Everything You Need to Know About Obstructive Sleep Apnea

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What is obstructive sleep apnea (OSA)

Obstructive sleep apnea occurs when the muscles that support the soft tissues in your throat, such as your tongue and soft palate, temporarily relax. The airway will be shortened or blocked when these muscles relax, and breathing will be cut off momentarily.

Obstructive sleep apnea vs normal

Obstructive sleep apnea is a sleep disorder that is potentially serious. It causes breathing to stop and start over and over again during sleep.

There are various types of sleep apnea, but obstructive sleep apnea is the most common. This type of apnea occurs when your throat muscles relax and block your airway during sleep on an intermittent basis. Snoring is a significant sign of obstructive sleep apnea.

Untreated apnea of sleep can cause serious health problems, for example:

Different types of sleep apnea

There are three types of sleep apnea, these are:

  • Obstructive sleep apnea: This is the most common type of sleep apnea that has narrowed, blocked, or floppy the airway.
  • Central sleep apnea: There is no airway blockage, but the brain does not signal breathing to the respiratory muscles.
  • Mixed sleep apnea: This is a mixture of obstructive and central apnea for sleep.

What are the symptoms of sleep apnea

Obstructive sleep apnea signs and symptoms include:

  • Excessive daytime sleepiness
  • Loud snoring
  • Observed episodes of stopped breathing during sleep
  • Abrupt awakenings accompanied by gasping or choking
  • Awakening with a dry mouth or sore throat
  • Morning headache
  • Difficulty concentrating during the day
  • Experiencing mood changes, such as depression or irritability
  • High blood pressure
  • Nighttime sweating
  • Decreased libido

When should you see a doctor about sleep apnea?

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When you witness, or if your partner observes these things, consult a medical professional:

  • Snoring loud enough to disturb your sleep or that of others
  • Waking up gasping or choking
  • Intermittent pauses in your breathing during sleep
  • Excessive daytime drowsiness, which may cause you to fall asleep while you’re working, watching television or even driving a vehicle

Most people may not think of snoring as a symptom of something that might be serious, and not everyone who snores has obstructive sleep apnea.

If you hear loud snoring, be sure to talk to your doctor, particularly snoring that is punctuated with periods of silence. Snoring is usually loudest when you sleep on your back with obstructive sleep apnea, and it quiets when you turn on your side.

Ask your doctor about any sleep problems that will cause you to be constantly tired, depressed and irritable. Some conditions, such as narcolepsy, can result in severe daytime drowsiness.

What causes sleep apnea?

Obstructive sleep apnea happens when the throat’s muscles relax too much to allow normal breathing. Both muscles protect structures including the back of your mouth’s roof (soft palate), the triangular tissue that hangs from the soft palate (uvula), tonsils, and tongue.

As your muscles relax, your airway narrows or closes as you breathe in, and for 10 seconds or longer, breathing may be insufficient. This may lower your blood’s oxygen level and cause carbon dioxide buildup.

The brain detects this disturbed breathing and rouses you momentarily so you can reopen the airway. Generally, this awakening is so fast you don’t recall it.

You will wake up in one or two deep breaths with shortness of breath that easily corrects itself. You may make a sound that’s snorting, coughing or gasping.

This pattern can be repeated five to thirty times or more every hour throughout the night. Such disturbances impair your ability to achieve the ideal intense, restful sleeping periods, and during your waking hours you will probably feel sleepy.

Individuals with obstructive apnea for sleep may not be aware of the disruption of their sleep. Yes, many people with this kind of sleep apnea say they’ve been sleeping well all night.

Who is at risk for obstructive sleep apnea?

OSA risk increases if you have symptoms or habits that obstruct the upper airway. These risk factors of OSA includes:

  • Children with large tonsils and adenoids
  • Men with a collar size of 17 inches or more
  • Women with a collar size of 16 inches or more
  • Large tongue, which can block the airway
  • Retrognathia, which is when your lower jaw is shorter than your upper jaw
  • A narrow palate or airway that collapses more easily

Among obese people, heart disease is more common, and obesity is a risk factor for heart disease, high blood pressure, and sleep apnea.

What are some risk factors?

