American Sleep Association

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What is Sleep Apnea?

Sleep Apnea is a serious medical condition that affects over 4 percent of the adult population. It is characterized by a cessation of breathing during sleep. Sleep apnea results in the patient waking up several times during the night time, often without realization of the arousals. Many patients will awaken hundreds of times during the night, awakening unrefreshed, sleepy and completely unaware of the arousing events.

Some of the symptoms of sleep apnea are: daytime sleepiness, snoring, fatigue, irritability, dry mouth and sore throat. Often the partner is the first one to report the problem. Not suprisingly, there has been a reported correlation between patients with sleep apnea and partners with hearing loss. However, not all snorers have sleep apnea, and not all sleep apnics snore.

The risk factors for sleep apnea include: increasing age, male sex, obesity, large neck size, small mandible (micrognathia), alcohol consumption and large tonsils. However, affected people,often will not have these characteristics.

There are several consequences of untreated sleep anea. Because the patient stops breathing, he/she does not receive enough oxygen and the patient suffers several episodes of hypoxia each night. There is a well documented correlation between sleep apnea and hypertension, pulmonary hypertension, strokes and congestive heart failure. Also, excessive daytime sleepiness leads to thousands of accident related deaths each year.

There are two major types of sleep apnea; 1. obstructive sleep apnea, and, 2. central sleep apnea. Some have components of both types of apnea. Obstructive sleep apnea is much more common. Central sleep apnea is seen in patients with neurologic disorders and also in congestive heart failure. Obstructive sleep apnea is caused by an interuption in the air passage from the mouth to the trachea. There are several areas that may be affected. These areas include the soft palate, tonsils, uvula and the tongue. Usually, snoring is a symptom of increasing airway resistance at these anatomic locations.

Obstructive sleep apnea is often exacerbated by actions that relax the upper airway or decrease the size of the airway, including: drinking alcohol, sleeping on one's back, R.E.M. sleep and weight gain.

Obstructive sleep apnea is recognized by the astute primary care physician who inquires about the patient's sleep history. The sleep history should include the above review of sympotms and question about the patient's sleep hygiene routines. Once sleep apnea is suspected, the patient should be referred to a sleep specialist who often will perform an overnight polysomnogram. Usually, patients will undergo treatment during the polysomnogram as well.

There are several treatment options for obstructive sleep apnea. For the patient with mild sleep apnea, lifestyle changes may be sufficient to improve sleep and resolve daytime sleepiness. These changes include weight loss, alcohol cessation and sleeping on one's side as opposed to one's back. More often, the patient will require additional therapy. The gold standard for treating obstructive sleep apnea is CPAP ( Continuous Positive Air Pressure). CPAP involves blowing room air through a thin tube that is attached to a mask that the patient wears over his/her nose. The air that blows through the patient's airway is sufficient to keep the air way patent, and prevent it from obstructing.

Although most patients are initially intimidated by the site of CPAP and the mask, most sleep very comfortably with it. There are several new options available that help patients tolerate CPAP.

Other treatments have been studied. But to date, CPAP is still the 'gold standard'. Other treatments include Jaw Advancing Devices, surgery (uvulo-palato-pharyngeoplasty "U.P.P.P or UP3"), neck positioning devices and electrical stimulation of the airway muscles. Nasal strips are usually not effective in treating most sleep apnea patients. They may be effective in reducing the severity of some snoring.

It is important for patients to be aware of the symptoms of sleep apnea and also important for primary care providers to ask all patients about their sleep history.