Sleep Apnea: A Comprehensive Guide To Diagnosing, Treating and Understanding the Condition

Sleep apnea is a serious disorder that approximately 22 million of adults in the USA suffer from – and when you consider that the majority of this population is undiagnosed and untreated, that leaves many adults vulnerable to the adverse effects of the condition, without any means of overcoming them. Left untreated, sleep apnea can have serious health consequences and can increase mortality rates.

Having sleep apnea can really affect your day-to-day life, so it’s essential to learn all you can about the condition, and especially the type of sleep apnea you have, in order to come up with the most effective way of treating it. If you suffer from sleep apnea or believe you have been experiencing some of the symptoms (such as snoring and irregular breathing), keep on reading to find out more about the condition, causes of sleep apnea, how to find out what type of sleep apnea you have, and, most importantly, effective treatment options for the disorder.

What is sleep apnea?

Sleep Apnea: A Comprehensive Guide To Diagnosing, Treating and Understanding the Condition

Sleep apnea is a serious sleeping disorder that is characterized by interrupted and irregular breathing throughout the night. Many of those that suffer from sleep apnea are unaware they have the condition – although often, they will suffer from symptoms such as daytime sleepiness, a dry mouth or sore throat in the mornings, as well as headaches immediately upon waking up.

The 3 types of sleep apnea

Sleep apnea has been classified into three different subgroups based on specific clusters of symptoms that sufferers experience. Most resources on sleep apnea focus on obstructive sleep apnea, without much attention given to the other two types. It’s crucial to figure out which type of sleep apnea you have in order to come up with the right approach when it comes to treating the condition, restoring the quality of your sleep and curing sleep apnea once and for all. As one form of apnea can sometimes transform into another, it’s also vital that you get an understanding of how to prevent this potential progression.

Obstructive sleep apnea

Obstructive sleep apnea, commonly abbreviated to OSA, is the most widespread type of apnea. In OSA, as the individual sleeps, the throat muscles relax, which causes the tongue and other soft tissue of the throat to collapse into the airway, thereby blocking it and restricting airflow. This lack of oxygen reduces blood flow to the brain, causing the sleeper to awaken and take a deep (often loud) breath to restore normal breathing and get rid of the blockage. Once they’ve taken a breath, oxygen levels are restored, the brain returns to sleep, and the same cycle begins all over again.

Sleep Apnea: A Comprehensive Guide To Diagnosing, Treating and Understanding the Condition

Depending on how often this episode happens, the severity of the OSA is classified into 3 levels, according to the apnea-hypopnea index (AHI):

  • Mild: 5 to 14 episodes in the course of an hour
  • Moderate: 15-30 episodes an hour
  • Severe: 30+ breathing interruptions an hour
Note – OSA is defined as 5 or more of these interruptions per hour. If you have less than 5 of these episodes – your sleep is considered healthy and well within the norm.
Approximately 4% of men and 2% of women suffer from OSA, but only a tiny percentage of this population is diagnosed. We’ll go into more details on the symptoms and diagnosis below, but if you or your partner experience irregular breathing during the night, or experience excessive daytime tiredness, these are often huge tell-tale symptoms of sleep apnea that are overlooked – definitely a reason to check in with your doctor.

Symptoms of obstructive sleep apnea

The key signs of OSA include:

  • Loud snoring, particularly when interrupted by long periods of silence
  • Abrupt awakenings throughout the night that are followed by coughing, choking or gasping for air
  • Pauses in breathing while sleeping

Sleep Apnea: A Comprehensive Guide To Diagnosing, Treating and Understanding the Condition

You may not notice any of the above signs, so ask a partner or family member if they’ve ever noticed or heard anything unusual while you slept. If you don’t have anyone that can monitor you, take a look at the following symptoms and consider if you experience any of them regularly – they can become pretty big pointers in helping to detect the condition:

  • Excessive tiredness and drowsiness throughout the day, feeling low on energy even after getting adequate sleep
  • Waking up with a sore throat and/or a dry mouth
  • Morning headaches
  • High blood pressure
  • Having trouble concentrating during the day
  • Mood swings, anxiety, and irritability
  • Excessive sweating during the night

Sleep apnea in children is rarer, but kids will experience similar symptoms, which may also be accompanied by:

  • Bedwetting
  • Teeth grinding (bruxism)
  • Restlessness during sleep, lots of tossing and turning
  • Acting ‘slow,’ sluggish, and having difficulties learning and keeping up with their peers at school

Sleep Apnea: A Comprehensive Guide To Diagnosing, Treating and Understanding the Condition

Of course, these can also often point to other conditions, so it’s always best to check in with a health professional. But if you’ve noticed odd breathing patterns or sleeping behavior, and these are accompanied by the daytime side-effects outlined above, it’s definitely something that’s worth investigating.

