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Sleep Apnea Guide
Sleep Apnea
What is sleep apnea?
What causes sleep apnea?
What are the different types of sleep apnea?
Who suffers from sleep apnea?
What are the symptoms of sleep apnea?
What sleep apnea treatments are available?
Where can I get further advice on curing and managing sleep apnea?
What is sleep apnea?
Sleep apnea (sometimes also mistakenly written as sleep apnia or sleep apnoea) is a common, though often undiagnosed, sleep disorder in which you stop breathing during the night, sometimes literally hundreds of times and for as much as a minute or more. The disorder derives its name from the Greek word "apnea" meaning "without breath".
When you stop breathing oxygen levels in the blood drop and carbon dioxide levels rise. This causes your heart to pump harder and sometimes to beat irregularly, or even to stop for several seconds. Your diaphragm and chest muscles work harder and your blood pressure rises. Finally, your brain senses that your body is in trouble and wakes you sufficiently for you to breathe and, as you do so, your breathing will often be accompanied by loud snoring.
It should be noted here that snoring itself is also very common and it is estimated that about forty percent of all adults snore. Snoring is also more commonly seen in men, rather than in women. While snoring is almost always seen in cases of sleep apnea, snoring by itself does not mean that you are suffering from sleep apnea.
What causes sleep apnea?
This condition most often occurs as the result of a blockage to the airway, usually when soft tissue at the rear of the throat collapses and closes the throat. It can, however, also result from a failure by the brain to signal the muscles of the body that control breathing.
What are the different types of sleep apnea?
There are 3 main types of the disorder:
- Obstructive Sleep Apnea. This is the commonest and most severe form of sleep apnea and results from a blockage to the airway. In many cases this is caused by the collapse of soft tissue at the rear of throat, although this blockage can also be caused by a number of other structures including, the tongue, enlarged tonsils and polyps.
- Central Sleep Apnea. This form of the disorder results from the brain's failure to send the necessary signals to those muscles that are responsible for controlling breathing. Central sleep apnea is more common in older people and is often also associated with heart disease or with a variety of neurological disorders.
- Mixed Sleep Apnea. As its name would suggest, mixed sleep apnea is a combination of the first two types of this disorder. It is not uncommon for the primary cause to be central sleep apnea, with obstructive sleep apnea as a secondary consequence. In this case, central sleep apnea causes the initial failure to breathe but, as your brain reacts to the problem and signals your diaphragm into sudden movement to restart your breathing, this creates a blockage, resulting in obstructive sleep apnea.
Who suffers from sleep apnea?
Sleep apnea affects people of all ages, including children, although it is more commonly seen in men over the age of 40. It is also more commonly seen in people who are overweight.
In very young children sleep apnea has been linked with Sudden Infant Death Syndrome (SIDS), while in older children it is often associated with being overweight, or with having unusually large tonsils or adenoids. In the case of children, snoring should be taken as a warning sign of the possible presence of sleep apnea as, although snoring is common in the adult population, it is not something that is normally seen in children.
Sleep apnea is also commonly seen in people with unusually large tongues, excessive tissue around the pharynx (the soft area at the top of the throat where the passages from the nose and mouth connect with the throat) and particularly small airways.
There is also evidence to suggest that there may be a genetic basis for some instances of sleep apnea and that it is possible to inherit the condition.
What are the symptoms of sleep apnea?
The most commonly recognized sleep apnea symptoms are:
- Loud snoring. Many cases of sleep apnea result from a blockage to the airway caused, at least in part, by excessive tissue at the back of the throat. When your brain awakens you sufficiently to start breathing again you take in a large breath initially and this causes this excess tissue to vibrate, resulting in loud snoring.
- Excessive daytime tiredness. Because your brain wakes you constantly throughout the night to breathe, you are enjoying only very light, fragmented and poor quality sleep, leaving you still tired at the end of your night's sleep. It should be noted that, although the brain wakes you many times during the night, it only raises your level of consciousness sufficiently for your to breathe. As a result, you are often not aware of this and will wake in the morning believing that you have slept right through the night.
In addition to these main symptoms sleep apnea, if left
untreated, can lead to:
- Headaches (particularly in the morning).
- High blood pressure (and other cardiovascular problems).
- Weight gain.
- Depression.
- Irritability.
- Learning and memory difficulties.
- Sexual dysfunction and impotency.
What sleep apnea treatments are available?
There are a very wide range of treatment options available from mild to severe sleep apnea treatment and from the established to the latest treatment for sleep apnea including:
- Behavioral changes. Behavioral changes form an extremely important part of any treatment plan and, in mild cases, may be all that is required. The subject of behavioral therapy for the treatment of sleep disorders (including sleep apnea and its associated insomnia) is too complex to cover here and so mention is made of only three changes that are particularly aimed at sleep apnea sufferers.
- Lose weight. Being only slightly overweight can have a marked impact on the effects of sleep apnea and even a small weight loss of 5 to 10 percent can make a significant difference.
- Avoid alcohol, tobacco and sleeping pills. Alcohol, tobacco and sleeping pills all make it more likely that your airways will collapse during sleep. In addition, alcohol and sleeping pills can increase both the frequency and duration of pauses in your breathing.
- Adjust your sleeping position. Many sufferers sleep on their back and this is the one position in which it is easy for the soft tissue at the back of your throat, or for your tongue, to block your airway. You should try using pillows or cushions therefore to prop yourself up so that you sleep on your side.
