What is Sleep Apnea?

Sleep apnea (AP-ne-ah) is a common disorder in which you have one or more
pauses in breathing or shallow breaths while you sleep. Breathing pauses can last
from a few seconds to minutes. They often occur 5 to 30 times or more an hour.
Typically, normal breathing then starts again, sometimes with a loud snort or
choking sound. Sleep apnea usually is a chronic (ongoing) condition that disrupts
your sleep. You often move out of deep sleep and into light sleep when your
breathing pauses or becomes shallow. This results in poor sleep quality that
makes you tired during the day. Sleep apnea is one of the leading causes of
excessive daytime sleepiness.

Sleep apnea often goes undiagnosed. Doctors usually can’t detect the condition
during routine office visits. Also, there are no blood tests for the condition.
Most people who have sleep apnea don’t know they have it because it only occurs
during sleep. A family member and/or bed partner may first notice the signs of
sleep apnea.

The most common type of sleep apnea is obstructive sleep apnea. This most often
means that the airway has collapsed or is blocked during sleep. The blockage may
cause shallow breathing or breathing pauses.

When you try to breathe, any air that squeezes past the blockage can cause loud
snoring. Obstructive sleep apnea is more common in people who are overweight,
but it can affect anyone. For example, small children may have enlarged tonsil
tissues in their throats, which can lead to obstructive sleep apnea.

What Causes Sleep Apnea?

When you’re awake, throat muscles help keep your airway stiff and open so air can flow into your lungs. When you sleep, these muscles are more relaxed. Normally, the relaxed throat muscles don’t prevent your airway from staying open to allow air into your lungs. But if you have obstructive sleep apnea, your airway can be blocked or narrowed
during sleep because:

  • Your throat muscles and tongue relax more than normal.
  • Your tongue and tonsils (tissue masses in the back of your mouth) are large
    compared to the opening into your windpipe.
  • You’re overweight. The extra soft fat tissue can thicken the wall of the windpipe. This causes the inside opening to narrow, which makes it harder to keep open.
  • The shape of your head and neck (bony structure) may cause a smaller airway size in
    the mouth and throat area.
  • The aging process limits your brain signals’ ability to keep your throat muscles stiff during sleep. This makes it more likely that the airway will narrow or collapse.

Not enough air flows into your lungs if your airway is fully or partly blocked during sleep. This can cause loud snoring and a drop in your blood oxygen level. If the oxygen drops to a dangerous level, it triggers your brain to disturb your sleep. This helps tighten the upper airway muscles and open your windpipe. Normal breaths then start again, often with a loud snort or choking sound.

The frequent drops in oxygen level and reduced sleep quality trigger the release of stress hormones. These compounds raise your heart rate and increase your risk of high blood pressure, heart attack, stroke, and arrhythmias (irregular
heartbeats). The hormones also raise the risk of, or worsen, heart failure. Untreated sleep apnea also can lead to changes in how your body uses energy. These changes increase your risk of obesity and diabetes.

Who is at Risk for Sleep Apnea?

Millions of American adults have obstructive sleep apnea. More than half of the people who have this condition are overweight. Sleep apnea appears to be more common in men than in women. The condition also becomes more common as you get older. At least 1 in 10 people older than 65 has sleep apnea. Women are more likely to develop sleep apnea during pregnancy and after menopause.

Sleep apnea also is more common in African Americans, Hispanics, and Pacific Islanders than in Caucasians. If someone in your family has sleep apnea, you’re more likely to develop it.

People who have small airways in their noses, throats, or mouths also are more likely to have sleep apnea. Smaller airways may be due to the shape of these structures or allergies or other medical conditions that cause congestion in these areas.

Small children may have enlarged tonsil tissues in their throats. This can increase their risk of sleep apnea. Overweight children also may be at increased risk for the condition.

About half of the people who have sleep apnea also have high blood pressure. Sleep apnea also is linked to smoking, metabolic syndrome, diabetes, and risk factors for stroke and heart failure.

What Are the Signs & Symptoms for Sleep Apnea?

Major Signs and Symptoms
One of the most common signs of obstructive sleep apnea is loud and chronic (ongoing) snoring. Pauses may occur in the snoring. Choking or gasping may follow the pauses.

The snoring usually is loudest when you sleep on your back; it may be less noisy when you turn on your side. Snoring may not happen every night. Over time, the snoring may happen more often and get louder.

You’re asleep when the snoring or gasping happens. You likely won’t know that you’re having problems breathing or be able to judge how severe the problem is. Your family members or bed partner often will notice these problems before you do.

Not everyone who snores has sleep apnea.

Another common sign of sleep apnea is fighting sleepiness during the day, at work, or while driving. You may find yourself rapidly falling asleep during the quiet moments of the day when you’re not active. Even if you don’t have daytime sleepiness, talk with your doctor if you have problems breathing during sleep.

