Sleep Apnea: Common Causes, Risk Factors, Treatments
Sleep Apnea is a sleep breathing disorder that is characterized by repetitive pauses in breathing during sleep. Pauses occur several times per hour and last for over 10 seconds. As the blood-oxygen levels decrease, the brain awakens the individual which often leads to a loud gasp or snort. Sleep apnea is associated with snoring, witnessed pauses in breathing, and excessive daytime sleepiness.
Sleep apnea is usually a chronic condition. Most people have sleep apnea for years before being diagnosed. When breathing appears to stop or becomes shallow, the sleeper comes out of a deep sleep and moves to a light sleep or awakens. This results in poor quality sleep, resulting in excessive daytime sleepiness. (1)
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Generally sleep apnea goes undiagnosed for a long time. It can’t be detected during a routine doctor’s appointment, and there’s no blood test to diagnose it. In fact most sufferers don’t even know they have it because it occurs during sleep. Often, it is the bed partner or family member who is suspicious. Usually, the person is referred to a sleep doctor.
Obstructive Sleep Apnea is the most common type of sleep apnea. The airway either becomes blocked or collapses during sleep, resulting in pauses in breathing, or very shallow breathing. The air that manages to squeeze through the blockage can create loud snoring. This is often seen in people who are overweight or obese.(2)
Sleep Apnea can be very serious when untreated because:
- There’s an increased risk of heart attack, high blood pressure, obesity, stroke, and diabetes;
- It makes irregular heartbeats, or arrhythmias, much more likely;It increases the risk of heart failure; and
- There’s a greater risk of having a driving incident, or work-related accident.
Sleep Apnea is a potentially serious condition that requires management for the long-term (3). Treatment can be in the form of breathing devices such as mouthpieces, CPAP mask, and other breathing devices; surgery is also an option in some cases, and there are lifestyle changes that can and should be made.
Sleep Apnea Definition: What Is Sleep Apnea?
Sleep Apnea is a serious and possibly life-threatening Sleep Disorder. More than just loud snoring, Sleep Apnea is when the tissue at the back of the throat between the mouth and lungs can briefly collapse and become so restricted that breathing actually stops, momentarily or for frighteningly longer periods. When this happens, the body sensors send a notification to the brain, which awakens and then intervenes to open the airways again. This can happen just a few times, or many times an hour, which means that you rarely get to enjoy the deeper level of restful, recovery style sleep that your body needs to function at optimum capacity. (4)
This form of sleep deprivation can cause symptoms that range from simply feeling sleepy to chronic tiredness. As a result, not only are there significant direct health risks from the Sleep Apnea itself such as stroke or heart failure, but also from injury from accidents due to poor sleep.
Why does the world use the term “disorder” when referring to sleep issues? Well, the definition of “disorder” is “a confused or messy state”. In this case, interruptions to sleep patterns can have multiple overlapping factors that can be medical, psychological or lifestyle driven(5). So using the term disorder covers a myriad of possible alternatives and options as to why you are not sleeping well.
Types Of Sleep Apnea
There are two primary types of Sleep Apnea. Each mostly occur in isolation but in approximately one in six cases, patients can have a combination of both forms in a wide variety of proportions.
Obstructive Sleep Apnea (OSA)
Obstructive sleep apnea is the most commonplace diagnosis and is where the throat muscles relax during sleep to such an extent that the passage of air to and from the lungs becomes blocked. When this happens the autonomic nervous system messages the brain which then wakes up briefly to reopen the airways and then usually tries to return to sleep.
There are broadly three levels of severity of obstructive sleep apnea – Mild, Moderate and Severe – where Mild Sleep Apnea represents half a dozen instances an hour through to Severe Sleep Apnea which would be more than one instance every couple of minutes.
Central Sleep Apnea (CSA)
Central Sleep Apnea this is a less common condition and is the opposite pathway for messaging. This is when the brain “forgets” to tell the airways to remain relatively open during sleep (like the rest of the body, muscles relax somewhat during sleep, but not entirely). Central Sleep Apnea can occur in 1 in 5 cases. In broad terms CSA is most often triggered by other medical conditions such as Parkinson’s Disease, brain infections or disorders and stroke victims. In can also be brought on as a side effect to opioid or narcotics medicines.
Mixed Sleep Apnea (MSA)
Mixed Sleep Apnea, as you can no doubt guess, is a combination of OSA and CSA in varying levels of severity and complexity.
