Sleep Apnea

Sleep apnea is a potentially serious sleep disorder in which breathing repeatedly stops and starts. It affects 25% of the adult US population. If you snore loudly and feel tired even after a full night's sleep, you might have sleep apnea.

The main types of sleep apnea are:

  • Obstructive sleep apnea, the more common form that occurs when throat muscles relax.

  • Central sleep apnea, which occurs when your brain doesn't send proper signals to the muscles that control breathing.

  • Complex sleep apnea syndrome, also known as treatment-emergent central sleep apnea, which occurs when someone has both obstructive sleep apnea and central sleep apnea

Symptoms

 

The most common signs and symptoms of obstructive and central sleep apneas include:

  • Loud snoring

  • Episodes in which you stop breathing during sleep — which would be reported by another person

  • Gasping for air during sleep

  • Awakening with a dry mouth

  • Morning headache

  • Difficulty staying asleep (insomnia)

  • Excessive daytime sleepiness (hypersomnia)

  • Difficulty paying attention while awake

  • Irritability

Risk factors

 

Sleep apnea can affect anyone, even children. But certain factors increase your risk.

  • Excess weight. Obesity greatly increases the risk of sleep apnea. Fat deposits around your upper airway can obstruct your breathing.

  • Neck circumference. People with thicker necks might have narrower airways.

  • A narrowed airway. You might have inherited a narrow throat. Tonsils or adenoids also can enlarge and block the airway, particularly in children.

  • Being male. Men are two to three times more likely to have sleep apnea than are women. However, women increase their risk if they're overweight, and their risk also appears to rise after menopause.

  • Being older. Sleep apnea occurs significantly more often in older adults.

  • Family history. Having family members with sleep apnea might increase your risk.

  • Use of alcohol, sedatives or tranquilizers. These substances relax the muscles in your throat, which can worsen obstructive sleep apnea.

  • Smoking. Smokers are three times more likely to have obstructive sleep apnea than are people who've never smoked. Smoking can increase the amount of inflammation and fluid retention in the upper airway.

  • Nasal congestion. If you have difficulty breathing through your nose — whether from an anatomical problem or allergies — you're more likely to develop obstructive sleep apnea.

  • Medical conditions. Congestive heart failure, high blood pressure, type 2 diabetes and Parkinson's disease are some of the conditions that may increase the risk of obstructive sleep apnea. Polycystic ovary syndrome, hormonal disorders, prior stroke and chronic lung diseases such as asthma also can increase risk.

Complications

  • Daytime fatigue

    The repeated awakenings associated with sleep apnea make normal, restorative sleep impossible, making severe daytime drowsiness, fatigue and irritability likely.

    You might have difficulty concentrating and find yourself falling asleep at work, while watching TV or even when driving. People with sleep apnea have an increased risk of motor vehicle and workplace accidents.

    You might also feel quick-tempered, moody or depressed. Children and adolescents with sleep apnea might perform poorly in school or have behavior problems.

  • High blood pressure or heart problems

    Sudden drops in blood oxygen levels that occur during sleep apnea increase blood pressure and strain the cardiovascular system. Having obstructive sleep apnea increases your risk of high blood pressure (hypertension).

    Obstructive sleep apnea might also increase your risk of recurrent heart attack, stroke and abnormal heartbeats, such as atrial fibrillation. If you have heart disease, multiple episodes of low blood oxygen (hypoxia or hypoxemia) can lead to sudden death from an irregular heartbeat.

  • Type 2 diabetes

    Having sleep apnea increases your risk of developing insulin resistance and type 2 diabetes.

  • Metabolic syndrome

    This disorder, which includes high blood pressure, abnormal cholesterol levels, high blood sugar and an increased waist circumference, is linked to a higher risk of heart disease.

  • Liver problems

    People with sleep apnea are more likely to have results on liver function tests, and their livers are more likely to show signs of scarring (nonalcoholic fatty liver disease).

  • Sleep-deprived partners

    Loud snoring can keep anyone who sleeps near you from getting good rest. It's not uncommon for a partner to have to go to another room, or even to another floor of the house, to be able to sleep.

Treatment Options

  • Behavioral Options

    As an initial treatment option, patients with mild-to-moderate OSA may begin with changes in lifestyle (diet, weight loss, exercise). Reducing alcohol consumption, especially before bedtime, may also provide preventive value.

  • Positional Sleep

    Patients may also be advised that sleeping in a supine position (horizontal position with face and torso facing up) has been found to aggravate symptoms.

    Sleeping on one’s side may assist in improving AHI levels and sleepiness measures. For individuals with mild to moderate OSA, mild head-of-bed elevation may also assist in reducing OSA severity.

  • Oral Appliances

    Oral appliances are custom-fitted by Dr. Bensoussan for placement in the mouth during sleep to advance the lower jaw, tongue and soft palate and prevent recurrent collapse and blockage of the upper airway.

    Oral appliances have been viewed as a simpler therapeutic option for patients with OSA, particularly for patients with mild to moderate OSA or patients with severe OSA who have difficulty tolerating PAP therapy. Patients with OSA should be advised to use their oral appliances nightly (or during each sleep session) to help achieve optimal control of OSA symptoms.

  • CPAP Therapy

    Positive airway pressure is recommended as a primary therapy for managing severe adult OSA. PAP devices use air pressure from a mechanical device to counteract airway narrowing through the delivery of compressed air to the oropharynx. Air pressure is delivered through a mask covering the nose, which splints the airway with increased air pressure to maintain patency during sleep.

    PAP can provide patients with improved sleep patterns and quality of life when used consistently and properly.

  • Surgical Options

    Surgery may be recommended for patients who do not improve or respond to non-surgical therapies for OSA. Surgical procedures are used to adjust structures (bone or soft tissues) to reduce obstruction in the upper airways, or for implantation of neurostimulator devices.