Sleep Apnea—What Is It?
Loud, constant snoring can indicate a potentially life-threatening disorder called sleep apnea. The word “apnea” is derived from Greek to mean “without breath.” An estimated 5 in 100 people suffer from sleep apnea. A person with sleep apnea stops breathing repeatedly while sleeping, anywhere from 10 seconds to 3 minutes.
Although an individual may not recall waking up, sleep is disrupted temporarily. As a result, sleep deprivation and excessive daytime sleepiness occur. If left untreated, sleep apnea can trigger high blood pressure and dangerous heart problems.
Sleep apnea can also occur in children and, in some cases, has been linked to Sudden Infant Death Syndrome (SIDS). In older children, sleep apnea occurs in those children who are overweight or who have unusually large tonsils and adenoids. Children with sleep apnea may snore, squeak, and thrash while sleeping. Since snoring is not normal for any child, parents should report this to their physician. Children may also exhibit symptoms similar to that of ADHD. A child who suffers from sleep apnea may be sleepy or sluggish during the daytime, although these symptoms are much more common in adults.
There are three types of sleep apnea: obstructive, central, and mixed.
Obstructive sleep apnea (OSA) is the most common and severe form. This type of apnea occurs when the airway closes and remains obstructed, resulting in blocked airflow. As pressure to breathe increases, the diaphragm and chest muscles work harder. Blood pressure rises and the heart can beat irregularly or even pause for several seconds.
Every time breathing stops, the level of oxygen in the blood falls and the heart must pump harder. Every time there is an obstruction, the person must awaken momentarily to resume breathing. Sleep is temporarily interrupted, activating the throat muscles to open the airway.
Physical abnormalities are usually the cause of OSA. Excessive pharyngeal tissue, an overly large tongue, a congenitally small airway, or fatty deposits are often found to be the reason. Corrective surgery is a common solution to eliminating obstructive sleep apnea.
Treatments: There are actually a number of forms of treatment for obstructive sleep apnea, not just surgery. These range from weight loss and other lifestyle changes to several surgical procedures. The most common, and still the most effective treatment, is the use of continuous positive airway pressure or CPAP, a device that uses pressurized air delivered through a nasal interface to hold the airway open while the patient sleeps. Combinations of these therapies are also used.
In central sleep apnea, the brain actually fails to signal the muscles to breathe. The airway is clear, but the diaphragm and chest muscles stop working. Eventually the decreased level of oxygen in the blood signals the brain to awaken the sleeper to restart breathing. This type of apnea becomes more common with age and is associated with heart disease or a neurological disorder.
Mixed sleep apnea is a combination of central and obstructive sleep apnea. This disorder initially occurs as central sleep apnea, where there is no brain signal to breathe. When the diaphragm suddenly begins moving, the airway is blocked by an obstruction (obstructive sleep apnea). It is not uncommon for a sleep disorder specialist to see all three types of apnea occur in one night.
What Is Snoring?
Snoring is produced as the soft palate and uvula (the skin tissue that hangs down in the back of the throat) vibrate during breathing as a person sleeps. It is a sign that the breathing airway is not completely open. The unpleasant and often annoying sound associated with snoring comes from efforts to force air through the narrowed passageway.
Primary snoring (snoring not caused by apnea) poses no known serious consequences, is not life threatening, and does not cause chronic fatigue in the sleeper. Snoring can, however, cause fatigue and extreme annoyance in other household members as well as the isolation of a bed partner. It is estimated that as many as 40 percent of adults snore. The majority of snorers are men.
When Should I See a Doctor?
If sleep apnea is suspected, scheduling an appointment with a physician is recommended. The physician will take a medical history and a referral for a night in a sleep evaluation laboratory will be required. It is often helpful for the doctor or sleep specialist to interview the bed partner or other members of the household.
For a diagnosis of sleep apnea to be made, each abnormal breathing episode must last at least 10 seconds and occur at least 5 times for each hour asleep. Doctors call this the Respiratory Disturbance Index (RDI).
What Treatments Are Available for Sleep Apnea?
Weight loss is often an effective treatment for snoring-related sleep apnea. Even just a few pounds can improve breathing during sleep. Another effective treatment is medication. Some antidepressants and asthma medications have been found to relieve sleep apnea because they are respiratory stimulants.
For severe sleep apnea cases, continuous positive airway pressure (CPAP) therapy may be required. Patients receiving this treatment wear a light mask over the nose during sleep. An air compressor forces air through the nose and into the airway. Other sleep apnea patients find relief with oral appliances that prop the airway open by moving the jaw, tongue, and soft palate forward.
In some cases, surgery may be required to correct physical abnormalities. Sleep apnea as the result of enlarged tonsils (and adenoids in children) can be alleviated with a tonsillectomy. Another surgical technique called uvulopalatopharyngoplasty (UPPP) removes excess tissue at the back of the throat. For some patients, however, there are negative side effects or unresolved apnea symptoms.
Somnoplasty is a non-invasive procedure that uses low power, low temperature radio frequency energy to reduce the tongue. The procedure takes place in the physician’s office under local anesthesia, and typically takes less than an hour. Multiple somnoplasty treatments may be required, but snoring and apnea episodes are often alleviated.
A tracheostomy, a procedure in which a tube is inserted into the throat to make an opening in the windpipe, is only used for severe cases of sleep apnea and when other treatments fail. The tube is closed during the day, allowing for normal activities, and opened at night, bypassing the obstruction in the throat.