Sleep Apnea Causes and Treatment

Sleep Disorders

What is Sleep Apnea?

Loud, constant snoring can indicate a potentially life-threatening disorder called sleep apnea. The word “apnea” is derived from Greek to mean “without breath.” An estimated 5 in 100 people, typically overweight middle-aged men, suffer from sleep apnea. A person with sleep apnea stops breathing repeatedly while sleeping, anywhere from 10 seconds to 3 minutes.

Although an individual may not recall waking up, sleep is disrupted temporarily. As a result, sleep deprivation and excessive daytime sleepiness occur. If left untreated, sleep apnea can trigger high blood pressure and dangerous heart problems.

Sleep apnea can also occur in children and, in some cases, has been linked to Sudden Infant Death Syndrome (SIDS). In older children, sleep apnea occurs in those children who are overweight or who have unusually large tonsils and adenoids. Children with sleep apnea may snore, squeak, and thrash while sleeping. During the day, a child who suffers from sleep apnea will be sluggish or termed “lazy.” Since snoring is not normal for any child, parents should report this to their physician.

There are three types of sleep apnea: obstructive, central, and mixed. Obstructive sleep apnea (OSA) is the most common and severe form. This type of apnea occurs when the airway closes and remains obstructed, resulting in blocked airflow. As pressure to breathe increases, the diaphragm and chest muscles work harder. Blood pressure rises and the heart can beat irregularly or even pause for several seconds.

Every time breathing stops, the level of oxygen in the blood falls and the heart must pump harder. Every time there is an obstruction, the person must awaken momentarily to resume breathing. Sleep is temporarily interrupted, activating the throat muscles to open the airway.

Physical abnormalities are usually the cause of OSA. Excessive pharyngeal tissue, an overly large tongue, a congenitally small airway, or fatty deposits are often found to be the reason. Corrective surgery is a common solution to eliminating obstructive sleep apnea.

(Editor’s note: There are actually a number of forms of treatment for obstructive sleep apnea, not just surgery. These range from weight loss and other lifestyle changes to several surgical procedures. The most common, and still the most effective treatment, is the use of continuous positive airway pressure or CPAP, a device that uses pressurized air delivered through a nasal interface to hold the airway open while the patient sleeps. Combinations of these therapies are also used. There is more information about treatment options for obstructive sleep apnea later in this article and also in our overview article of apnea treatments.)

In central sleep apnea, the brain actually fails to signal the muscles to breathe. The airway is clear, but the diaphragm and chest muscles stop working. Eventually the decreased level of oxygen in the blood signals the brain to awaken the sleeper to restart breathing. This type of apnea becomes more common with age and is associated with heart disease or a neurological disorder.

Mixed sleep apnea is a combination of central and obstructive sleep apnea. This disorder initially occurs as central sleep apnea; where there is no brain signal to breathe. When the diaphragm suddenly begins moving, the airway is blocked by an obstruction (obstructive sleep apnea). It is not uncommon for a sleep disorder specialist to see all three types of apnea occur in one night.

What Treatments Are Available For Sleep Apnea?

Weight loss is often an effective treatment for snoring-related sleep apnea. Even just a few pounds can improve breathing during sleep. Another effective treatment is medication. Some antidepressants and asthma medications have been found to relieve sleep apnea because they are respiratory stimulants.

For severe sleep apnea cases, continuous positive airway pressure, or CPAP, therapy may be required. Patients receiving this treatment wear a light mask over the nose during sleep. An air compressor forces air through the nose and into the airway. Other sleep apnea patients find relief with oral appliances that prop the airway open by moving the jaw, tongue, and soft palate forward.

In some cases, surgery may be required to correct physical abnormalities. Sleep apnea as the result of enlarged tonsils (and adenoids in children) can be alleviated with a tonsillectomy. Another surgical technique called uvulopalatopharyngoplasty (UPPP) removes excess tissue at the back of the throat. For some patients, however, there are negative side effects or apnea symptoms are not resolved.

Somnoplasty is a non-invasive procedure that uses low power, low temperature radio frequency energy to reduce the tongue. The procedure takes place in the physician’s office under local anesthesia, and typically takes less than an hour. Multiple somnoplasty treatments may be required, but snoring and apnea episodes are often alleviated.

