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Sleep Apnea – The Complete Guide

Sleep-Apnea

Last Updated on April 11, 2020 by Ben Locke

Sleep apnea is a far more common problem than it is given credit for. In the USA, an estimated 22 million people suffer from sleep apnea. It is a collection of conditions that have abnormal respiration characteristics during sleep. People with sleep apnea are prone to a host of other health problems. So how do you know if you are one of the countless people suffering from this deceptively silent condition? And what should be your plan of action if you are? This guide will not only help you understand sleep apnea as an independent medical condition but also help you relate to it and judge if your symptoms point in that direction.

What Are the Types and Causes of Sleep Apnea?

Sleep Apnea is known to manifest itself as periods when you stop breathing during your sleep. The duration can range from 10 seconds to minutes. This occurs when your upper airways get blocked, disrupting the smooth airflow. Sleep apnea also goes by the name of “Sleep Apnoea” and is a potentially serious sleeping disorder. It is classified under the following three types:

  • Obstructive Sleep Apnea (OSA): OSA is caused due to an obstruction in the airways, which causes your breathing to stop and start periodically. This happens when the tissues surrounding the base of the tongue and uvula relax. It is the most common form of sleep apnea and leads to the repeated collapse of the upper airways during sleep.
  • Central Sleep Apnea (CSA): CSA in the form of sleep apnea when your brain fails to send appropriate signals to the muscles that are responsible for your breathing. This causes a lack of breathing effort resulting in insufficient ventilation periods throughout the night.
  • Complex Sleep Apnea Syndrome (CSAS): CSAS is a type of CSA that presents itself in persons suffering from OSA when they undergo the initial treatment of Continuous Positive Airways Pressure (CPAP). In easier terms, it is the condition when a person with OSA develops CSA due to CPAP treatment.

How to Identify Sleep Apnea?

You should be able to identify a condition to be able to take steps to contain it. The sooner you realize you are suffering from a medical condition, the sooner you can take steps to rectify the situation. For this reason, you must know the signs and symptoms associated with sleep apnea. Some common signs of Sleep Apnea are:

  • Frequent waking up at night, accompanied by choking, snorting, and breathlessness.
  • Loud and incessant snoring
  • Finding yourself gasping for breath or difficulty breathing
  • Persistent morning headaches
  • Restless and troubled sleeping pattern
  • Reluctance and mounting anxiety as the evening sets and time for sleep draws near
  • Behavioral changes like excessive mood swings, irritability, short temper, etc
  • Lack of concentration and drive
  • Low libido and sex drive
  • Pronounced swelling in the leg known as “Oedema.” This happens in extreme cases of sleep apnea.
  • Pronounced disinterest in activities in general
  • Experiencing very dry and sore throat when you wake up in the morning
  • Having frequent involuntary pauses in breathing while asleep
  • Experiencing “Nocturia” ( Frequent bathroom trips at night)
  • Abnormal nighttime sweating episodes

All of these above signs can signal sleep apnea. You might suffer through a few and not display any of the other signs. The trick is to identify the signs that you are exhibiting and consult a medical specialist to appropriately diagnose your condition.

Snoring and Sleep Apnea

Most of the time, certain symptoms are asymptomatic for numerous medical conditions. Under such conditions, it becomes difficult to correctly interpret the symptom. It is always wise to consult a professional for a correct diagnosis. However, it also helps to understand some finer points regarding this. For sleep apnea, one such confusing symptom is snoring. Snoring is an extremely common problem. Every second adult in the USA exhibits snoring either regularly or periodically. So does that mean that every second US adult suffers from sleep apnea? The answer is no. Not every person who snores while asleep has sleep apnea, but almost every individual suffering from sleep apnea is known to snore. This distinction is very important when your doctor tries to ascertain whether you have sleep apnea or not. Since it points to the conclusion that if you do not snore, then the chances of you having sleep apnea episodes are very slim, and other alternative conditions need to be entertained to understand your problem.

Who’s at Risk?