Sleep Apnea In Children
Sleep Apnea in babies, infants and toddlers is clearly quite distressing for parents and even the mildest symptoms such as snoring or restlessness or sleeping in odd positions should be brought to your Family Doctor’s attention. In most cases the diagnosis will be Obstructive Sleep Apnea caused by larger than average tonsils or adenoids. The solution is usually to remove these somewhat superfluous tissues and 80% of cases are resolved. For the rest a more comprehensive “Sleep Study” should be undertaken which will typically identify the cause and appropriate treatment.
Importantly, if Sleep Apnea in children is left untreated, it can lead to learning, behavior and growth deficiencies, and in rare cases heart problems.
Causes of Sleep Apnea
Given that Sleep Apnea effects millions of people, it will come as no surprise that the most common factor to trigger OSA is people being overweight, obese or just plain fat.
Lifestyle issues including smoking, excessive drinking of alcohol and recreational drug use are also major contributing factors. (6)
All of the above act to compress or relax the tissues in the airways to such a point that they become blocked and you stop breathing, sometimes for minutes at a time. Then your brain kicks in, awakens, opens up the airways “manually” and then returns to sleep.
There are other factor such as allergies that can restrict airways and physical deviations such as an enlarged tongue, tonsils or septum. You may have been born with a thicker neck or a narrow airways. If you are male you are two times more likely to have Obstructive Sleep Apnea.
In the case of Central Sleep Apnea, the more likely causes are oriented towards other medical conditions such as diseases of the nervous system, brain disorders or motor neurone diseases, many of which are hereditary, which by inference makes CSA somewhat hereditary. In addition people with heart disorders or stroke victims have a higher likelihood to experience CSA.
In both types, being older increases the likelihood and severity of Sleep Apnea onset.
Sleep Apnea Symptoms & Effects
The most obvious sign of the potential onset of Sleep Apnea is loud and in particular, sudden snoring. Not everyone who snores has it, but nearly everyone that has it snores. (7)
Sleep Apnea is often closely aligned with many of the more well known Sleep Disorders and some contemporary research is indicating a much closer linear relationship than has been suggested in the past. Therefore there is a “chicken and egg” situation when describing symptoms and effects.
The other more noticeable signs of Sleep Apnea and effects are:
- Gasping or choking sounds whilst asleep
- Silence when asleep
- Loud snoring
- Being extraordinarily sleepy during the day
- Abrupt awakening during the night
- Sleep Apnea headache
- Frequent sore or dry throat
- Excessive weight gain
Sleep Apnea symptoms in men and women are almost identical and yet 3 times as many men are diagnosed than women. Women with Sleep Apnea have more subtle breathing disturbances and are more likely to have REM-related Apneas and a slightly higher prevalence of restless legs, hypersomnia or insomnia. Hormonal variations are somewhat to blame for the distinctions in sleep patterns, while anatomical differences between men and women also play a role.
Men most often report symptoms such as snoring, waking up gasping for air or snorting, whilst women are more likely to refer to fatigue, anxiety and depression as likely symptoms.
Sleep Apnea Diagnosis
There are four steps that an experienced Doctor will step through in order to correctly diagnose the symptoms you are experiencing:
- Review your personal medical history
- Review your family history
- Complete a physical examination which will include a detailed look at your airways to and from your lings
- Undertake a Sleep Study
The first three are relatively self-explanatory.
Sleep Studies are often conducted at Sleep Centers, clinical environments where you will go to for a “sleepover” for one and sometimes two nights using equipment that results in a Polysomnogram (a multiple sleep symptom report). More recently, new technologies allow for home based Sleep Studies where the equipment is portable and easy to set up and wear. The equipment is then returned and then the Polysomnogram is generated by downloading the recorded data.
A Sleep Study records your brain waves, eye movements, heart rate and blood pressure both when you are awake as well as when asleep. In addition, the test also keeps track of oxygen levels in the blood, the flow of air in and out of your mouth and lings, your chest movements and your overall movements whilst asleep.
Sleep Studies have an excellent track record of clearly diagnosing Sleep Apnea and the results are usually quite definitive. The scale or severity then helps determine the best treatments options for you and your Doctor to discuss.
There is a “pre Sleep Study” screening tool known as the “Stop Bang” questionnaire (www.stopbang.ca) that may help you to self-assess your situation before raising this with your Doctor.
Once you have completed the Sleep Study Test your Doctor will discuss the results with you and may refer to something called the Apnea Hypopnea Index. This a scoring system that defines whether you may have Mild, Moderate or Severe Sleep Apnea and helps to determine the best treatment plan.
