Sleep is a universal and imperative biological process to maintain and restore health. The duration of sleep usually is 6 to 9 hours in adults. However, good sleep is associated with a sense of having slept continuously throughout the night and feeling refreshed and alert on awakening in the morning.
Sleep apnea, a prevalent yet frequently undiagnosed sleep disorder, involves the intermittent cessation and resumption of breathing during sleep, thereby posing substantial risks to an individual’s health and well-being. It can lead to a number of health problems, including high blood pressure, heart disease, stroke, and diabetes.
Did you know that many dentists are trained to help treat and manage your sleep apnea and snoring? Dental sleep medicine is area of dental practice that focuses on the use of oral appliance therapy to treat sleep-disordered breathing, including snoring and sleep apnea. Dentists work together with physicians and sleep medicine specialist to identify the problem and to plan best treatment for the patient.
In this comprehensive guide, we will dive into the intricacies of sleep apnea, from understanding its various forms and symptoms to exploring diagnostic methods and treatment options. If you or someone you know suspects sleep apnea, this article is your gateway to a deeper understanding of this condition.
What is Sleep Apnea?
Sleep apnea is a serious sleep disorder characterized by repeated interruptions in breathing during sleep. These interruptions, known as apneas, can last for seconds to minutes and may occur dozens of times per hour.
Types of Sleep Apnea (SA)
There are three types of SA:
1. Obstructive sleep apnea (OSA): This is the most common type, caused by a blockage in the upper airway and/or the relaxation of throat muscles.
2. Central sleep apnea (CSA): In which, airway is not blocked but the brain fails to signal the muscles that controls breathing.
3. Mixed sleep apnea: This is the combination of the both obstructive and central sleep apnea.
Causes of Sleep Apnea
Obstructive sleep apnea (OSA):
When you have sleep apnea, your throat muscles relax too much while you’re breathing during sleep, causing your airway to become narrow. This can lead to breathing problems for 10 seconds or more, lowering the oxygen level in your blood and increasing carbon dioxide. Your brain notices this and briefly wakes you up, so you can clear your airway. You may make snorting, choking, or gasping sounds, but these wake-ups are so quick that you don’t remember them.
This cycle can happen multiple times throughout the night, preventing you from getting the deep, restful sleep you need. As a result, you’ll likely feel tired during the day. Surprisingly, many people with obstructive sleep apnea (OSA) are not even aware they have this problem. They may think they slept well all night. One common sign of OSA is loud snoring.
Central Sleep Apnea (CSA):
It is a less common type of sleep apnea. It occurs when your brain doesn’t send the right signals to your breathing muscles. This means you may stop trying to breathe for a short time. You might wake up feeling out of breath or have trouble falling asleep or staying asleep.
Risk Factors
Following factors can increase the risk of developing sleep apnea (SA):
- Age: Both OSA and CSA are more prevalent in middle-aged and older individuals, but sleep apnea can impact people of all age groups.
- Gender: Men are twice as likely as premenopausal women to have SA. The risk increases for women after menopause.
- Family history: If someone in your family has SA, you might be at a higher risk for it.
- Enlarged tonsils or adenoids: In children, enlarged tonsils or adenoids can sometimes cause OSA by blocking the airway.
- Narrowed airway: Some people are born with naturally narrow airways, or they may have enlarged tonsils, a large tongue, or a small jaw that can block the airway.
- Thick neck: If you have a thick neck, your airways may be narrower.
- Nasal problems: Chronic nasal congestion, allergies, sinus problems, or nasal defects can make it harder to breathe through your nose, increasing the likelihood of OSA.
- Smoking: Smoking increases inflammation and fluid retention in the upper airway, making it more likely to collapse during sleep. Learn effective strategies to quit smoking by reading our article, “Quitting Tobacco: From Smokes to Success – Your Journey to Becoming Healthier, Wealthier, and Famous.”
- Excess weight: Excess body weight, particularly around the throat, can obstruct breathing, and certain weight-related medical conditions such as hypothyroidism may contribute to obstructive sleep apnea (OSA). However, OSA can also affect individuals who are thin.
- Medical conditions: SA is more common in people with certain medical conditions, such as high blood pressure, diabetes, asthma, chronic lung diseases, or Parkinson’s disease.
- Alcohol, sedatives, or tranquilizers: The consumption of these substances, especially before bedtime can lead to the relaxation of your throat muscles, which can worsen the symptoms of sleep apnea.
- Hormones: OSA risk can rise during pregnancy or due to hormonal disorders because hormonal changes and weight gain can lead to airway narrowing and increased chances of breathing disruptions during sleep.
- Sleeping position: Sleeping on your back can exacerbate OSA as it may cause the tongue and soft palate to collapse toward the back of the throat.
- High blood pressure: High blood pressure, as well as the use of hypertensive medications, can heighten the risk of OSA due to their potential to alter the structure of the upper airway, rendering it more susceptible to collapse during sleep and consequently exacerbating OSA symptoms.