Central sleep apnea

Central sleep apnea – CSA – is a less common form of sleep apnea, but is no less disruptive for those that suffer from the condition.

CSA is also somewhat more complex, as in this case, interrupted breathing occurs as a result of the brain failing to send an impulse to the muscles that control breathing – not due to any physical obstructions of the airway.
In central sleep apnea, the individual experiences a type of breathing known as Cheyne-Stokes respiration, in which they have episodes where they periodically stop breathing altogether. This pause in breathing is then followed by a longer period of hyperventilation. Unlike OSA, no anatomical blockage prevents airflow – instead, the interruptions in breathing are caused by a problem in the organs that control breathing, which makes this condition all the more difficult to treat.

Central sleep apnea symptoms

While CSA can sometimes share symptoms with obstructive sleep apnea, there are some differences in the way these symptoms play out. One key difference is that snoring, which is one of the most prevalent signs of OSA, is not that common for those that suffer from central sleep apnea. The following are the key signs and symptoms:

  • Cessations in breathing through the night – the patient regularly misses a few breaths
  • Increased breathing rate to overcompensate for the lack of oxygen and build up of carbon dioxide in the bloodstream after the pause in breathing
  • Deep, gasping inhalations or choking
  • Waking up frequently throughout the night
  • Insomnia and restlessness
  • Feeling fatigued during the day
  • Difficulty concentrating and memory problems

Complex (mixed) sleep apnea

Sleep Apnea: A Comprehensive Guide To Diagnosing, Treating and Understanding the Condition

Mixed sleep apnea, as the name implies, is a combination of the two types of sleep apnea discussed above. Also known as complex sleep apnea (CompSA), this is the least common form of apnea and, as its name suggests once again, the most complicated.

Some sufferers of obstructive sleep apnea who are treated with CPAP therapy (more on this below) can also develop symptoms of central sleep apnea, which causes these patients to experience both OSA and CSA – this is complex sleep apnea.
More research needs to be carried out on CompSA to determine causes and effective treatment solutions.

Symptoms of mixed sleep apnea

Complex sleep apnea sufferers experience symptoms of both obstructive and central sleep apnea. The patient can have interrupted breathing in which they do not inhale for an extended period of time, and do not exhibit signs of trying to regain their breathing pattern. They may also exhibit loud snoring, and, like all those with sleep apnea, are likely to feel fatigued and unrested throughout the day, regardless of how much they slept. Sufferers may have a physical obstruction of the airway, as well as a problem with the regulation of their breathing cycles.

So, what causes sleep apnea?

From the different forms of sleep apnea mentioned above, you may have already figured they can all have different causes. To determine an effective treatment and/or prevention strategy, it’s crucial to identify the root cause(s) of the condition. Let’s take a look at these in more detail:

Obstructive sleep apnea causes

As previously mentioned, obstructive sleep apnea is caused primarily by a blockage of the airways during sleep. Those with obesity or excess weight are most likely to get OSA, as there is more soft tissue that will potentially collapse into the back of the throat and prevent proper breathing.

Smoking, alcohol and the use of sedatives and some prescription medications can also result in obstructive sleep apnea. There are many potential reasons for this, but the general idea is that these substances can often cause changes in the sleep architecture, as well as inflammation of the upper airways – particularly smoking, as this study found.

Sleep Apnea: A Comprehensive Guide To Diagnosing, Treating and Understanding the Condition

Some hereditary anatomical factors can also cause an individual to experience OSA – examples include a narrow – or, on the contrary, thick – neck. A larger than average tongue or enlarged tonsils can also block your airway. Another possible risk factor is hyperthyroidism, which, due to the thyroid being located in the throat, can also significantly narrow the upper respiratory tract and prevent normal breathing. The same goes for various throat tumors. Finally, some allergies can also play a role, as they, like smoking, can cause inflammation of the upper airways.