A tracheostomy, a procedure in which a tube is inserted into the throat to make an opening in the windpipe, is only used for severe cases of sleep apnea and when other treatments fail. The tube is closed during the day, allowing for normal activities, and opened at night, bypassing the obstruction in the throat.

When Should I See A Doctor?

If sleep apnea is suspected, scheduling an appointment with a physician is recommended. The physician will take a medical history and a referral for a night in a sleep evaluation laboratory will be required. It is often helpful for the doctor or sleep specialist to interview the bed partner or other members of the household. It is a good idea to complete the Bed Partner Questionnaire and review it with the doctor or sleep specialist.

For a diagnosis of sleep apnea to be made, each abnormal breathing episode must last at least 10 seconds and occur at least 5 times for each hour asleep. Doctors call this the Respiratory Disturbance Index (RDI).

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Comments (8)

  1. I was recently diagnosed with moderate to severe sleep apnea, and fitted with a CPAP machine. I have a new ResMed machine and use the nasal pillows. I am not having any problems getting used to the equipment and it doesn’t leak. I don’t really notice it or the air pressure now after two weeks. I don’t feel as though I am breathing through my mouth. My wife says the snoring has been eliminated. I have days where I feel a little better and days that I am tired all day long. I still wake up a few times at night on average. The medical personnel who diagnosed me and fitted the machine were giving me the impression I should feel better more or less right away. It’s definitely taking longer than I hoped to see real improvement.

    How long after some of you started CPAP did it take to feel better? What are reasonable expectations for the device and its effect, short and long term? Do I have to pay off my sleep debt to really feel the effect? I don’t expect to feel eighteen again, but was hoping people here who use it could give some feedback on their experiences adjusting to the machine and seeing results from the treatment. Again I don’t feel like I am having a problem adjust to the equipment and it seems like I am doing everything right. I have been getting excellent scores as well.

    Thanks in advance!

  2. Cape Codder;

    Same here. I’ve been on cpap with Phillips Resperonics Machine and AirFit P10 nasal pillow mask for 4.5 mos. now, since first part of April. My main symptoms is fragmented sleep, unrefreshing sleep, and insomnia. Have had alittle difference in feeling sleepiness some afternoons and evenings. Apnea is severe on my back and mild on my side. I got my pressure changed from fixed 7 cm to variable and have been experimenting with various variable pressures. Right now my minimum is 7cm and max is 13. Machine shows pressure goes at high as 9.5 to 11 from night to night. Still can’t sleep long enough, usually 5 to 5.5 hrs a night. Also trying to break the habit of dropping off initially in my recliner (with no treatment) before going to bed. Most likely I’m having apnea and that disturbs my sleep after getting on the machine. But improvement is gradual for me too. My untreated apnea caused neurology problems too, like restless legs and repetitive jerking awake at sleep onset. That has gotten better off and on. Just have to keep working at it. Some nights I think air is leaking from my mouth, waking with very dry mouth. Lots to work out one night at a time. Good luck!

  3. I am a widow so I have no one to be with me to check on how I sleep. I am asleep and awake all night long. I don’t know what wakes me up but I have trouble going back to sleep. I also have nights when I will sleep for 15 minutes then I am awake. This will go on all night long. I do have a very bad back and have a lot of pain especially getting to sleep.Do you think I have sleep Apnea? I am so tired during the day. I usually have to take a 30 minute nap during the day.
    Thank you for your input.

  4. I have been diagnosed with sleep apnea and was never given a reason why I have it. Who should I see to determine why I have it and how to treat my case?

  5. I think I may have mixed sleep apnea although I dont think it can be cured with a CPAP. I feel that maybe surgury is the best solution, possibly the removal of my tonsils or adenoids could fix it. I have sturggled for a long long time but not sure how to find people who specialize in this. Do you need to get a specialist to have your adenoids or tonsils removed or should I just ask my GP

  6. Looking at your computer and or TV , especially if you have Glocoma or other bright light sensitivities , is bad news. I would invest in orange or red tinted glasses and wear them ,say, from 9-12 at night or whatever three hour pre bedtime unit is.

  7. Also, if the nostril passages are tiny then the least bit of post nasal drip will really stop the sleep clock. Fior this I recommend the regular use of a Himalayan Salt Inhaler.

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