If using pillows or cushions doesn't work, then try sewing something like a tennis ball into the back of your pajama jacket. The discomfort of rolling onto the tennis ball will prompt your brain to react by turning you back onto your side.
- Continuous Positive Airway Pressure. A very popular form of treatment is the use of continuous positive airway pressure (CPAP). The principle here is to force air into your mouth while you are sleeping and, by so doing, 'push open' your airway. This is achieved by wearing a mask during sleep which is connected to a special CPAP machine. There are, however, a number of problems with this method that mean that it is not always a suitable treatment.
Apart from the obvious difficulty of getting used to sleeping with a mask on your face, the treatment can cause nasal irritation, facial skin irritation, abdominal bloating, sore eyes and headaches.
More importantly, however, is the fact that this is not a cure for sleep apnea. While you may derive benefit from CPAP treatment, you'll be right back to square one the moment you discontinue using the machine.
- Dental Appliances. A variety of dental appliances can be worn in the mouth during sleep to reposition your lower jaw and tongue and keep your airway open. These of course need to be individually manufactured and fitted by a medical specialist.
Once again these devices only provide relief while they are being used and you may find it difficult to get used to wearing them. There are also a range of problems associated with their use including damage to your teeth, the soft tissue of your mouth and your jaw joint.
- Surgery. In a significant number of cases, sufferers turn to surgery to cure their problem and, in very severe cases, this is often the only real solution. Surgery is not however without risk and the currently available surgical options are rarely completely successful. Indeed, many patients find that they have to try a series of different procedures before they see any real results.
There are four main types of surgery used in cases of sleep apnea:
- Nasal surgery. Procedures include:
- Septoplasty. The removal of bone and cartilage from the septum (which divides the two nasal passages) to enlarge the airway and prevent its collapse.
- Turbinate Reduction. Each nostril contains three structures (turbinates), composed of bone covered with soft tissue, that are designed to warm and moisturize the air you breathe in before it is passed to your lungs. Reducing the size of these structures enlarges the airway.
- Removal of Polyps. Polyps are small and normally harmless lumps that can appear throughout your body and which are particularly common in the nose. Their removal enlarges the airway.
- Sinus Surgery. Infection of the sinuses can often result in a restriction of the nasal airway and requires surgery to remove the infected sinus tissue.
- Upper Airway Surgery. Upper airway surgery includes:
- Tonsillectomy and Adenoidectomy. The removal of the tonsils or adenoids is often a preferred treatment in the case of children.
- Uvulopalatopharyngoplasty. An enlarged or elongated uvula (tissue that hangs from the roof of the mouth just above the throat) can be the cause of sleep apnea and uvulopalatopharyngoplasty (UPPP), carried out using standard surgical instruments or laser surgery, is used to remove this tissue. Commonly areas of the soft palate and the tonsils are also removed during this procedure.
- Somnoplasty. Areas of the soft palate can be reduced by placing needle electrodes under the surface of the soft palate and using low-power, low-temperature radio frequency energy. This is a progressive process and often requires multiple treatments.
- Lower Airway Surgery. Lower airway surgery includes:
- Genioglossus Advancement. The genioglossus muscle joins the back of the tongue to the chin and the aim here is to pull the tongue forward to prevent it from falling back and obstructing the airway during sleep.
- Hyoid Advancement. The hyoid bone is a C-shaped bone that sits in the upper neck, just above your adam's apple, and is attached to the back of your tongue and the sides of your lower throat. This procedure is designed to enlarge the airspace behind your tongue.
- Midline Glossectomy, Lingualplasty and Lingual Tonsillectomy. These procedures are performed in cases where the tongue is enlarged and are designed to reduce the size of the tongue and enlarge the airspace behind it.
- Bimaxillary Advancement. Both the upper and lower jaws, together with the teeth, are moved forward to, in turn, advance the soft structures at the rear of the mouth and create greater space behind the tongue.
- Tongue Suspension Suturing. To prevent the tongue falling backwards during sleep a titanium screw is placed in the back of the chin and a permanent stitch is inserted from this screw to the back of the tongue, pulling the tongue forward.
- Bypass Surgery. If all else fails bypass surgery can be performed.
- Tracheostomy. If other forms of nasal, upper and lower airway surgery prove ineffective, or are not possible, then one solution is to simply bypass the problem altogether.
Instead of attempting to enlarged the airway, a tracheostomy (also sometimes referred to as a tracheotomy) creates a opening in the front of the neck directly into the windpipe into which a tube is inserted. During the day this tube is closed and breathing is carried out normally through the nose and mouth. At night, however, this tube is left open and breathing is effected through the tube.
Many medical practitioners will only perform this form of surgery in severe (often life-threatening) cases of sleep apnea.
Much of this page has been devoted to sleep apnea symptoms, treatment and, in particular, the surgical option for treating sleep apnea however, in the vast majority of cases, this is not recommended. Apart from the risks involved in any form of surgery, and the often unpleasant and lengthy recovery period following surgery, the plain fact is that surgery is rarely effective.
The information contained here should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider.
The information provided here is for educational and informational purposes only and in no way should be considered as an offering of medical advice.
Additional reading:
The information contained here should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider.
The information provided here is for educational and informational purposes only and in no way should be considered as an offering of medical advice.
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