Every individual is different. Some people are more prone to certain illnesses than other people. This depends on a lot of factors ranging from genetics to circumstances and exposure. The people who are most at risk of developing sleep apnea exhibit the following traits:

General Risk Factors

  • Neck: People with a neck circumference of 15.7 inches tend to have narrower airways and hence are more prone to sleep apnea.
  • Gender: Your sex also plays a major role. Men are more predisposed to sleep apnea than women.
  • Age: The chances of developing sleep apnea increase with your age with people over 55 years in the high-risk category.
  • Genetics: Sleep apnea tends to run in the family. If you have other family members with this problem, then your chances of developing sleep apnea at some point doubles.

Risk Factors for OSA

  • Weight: People who are overweight or obese are more prone to developing sleep apnea since fatty deposits around your airway passages can lead to obstruction in breathing. Statistics reveal that about% of obese people will develop sleep apnea.
  • Medical: Some people have naturally narrow airways or might suffer from conditions like enlarged tonsils and adenoids.
  • Menopause: Women post menopause is at a greater risk of developing sleep apnea than women at the pre-menopause age group. This is because menopause causes a lot of hormonal changes, including putting on weight.
  • Smoking: Nicotine is a known inflammatory and irritant. It leads to scratching, irritation, and inflammation in your lungs and airways. Apart from this, smoking also disrupts your breathing capacity. All of these make you an easy target for sleep apnea.
  • Alcohol: Alcohol is a muscle relaxant. It loosens the tongue and your throat muscles, which then obstruct your air passage.
  • Allergy: This causes nasal congestion that makes it difficult to properly draw your breath.
  • Asthma: Statistics point that adults with sleep apnea are times more likely to develop sleep apnea
  • Diabetes: Studies show that people with diabetes are at high risk of developing sleep apnea.

Risk Factors for CSA

  • Cardio disorder: Certain illnesses like heart attacks and congestive heart failure makes you prone to developing sleep apnea.
  • Stroke: People who have had episodes of strokes are more likely to have developed CSA or CSAS.
  • Medications: Some medicines like narcotics, an opioid medication, especially methadone, increases your chances of getting CSA.
  • Brainstem: Certain conditions that affect your brain capacity like brain infection are likely to interfere with the signals that the brain transmits to control your breathing leading to CSA.
  • Cervical Spine: People with cervical spine (neck) have difficulty getting the signals from the brain properly transmitted, leading to irregular breathing.

Seeking Professional Help

You are the best judge when you need to seek medical help. Some people like to try out an alternative holistic approach to the condition first before going down the medical route. However, you should always consult a doctor regarding your symptoms to effectively diagnose before deciding on the wait and try home remedies approach. If you experience any of the following symptoms, then a doctor’s visit is recommended:

  • Loud, incessant snoring through the night
  • Periods of waking up at night gasping for breath or choking
  • Your partner getting concerned and feeling like you have moments while sleeping when you do not breath
  • You are feeling too sleepy during the day. So much so that it is difficult for you to carry on through the day with even a small degree of concentration, alertness, and productivity

Diagnosis

Your doctor will take you through various diagnostic tools before arriving at any particular conclusion. These tools will be oral as well as practical tests. They are discussed below:

Oral Test

The oral testing is the method in which your doctor will ask you certain questions and get you to fill a questionnaire. This will include details about your lifestyle and medical history. This information helps your doctor to understand your sleeping pattern and the symptoms that you are experiencing. The questions include:

  • Lifestyle and Medical History Question
    • Your Age and Weight
    • The medication you might be currently taking
    • Nicotine consumption
    • Allergy issues
    • If you suffer from any pre-existing respiratory disorders like COPD and chronically inflamed airway passages
    • If you suffer from childhood asthma or currently suffer from adult asthma
  • Sleeping Behavior Questions
    • Your sleeping and waking times
    • The number of times you wake up during the night
    • Bathroom trips during the night
    • The frequency of choking and breathless incidences
    • Your preferred sleeping position
    • Daytime sleepiness
    • Duration and frequency of daytime naps
    • Your snoring pattern

Physical Test

The physical test includes various examinations that test the specific function of your body. These include:

  • Physical examination of your neck, throat, and tongue to look for fatty tissue layers that might obstruct your airways
  • Chest and Lung X-Rays to ascertain the airflow passage is free from any internal obstruction Snore Microphone to test how loud you snore and record your snoring pattern
  • Nasal airflow sensor is attached to the nostrils to monitor your airflow pattern, rhythm, and quantity
  • Polysomnogram or Sleep Study: This is discussed in depth below.