Other Signs and Symptoms
Others signs and symptoms of sleep apnea may include:

  • Morning headaches
  • Memory or learning problems and not being able to concentrate
  • Feeling irritable, depressed, or having mood swings or personality changes
  • Urination at night
  • A dry throat when you wake up

In children, sleep apnea can cause hyperactivity, poor school performance, and
angry or hostile behavior. Children who have sleep apnea also may have unusual
sleeping positions, bedwetting, and may breathe through their mouths instead of
their noses during the day.

How is Sleep Apnea Diagnosed?

Doctors diagnose sleep apnea based on medical and family histories, a physical
exam, and results from sleep studies. Usually, your primary care doctor evaluates
your symptoms first. He or she then decides whether you need to see a sleep
specialist.
Sleep specialists are doctors who diagnose and treat people who have sleep
problems. Examples of such doctors include lung and nerve specialists and ear,
nose, and throat specialists. Other types of doctors also can be sleep specialists.

Medical and Family Histories

Your doctor will ask you and your family questions about how you sleep and how
you function during the day. To help your doctor, consider keeping a sleep diary
for 1 to 2 weeks. Write down how much you sleep each night, as well as how
sleepy you feel throughout the day.
You can find a sample sleep diary in the National Heart, Lung, and Blood
Institute’s “Your Guide to Healthy Sleep.”
Your doctor also will want to know how loudly and often you snore or make
gasping or choking sounds during sleep. Often you’re not aware of such
symptoms and must ask a family member or bed partner to report them.
If you’re a parent of a child who may have sleep apnea, tell your child’s doctor
about your child’s signs and symptoms.
Let your doctor know if anyone in your family has been diagnosed with sleep
apnea or has had symptoms of the disorder.
Many people aren’t aware of their symptoms and aren’t diagnosed.

Physical Exam

Your doctor will check your mouth, nose, and throat for extra or large tissues. The
tonsils may be enlarged in children who have sleep apnea. A physical exam and
medical history may be all that’s needed to diagnose sleep apnea in children.
Adults who have sleep apnea may have an enlarged uvula (U-vu-luh) or soft
palate. The uvula is the tissue that hangs from the middle of the back of your
mouth. The soft palate is the roof of your mouth in the back of your throat.

Sleep Studies

A sleep study is the most accurate test for diagnosing sleep apnea. It records what
happens with your breathing while you sleep.
There are different kinds of sleep studies. If your doctor suspects you have sleep
apnea, he or she may recommend a polysomnogram (poly-SOM-no-gram; also
called a PSG) or a home-based portable monitor. PSGs often are done at sleep
centers or sleep labs. In some cases, doctors suggest using portable sleep
monitors at home.

Polysomnogram

A PSG is the most common sleep study for diagnosing sleep apnea. This test
records:

  • Brain activity
  • Eye movement and other muscle activity
  • Breathing, heart rate, and blood pressure
  • How much air moves in and out of your lungs while you’re sleeping
  • The amount of oxygen in your blood

A PSG is painless. You’ll go to sleep as usual, except you’ll have sensors on your
scalp, face, chest, limbs, and finger. The staff at the sleep center will use the
sensors to check on you throughout the night.
A sleep specialist reviews the results of your PSG to see whether you have sleep
apnea and how severe it is. He or she will use the results to plan your treatment.
Your doctor also may use a PSG to find the right setting for you on a CPAP
(continuous positive airway pressure) machine. CPAP is the most common
treatment for sleep apnea. A CPAP machine uses mild air pressure to keep your
airway open while you sleep.
If your doctor thinks that you have sleep apnea, he or she may schedule a splitnight sleep study. During the first half of the night, your sleep is checked without a
CPAP machine. This will show whether you have sleep apnea and how severe it is.
If the PSG shows that you have sleep apnea, you may use a CPAP machine during
the second half of the split-night study. During this time, the flow of air from the
CPAP machine will be adjusted to find the setting that works best for you.

Home-Based Portable Monitor

Your doctor may recommend a home-based sleep test with a portable monitor.
The portable monitor will record some of the same information as a PSG. For
example, it may record:
The amount of oxygen in your blood
How much air is moving through your nose while you breathe
Your heart rate
Chest movements that show whether you’re making an effort to breath
A sleep specialist may use the results from a home-based sleep test to help
diagnose sleep apnea. He or she also may use the results to determine whether
you need a full PSG study in a sleep center.

How is Sleep Apnea Treated?
Lifestyle changes, mouthpieces, breathing devices, and surgery are used to treat sleep apnea. Medicines typically aren’t used to treat the condition.

