Sleep Apnea

Overview

Definition

Sleep apnea is a disorder with pauses in breathing while you are asleep. These pauses can last for 10 to 30 seconds at a time. During one night, breathing may stop up to 400 times.

There are 3 types of sleep apnea:

  • Obstructive
  • Central
  • Mixed

The brain will sense a pause in breathing and wake you up. You may not be fully awake and often do not remember in the morning. However, waking breaks the sleep cycle. Poor sleep can make you tired during the day. Over time this will also lead to other serious medical conditions like high blood pressure or depression .

Causes

Major causes will depend on the type of sleep apnea:

  • Obstructive—Muscles in the body to relax during sleep. Soft tissue in the back of the throat and mouth may then sink toward the throat. This tissue can block the airway until the person wakes.
  • Central—Breathing is controlled by signals from the brain. It can be slowed or paused if the signals are not working as they should.
  • Mixed—Both soft tissue and nerve signals are causing problems.
Obstructive Sleep Apnea
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Risk Factors

Sleep apnea is more common in men and adults over 40 years. Other things that may increase the chances of sleep apnea are:

  • Excess weight or obesity
  • Large neck
  • Family history of apnea
  • Problems in the nose or throat such as:
    • Nasal polyps
    • Very large tonsils
    • Deviated nasal septum
  • Hypothyroidism
  • Asthma
  • Certain medicine, such as sedatives, opioids, and sleeping aids
  • Excess alcohol intake
  • Smoking
  • Sleeping without dentures (if you have them)
  • Heart failure (central sleep apnea)
  • Pregnancy

SymptomsandDiagnosis

Symptoms

Your partner may notice loud snoring or that you stop breathing at night. You may notice that you wake often during the night.

Regular sleep apnea can lead to:

  • Fatigue and sleepiness throughout the day
  • Feeling tired even after a night of sleep
  • Morning headaches
  • Poor concentration or problems with memory
  • Irritability or short temper

Untreated sleep apnea has been linked to other health problems, such as:

  • High blood pressure
  • Cardiovascular disease
  • Depression
  • Stroke
  • Kidney disease

Sleep apnea also increases the risk of car accidents. It is most likely due to lack of sleep. Avoid driving or using hazardous equipment if you are sleepy during the day .

Diagnosis

The doctor will ask about your symptoms and past health. The doctor may suspect sleep apnea based on questions. An overnight sleep study may be done. Sleep will be monitored by a medical team. Most sleep studies will take place in a clinic but some may be done at home.

The study will measure:

  • Eye and muscle movements
  • Brain activity using an EEG
  • Heart rate
  • Breathing pattern and depth
  • Amount of oxygen that reaches your blood

These details will show how severe the sleep apnea is.

Treatments

Treatment

Treatment will help you can sleep better. This should reduce symptoms. Healthy sleep will also reduce risk factors for other health problems. The exact treatment will depend on the type of sleep apnea.

Managing Mild Apnea

Mild obstructive apnea may be relieved with some of the following:

  • Lose excess weight. The doctor or a registered dietitian can help to make a meal plan.
  • Avoid sedatives, opioids, sleeping pills, alcohol, and tobacco. They make your tissue relax more. It will make apnea worse.
  • Try sleeping on your side instead of on your back. Soft tissue will easily fall into your airway if you are on your back.
  • Use pillows to help you prop yourself into a better position when sleeping.

Oral appliances are small devices you put in your mouth. They will keep the lower jaw in a forward position. This position pulls the tongue away from the airway. It may be helpful for those with mild sleep apnea. The devices may also be used for those with moderate obstructive sleep apnea who cannot use CPAP therapy.

Mechanical Therapy

Continuous positive airway pressure (CPAP) is a machine that gently blows air into your airway to help keep it open. The air is delivered through a mask that you wear while sleeping. CPAP will help you manage sleep apnea but it does not cure it. If you stop using CPAP, the sleep apnea will return immediately.

Oxygen may also be added at night with CPAP. It may be needed if the level of oxygen in the blood falls too low during sleep.

Surgery

Surgery may be helpful for some with obstructive sleep apnea. It can be used to shrink or remove extra tissue. Types of surgery include:

  • Maxillomandibular advancement—lower jawbone is placed in a more forward position.
  • Adenotonsillectomy—adenoids and tonsils are removed.
  • Uvulopalatopharyngoplasty —extra soft tissue is removed from the nose and/or throat.

A less available option is called phrenic nerve stimulation. A device is implanted under the skin and sends signals to the phrenic nerve. This nerve controls a large muscle that helps draw air into the lungs. This options is still being assessed for those with central sleep apnea.

Medications

Certain medicine may be used to reduce daytime symptoms. Other medicine may need to be changed or stopped if they are making sleep apnea worse.

Prevention

You may be able to prevent sleep apnea by maintaining a healthy weight.

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

Edits to original content made by Denver Health.

a (Obstructive Apnea; Central Apnea; Mixed Apnea)

RESOURCES

American Sleep Apnea Association https://www.sleepapnea.org 

National Sleep Foundation https://sleepfoundation.org 

CANADIAN RESOURCES

Canadian Sleep Society https://css-scs.ca 

The Lung Association https://www.lung.ca 

References

Central sleep apnea. EBSCO DynaMed Plus website. Available at:  http://www.dynamed.com/topics/dmp~AN~T115123/Central-sleep-apnea  . Updated January 13, 2020. Accessed January 17, 2020.

Greenstone M, Hack M. Obstructive sleep apnoea. BMJ. 2014 Jun 17;348:g3745

Mason M, Welsh EJ, Smith I. Drug therapy for obstructive sleep apnea. Cochrane Database Syst Rev. 2013;(5):CD003002.

Obstructive sleep apnea (OSA) in adults. EBSCO DynaMed Plus website. Available at:  http://www.dynamed.com/topics/dmp~AN~T115600/Obstructive-sleep-apnea-OSA-in-adults  . Updated August 29, 2019. Accessed January 17, 2020.

Sleep apnea. National Heart, Lung and Blood Institute (NHLBI) website. Available at: https://www.nhlbi.nih.gov/health-topics/sleep-apnea. Accessed January 17, 2020.

1/28/2015 DynaMed Plus Systematic Literature Surveillance  http://www.dynamed.com/topics/dmp~AN~T115600/Obstructive-sleep-apnea-OSA-in-adults  : Teodorescu M, Barnet JH, Hagen EW, et al. Association between asthma and risk of developing obstructive sleep apnea. JAMA. 2015;313(2):156-164.

12/20/2016 DynaMed Plus Systematic Literature Surveillance  http://www.dynamed.com/topics/dmp~AN~T115123/Central-sleep-apnea  : Costanzo MR, Ponikowski P, Javaheri S. Transvenous neurostimulation for central sleep apnoea: a randomised controlled trial. Lancet. 2016;388(10048):974-982.