Sleep Apnea

What is sleep apnea?

Sleep apnea is a common sleep disorder that occurs when you breathe abnormally while you are sleeping. It is characterized by extended pauses in breath and breathing lapses when you sleep. Sleep apnea can cause a lower quality sleep and affects your body’s supply of oxygen to be affected. Due to lowered oxygen intake, sleep apnea can potentially lead to serious conditions. It is more commonly found in men than it is in women. 

There are different types of sleep apnea. This includes: 

Obstructive sleep apnea. The first type of sleep apnea is obstructive sleep apnea which is also known as OSA. This is when sleep apnea occurs for physical reasons. Usually it occurs when the airway at the back of the throat is physically blocked, resulting in abnormal breathing. 

Central sleep apnea. The next type of sleep apnea is called central sleep apnea, or CSA for short. Here instead of a physically blocked airway, the brain has problems controlling the muscles that are required for respiration and breathing. Therefore, this results in slower, shallower, and more inconsistent breaths. 

Complex sleep apnea. There is also another type of sleep apnea called mixed or complex sleep apnea. Just like its name suggests, mixed sleep apnea is a combination of obstructive sleep apnea (OSA) and central sleep apnea (CSA). 

It is important to differentiate between OSA and CSA as the underlying reasons and causes of sleep apnea in each of these cases are different. This means that there are slight differences in terms of symptoms and in terms of treatments of OSA and CSA. 

What does having sleep apnea feel like?

There are some signs and symptoms of sleep apnea that you can look out for. 

Obstructive sleep apnea has symptoms that are present during both the day and night. If you habitually snore loudly during the night (so much so that it bothers others around you) you may have obstructive sleep apnea. During the night, you may also experience a witnessed apnea, where snoring is interrupted and ends with a snort. At times, witnessed apneas may also evoke gasping and choking sensations which would awake you from your sleep. People with obstructive sleep apnea may also experience nocturia (frequent urination during the night) as well as insomnia and restlessness when sleeping. 

During the daytime, people with obstructive sleep apnea may experience nonrestorative sleep that leaves them feeling as tired as when they went to bed. If you experience excessive daytime sleepiness and fatigue that leaves you unable to concentrate, impairing your thinking and memory, you may also have OSA. OSA also manifests itself in other ways during the day including but not limited to morning headache, dry/sore throat, sexual dysfunction (i.e. decreased libido, and sexual impotence), personality and mood changes, and hypertension.

What are the causes and risk factors of sleep apnea?

While sleep apnea can affect anyone of any age, gender, and race, there are certain factors that increase your risk for getting sleep apnea. 

Age. As we age, our risk of sleep apnea increases. Changes in how the brain controls the sleep process might be a reason for the increased risk of sleep apnea as we get older. Another reason for an increased risk is more fatty tissue that is present in the tongue and the neck. This is because these fatty tissues near and surrounding the throat may fall back and block your airway, resulting in obstructive sleep apnea. 

Medical conditions. In addition, there are certain medical conditions which may make you more predisposed to developing sleep apnea. These include heart disorders, prior stroke, obesity, high blood pressure, type 2 diabetes and Parkinson’s disease. 

Certain substances and medications. Substances such as alcohol and sedatives, as well as narcotic pain medications are known to increase the risk of sleep apnea as well. Smoking may also damage the function of your upper airway, increasing the risk and severity of sleep apnea.

Genetics. Lastly, research has shown how 35 to 40 percent of sleep apnea cases can be attributed to genetics [1]. Thus, having a family history of sleep apnea may increase your risk of developing it.

How is sleep apnea diagnosed?

It may be a good idea to consult a doctor if you feel excessively tired during the daytime despite getting enough sleep or if you snore very loudly.

Through the use of a sleep study (also known as PSG, a polysomnogram), OSA might be diagnosed. In a sleep study, you would sleep overnight in a sleep laboratory. A polysomnogram is a non-invasive diagnostic test. The test can determine the severity of OSA if present by monitoring your stages of sleep, breathing effort, oxygen levels, heart rhythm, and muscle activity during sleep. 

How is sleep apnea treated?

For milder cases of sleep apnea, your doctor may encourage you to make lifestyle changes like losing weight that may help to relieve your symptoms. However if you are not experiencing any improvement or have a moderate/severe case of sleep apnea there are treatments available to help relieve your symptoms. 

Oral appliances are available to relieve the symptoms you experience. They are particularly effective when the obstruction in the airway occurs at the level of the tongue. They work by pulling the lower jaw forward while worn so that your airway is opened up and maintained during sleep. It may take some time for you to get adjusted to wearing it while sleeping. You may feel an ache in your jaw when you wake up and might experience a lot of drooling during the night. While there are some side effects, it is proven as a useful tool for mild/moderate cases of sleep apnea. 

Another treatment option for more serious cases is continuous positive airway pressure (CPAP). Through a mask that is strapped onto the face and connected to a tube, air pressure that is higher than normal helps to keep the airway open and prevent snoring and sleep apnea. 

If people with severe sleep apnea have tried other methods but still see no improvement, surgery is an option. There are many different types of surgeries that all help severe cases of sleep apnea. The main goal of these surgeries are to open up the airway reducing the effect of the patient’s condition. 

References
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  1. Casale, M., Pappacena, M., Rinaldi, V., Bressi, F., Baptista, P., & Salvinelli, F. (2009). Obstructive Sleep Apnea Syndrome: From Phenotype to Genetic Basis. Current Genomics, 10(2), 119–126. https://doi.org/10.2174/138920209787846998 
  2. Obstructive Sleep Apnea Treatment: Non-surgical and Surgical – Doctor | National Dental Centre Singapore. (2018, April 9). Www.Singhealth.com.Sg. https://www.nni.com.sg/patient-care/conditions-treatments/obstructive-sleep-apnea-osa/treatment
  3. Wickramasinghe, H. (2020). Obstructive Sleep Apnea (OSA): Practice Essentials, Background, Pathophysiology. EMedicine. https://emedicine.medscape.com/article/295807-overview#a1