Quick glance – causes of OSA:
  • excess weight
  • smoking, alcohol, prescription medication, sedatives
  • genetic/hereditary factors
  • anatomy that causes an obstruction of the airway

Central sleep apnea causes

The main causes of CSA are problems with the heart and brain, but certain medications and substances can also play a contributing role.

The root cause of central sleep apnea is a failure of the brainstem to regulate breathing. A variety of conditions can affect the brainstem’s ability to send the necessary impulses to the lungs and other organs. For example, central sleep apnea often develops after a stroke, heart failure, or as a result of a brain infection. It can also occur due to damage of the spinal cord, or any other neurological damage.

As these causes may suggest, CSA is more common among adults over the age of 65, as the likelihood of diseases such as a stroke or heart failure is much higher in this risk group.

Another common cause of central sleep apnea is continuous positive airway pressure (CPAP) therapy – some obstructive sleep apnea sufferers can develop central sleep apnea after treatment. This can happen if the individual gets prescribed the wrong treatment plan, or doesn’t adhere to the CPAP treatment that was prescribed.

Quick glance – causes of CSA:
  • problems with the heart and/or brain, including after a stroke, heart failure or brain infection
  • medication or other substances that list CSA as a side-effect
  • wrong CPAP therapy treatment plan for patients with obstructive sleep apnea

Mixed (complex) sleep apnea causes

Sleep Apnea: A Comprehensive Guide To Diagnosing, Treating and Understanding the Condition

Complex sleep apnea is also often referred to as treatment-emergent sleep apnea. The clue is in the name with this one, as it’s often the case that treatment, specifically CPAP therapy, causes the patient to develop mixed sleep apnea. Once the dosage is modified or the patient stops CPAP therapy, mixed sleep apnea reverts to its initial form. However, this is not the case for all patients, and some do not show signs of improvement. Much more research needs to be carried out on the causes of mixed sleep apnea, as the majority of studies focus on obstructive and central sleep apneas.

Sleep apnea diagnosis

The first step in diagnosis is to see your doctor if you believe you have been experiencing some of the sleep apnea symptoms mentioned above. Your partner may have noticed unusual breathing patterns or noises while you sleep, which is also reason to consult with your doctor. If you always feel tired, even after getting plenty of sleep, this is another common symptom that is often disregarded and results in sleep apnea going unnoticed and undiagnosed – so definitely mention this during your appointment.

In order to determine whether you have sleep apnea, you’ll need to undergo a sleep study, or a ‘polysomnogram.’ This will monitor and record changes in your brain waves, breathing, heart rate, and oxygen levels, in addition to eye and leg movements as you sleep, allowing your doctor to determine any irregularities.

You might also get an at-home version of this sleep study, which will essentially monitor exactly the same variables. After polysomnography, you’ll also often be able to find out which type of sleep apnea you have as they all demonstrate slightly different patterns.

Sleep apnea treatment options

To come up with an effective treatment plan for sleep apnea, it’s essential to determine the root cause of the condition in each individual case. The following are some of the most common cures for sleep apnea.

Weight loss

For obstructive sleep apnea, often, losing weight can completely eradicate all the symptoms and side effects of the disorder. Sometimes shedding just a few extra pounds can make all the difference, and prevent any airway blockage throughout the night.

CPAP therapy

Continuous positive airway pressure (CPAP) remains one of the key therapies for obstructive sleep apnea. During the night, you’ll need to wear a mask over your nose and mouth (or just one of the two), which will be connected to a CPAP machine that forces air into your nose and/or mouth to prevent the soft tissue from collapsing.

Sleep Apnea: A Comprehensive Guide To Diagnosing, Treating and Understanding the Condition

The major downside to CPAP therapy is that it can take some trial and error: your doctor may need to change the prescribed pressure a few times so that you use the most effective and comfortable setting. You’ll also likely need some time to get used to sleeping with a mask on. Some common CPAP side-effects include a dry mouth or nose, which may feel somewhat unpleasant at first, but it’s a small price to pay for feeling refreshed and full of energy after sleeping – as opposed to the usual grogginess and fatigue.

CPAP is used for the treatment of obstructive, central and complex sleep apnea, although it does not work for all cases and patients.