Sleep Apnea Risks
Please understand that Sleep Apnea is a serious and sometimes life threatening Sleep Disorder – 6.0%+ of all people that experience heart attack fatalities have Sleep Apnea and people with Sleep Apnea are 45% more likely to develop high blood pressure.
Having untreated Sleep Apnea will:
- Increase the likelihood of high blood pressure, heart attack, stroke, obesity, and diabetes
- Increase the possibility of being involved in work- connected or driving accidents
- Make arrhythmias or irregular heartbeats more likely
- Increase the potential of, or worsen the severity of, heart attacks
Sleep Apnea Treatment Options & Cures
Because of the two prevalent types of Sleep Apnea, treating Sleep Apnea is not as straightforward as you would wish. In essence everyone wants a Sleep Apnea cure, but in reality the prospect of a cure is minor and related to very specific instances. For the majority of Sleep Apnea sufferers, the likely outcome is a long term plan to treat the symptoms and minimise the impact the this disorder has on your day-to-day life.
Sleep Apnea Devices & Appliances Solutions
Sleep Apnea CPAP Machine – A CPAP machine is the most popular treatment for obstructive Sleep Apnea and stands for Continuous Positive Airway Pressure. A CPAP Machine is a breathing machine for Sleep Apnea and uses air pressure to keep your airway open during sleep. Discover more about CPAP Machines.
Sleep Apnea Mask – these masks deliver air from the CPAP machine through a hose to your airway. Most CPAP masks are made of plastic and/or silicone or gel-like materials. Some are made of fabric and other hybrid materials and most of them are attached to an adjustable strap that keeps the mask attached to your face. Discover more about Sleep Apnea cpap masks.
Oral Appliances For Sleep Apnea – Sleep Apnea Mouthpieces or Sleep Apnea Mouth Guards, also called Jaw Advancing Device (JAD) or Mandibular Advancement Device (MAD), are custom made by dentists using a plastic-like mold to form to the specific shape of the patients teeth and mouth. Not only do they work against sleep apnea, they are also effective to stop snoring. Discover more about Dental Appliances For Sleep Apnea.
Sleep Apnea Surgery – if you are unable to sleep comfortably with CPAP assistance in spite of best efforts, surgery to treat your Obstructive Sleep Apnea may be an option. There are three important things to know about surgery: that not all surgeries are the same, that patients should only consider procedures that are well-suited to them, and that not everyone is a good candidate for surgery. Discover more about Sleep Apnea Surgery.
Natural Sleep Apnea Remedies
Lifestyle factors like drinking, smoking, and overeating increase the chances of developing the condition. Reducing alcohol intake, losing weight, quitting smoking, and avoiding sedative medications are a starting point for treating physicians. Good Sleep Hygiene helps promote good sleep using behavioral interventions such as maintaining a regular sleep routine, avoiding naps during the day, not watching TV or tablets in bed and regular exercise, even modest exercise.
You can also undertake Sleep Apnea exercises specific to the tongue mouth and throat, or more “whole of body” exercises that include deep breathing, Pilates core exercises and deep diaphragm compression and stretching.
Unfortunately, apart from the lifestyle changes mentioned above, there are as yet no reliable Sleep Apnea Home Remedies.
New Sleep Apnea Treatments & Innovations
There continues to be new developments in the technology and equipment used to treat Sleep Apnea. CPAP devices without houses and cords, dental devices that mold to your mouth in seconds rather than requiring complex fitting sessions and even “pacemaker” type devices that deliver connective current to assist in aligning airway opening with breathing. Whilst these are excellent forward steps in treatment, and new inroads are also being made in medicinal solutions, a cure remains elusive.
Sleep Apnea Prognosis
A CPAP Machine or Oral Sleep Mouthpieces are not cures for Sleep Apnea; these are tools to treat the symptoms but will not “fix” your condition. However, if your sleep apnea is caused by being overweight, losing weight may resolve the condition. Treating high blood pressure or diabetes may eliminate your sleep apnea. In some cases, finding the right medication for nasal congestion may alleviate sleep apnea symptoms. And in reality, you may need to continue treatment indefinitely.
Sleep Apnea Doctors & Dentists
Physicians and Dentists who specialize in Sleep Disorders must complete specific training and accreditation with their State or National medical body. Often referred to as “Sleep Specialists” there are sub-specialities such as Insomnia, Sleep Apnea, Narcolepsy, Sleep Deprivation and even Snoring. Normally you would explore the options with your General Practitioner first and then they would refer you to a Sleep Specialist.