Sleep Study

The sleep study, also known as “Polysomnogram,” is a test with multiple components that electronically transmit, record, monitor, and interpret various specific physical activities when you are asleep. The interpreted results from these tests are then analyzed by the medical specialist to ascertain whether or not you suffer from sleep apnea.

  • Preparing for Sleep Study

When you come to the sleep center for a sleep test, you will be assigned a private room with a glass panel on one side. Much like you would see on the TV. After that, you will be hooked on to the required equipment. This might look uncomfortable, but the looks are deceptive. The majority of people have no problems drifting off to sleep.

These days you even have to option of conducting these tests from the comfort of your home with the use of portable home testing kits. However, these kits are only good for mild cases.

Equipment Used in Sleep Study

The types of equipment used for testing are as follows:

  • Surface Rod: These rods are attached to your face and scalp. These record the electric signals sent by your body. The signals are sent from the brain for muscle activity, and these are then transmitted digitally.
  • Belts: These are placed around your chest and abdomen to monitor your breathing pattern.
  • Oximeter: This device is used to measure the oxygen saturation level in your body. They are portable devices and attached to either your fingertips or ear lobes. The oxygen saturation should ideally be between 95 to 100% in your body.
  • Sleep Study Tests

The various tests conducted under sleep study are:

  • Electroencephalogram (EEG): An electrode is attached to your brain, which monitors your brain waves. The brain waves are monitored in the three phases and then compared to establish your sleeping pattern. The three phases are:
    • Before sleep
    • During sleep
    • After sleep
  • Electro Oculogram (EOM): An EOM records your eye movements when they shift away from the center of the eye. This also uses electrodes to establish an eye pattern. The electrodes are fixed one cm to the above and below the outer corner of your right and left eye, respectively. The eye pattern is then studied to understand the different sleep phases you and REM cycles of your body
  • Electromyogram (EMG): The EMG is used to measure your muscle activity. An EMG is also conducted with the help of electrodes. They are attached to space above and below your chin and one on each of your shin. The muscle activity helps to understand the moment you enter deep sleep by judging from how relaxed the muscles get.
  • Electrocardiogram (EKG or ECG): An EKG helps in diagnosing any heart conditions you might be suffering from. They are also used for the detection of a high blood pressure condition. It involves wrapping a device around your chest, which then measures and monitors your heart rate and rhythm. This helps to identify any abnormal cardiac activity and blood pressure changes in your body while you are asleep.
  • Pulse Oximetry Test (POT): POT is carried out using the “Pulse Oximeter. This is a small device that is attached to the fingertips or the ear lobes to determine the oxygen saturation in your body. It uses a LED light to find out your oxygen levels while you sleep. The ideal oxygen saturation is from 95 to 100%. The POT helps determine whether you require oxygen during your sleep apnea episodes.
  • Arterial Blood Gas Analysis (ABG): In ABG, blood is drawn from your arteries to determine various levels. These levels are:
    • Oxygen partial pressure
    • Carbon Dioxide partial pressure
    • Oxygen level
    • Oxygen saturation level
    • Bicarbonate level

These tests also help the medical specialist to understand if you need any additional oxygen. Apart from this, it also measures the acidic content of your body, helping in ascertaining if you suffer from GERD as a result of sleep apnea.

Remedies for Sleep Apnea

There are two approaches to sleep apnea. Apart from the medical treatments available, you can also try the home remedies to get rid of the less severe or mild forms of sleep apnea. Both of these methods are discussed below:

Home Remedies

Some people swear by an alternate holistic approach to treating a condition. While a lot of conditions do not get eliminated simply by using these approaches, they do tend to alleviate the condition considerably. These home remedies are best when used, along with traditional medical treatments. These remedies are:

  • Weight Loss: This is the first line of treatment suggested by even the doctors. The most common cause of sleep apnea is obesity. When you are overweight, it makes the tissue layer under your mouth, throat, and neck fatty leading to upper airway obstruction. This causes difficulty in breathing, especially while you are asleep and may even result in episodes when you cannot breathe.