Bilevel Positive Airway Pressure — BiPAP therapy

If CPAP proves ineffective, BiPAP therapy can be a very successful alternative. BiPAP is somewhat similar to CPAP therapy – the patient is also connected to a machine that forces air into the airway. However, BiPAP machines offer variable flows of air pressure, whereas CPAP therapy offers one continuous flow of air pressure. In simple terms, this means that BiPAP is more flexible and you can set different pressure for inhalation and exhalation, which can really help those who have breathing problems.

Although BiPAP is a highly successful treatment, it is also more costly than CPAP therapy and isn’t the best for mild obstructive sleep apnea. It is, however, an excellent choice for severe forms of apnea.

Surgery for sleep apnea

Sleep Apnea: A Comprehensive Guide To Diagnosing, Treating and Understanding the Condition

If neither of the above two options works, then your doctor may suggest getting surgery. There are several possible surgical procedures for sleep apnea, some of which may be combined. Surgery is most often carried out for treating OSA on areas such as the soft palate, tongue, tonsils, uvula or even the jaws. The aim is to reduce or remove the tissue that is causing the obstruction.

Multiple surgeries may be necessary to resolve the problem. The following are some of the most common options:

  • Uvulopalatopharyngoplasty (UPPP)

In UPPP, excess tissue in the back of the patient’s throat is removed in order to widen the airway. As a standalone procedure, it may only work for treating mild sleep apnea, but for treating more severe forms of the disorder, it will most often need to be combined with other surgical procedures.

  • Laser-assisted uvulopalatoplasty (LAUP)

This is a somewhat less effective alternative of UPPP, and less frequently used. However, this procedure also offers fewer side effects. In LAUP, a laser is used to scar the tissue of the soft palate, which then tightens this area, thereby widening the airway.

  • Radiofrequency Volumetric Tissue Reduction (RFVTR)

This procedure involves reducing various soft tissue in the throat through controlled cauterization to prevent obstruction and increase the size of the airway. Nasal surgery Nasal surgery is used for those that have difficulties breathing through their nose. There are a few different variations of this surgery, but most often, a septoplasty and turbinate reduction are performed. In this procedure, the septum is straightened and the turbinates are reduced in order to allow air to pass through with ease.

  • Hyoid Suspension

The hyoid is a U-shaped bone located in the neck that’s connected to the tongue and other soft tissue in the throat. In hyoid suspension or hyoid ‘advancement’ surgery, this bone is moved slightly forward, which then pulls along the attached tissue, widening the airway as a result and removing any possible breathing obstructions.

This is a minimally invasive surgical procedure, that has a short recovery time and minimal discomfort post-surgery. This surgery has shown excellent results, especially when combined with other surgeries for sleep apnea.

  • Pillar Procedure

This is another minimally invasive surgery, which involves placing special implants into the soft palate. As a result, the soft palate becomes stiffer, and this reduces tissue vibration and contact during sleep. The Pillar Procedure is a popular operation for those who snore and those who suffer from mild OSA.

Less common procedures include shortening the tongue (tongue base reduction) or inserting a special tube into the windpipe, which is then widened at night to open up the airway (tracheostomy). Finally, as patients with sleep apnea often have smaller jaws, jaw advancement surgery is also sometimes performed – however, this is a very serious procedure that has a lot of risks and entails a lengthy recovery period.

Positional therapy

Sleep Apnea: A Comprehensive Guide To Diagnosing, Treating and Understanding the Condition

A much more risk-free alternative to surgery is changing some of your sleeping habits. If you’re a back sleeper, try sleeping on your side, as this has been found to be an effective solution that works well in the long term. You can find special wearable devices that will keep you sleeping on your side throughout the night. If you’re not used to this sleeping position, take a look at some mattress toppers for side sleepers that can help you to adjust, or alternatively, replace your old mattress with a mattress for side sleepers to give you the best alignment. Another option that can help is getting a sleep apnea pillow, as this will enable just the right elevation angle, and prevent any soft tissue from collapsing into the airway. A wedge pillow works best, but some contoured options can also be highly effective – check out our roundup of the best pillows for sleep apnea and try one out for yourself.

Sleep apnea oral appliances / mouth guards

Oral appliances for sleep apnea look somewhat like mouth guards, and their primary function is to alter the jaw position in a way that prevents the airway from closing up. The jaw is moved forward, preventing soft tissue from falling onto the back of the throat as the muscles relax and the patient falls asleep. One huge advantage of a sleep apnea mouth guard is that it is a highly accessible, simple therapy option, that does not require any surgery or subsequent recovery. The only downside is that, like most mild therapies, it only works for mild to moderate sleep apnea cases.