The goals of treating sleep apnea are to:

  • Restore regular breathing during sleep
  • Relieve symptoms such as loud snoring and daytime sleepiness

Treatment may improve other medical problems linked to sleep apnea, such as high blood pressure. Treatment also can reduce your risk of heart disease, stroke, and diabetes.

If you have sleep apnea, talk with your doctor or sleep specialist about the
treatment options that will work best for you.

Lifestyle changes and/or mouthpieces may be enough to relieve mild sleep apnea.

People who have moderate or severe sleep apnea may need breathing devices (Mild sleep apnea machines) or
surgery.

If you continue to have daytime sleepiness despite treatment, your doctor may
ask whether you’re getting enough sleep. (Adults should get at least 7 to 8 hours
of sleep; children and adolescents need more.)

If treatment and enough sleep don’t relieve your daytime sleepiness, your doctor
will consider other treatment options.

Lifestyle Changes

If you have mild sleep apnea, some changes in daily activities or habits may be all
the treatment you need.

  • Avoid alcohol and medicines that make you sleepy. They make it harder for your
    throat to stay open while you sleep.
  • Lose weight if you’re overweight or obese. Even a little weight loss can improve your
    symptoms.
  • Sleep on your side instead of your back to help keep your throat open. You can sleep
    with special pillows or shirts that prevent you from sleeping on your back.
  • Keep your nasal passages open at night with nasal sprays or allergy medicines, if
    needed. Talk with your doctor about whether these treatments might help you.
  • If you smoke, quit. Talk with your doctor about programs and products that can help
    you quit smoking.

Mouthpieces

A mouthpiece, sometimes called an oral appliance, may help some people who have mild sleep apnea. Your doctor also may recommend a mouthpiece if you snore loudly but don’t have sleep apnea.
A dentist or orthodontist can make a custom-fit plastic mouthpiece for treating sleep apnea. (An orthodontist specializes in correcting teeth or jaw problems.) The mouthpiece will adjust your lower jaw and your tongue to help keep your airways open while you sleep.

If you use a mouthpiece, tell your doctor if you have discomfort or pain while using the device or machine. You may need periodic office visits so your doctor can adjust your mouthpiece to fit better.

Breathing Devices or Machine

CPAP (continuous positive airway pressure) is the most common treatment for moderate to severe sleep apnea in adults. A CPAP machine uses a mask that fits over your mouth and nose, or just over your nose. The machine gently blows air into your throat.

The air presses on the wall of your airway. The air pressure is adjusted so that it’s just enough to stop the airways from becoming narrowed or blocked during sleep.

Treating sleep apnea may help you stop snoring. But not snoring doesn’t mean that you no longer have sleep apnea or can stop using CPAP. Sleep apnea will return if CPAP is stopped or not used correctly.

Usually, a technician will come to your home to bring the CPAP equipment. The technician will set up the CPAP machine and adjust it based on your doctor’s prescription. After the initial setup, you may need to have the CPAP adjusted on occasion for the best results.

CPAP treatment may cause side effects in some people. These side effects include a dry or stuffy nose, irritated skin on your face, dry mouth, and headaches. If your CPAP isn’t adjusted properly, you may get stomach bloating and discomfort while wearing the mask.

If you’re having trouble with CPAP side effects, work with your sleep specialist, his or her nursing staff, and the CPAP technician. Together, you can take steps to reduce these side effects. These steps include adjusting the CPAP settings or the size/fit of the mask, or adding moisture to the air as it flows through the mask. A nasal spray may relieve a dry, stuffy, or runny nose.

There are many types of CPAP machines and masks. Tell your doctor if you’re not happy with the type you’re using. He or she may suggest switching to a different type that may work better for you.

People who have severe sleep apnea symptoms generally feel much better once they begin treatment with CPAP.

Surgery

Some people who have sleep apnea may benefit from surgery. The type of surgery and how well it works depend on the cause of the sleep apnea. Surgery is done to widen breathing passages. It usually involves shrinking, stiffening, or removing excess tissue in the mouth and throat or resetting the lower jaw.

Surgery to shrink or stiffen excess tissue in the mouth or throat is done in a doctor’s office or a hospital. Shrinking tissue may involve small shots or other treatments to the tissue. A series of such treatments may be needed to shrink the excess tissue. To stiffen excess tissue, the doctor makes a small cut in the tissue and inserts a small piece of stiff plastic.

Surgery to remove excess tissue is done in a hospital. You’re given medicine that makes you sleep during the surgery. After surgery, you may have throat pain that lasts for 1 to 2 weeks.

Surgery to remove the tonsils, if they’re blocking the airway, may be very helpful for some children. Your child’s doctor may suggest waiting some time to see whether these tissues shrink on their own. This is common as small children grow.