Research supports that even a little weight loss is enough for most people to clear their airways and eliminate the sleep apnea problem.

  • Exercise: Doing normal exercises for about 15 to 20 minutes per day is known to strengthen your heart and lung function, thereby regulating your breathing pattern. Yoga goes one step further in helping you to control your breathing, which helps improve your respiratory tract strength. It also enables better oxygen circulation.

Both the breathing control and improved oxygen levels lead to eliminating sleep apnea.

  • Sleep position: The position that you sleep in is very important. Research shows that sleeping in the supine position makes you prone to snoring and constricted airflow. The best position to promote airflow and reduce snoring is sleeping on your side, especially the left side. This only holds for adults. A 2002 study found that a supine position is better for children with sleep apnea.
  • Humidifier: Humidifiers are a machine that adds moisture to the air around it. They are helpful since dry air is known to irritate the throat and nasal passage leading to inflammation. Humidifier, therefore, helps in de-congesting your passages and opening airways, thereby leading to better breathing patterns.
  • Alcohol and Smoking: Alcohol is known to relax your throat muscles. This causes you to snore, leading to a disrupted sleep pattern. This snoring can also add to inflammation in your throat, which will further complicate your sleep apnea condition.

Smoking contains nicotine, which also irritates the throat and causes airway inflammation and swelling. A 2012 study successfully linked smoking to snoring and sleep apnea.

  • Oral devices: Some devices are available that help repositions your jaw or tongue to keep the air passage open throughout the night. These devices range from over the counter available at any pharmacy to specialized ones that are custom fit to your physical specifications by a registered dentist. They are primarily of two types, namely:
    • Mandibular Advancement Devices
    • Tongue Stabilizing Devices

Both of these devices work on the same principle. They move either the jaw or the tongue forward, thereby decreasing your throat obstruction.

Medical Remedies

The traditional treatment for sleep apnea includes certain medications and even surgery. Though surgery is kept as a last resort and only when other forms have failed. These treatments include:

  • Continuous Positive Airflow Pressure (CPAP): The first treatment that is suggested by most doctors for sleep apnea is the CPAP. It involves propping open your airways by giving a continuous flow of positive air through the night. This airflow is administered through a face mask.
  • Bilevel Positive Airflow Pressure (BPAP): BPAP involves administering positive airflow into your passageways with the help of a device that adjusts the pressure to match your breathing pattern. This method is used after CPAP has proven ineffective.
  • Surgery: There are two types of surgeries that are used for sleep apnea. These are:
    • Uvulopalatopharyngoplasty (UPPP): It is the most common surgery performed to relieve OSA. UPPP works by removing the extra layer of tissues from the back of your throat, which in turn eases your snoring and improves your breathing levels.
    • Tracheotomy: Tracheotomy is a surgery where a puncture is made in your windpipe. This puncture is used to bypass the throat obstruction by connecting directly to the windpipe. It is a very invasive surgery and is best avoided due to the complication it affords.
    • Other surgical procedures: These involve face surgery, tonsil, and adenoid removal surgery. These types of surgeries are especially helpful in treating sleep apnea in children.

Certain Complication Stemming from Sleep Apnea

Sleep apnea can affect your health if left untreated. It has both physical and mental implications. The primary cause is that sleep apnea is a sleeping disorder. And as such, anything that leads you to be sleep deficient has a profound effect on your mind and body.

