When you sleep, the muscles that control your upper airways relax. When they relax too much, you begin to snore and may even experience breathing difficulties. You are likely unaware of the sleep disturbance at the time it occurs, but you’ll see the signs in the next day—a morning headache, excessive daytime sleepiness and/or trouble focusing your thoughts. These are symptoms of sleep apnea.
What is Sleep Apnea?
Sleep apnea is a serious, potentially life-threatening condition that is far more common than generally understood. First described in 1965, sleep apnea is a breathing disorder characterized by brief interruptions of breathing during sleep. It owes its name to a Greek word, apnea, meaning, "want of breath."
Two types of Sleep Apnea
Obstructive sleep apnea is most common and occurs when air cannot flow sufficiently into or out of the person's nose or mouth. Central sleep apnea, which is less common, occurs when the brain fails to send the appropriate signals to the breathing muscles to initiate respirations.
Breathing Becomes Labored or Stops
In a given night, a person with sleep apnea may stop breathing 20 to 60 or more times per hour. In addition to these apneic events, people may experience:
- Snoring. (Note: not everyone who snores has this condition.)
- Gasping or choking sensations
- Daytime sleepiness
- Early morning headaches
When breathing stops, the sleeper is awakened just enough to inhale and resume breathing, often without being aware of the sleep disruption. In fact, most people with sleep apnea may be unaware of the problem.
Early recognition and treatment of sleep apnea is important because it may be associated with irregular heartbeat, high blood pressure, heart attack, and stroke.
Who is At Risk for Sleep Apnea?
Sleep apnea occurs in all age groups and both sexes. People most likely to have or develop sleep apnea include those who snore loudly and also are overweight, or have high blood pressure, or have some physical abnormality in the nose, throat, or other parts of the upper airway. Sleep apnea seems to run in some families, suggesting a possible genetic basis.
What Causes Sleep Apnea?
- Mechanical and structural problems in the airway
- Throat muscles that relax during sleep and partially block the opening of the airway
- Obesity-when an excess amount of tissue in the airway causes it to be narrowed
With a narrowed airway, the person continues his or her efforts to breathe, but air cannot easily flow into or out of the nose or mouth. Unknown to the person, this results in heavy snoring, periods of no breathing, and frequent arousals (causing abrupt changes from deep sleep to light sleep). Ingestion of alcohol and sleeping pills increases the frequency and duration of breathing pauses in people with sleep apnea.
How is Normal Breathing Restored During Sleep?
During the apneic event, the person is unable to breathe in oxygen and to exhale carbon dioxide, resulting in low levels of oxygen and increased levels of carbon dioxide in the blood. That chemical reaction alerts the brain to resume breathing, often with a loud snort or gasp.
This pattern repeats itself several times throughout the night, preventing the patient from getting enough restorative, deep sleep.
What are the Effects of Sleep Apnea?
The consequences of sleep apnea range from annoying to life-threatening. Because of the serious disturbances in their normal sleep patterns, people with sleep apnea often experience:
- Sleepiness during the day
- Poor concentration and daytime performance
- Depression
- Irritability
- Sexual dysfunction
- Learning and memory difficulties
- Falling asleep while at work, on the phone or driving
- High blood pressure
- Risk of heart attack or stroke
Untreated sleep apnea patients are 3X (or more) likely to have automobile accidents; CPAP treatment reverses the increased risk.
How is Sleep Apnea Diagnosed?
North Dakota Center for Sleep conducts a sleep study using Polysomnography (PSG), a test that records a variety of body functions during sleep, such as the electrical activity of the brain, eye movement, muscle activity, heart rate, respiratory effort, air flow and blood oxygen levels.
Learn more about the process
How is Sleep Apnea Treated?
The specific therapy for sleep apnea is tailored to the individual patient based on medical history, physical examination and the results of polysomnography. Medications are generally not effective in the treatment of sleep apnea. Oxygen is sometimes used in patients with central apnea caused by heart failure. It is not used to treat obstructive sleep apnea.
Physical or Mechanical Therapy
Nasal continuous positive airway pressure (CPAP) is the most common therapy for sleep apnea. With this therapy, the patient wears a mask over the nose during sleep and pressure from a blower forces air through the nasal passages preventing the throat from collapsing during sleep.
Occasionally, our doctor may suggest other therapies such as
- Weight loss
- Behavioral changes
- Dental appliances
- Variations
- Other procedures
Non-specific Therapy
Behavioral changes are an important part of the treatment program. In mild cases, behavioral therapy may be all that is needed.
- Weight loss -Even a 10 percent weight loss can reduce the number of apneic events for most patients.
- Behavioral changes -Individuals with apnea should avoid the use of alcohol, tobacco and sleeping pills, which make the airway more likely to collapse during sleep and prolong the apneic periods.
- Sleep changes -In some patients with mild sleep apnea, breathing pauses occur only when they sleep on their backs. Using pillows and other devices that help them sleep in a side position may be all they need to overcome their sleep apnea.