What is Sleep Apnea?
Sleep apnea is a chronic illness that causes the body to stop breathing for 10-30 second intervals during sleep. With each apnea ‘event’ (when breathing stops), the brain reacts with urgency and the patient awakes, gasping for air.
For the majority of sleep apnea patients, the apnea event cycle occurs multiple times per hour during the night.
Sleep Apnea Health Hazards
Sleep apnea is harmful in many different ways. While stopping breathing is clearly hazardous, over time, not getting enough sleep can also contribute to serious health problems:
Sleep Apnea can reduce blood oxygen levels.
Our brain, body systems and vital organs depend on the oxygen supply delivered through blood circulation to function properly and stay healthy. The lack of consistent air flow for the sleep apnea patient can cause blood oxygen levels to drop below normal.
A person with low blood oxygen levels (hypoxemia) may experience shortness of breath, headaches, fatigue or dizziness. Without intervention and treatment, chronic low blood oxygen levels may lead to dangerously low oxygen levels in the organs and tissues of necessary oxygen (hypoxia). Hypoxia is a medical emergency that can lead to critical illness such as heart disease, brain injury, or liver and organ damage.
Lack of quality sleep impairs body systems functions.
While we are asleep, our body releases hormones and uses nutrients to support muscle tissue growth, promote healing and boost our immune system.
Our brain depends on sleep to refresh the communication processes that help us store memories and retain learning. Getting adequate sleep enables us to wake up energized and ready to problem-solve in the morning. (Not just a coined phrase, ‘sleeping on it’ can actually help with decision-making).
When sleep is continuously disrupted by the sleep apnea disordered breathing cycle, the body is unable to fully perform these and other vital restoration processes. Sleep deprivation not only makes us feel grumpy and tired, it can contribute to morning headaches or dizziness and increase the risk of other illnesses, including depression, heart disease, diabetes, high blood pressure and stroke.
What causes Sleep Apnea?
Sleep apnea falls into three primary categories based on the triggering cause of the apnea events:
Central Sleep Apnea (CSA)
Central Sleep Apnea is the result of the brain and nervous system failing to instruct the muscles that control breathing to work properly during sleep. This causes breathing to stop and re-start; as the brain detects ‘breathing stopped’, the patient wakes up gasping for air, then falls back asleep until breathing ceases again. This cycle repeats multiple times during the night.
Central sleep apnea may be directly connected to brain disease or injury, narcotic medications or other medical conditions such as heart disease or stroke.
Obstructive Sleep Apnea (OSA)
Obstructive Sleep Apnea is the most common form of sleep apnea. It occurs when the muscles and soft tissue structures that form the upper airway become so relaxed during sleep that they collapse and block the airway, causing breathing to stop until the patient wakes up. Learn more about Obstructive Sleep Apnea.
Mixed Sleep Apnea
Mixed sleep apnea is a combination of central sleep apnea and obstructive sleep apnea. For patients diagnosed with mixed sleep apnea, complex health issues (such as heart disease, diabetes or stroke) that are the result of untreated obstructive sleep apnea may be the medical cause behind central sleep apnea.
What are the signs and symptoms of Sleep Apnea?
Loud snoring is a classic symptom of obstructive sleep apnea. Snoring sounds occur when the loose soft tissue that forms the airway obstruction ‘rattles’ noisily as some air passes through. Snoring is not always due to sleep apnea, however. Learn more about what causes snoring.
Incidents of stopped breathing followed by gasping for air, then waking up during sleep are telltale signs of sleep apnea. (Some patients do not even realize they are doing this until their sleep partner tells them.)
Other signs and symptoms of sleep apnea include:
- Morning headaches and irritability
- Excessive daytime drowsiness
- Nighttime incontinence
- Inability to focus or remember things
- Feeling tired upon waking
How is Sleep Apnea diagnosed?
Sleep apnea is diagnosed by medical professionals. Your primary care doctor will talk with you about your sleep patterns and medical history, and may give you a referral to a sleep specialist for further evaluation and testing.
If a sleep study is recommended, you may be scheduled to spend the night at a sleep facility for recording and analysis of your breathing, oxygen saturation levels, heart rate, brain waves, eye movement and other indicators. These measurements are recorded by wearing a set of small stick-on sensors connected to testing equipment while you sleep (polysomnography).
A home sleep test may be recommended for initial or follow-up evaluation for sleep apnea or hypopnea (shallow breathing during sleep). The doctor will send you home with a portable device to wear during sleep that measures respiratory and heart rate, air flow, oxygen saturation or other criteria. While not as detailed as a facility sleep study, a home test can provide valuable information about your sleep health.
