Do you stop breathing for brief periods midway in sleep? And was it as if your brain momentarily “forgot” to tell your muscles to breathe? And if such moments of apnea are a constant feature of your sleep cycle, you need to read the following post.
The word ‘Apnea’ is Greek for ‘without breath’. This common ailment causes one or more pauses in your breath or produces shallow breathing, moving you out of a deep sleep and into a light sleep, thus disrupting your sleep.
These involuntary cessations in breathing occur from a few seconds to a minute and can occur 30 or more times in an hour.
The most common version of sleep apnea, this condition is a result of the muscles at the back of the throat failing to keep the airway open. The soft tissue at the rear end of the throat collapses and closes during sleep causing shallow breathing or pauses in breathing. When you start breathing again, you do so with a loud snorting or choking sound as you push the air past the blockage.
In this form of Sleep Apnea, the brain fails to send proper signals to the muscles to control your breathing while you are asleep.
Complex or Mixed Sleep Apnea– This version of Sleep Apnea has symptoms of both the above-mentioned conditions.
The basic cause of sleep apnea is the obstruction of the airway which limits the amount of air reaching the lungs. This potentially harmful condition may be due to a variety of reasons:
1. Your throat muscles and tongue relax more than is usual
2. Your tonsils and tongue are larger compared to your windpipe opening
3. You are overweight, and the excess fat tissues are thickening the walls of your windpipe, causing an obstruction
4. The shape of your head and neck is such that you have smaller airway in your mouth and throat area.
5. Age may also be a factor as aging reduces the brain’s ability to control the throat muscles and keep them stiff while you are asleep.
Sleep Apnea often goes untreated because it cannot be diagnosed easily by the doctor since it occurs only when you are sleeping. No blood test can help in diagnosing this condition. People with untreated sleep apnea are often not aware of their condition because the pauses in the breathing may not trigger wakefulness.
They may snore very loudly, occasionally wake up gasping for air and may feel tired throughout the day due to lack of proper sleep. They may be made aware by their spouse or family member.
If sleep apnea is suspected, your doctor will probably perform a physical exam, analyze your symptoms and conduct a sleep test. Some of the symptoms areas follows:
• Loud continuous snoring
• Choking or snorting while asleep
• Pauses in breathing while asleep
• Waking up suddenly, gasping for breath
• Waking up with a dry mouth or a sore throat
• Morning Headache
• Disturbed or Light Sleep
• Frequent urge to urinate at night
• Mood swings and irritable feeling
• Inability to remember or focus
• Daytime tiredness
• Daytime drowsiness.
In children, there may be some additional symptoms which are as follows,
• Hyperactivity or disruptive behavior
• Poor performance in school
• Bed Wetting
• Excessive sweating while asleep
• Breathing through the mouth instead of the nose during the day
• Daytime Fatigue– Due to a disturbed sleep, people suffering from sleep apnea feel tired, drowsy and irritable during the day time. These people suffer from attention lapses and slower reaction.
• Psychological conditions– People suffering from Sleep Apnea do not get adequate sleep or a full sleep rest, and hence they are prone to depression, anxiety, stress and so on. Children with this condition may suffer from behavioral abnormalities.
• High Blood Pressure and Cardio Vascular Problems– Sleep Apnea causes a reduction in the blood oxygen levels and thus increases the blood pressure, putting stress on the cardiovascular system, increasing the possibility of changes in heart rhythm, strokes and heart attacks.
• Liver Disease – People with sleep apnea are most likely to develop the non-alcoholic fatty liver disease.
• Type II diabetes– Chances of developing insulin resistance and type II diabetes is high for people suffering from Sleep Apnea. 48% of people with type II diabetes and 86% of obese type 2 patients have sleep apnea.
• Complications with Medications and during Surgery – You may experience complications after taking medication or undergoing certain major surgeries if you have sleep apnea which is not diagnosed.
• Memory Problems– Certain patients of Sleep Apnea suffer from memory problems.
• Weight Gain– Lack of proper sleep due to this condition may lead to increase in weight which further complicates the situation.
• Metabolic Syndrome– Sleep Apnea gives rise to a cluster of related conditions such as hypertension, cholesterol and hyperglycemia all of which may cause cardiovascular and other diseases.
• Sexual Dysfunction – Sleep Apnea also impacts sexual function. 40 to 60% of males with sleep apnea have erectile dysfunction. Even women with sleep apnea face higher chances of sexual problems.
According to the American Association for Respiratory Care, you are more susceptible to this disorder if
1. You are overweight
2. You have large tonsils or adenoids,
3. You have certain medical conditions such as high blood pressure, Polycystic Ovarian Disease or Down’ syndrome
4. You have allergies and problems which lead to nasal congestion
5. You have a thick neck
6. You have a deviated septum or receding chin
7. You are male
8. You are above 40
9. You are Hispanic, Black or a Pacific Outlander
10. You smoke
11. Your relatives have Sleep Apnea.
Pregnant women face the risk of suffering from sleep apnea due to hormonal and physical changes, especially if the expecting mother has high blood pressure or gestational diabetes.