- Heart disorders: Conditions like congestive heart failure and prior heart attacks can result in fluid accumulation and alterations in blood vessels. These factors increase the risk of obstructive sleep apnea by affecting airway function and oxygen levels during sleep, exacerbating the condition’s severity.
- Medications: Certain opioid pain medications, like long-acting methadone, heighten CSA risk by altering central nervous system control of breathing, resulting in disrupted sleep breathing patterns.
- Strokes: If you’ve had a stroke, it increases your risk of developing central sleep apnea or treatment-emergent CSA.
- Mouth breathing: Mouth breathing is a risk factor for OSA as it can lead to the relaxation of throat muscles, potentially contributing to airway obstruction during sleep. This increases the likelihood of OSA development or worsening.
Remember, while these factors can increase the risk of sleep apnea, it can affect anyone. If you suspect you may have SA, it’s important to seek evaluation and treatment from a healthcare professional.
Features of sleep apnea, including both obstructive and central sleep apnea
- Loud and frequent snoring: Especially prominent in OSA. Remember, snoring is a warning sign that should never be ignored.
- Episodes of stopped breathing during sleep: These are often followed by abrupt awakenings with gasping or choking sounds. Witnessed by a family member.
- Waking up with a dry mouth, sore throat, or nighttime sweating.
- Difficulty staying asleep (insomnia).
- Morning headaches: Often due to oxygen deprivation during sleep.
- Excessive daytime sleepiness (hypersomnia) and fatigue.
- Trouble concentrating or paying attention: Impairment in cognitive function.
- Mood changes, such as feelings of depression or irritability.
These features can indicate the presence of sleep apnea, a condition where breathing is repeatedly interrupted during sleep, leading to poor sleep quality and potential health problems. If you experience these symptoms, it’s essential to seek medical evaluation and diagnosis.
Complications
Sleep apnea (SA), when left untreated, can lead to severe health complications, including:
- COVID-19: Recent studies suggest that SA increases the risk of severe outcomes from COVID-19, including death.
- Daytime fatigue and sleepiness: SA can lead to work-related accidents. Children with OSA may have attention or behaviour problems and struggle in school.
- Dental and Oral problems: Oral Problems associated with sleep apnea include waking up with a dry mouth and sore throat. Furthermore, dry mouth can increase the risk of tooth decay and gum disease.
- Neurological problems: Headaches, depression, memory loss, or confusion.
- Heart problems: SA can raise blood pressure, strain the heart, and increase the risk of heart issues like coronary artery disease, heart attacks, heart failure, and stroke. It can also lead to abnormal heart rhythms.
- Respiratory disorders: SA can worsen conditions like asthma and chronic obstructive pulmonary disease (COPD).
- Gut problems: SA can exacerbate acid reflux and heartburn, often seen in people with gastroesophageal reflux disease (GERD).
- Liver problems: SA is associated with a higher likelihood of fatty liver and abnormal liver function tests.
- Blood problems: Low oxygen levels can weaken your immune system, making you more susceptible to infections.
- Metabolic Disorders: SA is linked to a higher risk of diabetes and weight gain. It can also worsen the existing diabetes.
- Sexual dysfunction: SA can affect sexual desire and lead to erectile dysfunction resulting from hormone imbalances.
- Complications with medications, anesthesia, and surgery: Some medications and anesthesia can worsen SA, and surgery may pose risks for those with SA.
- Accidents: People with SA are more prone to work-related or traffic accidents causing diminished quality of life.
- Sleep-deprived family members: Loud snoring can disrupt the sleep of family members and strain relationships.
Diagnosis and Evaluation
A proper diagnosis of sleep apnea is crucial for effective treatment. Diagnosis typically involves:
- Signs and symptoms: If you snore loudly, feel persistently tired after a full night’s sleep, or have any other sleep apnea symptoms, it’s important to seek evaluation and advice from sleep medicine and dental sleep medicine specialists. However, not everyone with sleep apnea snores.
- Medical History: Discussing symptoms, medical conditions, and family history.
- Physical and X-ray Examination: Focusing on throat and facial features. The initial diagnosis of CSA usually does not require an MRI, but an MRI might be necessary to rule out structural brain issues.
- Sleep Study (Polysomnography): A comprehensive test that monitors sleep patterns, brain activity, heart rate, and more.
Treatment Options
The good news is that sleep apnea can be managed and treated effectively. Treatment options include:
Continuous Positive Airway Pressure (CPAP) Therapy
- What is it? The most common treatment for sleep apnea. It uses a mask and a machine to provide forced air to keep your airway open.
- How does it work? You wear a mask while you sleep, and the machine delivers air pressure to prevent airway blockage.
- Pros: It’s effective in treating sleep apnea.
- Cons: Some people find it uncomfortable and prefer other options.
