There are many things that can contribute to a restless night’s sleep – stress , anxiety, and medication are just a few of the reasons, but what if sleep apnea is to blame? How can you know if it is affecting you? And how are you going to treat it? Here you will find everything you need to know about this chronic disease.
What is sleep apnea?
It is a common condition that is characterized by a periodic reduction or a complete interruption of breathing during sleep, this can happen because the airway is obstructed or the area of the brain that controls breathing does not send the correct signals to the muscles of the breathing, the body will automatically restart the breathing process, without the subject’s conscious knowledge, but there is a physical cost, at the very least it produces daytime fatigue. At worst, it is associated with heart attack, high blood pressure, and stroke.
Apnea is defined as the cessation or almost total cessation of breathing for 10 seconds or more that results in a reduction in air flow to 90% below normal, a less severe reduction in breathing is called hypopnea.
On any given night, the number of involuntary respiratory pauses or “apneic events” can be as high as 20 to 30 or more per hour, these pauses are almost always accompanied by snoring between apnea episodes, although not everyone who snores has this condition. Sleep apnea can also be characterized by feelings of suffocation, frequent interruptions to deep and restful sleep leading to early morning headaches and excessive daytime sleepiness.
Types of sleep apnea
There are three main types: obstructive sleep apnea, central sleep apnea, and mixed sleep apnea.
Obstructive sleep apnea (OSA)
It is the most common type, accounting for 84% of diagnoses of this disorder. In most cases, air stops flowing into the lungs due to a blockage (or obstruction) in the upper airway, that is, in the nose or throat.
The upper airway could become blocked due to:
- The muscles around the airways relax too much during sleep, blocking enough air from passing through, this narrow airway causes a vibration in the throat, which creates the sound of snoring.
- The weight of your neck narrowing your airways,
swollen tonsils , or other temporary
structural reasons, such as the shape of your nose, neck, or jaw.
Individuals with low muscle tone and soft tissue around the airways (for example, due to obesity) and structural features that result in a narrow airway are at high risk for obstructive sleep apnea. The elderly are more likely to have it than the young and men are more likely to suffer it than women and children.
Central sleep apnea (ACS)
It is a less common type, in some cases, the airway is really open, but the air stops flowing to the lungs because no effort is made to breathe, this is because the communication between the brain and the body has been affected, so the automatic action of respiration stops. People with ACS do not snore, so the condition sometimes goes unnoticed.
The basic neurological controls of the respiratory rate malfunction and do not provide the signal to inhale, causing the individual to miss one or more breathing cycles, if the pause in breathing is long enough, the percentage of oxygen in the circulation it will drop to a lower than normal level (hypoxemia) and the carbon dioxide concentration will rise to a higher than normal level (hypercapnia). In turn, these conditions will trigger additional effects on the body. Brain cells need constant oxygen to live, and if the oxygen level in the blood falls low enough for long enough, the consequences of brain damage and even death will ensue.
Mixed sleep apnea
Some people have a combination of both types; its prevalence varies from 0.56% to 18%. The exact mechanism of loss of central respiratory drive during sleep in OSA is unknown, but it is likely related to improper treatment adjustments with continuous positive airway pressure and other medical conditions.
Symptoms of sleep apnea
- Daytime fatigue and drowsiness.
- Little concentration and attention.
- Memory problems
- Difficulty performing work tasks.
Other more serious complications of sleep apnea can include work or car accidents (people are three times more likely to have car accidents due to drowsiness). Some people with mild sleep apnea may have no obvious symptoms at all. Additionally, it can lead to frequent waking from bed, leading to insomnia and associated symptoms.
Obstructive sleep apnea can also be associated with dreaded long-term complications if it is not properly diagnosed and treated. Some of these complications can include:
- High blood pressure (hypertension).
- Ischemic heart disease (poor blood flow to the heart).
- Heart attack.
- Heart failure.
- Irregular heart rate
- Pulmonary hypertension (elevation of blood pressure in the blood vessels of the lungs).
- Including death.
Causes of sleep apnea
The causes depend on whether the main problem is central or obstructive.
Central sleep apnea
Central sleep apnea syndromes can be divided into two groups: primary (without an underlying cause) or secondary (as a consequence of another condition). In general, it comes from an abnormal regulatory mechanism in the brain.
Some common causes of central sleep apnea include:
- Heart failure.
- Certain medications
- Some congenital abnormalities.
- High altitude.
Premature babies can also be at risk for central sleep apnea.
The brain regulates respiration by monitoring the levels of oxygen and carbon dioxide in the blood. If the oxygen level is low or the carbon dioxide level is high, the brain signals the muscles of respiration to breathe faster to expire more carbon dioxide and breathe in more oxygen. On the other hand, if the oxygen level is too high or the carbon dioxide is too low, then the brain slows down breathing to allow for a more normal balance.
Obstructive sleep apnea
In obstructive sleep apnea, the problem is not the regulation of breathing by the brain, but rather, it has to do with an obstruction to the flow of air to the lungs. The brain signals the breathing muscles to breathe, the muscles try to breathe, but air cannot flow due to the obstruction of the air flow. Thus, oxygen levels drop and carbon dioxide levels rise to a level that signals the brain to wake up the body to take a breath (causing it to gasp for air).
In normal breathing: Air flows through the nose and nasal passages (or mouth), then flows behind the soft palate and the base of the tongue, through the pharynx and associated muscles, and between the cords vowels before entering the lungs. This airflow can be compromised at any of these levels for a variety of reasons. Some common reasons include:
- A deviated nasal septum.
