Sleep Apnea:

Symptoms, Causes, Diagnosis, and Treatment

What is sleep apnea?

If you stop breathing periodically during sleep, you have sleep apnea. You may awaken to restart breathing up to 100 times per night.

Probably you remember nothing at all about the awakenings. However, if you sleep with someone else, your sleep partner will remember a great deal about the awakenings. If you don’t have a sleep partner and suspect that you have sleep apnea, there other ways to monitor your sleep using audio recording (see below).

There are three vital things that you need to know about sleep apnea:

• Not only does sleep apnea result in sleep deprivation, but it can also threaten your life.
• Sleep apnea is a progressive sleep disorder (it gets worse as you age).
• Treatment for sleep apnea is necessary and usually successful.

Is snoring the same as sleep apnea?

Snoring and sleep apnea are not the same thing. Snoring is simply a loud sound that you make during breathing while asleep. Snoring may accompany sleep apnea, but snoring by itself does not mean that breathing has stopped.

What are the signs and symptoms of sleep apnea?

Warning signs and symptoms of sleep apnea are:

• Frequent cessation of breathing (apnea) during sleep. Your sleep partner may notice repeated silences from your side of the bed.
• Choking or gasping during sleep to get air into the lungs
• Loud snoring
• Sudden awakenings to restart breathing
• Waking up in a sweat during the night
• Feeling unrefreshed in the morning after a night’s sleep
• Headaches, sore throat, or dry mouth in the mornings after waking up
• Daytime sleepiness, including falling asleep at inappropriate times, such as during driving or at work
• Lethargy
• Rapid weight gain
• Memory loss and learning difficulties
• Short attention span
• Poor judgment
• Depression
• Personality changes

How can I get diagnosed for sleep apnea?

Before you visit a doctor for a possible diagnosis of sleep apnea, ask your spouse or sleeping partner to keep a sleep diary for you. Your bed partner probably wakes up frequently because of your sleep problems, so keeping a record of awakenings can be a constructive way to move toward solution of your sleep disorder.

A willing bed partner can keep a notepad, a pen, and a flashlight near the bed, and can make written records for an entire night every so often. Whenever your bed partner wakes up, they can note

• how loud your snoring is,
• whether you are asleep or not, and
• whether you are having trouble breathing (that is, choking or gasping).

If you don’t have someone to record your sleep patterns, you can use a tape recorder yourself. You can automatically audiotape yourself during sleep with a sound-activated audio recorder or a software program that turns your computer into a sound-activated recorder. If you don’t have access to recording equipment, it may be worthwhile to ask a friend or loved one to monitor your sleep pattern for a few nights, or visit a sleep center for observation.

With your sleep record in hand, consult a knowledgeable doctor or a sleep specialist. To diagnose for sleep apnea, the doctor or specialist will:

• perform a physical examination of your mouth and nose to look for obstructions,
• possibly do an endoscopy of your nose and throat, and x-rays or a CT scan of the head and neck, and
• recommend an overnight sleep study in a sleep clinic.

Sleep tests in a sleep clinic help to diagnose sleep apnea by measuring how frequently you stop breathing. Polysomnography is a standard test that records:

• electrical activity of the brain,
   
• eye movement,
   
• muscle movement,
   
• heart rate,
   
• respiratory effort,
   
• air flow, and
   
• blood oxygen levels during sleep.

What are the types of sleep apnea?

There are three types of sleep apnea.

What are the causes of sleep apnea?

Various risk factors can predispose you to have an obstructed airway and therefore cause sleep apnea. If you have a number of the risk factors below, and you are not sleeping well, you might consult a doctor for a diagnosis of sleep apnea. The risk factors for sleep apnea are:

• Obesity or excessive fat in the neck and throat – However, note that almost half of people with sleep apnea are not obese.
   
• Age
   
• Male gender
   
• Irregular sleep hours - An irregular sleep schedule can throw off your sleep cycles. Disruptions include work days vs. non-work days; a snoring bed partner; a new baby; aggravation from the day’s events; not following a natural preference for sleep during unconventional hours; and overuse of caffeinated products. Particularly affected are Stage 1 sleep (when you first fall asleep) and REM sleep (when you dream). The result of disruption can be unstable breathing and sleep apnea during these phases of sleep.
   
• Anatomical anomalies that narrow your airway – For example, a deviated septum, an enlarged tongue, or a receding chin.
   