What treatment is available for Sleep Apnea?
A sleep physician will recommend treatment based on the type of sleep apnea diagnosed and severity of symptoms. Common treatment recommendations for sleep apnea include:
Lifestyle Changes
Physicians will generally recommend taking steps towards a healthy lifestyle to help with management and treatment of sleep apnea:
Overweight patients tend to have more fatty tissue around the neck and upper back that can compress the airway during sleep and add to the risk of soft tissue airway obstruction. Losing weight may help reduce or eliminate this risk.
Smoking causes airway tissues to become inflamed and irritated and creates congestion; all factors that may contribute to airway obstruction. Nicotine is also a stimulant that can make it difficult to fall asleep or stay asleep. If you smoke, your doctor will assist you with support tips and nicotine alternatives to help you quit for good.
Drinking alcohol before sleep has a sedative effect that can cause the airway tissues to become overly relaxed, with a raised risk of airway obstruction and sleep apnea. And, even though alcohol helps you fall asleep, it can cause you to wake up during the night and have a hard time going back to sleep.
For some obstructive sleep apnea patients, sleeping on their side can be a simple adjustment to gravity; if the tongue and throat tissues fall backward and block the airway while sleeping on their back, switching to sleeping on their side may help to some extent. There are a number of special pillows and devices that the physician may recommend to prevent the patient from rolling onto their back while asleep.
Continuous Positive Airway Pressure (CPAP)
Continuous positive airway pressure therapy (CPAP) is a standard treatment for moderate to severe cases of obstructive sleep apnea.
A sleep apnea patient undergoing CPAP therapy wears a face mask that is connected by a tube to a small machine that produces a steady flow of lightly pressurized air. Breathing CPAP pressurized air during sleep assists in maintaining the proper tension and firmness of airway muscles and tissues to prevent collapse and blockage.
The CPAP system does not provide oxygen as a rule, however, there are several types of CPAP systems and a sleep physician may recommend the addition of supplemental oxygen if necessary.
Bilevel Positive Airway Pressure (BiPAP)
Similar to CPAP, BiPAP delivers pressurized air through a mask and hose set up, however it allows for different settings for exhaled breathing support (CPAP is typically a single setting for both inhale/exhale breathing).
BiPAP equipment is considered to be a ventilator; it is not as portable as CPAP and is primarily used to treat central sleep apnea or other respiratory illnesses.
Image courtesy of True Function Laboratory
Oral Appliance Therapy (OAT)
A sleep physician may refer a patient diagnosed with obstructive sleep apnea (OSA) to a dentist trained in dental sleep medicine for oral appliance therapy (OAT).
Dr. Phillip Durden has completed advanced training in dental sleep medicine and has extensive experience in OSA oral appliance therapy in collaboration with medical sleep professionals.
An oral sleep appliance is worn similarly to a dental mouthguard. Dr. Durden designs the sleep appliance based on the physician’s prescription; a dental laboratory then produces the device per Dr. Durden’s specific instructions.
Most OSA oral appliances are designed to shift the lower jaw (mandible) forward; this helps to maintain an open airway position while the patient sleeps.
Oral appliance therapy may be recommended for treatment of mild cases of obstructive sleep apnea, or, in more advanced cases, the oral appliance may be adapted for use in conjunction with CPAP equipment.
Some OSA patients are not able to tolerate CPAP for a variety of reasons, including difficulty sleeping because of the noise of the machine, discomfort wearing the CPAP mask or other challenges. In cases of CPAP intolerance, the sleep physician may prescribe oral appliance therapy as the primary treatment for obstructive sleep apnea. Learn more about CPAP intolerance.
Surgery
Sleep apnea surgery is less common than other forms of treatment, however, medical professionals sometimes recommend removal of tonsils or adenoids, or, surgical modification of the palate or pharynx soft tissue for treatment of obstructive sleep apnea. The objective of surgery is to prevent these tissues from collapsing and blocking the airway during sleep.
Medication for Sleep Apnea
While no medication can correct airway obstruction linked to sleep apnea, your doctor may prescribe medications to treat secondary or related illnesses, such as sinus congestion or asthma.
Is sleep apnea causing my daytime drowsiness?
Daytime drowsiness is often an indicator of sleep-disordered breathing. The Epworth Sleepiness Scale is used by physicians and sleep medicine doctors as a screening tool. Take the sleepiness quiz and share your results with your primary care doctor and Dr. Durden.
Dental Sleep Medicine of Athens
Do you snore loudly followed by gasps for air during sleep? It's time for you to get the answers you need about sleep apnea. Contact your primary care doctor or give Dental Sleep Medicine of Athens a call to learn more about sleep breathing disorders.