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It is possible for anyone to develop obstructive sleep apnea. Some factors, however, placed you at increased risk, including:

  • Excess weight. Most but not all of them are obese with obstructive sleep apnea. Fat deposits may block breathing around the upper airway. Obstructive sleep apnea can also be caused by medical conditions associated with obesity, such as hypothyroidism and polycystic ovary syndrome. Not all people with obstructive sleep apnea are overweight, however, and vice versa. The disease can also grow thin people.
  • Narrowed airway. You will inherit narrow airways naturally. Or you may expand your tonsils or adenoids, which may obstruct your airway.
  • High blood pressure (hypertension). Obstructive sleep apnea in people with hypertension is relatively common.
  • Chronic nasal congestion. In those with chronic nasal congestion at night, obstructive sleep apnea occurs twice as often, regardless of the cause. This could be attributed to the narrowing of airways.
  • Smoking. It is more likely that people who smoke will have obstructive sleep apnea.
  • Diabetes. Obstructive sleep apnea in people with diabetes may be more common.
  • Gender. Men are generally twice as likely to have obstructive sleep apnea as premenopausal women. Obstructive sleep apnea frequency increases in women following menopause.
  • A family history of sleep apnea. You may be at increased risk if you have family members with obstructive sleep apnea.
  • Asthma. A combination of asthma and the risk of obstructive sleep apnea has been identified through studies.

What are some complications?

Obstructive sleep apnea is a serious medical condition. There may be complications:

  • Daytime fatigue and sleepiness. Repeated awakenings associated with obstructive sleep apnea make normal, restored sleep impossible. People with obstructive sleep apnea also experience severe daytime drowsiness, fatigue, and irritation. They may find it difficult to concentrate and fall asleep at work, watching television or even driving. They may also be at higher risk of work-related accidents. In school, children and youth with obstructive sleep apnea may do poorly and often have problems with attention or behavior.
  • Cardiovascular problems. Sudden decreases in blood oxygen levels caused by obstructive sleep apnea increase blood pressure and stress the cardiovascular system. Most individuals with obstructive sleep apnea experience high blood pressure (hypertension), which can raise the risk of heart disease. The more serious the obstructive sleep apnea, the greater the risk of coronary artery disease, heart attack, heart failure and stroke. Obstructive sleep apnea increases the risk of abnormal heart rhythms (arrhythmia). Such irregular rhythms can reduce blood pressure. Such repeated frequent episodes of arrhythmias may lead to sudden death if underlying heart disease exists.
  • Complications with medications and surgery. Obstructive sleep apnea is also a problem for some drugs and general anesthesia. Such drugs, such as sedatives, narcotic analgesics and general anesthetics, ease your upper airway and may make your obstructive sleep apnea worse. If you have obstructive sleep apnea, you might have more breathing problems after major surgery, particularly after being sedated and lying on your back. Patients with obstructive sleep apnea may be more likely to experience problems following surgery. If you have obstructive sleep apnea or symptoms associated with obstructive sleep apnea, tell your doctor before you have surgery. If you have obstructive signs of sleep apnea, your doctor may be able to test you before surgery for obstructive sleep apnea.
  • Eye problems. A link between obstructive sleep apnea and certain eye disorders, such as glaucoma, has been identified in some studies. It is generally possible to treat problems of the eye.
  • Sleep-deprived partners. Loud snoring can prevent good rest from those around you and eventually disrupt your relationships. Some spouses may choose to sleep in a different room. Many bed partners are also deprived of sleep by people who snore.

Persons with obstructive sleep apnea may also complain of memory problems, headaches in the morning, mood swings, or symptoms of distress, and frequent urination at night (nocturia).

How is obstructive sleep apnea diagnosed?

Sleep apnea diagnosis starts with a detailed history and physical examination. A history of daytime drowsiness and snoring are important clues. Your doctor will examine your head and neck to identify any sleep apnea-related physical factors. Your doctor may ask you to complete a questionnaire on daytime drowsiness, sleeping habits, and sleep quality. Tests that can be carried out include:

Polysomnogram

Typically a polysomnogram test requires you to stay overnight in a sleep study center or hospital. The test is going on for a whole night. Throughout sleep, the polysomnogram can assess the function of different sleep-related organ systems. It could include the following:

  • Electroencephalogram (EEG), which measures brain waves
  • Electro-oculogram (EOM), which measures eye movement
  • Electromyogram (EMG), which measures muscle activity
  • Electrocardiogram (EKG or ECG), which measures heart rate and rhythm
  • Pulse oximetry test, which measures changes in your oxygen levels in your blood
  • Arterial blood gas analysis (ABG)

Electroencephalogram EEG and Electro-oculogram EOM

Electrodes that track brain waves before, during, and after sleep are connected to your scalp during an EEG. The EOM tracks the movement of the hand. A small electrode is positioned 1 centimeter above the right eye’s outer corner and another one is located 1 centimeter below the left eye’s outer corner. This movement is documented when the eyes move away from the center.