Physical Complication

  • Acid Reflux: Sleep Apnea can cause acid reflux or make the existing condition worse. Statistics show that 65% of OSA patients suffer from GERD.
  • Adult Asthma: Sleep apnea can worsen your asthma by contributing to your breathing difficulties.
  • Liver: Sleep apnea leads to increased liver enzymes and is also linked with fatty liver disease.
  • Oxygen level: Sleep Apnea makes it difficult for you to breathe and sometimes causes a cessation in breathing altogether. This causes the oxygen levels of your blood to decrease, sometimes to the point that you might require supplementary oxygen.
  • Diabetes: Type 2 diabetes is linked to sleep apnea. Apart from causing diabetes by affecting the way your body processes insulin, sleep apnea also worsens the condition and makes it difficult for you to manage it appropriately.
  • Fatigue: Sleep apnea is a sleeping disorder. It hampers your sleep. This will make you feel tired the next day since your body is stressed with too little rest.
  • Cholesterol: People having sleep apnea are also known to have higher LDL levels, which can cause heart diseases.
  • Hypertension: OSA is recognized as a common causal factor of hypertension. Over 50% of the people suffering from sleep apnea are known to have hypertension as well.
  • Premature death: Sleep apnea causes your breathing to stop. Under normal circumstances, your body will resume breathing in seconds, but sometimes it is unable to. This episode can trigger certain other medical episodes a well as heart attack, asthma attack, or even stroke. All of these make people suffering from sleep apnea susceptible to early death.
  • Immunity: Anything that affects your sleep affects your immunity. By compromising your sleep, sleep apnea causes your immune system to weaken. This, in turn, makes you an easy target for a host of complications.

Mental Complications

  • Depression: Sleep apnea affects your lifestyle. It severely impacts your moods and behaviors. It has been known to socially distance people from their friends and family. All of this adds up to depression. Research shows that more than about 59.7% of OSA patients develop depression.
  • Anxiety: It is natural to get anxious when you know that your breathing stops involuntarily for regular periods while you are asleep. Apart from this, just not getting adequate rest is enough to make you feel anxious and tired.
  • Moodiness and Irritability: People with sleep apnea tend to have frequent mood swings and are generally irritable throughout the day.
  • Concentration and Productivity: Sleep apnea makes you tired, irritable, and generally low. This, along with the lack of sleep, will cause a low level of concentration and a decrease in your production levels.

Sleep Apnea FAQ Section

Some commonly asked questions are answered below:

Is it possible to cure sleep apnea naturally?

Sleep apnea can be cured naturally with weight loss. Research shows that even a slight weight loss can help you increase the airway capacity by decongesting those, thereby eliminating sleep panes. However, this only holds for mild cases of OSA. In CSA and severe sleep apnea cases, weight loss can help lessen the symptoms but cannot eliminates the problem of sleep apnea.

Which is the best sleeping position for sleep apnea?

The symptoms of sleep apnea can worsen, depending on your sleeping position. The supine position or sleeping on your back position is the worst. Side sleeping, especially left-side sleeping position, is the best for combating sleep apnea.

Does sleeping in the sitting position help with sleep apnea?

Sleeping in the sitting position is not necessary, but sleeping with your upper body elevated is known to help people with sleep apnea problems. You can use a pillow or foam wedges for this. Some people also elevate the heads of their beds for this purpose.

Is it possible to test for sleep apnea at home?

Over the years, with the advancement of medical science, certainly do at home self-test kits are available at the pharmacy to help you diagnose this condition from the comfort of your home. However, these self-test kits must be used after taking medical advice, and the results must be discussed with a medical practitioner.

Remember that at home, sleep tests are not that thorough and are just used to check if you might be suffering from sleep apnea. If you test positive in this kit, your doctor will make you undergo a proper sleep test to better understand your condition and its specifications. These kits include:

  • Finger clip to measure your oxygen levels and heart rate
  • Nasal cannula which measures the oxygen and airflow from your nasal passage
  • Chest sensor to monitor the rise and fall of your chest

Bottom Line

Sleep Apnea can be a physically and debilitating condition. It affects your sleeping pattern through irregular breathing. A lot of people are unaware that they suffer through this condition and try to get through their sleepless nights without understanding the root of their anxiety and breathlessness. Statistically, 80% of the sleep apnea cases remain unreported. You must understand your symptoms and the condition relating to it so that you can get help at the earliest before the situation worsens.

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