Bi-Level Positive Airway Pressure (BiPAP) Therapy
- What is it? BiPAP (Bilevel Positive Airway Pressure) therapy is a sleep apnea treatment using a machine that provides two different air pressure levels: a higher one for inhalation and a lower one for exhalation, helping maintain an open airway.
- How does it work? During sleep, a mask is worn, and the machine delivers varying air pressure to prevent airway blockage.
- Pros: Effectively treats sleep apnea, especially for those with severe cases or difficulty with CPAP therapy.
- Cons: Some individuals may find it uncomfortable and may prefer alternative treatment options.
Oral Appliance Therapy (OAT)
- What is it? A comfortable, quiet, and portable therapy that involves a custom-fit device worn in your mouth only during sleep.
- How does it work? The device supports your jaw in a forward position, preventing the airway from collapsing.
- Provider: Should be a qualified dentist trained in dental sleep medicine.
- Use: It’s used for treating obstructive sleep apnea and snoring in adults.
Surgery
- When is it considered? Usually, it’s an option after other treatments haven’t worked.
- Types: Options include tonsil removal, tissue removal from the back of your throat, jaw repositioning, nerve stimulation, or weight-loss surgery.
These treatments are used to manage sleep apnea and its symptoms, each with its own advantages and considerations.
Life Style Management and Home Remedies
- Weight loss: Shedding extra pounds can improve sleep apnea and reduce the risk of heart disease.
- Exercise: Regular, moderate exercise can help ease sleep apnea symptoms.
- Avoid alcohol and certain medications: Don’t use substances like tranquilizers and sleeping pills, as they relax throat muscles and make sleep apnea worse.
- Don’t smoke: Smoking is harmful to your health. Quitting can improve sleep apnea and reduce the risk of other health issues. Discover effective strategies to quit smoking by reading our article, “Quitting Tobacco: From Smokes to Success – Your Journey to Becoming Healthier, Wealthier, and Famous.”
- Change sleep position: Try sleeping on your side or abdomen instead of your back to prevent your tongue and soft palate from blocking your airway.
- Timely treatment: Address issues like nasal congestion, tonsil problems, or diabetes promptly to prevent them from getting worse and aggravating sleep apnea.
Conclusion
Sleep apnea is a common but often overlooked sleep disorder that can have serious health consequences. It occurs when a person’s breathing is repeatedly disrupted during sleep, leading to poor rest and potential health issues. If you or someone you know shows symptoms like loud snoring, choking, or pauses in breathing during sleep, it’s important to seek medical advice for diagnosis and treatment. Effective management can improve sleep quality, enhance overall well-being, and reduce the risks associated with this condition.
FAQs
Q: Who is at risk for sleep apnea?
A: Sleep apnea is more common in men, people who are overweight or obese, and people with certain medical conditions, such as heart failure and hypothyroidism.
Q: How can I tell if I have sleep apnea?
Common signs include loud snoring, excessive daytime sleepiness, and pauses in breathing during sleep. A medical evaluation, including a sleep study, is necessary for a definitive diagnosis.
Q: How is sleep apnea diagnosed?
A: Sleep apnea is diagnosed with a sleep study. A sleep study is a test that measures your breathing, brain waves, and other bodily functions while you sleep.
Q: What are the complications of sleep apnea?
A: Untreated sleep apnea can lead to a number of health problems, including high blood pressure, heart disease, stroke, and diabetes.
Q: How can I prevent sleep apnea?
A: There are a number of things you can do to help prevent sleep apnea, including maintaining a healthy weight, avoiding alcohol and smoking before bed, and sleeping on your side or stomach.
Q: Is sleep apnea a life-threatening condition?
Untreated sleep apnea can lead to severe health issues, including high blood pressure, heart disease, stroke, and diabetes. However, with proper diagnosis and treatment, most individuals can effectively manage the condition.
Q: Can lifestyle changes alone treat sleep apnea?
In some cases, lifestyle changes like weight loss and smoking cessation can alleviate sleep apnea symptoms, particularly in mild cases. However, moderate to severe cases may require additional treatments.
Q: What’s the difference between CPAP and BiPAP therapy?
CPAP provides a continuous, fixed pressure, while BiPAP adjusts pressure levels for inhaling and exhaling, making it more comfortable for some patients.
Q: How can I find a sleep specialist for diagnosis and treatment?
Consult your primary care physician for a referral to a sleep medicine or dental sleep medicine specialist or contact a local sleep center for an appointment.
Q: What is the difference between snoring and sleep apnea?
Snoring is the noisy sound produced when air flows past relaxed throat tissues during sleep, often benign. In contrast, sleep apnea is a sleep disorder characterized by repeated pauses in breathing, potentially leading to severe health issues due to oxygen deprivation. While snoring is a common symptom, sleep apnea is a more serious condition.
Q: Is the presence of snoring an indication that a person has sleep apnea?
While snoring can be a symptom of sleep apnea, not everyone who snores has sleep apnea. Snoring is a common occurrence and can result from various factors, including relaxed throat tissues, without necessarily indicating the presence of sleep apnea.