory. 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.

A PSG 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 percentage 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, a sleep study can be done at home. For this test, a technician will come to your home and help you apply the monitor that 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.  Typically, not as much information is gathered by a home sleep study. Your doctor will help decide which test is best for you.

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 (treated by a pulmonologist)
• Problems with the brain or nerves (treated by a neurologist)
• Heart or blood pressure problems (treated by a cardiologist)
• Ear, nose, or throat problems (treated by an ENT specialist)
• Mental health, such as anxiety or depression (treated by a psychologist or psychiatrist)
  

How is Sleep Apnea Treated?

Treatment is aimed at restoring regular nighttime breathing and relieving symptoms such as very loud snoring and daytime sleepiness. Treatment of OSA may also help associated medical problems, such as high blood pressure, and may reduce your risk for heart attack and stroke.

Changes in Activities or Habits

If you have mild sleep apnea, some changes in daily activities or habits may be all that are needed:

• Avoid alcohol, smoking, and medicines that make you sleepy. They 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.
• 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 will also need other treatments. Refer to the treatment options.

To schedule an appointment, call MetroHealth's Center for Sleep Medicine at (216) 778-5985.

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