Sleep Apnea: Symptoms, Types, Causes, Risks, Complications, Diagnosis, Treatment and Prognosis

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woman with Sleep Apnea

1Overview

Literally meaning “without breath” in Greek, apnea refers to a person’s breathing pauses while asleep. There are two types of sleep apnea with obstructive sleep apnea being the most common. It is due to the collapsing of the muscles in the back of the throat. When a person suffering from OSA sleeps on his back, his tongue falls back with gravity, resulting in the narrowing of the airway and ensuing reduction in the amount of air that reaches the lungs. As the patient breathes, the tissues in the back of his throat vibrate, causing him to snore.

Sleep apnea is one of the common sleep disorders. It causes a disturbance in the natural sleep rhythm of a person and, over time, the patient may suffer symptoms, from waking up unrefreshed and getting irritable to developing more complicated illnesses such as diabetes and high-blood pressure. This is due to sleep deprivation, as sleep helps the body repair and recuperate after a day’s work. Apart from being sleep deprived, the patient can cause sleep deprivation as well to someone he or she is sharing the bed or room with.

This health condition is more common among men than women, but it is possible for children to also suffer from sleep apnea. Some of the common signs observed in these patients include daytime sleepiness, fatigue, loss of focus, and loud snoring when sleeping. There are laboratory tests that can help identify the severity of the disorder, and it is also possible to have this treated. While this disorder is considered common, it can affect the overall well-being of a patient over time if left untreated.

2Symptoms

The most notable symptoms sufferers of the sleep apnea exhibit are restless sleep, daytime sleepiness (hypersomnia), and fatigue. In most cases, sufferers of this health condition are unaware of it as the breathing cessations do not awaken them, and so they ignore the signs until later on. Snoring can also be an indication of sleep apnea. However, not all people who snore while sleeping are sufferers of sleep apnea in the same way not all sleep apnea sufferers snore while sleeping. For this reason, symptoms to observe must focus on the quality of sleep as well as the overall health of a person.

Some of the symptoms that can be observed over time when the disorder is left untreated include:

  • Shallow sleep (unable to reach rapid-eye movement or REM sleep)
  • Choking or gasping while asleep
  • Frequent urination at night
  • Sleep deprivation or insomnia
  • Difficulty in concentrating
  • Low energy during daytime
  • Weakened short-term memory
  • Waking up with a sore throat or dry mouth
  • Waking up abruptly accompanied by palpitations or shortness of breath
  • Breathing cessation (as noted by another person)
  • Headaches in the morning
  • Being irritable more often
  • Chronic loud snoring

Children may also suffer from sleep apnea. Some of the symptoms observed in these children include:

  • Choking, gasping, snorting while asleep
  • Strange sleeping positions
  • Bedwetting
  • Abnormal perspiration while asleep
  • Daytime sleepiness
  •  Night terrors
  • Increasing behavioral problems
  • Loss of focus or concentration

3Types

There are two main types of sleep apnea: obstructive sleep apnea and central sleep apnea. A third type is a combination of these two called complex sleep apnea. The symptoms of the two main types are often overlapping, but the cause of the breathing cessation between the two is different.

Obstructive sleep apnea is the most common type of sleep apnea. The breathing cessation is caused by the blockage of the airway due to the relaxed throat tissues in the back of the throat, resulting in snoring. Oftentimes, it is observed by a roommate or bed partner upon witnessing the patient’s loud snoring and complaints of sleep deprivation in the morning.

Meanwhile, with central sleep apnea, a person suffers from breathing cessation while sleeping because the brain is not sending the right signals to the muscles that control breathing. This causes a person to wake up in order to resume normal breathing.

4Causes

Obstructive sleep apnea is caused by the relaxing of the muscles in the back of a patient’s throat. When the muscles collapse and the patient breathes, this causes the vibration of the muscles, resulting in snoring. Oftentimes, patients who suffer from obstructive sleep apnea are unaware of their condition as the breathing cessation do not necessarily waken them. However, patients may be awakened by their choking, gasping, or snorting, as the brain wakes them up to resume normal breathing.

Central sleep apnea is caused by the brain failing to send signals to muscles that control breathing. This results in another part of the brain to wake up the patient to resume breathing.

Health condition can cause a person to develop this sleep disorder. Type-2 diabetes patients and overweight or obese people are some of the those who are most likely to develop sleep apnea.

5Risk Factors

A person’s risk of developing sleep apnea depends on the following:

Weight

The heavier a person is, the higher is his risk of developing sleep apnea. However, it is possible for people with normal weight or who are underweight to also suffer from sleep apnea.

Family medical history

If a person’s father, mother, or grandparent suffers from sleep apnea, his chances of developing the disorder are higher than most people.

Gender

Men are more likely to develop sleep apnea than women. Among women, those who are menopause are more likely to develop the condition.

Age

Middle-aged people are more likely to be sufferers of sleep apnea than younger people.

Health condition

A person has a higher chance of developing sleep apnea if he is a sufferer of diabetes, high-blood pressure, and/or heart illnesses or had suffered a stroke. People who have allergies may also develop the sleep disorder due to clogged air passageway brought about by allergic reactions. Those who have colds are also likely to develop sleep apnea, but only during the illness.