Sleep Apnea Test
Your doctor may perform a sleep apnea test to monitor your breathing and other parameters while you sleep. These tests may be as follows
• Nocturnal polysomnography – This requires you to stay overnight in the lab or hospital. It involves several special sensors to monitor your lung, heart and brain activities along with your body movements, breathing, and body oxygen levels.
• Home Sleep Tests– This makes use of simpler, portable monitors to collect the same information as mentioned above.
Treating sleep apnea
For mild cases of sleep apnea, certain home remedies may be recommended by your doctor such as
1. Losing weight– If you areoverweight, then the extra tissue at the back of your throat may be causing the airway blockage. Losing some weight will help to reduce the excess fat issues and remove such obstructions, relieving you of this condition.
2. Daily Exercise – Not only will this help you lose weight but also help in reducing the other symptoms of sleep apnea
3. Avoiding Alcohol and Tobacco– These vices worsen the condition of sleep apnea
4. Sleeping on your side or stomach– sleeping on your back may cause your tongue and palate to obstruct your airway. Hence, you may try sleeping on your side or stomach to ease the symptoms
5. Opening the Nasal Passages– Use breathing strips and sprays to open up the nasal passage
6. Avoiding sedatives– Sleeping pills and other sedatives further relax your tongue and throat muscles worsening the situation
7. Maintaining a sleep schedule– Waking up and going to bed at the same time every day not only helps you sleep better but also is good for your overall health
8. Singing or playing a wind instrument– Taking up musical activities helps you to increase muscle control.
9. Cognitive behavioral therapy– Trying therapy may help you to control your thoughts and behaviors which are keeping you from sleeping soundly.
These changes in lifestyle help greatly in combating Sleep Apnea. However, some may require a more intensive medical treatment involving a CPAP machine and other devices, therapy and maybe surgery.
CPAP stands for “continuous positive airway pressure.” It delivers air pressure through a mask worn while you are sleeping. This pressure helps to open up the upper airway passage, thus preventing pauses in your breathing and snoring.
Treatment using CPAP is effective and reduces the risk of developing serious ailments related to sleep apnea along with warding off fatigue and ensuring a sound sleep.
However, there are many who cannot use a CPAP machine. For them, there are other options such as
• Auto-CPAP which automatically provides the ideal air pressure while you sleep
• Bi-level positive airway pressure (BiPAP) which delivers more pressure while you inhale and less pressure when you exhale
• Expiratory positive airway pressure (EPAP) which uses a disposable device, placed in the nostrils, consisting of a valve which creates pressure when you exhale, holding the airway open.
• Adaptive servo-ventilation (ASV) is a type of machine which records your normal breathing pattern, and when you sleep, it uses this data to regulate your breathing. This therapy is used for mixed sleep apnea.
• Oral appliances are those which can be placed in your mouth to prevent the airway from collapsing by sliding your jaw forward, allowing you to breathe better.
• Supplemental oxygen is a machine which delivers oxygen to the lungs. They are used to treat severe cases of sleep apnea.
Surgery is performed only in cases where all other treatment has failed to yield results, but in some cases, it may be the first option. Some of the techniques are as follows:
• Uvulopalatopharyngoplasty (UPPP) where the tissue from the back of the mouth and top of the throat is removed surgically. The tonsils and adenoids may also be removed. This may stop snoring but is not as effective as CPAP
• Radiofrequency volumetric tissue reduction (RFVTR) is a treatment where radio frequency energy is used to tighten the tissues in and around the throat.
• Maxillomandibular advancement is a surgery related to jaw repositioning and involves moving your jaw forward to enlarge the space behind the tongue and soft palate.
• Doctors may surgically implant plastic rods into the soft palate to stiffen the tissue and prevent airway blockage.
• Tracheostomy is a procedure to create an opening in the neck through which a breathing tube is inserted. The tube is opened in the night to let the air move in and out of the lungs without any blockages. This is an option for people with life-threatening sleep apnea.
• Tonsillectomy and adenoidectomy involve removal of your tonsils or adenoids.
• Bariatric surgery is recommended for people who have other health problems caused by excess body weight.
• Nasal surgery is used to remove polyps, or aseptoplasty is used to straighten a deviated septum, both of which may help open up the nasal passages and improve airflow.
So this World Sleep Day, get in touch with the health care experts at PORTEA. Download the PORTEA mobile app and chat with a doctor for free, and get all your sleep-related queries answered. You can also rent or buy the latest sleep equipment at PORTEA, which features a diagnostic test package comprising of CPAP titration for sleep related disorders and management of obstructive sleep apnea.
Sreedevi Madhavan manages the content at Portea. She has 6 years of experience writing and managing medical content relevant to the patient and physician community. She also writes blogs for self-development, a handiwork of which can be seen at: www.sreedevi96.blog Sreedevi’s motto in life is “Keep learning, as learning keeps us young and dreams keep us alive.”
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Mr. Raj Shekhar
Age 32, Chennai
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