Sleep Apnea, What You Need To Know

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Do you, your partner, or your child stop breathing repeatedly during sleep? If the answer is yes, then you or they may be among the more than 12 million Americans suffering from sleep apnea. Is sleep apnea dangerous or harmful? What can you do to correct it?

Sleep apnea can be serious

Although there are three different types of sleep apnea—central, mixed, and obstructive, all have the same basic effect: people stop breathing repeatedly throughout their sleep cycle, for up to a minute or longer, and frequently hundreds of times per night.

Obstructive sleep apnea is the most common type, affecting 90 percent of people with this sleep disorder. Cases of obstructive sleep apnea are caused by a blockage of the airway, which can occur when the soft tissue in the back of the throat closes while people sleep. Central sleep apnea occurs when signals in the brain fail to tell the muscles to breathe. Mixed sleep apnea is a combination of these two types.

Even though people with sleep apnea resume breathing, quality of sleep can suffer significantly, which leaves individuals feeling tired and mentally fatigued during the day. The long-term consequences, however, can be more serious, and include headache, memory problems, cardiovascular disease, high blood pressure, impotency, and weight gain.

Am I at risk for sleep apnea?

Even though sleep apnea can affect both males and females of any age, certain risk factors make it more likely you will experience this sleep disorder. They include

  • Being male
  • Being overweight
  • Age 40 and older
  • Having a large neck (17 inches or larger for men, 16 inches or larger for women)
  • Having a family history of sleep apnea
  • Having gastroesophageal reflux
  • Having nasal obstruction associated with allergies, sinus problems, or a deviated septum
  • Having large tonsils or tongue, or a small jaw

Diagnosing sleep apnea

Many people who have sleep apnea don’t know they are affected unless a bed partner lets them know or they see a healthcare professional about excessive daytime sleepiness or other symptoms and participate in a sleep study.

Diagnosing sleep apnea may involve taking the Epworth Sleepiness Scale, which is a self-report test that helps identify your severity of sleepiness. A physician can also examine your nose, mouth, throat, tonsils, and airways for areas of possible airway collapse.

The main objective test for obstructive sleep apnea is a sleep study, or polysomnography. During this test, your brain waves, eye movements, muscle activity, airflow, and other features are monitored while you sleep. The results can help your physician determine your best treatment options.

Treating sleep apnea

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For mild cases of sleep apnea, some people eliminate the problem after losing weight, stopping alcohol consumption or smoking, or changing their sleep position, including not sleeping on their back. Dental devices designed to keep the airway open during sleep may also be helpful.

A common treatment for more persistent cases is continuous positive airway pressure, or CPAP. This approach is considered by many medical professionals to be the most effective way to treat sleep apnea. CPAP involves wearing a mask over the nose and/or mouth while you sleep. The mask is attached to a machine that delivers air flow into the nostrils, which helps keep the airways open.

A variation of CPAP is nasal automatic positive airway pressure (APAP). This approach also uses a mask and air delivery machine, but the amount of air it delivers automatically adjusts to the patient’s needs rather than deliver a steady, unfaltering flow.

Compliance is a problem with CPAP and APAP, however, because many people find them to be uncomfortable and have difficulty adjusting to them. Side effects may also include runny nose, nasal congestion, dizziness, dry eyes, and sinus infections.

Positive airway pressure can be helpful, however, in reducing sleep apnea and its symptoms. In a recent study of the effectiveness of APAP in 98 men (mean age, 55 years) with moderate to severe obstructive sleep apnea, researchers found that after six months of using APAP, the men experienced statistically significant reductions in nocturia (getting up at night to urinate), nighttime sweating, gasping, fatigue, and heartburn. Morning headaches and erectile dysfunction, however, did not improve.

For people who do not respond to other treatments for sleep apnea, there is always surgery. The most common surgical procedure performed over the past few decades has been uvulopalatopharyngoplasty, which is removal of excess tissue from the soft palate and pharynx, including tonsil removal in some cases. For people who snore, this surgery can provide great improvement.

Other surgical procedures include nasal surgery to fix the septum and/or nasal valve and turbinates (bone that divides the nasal air passages), soft palate implants, hyoid advancement (repositioning of the hyoid bone in the neck to prevent the base of the tongue from obstructing the airway), and reducing the amount of tissue at the base of the tongue, among other procedures.

Sleep apnea can disrupt your life and lead to serious health problems. If you or a loved one is suffering from sleep apnea or suspects it, see your healthcare professional. The American Sleep Apnea Association offers information about the condition, support groups, and a forum.

SOURCES:
American Sleep Apnea Association
Cruz IA et al. Sleep Breath 2011 Mar 2

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