• Snoring - Snoring itself is not only a result of sleep apnea, but also a cause. The repeated vibrations of the soft palate during snoring can cause the soft palate to lengthen, which can obstruct the airway.
   
• Enlarged tonsils or adenoids - Especially can cause sleep apnea in children.
   
• Use of alcohol and sedatives before bedtime
   
• Smoking or exposure to secondhand smoke
   
• Nasal congestion, nasal blockages, and nasal irritants - For example, household dust and dander can inhibit breathing through the nose and force breathing through the throat, which may also be blocked.
   
• Family history of sleep apnea - No specific genetic marker for sleep apnea has been discovered, but obstructive sleep apnea seems to run in families. This may be a result of facial and neck characteristics or anatomic abnormalities that are passed along to succeeding generations.
   
• Other disorders and syndromes - Hypothyroidism, acromegaly, amyloidosis, vocal cord paralysis, post-polio syndrome, neuromuscular disorders, Marfan's syndrome, and Down Syndrome.

Sleep apnea is associated with some other conditions, but whether these conditions are the cause or the result of sleep apnea is not yet clear:

• Immune-system abnormalities
   
• Severe heartburn or acid reflux (gastroesophageal reflux disease, or GERD)
   
• High blood pressure

What are the results or effects of sleep apnea on health?

What Happens When You Stop Breathing During Sleep?

If you have sleep apnea, you stop breathing during sleep, and the balance of oxygen and carbon dioxide in the blood is upset. This imbalance stimulates the brain to restart the breathing process. The brain signals you to wake up so that the muscles of the tongue and throat can increase the size of the airway. Then, carbon dioxide can escape, and oxygen can enter the airway. These waking episodes are necessary to restart breathing (and to save your life), but you become sleep-deprived.

Sleep apnea has serious health consequences and can even be life-threatening. The main effects of sleep apnea are:

• sleep deprivation, and
   
• oxygen deprivation.

Sleep deprivation

Both the person with sleep apnea and the bed partner suffer from sleep deprivation. A bed partner may lose an hour of sleep each night from sleeping next to a person with sleep apnea.

Some trickle-down effects of sleep deprivation are:

• Daytime sleepiness
• A compromised immune system and slower healing
• Poor mental and emotional health
• Lack of smooth functioning of the body
• Decreased productivity
• A negative mood, irritability
• Low energy
• Unclear thinking, lack of concentration
• Slower reaction time
• Oxygen deprivation

When you stop breathing, your brain does not get enough oxygen. Drastic problems can result from the oxygen deprivation of sleep apnea:

• Insomnia, restless sleep
• Heart disease, heart failure, or heart abnormalities such as arrhythmia (irregular heart beat)
• Stroke, high blood pressure (hypertension), and other cardiovascular system problems
• Type II diabetes
• Cognitive impairment: memory problems, learning difficulties, and lack of attention
• Rapid weight gain and obesity
• Impotence, sexual dysfunction, or reduced libido
• Morning headaches
• Depression
• Sevenfold increase in involvement in auto accidents
• Premature death, such as Sudden Infant Death Syndrome (SIDS)

Other, more mild effects of sleep apnea

Some other consequences of sleep apnea are:

• Frequent bathroom visits to urinate during the night
• Heartburn
• Excessive sweating during sleep
• Dry mouth in the morning
• Loud snoring
• In children, a concave chest during sleep

What are the treatments for sleep apnea?

Sleep apnea responds well to treatment. Your specific sleep apnea characteristics determine which treatment will work best for you. Treatments include:

• Behavioral treatments for sleep apnea (self-help)
• Physical or mechanical therapy or treatment for sleep apnea, including surgery

Medication is not usually an effective treatment for sleep apnea.

You may wish to try several treatments, either in succession or simultaneously.

What self-help remedies are there for sleep apnea?

Minor sleep apnea is responsive to self-help remedies, or “behavioral treatments.” Some of the following self-help treatments for sleep apnea may work for you.

What physical or mechanical treatments can cure sleep apnea?

Physical devices and mechanical therapies are effective in treating many cases of sleep apnea. These treatments for sleep apnea are:

• Continuous Positive Airway Pressure (CPAP)
   
• Dental appliances or jaw adjustment devices
   
• Surgery
   
• Oxygen administration

What are the advantages and disadvantages of the various types of treatment for sleep apnea?

Choosing the right treatment for your case of sleep apnea is an important decision. Following is a summary of the main advantages and disadvantages of each type of treatment for sleep apnea. Always consult a sleep specialist when making this decision.