Common questions about sleep apnea

Sleep apnea is pretty complex, and even after reading tons of articles, studies and other literature on the condition, you’ll probably still have some questions left. Below, we’ve answered the most important and frequently asked questions people have about sleep apnea.

Can sleep apnea be cured?

The good news is – yes! You can definitely get rid of sleep apnea once and for all. However, this requires getting to the root cause of the problem. If you have sleep apnea as a result of being overweight, then treating it is fairly simple – once you’ve lost weight, your breathing patterns during the night should return to normal. The same goes for excess tissue and other anatomical causes – surgery is a highly effective treatment method and is pretty widespread. Though not without some shortcomings, it can widen the airway and remove any obstructions that are causing a patient’s apnea.

Central and complex apneas are more challenging to cure due to the fact that the problem often lies in other centers of the body that are not functioning properly. However, the effects can definitely be lessened by following a healthy lifestyle and changing sleep habits.

How can I prevent sleep apnea?

Sleep Apnea: A Comprehensive Guide To Diagnosing, Treating and Understanding the Condition

You can prevent sleep apnea by avoiding inflammation (that means removing alcohol, nicotine and any other potential substances that can cause fluid retention and swelling). Keep yourself in shape and avoid gaining excess weight. Avoid sleep apnea by sleeping on your side and using an elevated sleep apnea pillow. Use oral and nasal appliances to prevent snoring and promote proper breathing.

Can you die from sleep apnea?

Dying in one’s sleep from sleep apnea is near impossible – due to the low oxygen levels in your bloodstream, your body will force you to awaken, one way or another, and restore proper breathing. However, if left untreated, sleep apnea can increase mortality. Those that live with untreated sleep apnea are more likely to have a stroke or a heart attack and have a higher risk of dying prematurely. This is why it’s so crucial to speak to a doctor and get tested as soon as the patient suspects they may have some of the symptoms

What happens with untreated sleep apnea?

Left untreated, sleep apnea has serious health consequences, as mentioned above. It can (and often does) develop into more severe forms of sleep apnea that become increasingly more difficult to treat. Sleep apnea that is not treated is unlikely to disappear of its own accord (unless it was caused by something relatively simple, such as excess weight). Furthermore, sleep apnea and weight gain can also often go hand in hand. It is not just excess weight that can cause the disorder – the disorder can also affect your weight. Feeling tired all the time can cause you to overeat, and if you’re always low on energy – you won’t feel like exercising and staying in shape, resulting in a vicious cycle of sorts, where you overeat and lead a sedentary lifestyle. To top this all off, disrupted sleep patterns can result in a whole myriad of hormonal imbalances that can make the patient pile on the pounds.

Sleep Apnea: A Comprehensive Guide To Diagnosing, Treating and Understanding the Condition

As untreated sleep apnea is often sleep apnea that has not been diagnosed, there is limited information on what happens when a patient does not get therapy for the disorder – those with untreated sleep apnea are simply not monitored. However, the evidence that is available clearly shows a decline in the physical and, oftentimes, mental, health of patients.

How do I stop snoring?

First of all, check in with your doctor to see if you may have sleep apnea. If you have sleep apnea and snore, there are a number of different measures you can take to prevent or quiet snoring. These include the standard checklist for treating sleep apnea, including losing weight, avoiding smoking and drinking, and keeping your head elevated while you sleep. You should also try the following:

  • sleep on your side
  • wear a snoring aid such as a specialized mouthpiece or a nose clip
  • choose a mattress for snoring, which will help keep your body aligned and prevent any airway blockages

Afterword

If you have recognized some of the symptoms outlined above, or you believe you’ve heard someone in the household exhibit some of the most common signs of sleep apnea, then you may understand by now how important it is to see a health professional. Sleep apnea can have severe consequences if left undiagnosed and untreated.

The good news is that treating sleep apnea need not be difficult – it’s all about finding what will work for each individual patient, and, as with any therapy, tailoring it to their specific needs – whether you simply need to lose weight and change your sleeping position, or require a more complex surgical approach.

We hope this article has helped you find out more about sleep apnea, and we wish you a healthy sleep!

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