Do I Have Sleep Apnea?
The information we provide here is for general educational purposes and should not be thought of as a substitute for professional medical advice. We highly recommend that you consult with your Doctor, Sleep Specialist to explore this issue.
However, if you review the list of Sleep Apnea Symptoms & Effects and the section on Sleep Apnea Diagnosis, you will certainly have a better way to gauge whether you have Sleep Apnea or not; if in any doubt please visit your General Practitioner.
Living With Sleep Apnea
Sleep Apnea is a serious medical condition and if left untreated can lead to a very poor life situation and in extreme cases severe side effects and even premature death. Good advice from Sleep Specialists will help you manage your condition and significantly improve your lifestyle. The following video courtesy of National Geographic explores many aspects of living with Sleep Apnea.
Sleep Apnea FAQ’s – Frequently Asked Questions
- Sleep Apnea & Death – Sleep Apnea is a serious medical condition and if left untreated can lead to a very poor life situation and in extreme cases severe side effects and even premature death. Discover more here.
- How To Cure Sleep Apnea – In essence everyone wants a Sleep Apnea cure, but in reality the prospect of a cure is minor and related to very specific instances. For the majority of Sleep Apnea sufferers, the likely outcome is a long term plan to treat the symptoms and minimize the impact the this disorder has on your day-to-day life.
- Is Sleep Apnea Dangerous – untreated Sleep Apnea leads to an increased risk of stroke, heart attack, and dementia (brain damage). Sleep Apnea is literally when a person stops breathing during sleep. As a result, the brain undergoes repeated moments of suffocating. Yes, it is dangerous and you should seek professional advice as soon as you think you or your partner may be experiencing Sleep Apnea.
- Is Sleep Apnea A Disability – OSA is a recognized Sleep Disorder and considered a disease. As for the technical interpretation of it being a “Disability” from a pension of health benefits perspective, you will have to consult your state or national health organization or your health insurance provider.
- Sleep Apnea & Your Weight – there is clear research and clinical evidence that obesity can be directly associated with Sleep Apnea; losing weight is typically one of the first steps that a Sleep Specialist will want to take when developing a treatment plan
- Sleep Apnea VS Narcolepsy – whilst both of these conditions can co-exist, they are distinctly different Sleep Disorders. This section of our site should help you with gaining a better understanding Sleep Apnea and you can discover more about Narcolepsy here.
- Sleep Apnea & Snoring – if you do have Sleep Apnea it would be unusual if you did not snore, however, you can be a heavy snorer and not experience Sleep Apnea. You can discover more about Snoring here.
Sleep Apnea Support Group – https://sleep-apnea.supportgroups.com/
The Sleep Apnea Trust Association – http://www.sleep-apnoea-trust.org/sleep-apnoea-support-available-trust/sleep-apnoea-trust-help-lines/
Apnea Board – http://www.apneaboard.com/forums/
- Sleep Apnea – The Phantom of the Night: Overcome sleep apnea syndrome and snoring
- By T. Scott Johnson (Author), William A. Broughton (Author), Jerry Halberstadt (Author), B. Gail Demko (Author), Carl E. Hunt (Author), William Dement (Author), Colin Sullivan (Author)
- Sleep Apnea and Snoring – Surgical and Non-surgical Therapy
- By Michael Friedman, MD, FACS
- Relief from Snoring and Sleep Apnea
- by Tess Graham (Author)
- Obstructive Sleep Apnea Syndrome in Childhood
- By Leila A. Azevedo, Heidi H. Sander, Wilma T. Anselmo-Lima and Fabiana C.P. Valera
- Snoring & Sleep Apnea: Sleep Well, Feel Better
- By Ralph Pascualy (Author)
Latest Sleep Apnea Research Resources:
- New England Journal of Medicine
- CPAP for Prevention of Cardiovascular Events in Obstructive Sleep Apnea
- Journal Of the American Board of Family Medicine
- Obstructive Sleep Apnea (OSA) in Primary Care: Evidence-based Practice
- The Medical Roundtable
- The Diagnosis and Management of Obstructive Sleep Apnea
- Journal of Clinical Sleep Medicine
- Clinical Use of a Home Sleep Apnea Test: An American Academy of Sleep Medicine Position Statement
- Sleep Research Society
- Untreated Obstructive Sleep Apnea Is Associated With Reduced Exercise Capacity: A Meta Analysis
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