Race

Sleep apnea affects more American, African-American, Hispanic, or a Pacific Islander people.

Physical attributes

If a person has a neck circumference greater than 15.75 inches, he is more likely to develop sleep apnea. In the same way, people who have enlarged adenoids or tonsils, narrow throat, or receding chin have a higher risk of developing the disorder.

Lifestyle

People who are dependent on drugs or alcohol have an increased risk of developing sleep apnea later in life due to substances that cause the relaxation of the muscles in the back of the throat. Some substances, such as opioids can cause the development of central sleep apnea. Smokers have a higher risk of developing sleep apnea as smoking can cause the airway to become inflamed or retain fluids.

6Complications

While sleep apnea is common, it can cause health complications and should be treated as soon as detected. Some of the complications that may arise with sleep apnea if left untreated include the development of heart diseases, neurological diseases, liver diseases, pancreatic diseases, spinal injury, stroke, memory impairment, weight problems, frequent headaches, and even impotence.

Due to sleep deprivation, sleep apnea sufferers have a higher risk of being drowsy throughout the day and getting involved in accidents including work-related accidents and car crashes. Sleep apnea can also affect the mental and emotional health of a person due to sleep deprivation. They can end up being irritable, having poor concentration, or suffer from extreme mood swings and even depression (due to the possibility of their partner or roommate to move to another room or refuse to share the room with him because of his loud snoring).

People who suffer from obstructive sleep apnea may experience complications during a major surgery due to their chances of experiencing breathing problems while lying on their back. To prevent this, patients should always mention their sleep disorder to their surgeon.

Some patients who suffer from obstructive sleep apnea develop central sleep apnea while being treated with the use of positive airway pressure (PAP) devices.

7Diagnosis

After checking on the symptoms, the patient may seek medical help to confirm he is suffering from the sleep disorder. There is a sleep specialist who can help with this, and there are sleep disorder centers where patients can be evaluated in terms of their sleep behavior and sleep rhythm. Some of the tests that these specialists may ask the patient to undergo include:

Nocturnal polysomnography

Also known as a sleep study, this test tells the brain activity as well as the activity of the heart, lungs, and other movements the patient may end up doing while he is asleep. It is often the choice of most doctors in determining sleep apnea. It will help the specialist study their breathing pattern, their ability to reach REM sleep (deep sleep), and the amount of oxygen that enters their bodily systems while asleep.

Home tests

Some specialists ask patients to perform sleep tests at home in order to diagnose a sleep disorder. These tests help determine the heart rate, the flow of air in the air passageway, and the breathing patterns while the patient is asleep.

Electroencephalogram (EEG)

The patient may be asked to undergo this test, which is designed to determine brain waves.

Electrooculogram (EOG)

This test helps specialists determine the movements of the eyes and the chin during sleep.

Electrocardiogram (EKG)

This helps specialists determine the heart rate as well as its rhythm.

Other medical check-ups

If a person is a sufferer of obstructive sleep apnea, he may be referred as well by his physician or sleep specialist to an ear, nose, and throat (ENT) doctor to help determine whether the disorder is caused by clogging in the nose or throat. Central sleep apnea sufferers may be referred to a neurologist (specialist in treating diseases in the brain and nervous system), a cardiologist (specialist in treating cardiovascular diseases), a psychiatrist (specialize in treating mental disorders), or a pulmonologist (specialize in treating lung diseases).

Split-night study

This may be conducted to determine how well the patient will respond to PAP devices.

8Treatment

Treatment will depend on the situation of the patients. Patients whose sleep apnea is brought on by their abuse of alcohol or drugs and/or smoking will be asked to change their lifestyle. People who are overweight or obese and are sufferers of sleep apnea may be asked to lose weight. Those who have allergies and are suffering from sleep apnea will be asked to have their allergies treated. If despite all these measures, the symptoms of sleep apnea still persist, then sleep specialists may offer some treatments.

The most common treatment offered by sleep experts to obstructive sleep apnea sufferers is the continuous positive airway pressure (CPAP) therapy which involved the use of PAP devices. A PAP device is worn as a mask before sleeping. This will provide air pressure to help patients breathe better during sleep. Other treatments that use PAP devices include expiratory positive airway pressure (EPAP) and bilevel positive airway pressure (BiPAP).

Patients may also be offered to wear an oral appliance. This will keep open the patient’s throat and will help PAP devices work more effectively.

Adaptive servo-ventilation (ASV) may be offered by specialists to better understand the breathing patterns of the patient. This machine helps normalize their breathing patterns and prevent breathing cessations.

Some patients may opt for physical therapies to strengthen the muscles in the back of their throat. The improvement of their condition may be observed gradually as it takes a while before muscles strengthen. There are also dental devices that can help prevent the obstruction of the airway.

Some specialists may also offer the option of undergoing surgery to help treat sleep apnea; however, this option is considered as the last resort. For those who suffer from sleep apnea due to jaw problems, this may be offered as the first option.

9Prognosis

Sleep apnea is linked to the development of serious illnesses including heart diseases, neurological diseases, and pancreatic diseases, due to the inability of the body to recuperate by having a restful sleep. Seek medical help as soon as possible after diagnosis.