- Nasal congestion.
- Narrow airway passages.
- Enlarged tonsils.
- Weak pharyngeal muscles.
- Reduced vocal tone (may be related to drugs or alcohol).
- Injury to the vocal cords.
- Facial trauma leading to distorted air passages, or
retraction of the tongue to the back of the throat.
Some other risk factors for obstructive sleep apnea and obstructed airflow include:
- Obesity and weight gain.
- Some sedative medications and alcohol (leading to lax pharyngeal muscles, soft palate, and tongue).
- Neuromuscular diseases (such as stroke, which leads to weak muscles in the airways).
- Upper respiratory infections (leading to narrow and swollen nasal passages).
Sleep apnea diagnosis
Anyone who feels chronically tired or dizzy during the day should see a medical provider to determine the exact cause and the steps needed to address the problem.
Common questions they can ask include:
- What is your typical sleep schedule on weekdays and weekends?
- How long does it take you to fall asleep?
- Do you take any medicine to help you sleep?
- How much do you sleep each night?
- Has anyone told you that you snore?
- Do you wake up feeling panicky or startled?
- How do you feel when you wake up?
- Do you settle easily when you watch TV or read?
- Does anyone in your immediate family have a diagnosed sleep disorder ?
- Describe your sleeping environment.
Sleep apnea is diagnosed with a sleep study (nocturnal polysomnography) carried out in a night laboratory, this records brain waves, eye and leg movements, oxygen levels, air flow, and heart rate during sleep. A doctor who specializes in sleep disorders interprets the test.
For some people, the test can be done at home instead of the lab study. The number of apnea episodes that occur each hour determines the severity:
- Normal: 0-5 apnea episodes per hour.
- Mild: 5-15 apnea episodes per hour.
- Moderate: 16-30 apnea episodes per hour.
- Severe: more than 31 episodes per hour.
Sleep apnea treatment
Being a serious sleep disorder it must be treated, a board certified sleep doctor can help you select a treatment plan that is right for you. Your plan can include any combination of these treatments:
Continuous positive airway pressure
It is a machine that uses a constant stream of air to gently keep the airways open throughout the night so that you can breathe, you sleep with a mask and with a hose that is attached to the machine that is kept next to the bed. Masks and machines may vary depending on treatment and comfort needs. It is the first-line treatment for obstructive sleep apnea and is recommended for all cases.
Oral device therapy
An oral appliance is a device that fits in your mouth over your teeth while you sleep, it can look like a sports mouth guard or an orthodontic retainer. The device prevents the airway from collapsing by keeping the tongue in position or sliding the jaw forward so that you can breathe while sleeping, some patients prefer to sleep with an oral appliance on a continuous positive airway pressure machine. Oral device therapy is recommended for patients with mild to moderate apnea.
Surgical therapies are not as effective in treating sleep apnea as those listed above, there are a variety of surgical options you can choose from and the most common ones reduce or eliminate extra tissue in the throat that collapses and blocks the airway. During the dream. More complex procedures can adjust your bone structures, including your jaw, nose, and facial bones. Weight loss surgery can also be an option, talk to your doctor about which surgery is right for you.
In some cases, losing weight can help improve or eliminate your sleep apnea symptoms if you are overweight or obese. Overweight people often have thick necks with extra throat tissue that can block the airway, there is no guarantee that losing weight will eliminate your apnea, although it can help. This approach is unlikely to make a difference in patients with a narrow nasal passage or airway.
It is a behavioral strategy to treat positional sleep apnea, some people have this disorder mainly when they sleep on their back, this is called the “supine” position, their breathing returns to normal when they sleep on their side. Positional therapy may involve wearing a special device around the waist or back, keeping you sleeping in the lateral position. Another option is a small device that uses “vibro-tactile feedback” technology, worn on the back of the neck, it vibrates gently when you start to sleep on your back and without waking you up, the vibration alerts your body to change position. Positional therapy can be used alone or in conjunction with other sleep apnea treatment.
If you have trouble sticking with your treatment plan or can’t sleep even with treatment, your doctor may recommend Cognitive Behavioral Therapy .
Changes in lifestyle
There are a variety of lifestyle changes you can make to help reduce your snoring and improve your sleep apnea symptoms. Behavioral changes, such as quitting smoking or not drinking alcohol, can improve symptoms. Alcohol relaxes your throat muscles and can cause you to snore or collapse. If you have allergies, taking a decongestant before bed can help improve airflow through your nose.
Avoid sleeping pills and any sedatives as these can relax your throat muscles and thus interfere with breathing. Exercising is also essential, because in addition to helping you lose weight, it can have a great effect on the quality and duration of sleep, on the one hand, aerobic training will help you improve symptoms and yoga will help you improve. breathing because it strengthens the muscles of the airways.
Maintain regular sleep hours, as sticking to a consistent sleep schedule will help you relax and sleep better. Sleep apnea episodes decrease when you sleep a lot.
If you have trouble sticking with your treatment plan or can’t sleep even with treatment, your doctor may recommend Cognitive Behavioral Therapy. A sleep behavior specialist will help you eliminate thoughts and behaviors that prevent you from sleeping well or complying with your treatment.
Hello, how are you? My name is Georgia Tarrant, and I am a clinical psychologist. In everyday life, professional obligations seem to predominate over our personal life. It's as if work takes up more and more of the time we'd love to devote to our love life, our family, or even a moment of leisure.