Brain waves and eye movements inform physicians of the timing of the different sleep stages. The sleep periods are non-REM (non-rapid eye movement) and REM (rapid eye movement). Dreaming, muscle tone and movement diminished, and paralysis during REM sleep occurs.

Electromyogram EMG

Two electrodes are mounted on the chin during the EMG: one above and one below the jawline. Every shin is positioned with another electrode. The electrical activity produced during muscle movements is collected by the EMG electrodes. Deep relaxation of the muscle during sleep will occur. As the muscles relax and shift while sleeping, the EMG picks up.

Electrocardiogram EKG

A 12-lead EKG can help your doctor assess the existence of heart disease. Long-standing high blood pressure may also cause an EKG to alter. Heart rate and rhythm monitoring help physicians to see if any heart problems arise during apnea episodes.

Pulse Oximetry

In this study, a small device called a pulse oximeter is clipped onto a thin region of your body with good blood flow, like your fingertip or earlobe. The pulse oximeter uses a small red and infrared LED emitter to measure the amount of oxygen in your blood. During apnea episodes, the amount of oxygen in your blood, or saturation of oxygen, decreases. Oxygen saturation is normally around 95-100%. The doctor is going to describe the tests.

Arterial Blood Gas (ABG)

A syringe is used in this study to get blood from an artery. In arterial blood, the ABG measures several factors, including:

  • Oxygen content
  • Oxygen saturation
  • Partial pressure of oxygen
  • Partial pressure of carbon dioxide
  • Bicarbonate levels

The test will provide your doctor with a more detailed picture of your blood’s oxygen, carbon dioxide, and acid-base balance. The doctor will also know whether and when you need extra oxygen.

What are some treatments for OSA?

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There are treatments available for obstructive sleep apnea. Another treatment involves the use of a system using positive pressure to keep the airway open while you’re sleeping. Another alternative is a mouthpiece during sleep to move your lower jaw forward. Surgery may also be a choice in some situations.

The aim of sleep apnea treatment is to ensure that ventilation during sleep is not obstructed. Types of treatment include:

Weight Loss

Weight loss provides excellent relief from OSA’s effects.

Nasal Decongestants

For moderate OSA, nasal decongestants are more likely to work. We will aid in relieving snoring.

Continuous Positive Airway Pressure (CPAP)

The first line of treatment for obstructive sleep apnea is continuous positive airway pressure (CPAP) therapy. CPAP is delivered through a night-wearing facemask. Gently, the facemask provides sufficient ventilation in order to keep the airways open at night. The optimistic airflow props open the airways. CPAP is a highly effective sleep apnea treatment. It may also be important to have a dental device to hold the lower jaw straight.

Bilevel Positive Airway Pressure (BiPAP or BPAP)

When CPAP treatment is not successful, Bilevel positive airway pressure machines are sometimes used to treat OSA. BiPAP machines have settings that respond to your breathing, high and low. This means changes in pressure during inhalation versus exhalation.

Positional Therapy

Because sleeping on the back (supine position) can make sleep apnea worse for some people, positional therapy is used to help people with sleep apnea learn to sleep in different positions. Positional treatment and CPAP use can be addressed at a sleep center with a doctor.

Surgery

Uvulopalatopharyngoplasty (UPPP) involves removing extra tissue from the throat back. UPPP is the most common type of OSA surgery and helps to relieve snoring. Nevertheless, it has not been established that this surgery completely removes sleep apnea, and complications will occur.

Tracheostomy may be performed as a last resort treatment. Tracheostomy punctures a windpipe opening that bypasses the throat obstruction.

If sleep apnea does not lead to therapies such as CPAP, other surgical procedures may be needed to address structural problems in the face and elsewhere. Approximately 75% of children with OSA are relieved from surgery due to swollen tonsils or adenoids. The American Sleep Apnea Association (ASAA) states that because of enlarged tonsils or adenoids, the American Academy of Pediatrics has approved surgical removal of tonsils and adenoids as the preferred treatment for children with sleep problems.

Conclusion

When you experience daytime drowsiness or regularly have sleeping problems, you should always talk to your doctor. OSA has a number of treatment options that can help manage symptoms. The doctor will formulate a treatment plan that will include changes in lifestyle with other treatments.