Sleep Apnea

Sleep Apnea Overview

Sleep apnea is a serious sleep disorder that occurs when a person’s breathing is interrupted during sleep. People with untreated sleep apnea stop breathing repeatedly during their sleep, sometimes hundreds of times. This means the brain — and the rest of the body — may not get enough oxygen.

There are two types of sleep apnea:

Obstructive sleep apnea (OSA): The more common of the two forms of apnea, it is caused by a blockage of the airway, usually when the soft tissue in the back of the throat collapses during sleep.
Central sleep apnea: Unlike OSA, the airway is not blocked, but the brain fails to signal the muscles to breathe, due to instability in the respiratory control center.

Am I at Risk for Sleep Apnea?

Sleep apnea can affect anyone at any age, even children. Risk factors for sleep apnea include:

  • Being male
  • Being overweight
  • Being over age 40
  • Having a large neck size (17 inches or greater in men and 16 inches or greater in women)
  • Having large tonsils, a large tongue, or a small jaw bone
  • Having a family history of sleep apnea
  • Gastroesophageal reflux, or GERD
  • Nasal obstruction due to a deviated septum, allergies, or sinus problems

What Are the Effects of Sleep Apnea?

If left untreated, sleep apnea can result in a growing number of health problems, including:

  • High blood pressure
  • Stroke
  • Heart failure, irregular heart beats, and heart attacks
  • Diabetes
  • Depression
  • Worsening of ADHD
  • Headaches

In addition, untreated sleep apnea may be responsible for poor performance in everyday activities, such as at work and school, motor vehicle crashes, and academic underachievement in children and adolescents.

Common sleep apnea symptoms include:

  • Waking up with a very sore or dry throat
  • Loud snoring
  • Occasionally waking up with a choking or gasping sensation
  • Sleepiness or lack of energy during the day
  • Sleepiness while driving
  • Morning headaches
  • Restless sleep
  • Forgetfulness, mood changes, and a decreased interest in sex
  • Recurrent awakenings or insomnia

Sleep Apnea Tests and Diagnosis

If you have symptoms of sleep apnea, your doctor may ask you to have a sleep apnea test, called a polysomnogram. This may be done in a sleep disorder center or even at home.

A polysomnogram (sleep study) is a multiple-component test that electronically transmits and records specific physical activities while you sleep. The recordings are analyzed by a qualified sleep specialist to determine whether or not you have sleep apneaor another type of sleep disorder.

If sleep apnea is determined, you may be asked to do further sleep testing in order to determine the best treatment option.

What to Expect During a Sleep Study

On the night of your sleep study if you are in a sleep center lab, you will be assigned to a private bedroom in the sleep center or hospital. Near the bedroom will be a central monitoring area, where the technicians monitor sleeping patients.

You will be hooked up to equipment that may look uncomfortable. However, most people fall asleep with little difficulty.

Similar, more portable equipment is now available for home testing, especially for less complicated cases or situations.

Equipment Frequently Used for a Sleep Study

During a sleep study, surface electrodes will be put on your face and scalp and will send recorded electrical signals to the measuring equipment. These signals, which are generated by your brain and muscle activity, are then recorded digitally. Belts will be placed around your chest and abdomen to measure your breathing. A bandage-like oximeter probe will be put on your finger to measure the amount of oxygen in your blood.

Other Tests for Sleep Apnea

EEG (electroencephalogram) to measure and record brain wave activity.

EMG (electromyogram) to record muscle activity such as face twitches, teeth grinding, and leg movements, and to determine the presence of REM stage sleep. During REM sleep, intense dreams often occur as the brain undergoes heightened activity.

EOG (electro-oculogram) to record eye movements. These movements are important in determining the different sleep stages, particularly REM stage sleep.

ECG (electrocardiogram) to record heart rate and rhythm.
Nasal airflow sensor to record airflow.
Snore microphone to record snoring activity

Sleep apnea treatments range from lifestyle changes, such as losing weight or changing sleep positions, to CPAP therapy, to surgery.

Treating Sleep Apnea at Home

You may be able to treat mild cases of sleep apnea by changing your behavior, for example:

  • Losing weight
  • Avoiding alcohol and sleeping pills
  • Changing sleep positions to improve breathing
  • Stopping smoking. Smoking can increase the swelling in the upper airway, which may worsen both snoring and apnea
  • Avoiding sleeping on your back

Continuous Positive Airway Pressure (CPAP)

Continuous positive airway pressure — also called CPAP — is a treatment in which a mask is worn over the nose and/or mouth while you sleep. The mask is hooked up to a machine that delivers a continuous flow of air into the nose. This air flow helps keep the airways open so that breathing is regular. CPAP is the most common treatment for sleep apnea. There’s also bi-level positive airway pressure, or BPAP, which is similar to CPAP but the air flow changes when you breathe in and then breathe out.

Sleep Apnea and Dental Devices

Dental devices can be made that help keep the airway open during sleep. Such devices can be specifically designed by dentists with special expertise in treating sleep apnea.

Surgery for Sleep Apnea

If you have a deviated nasal septum, enlarged tonsils, or a small lower jaw with an overbite causing the throat to be too narrow, surgery may be needed to correct sleep apnea.

The most commonly performed types of surgery for sleep apnea include:

Nasal surgery: Correction of nasal problems such as a deviated septum.

Uvulopalatopharyngoplasty (UPPP): A procedure that removes soft tissue on the back of the throat and palate, increasing the width of the airway at the opening of throat.

Mandibular maxillomandibular advancement surgery: Surgery to correct certain facial problems or throat obstructions that contribute to sleep apnea.

Other Treatment Options for Sleep Apnea

There are minimally invasive office procedures that reduce and stiffen the soft tissue of the soft palate. While these procedures have been effective in treating snoring, their effectiveness in treating sleep apnea in the long term isn’t known.

For people unable to use a CPAP, an implanted device called Inspire is now available. The device, called an upper airway stimulator, consists of a small pulse generator placed under the skin in the upper chest. A wire leading to the lung detects the person’s natural breathing pattern. Another wire, leading up to the neck, delivers mild stimulation to nerves that control airway muscles, keeping them open. A doctor can program the device from an external remote. Also, those who have Inspire use a remote to turn it on before bed and turn off upon waking in the morning.

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