Sleep apnea has become known as a bothersome sleep disorder that not only affects an individual's quality of sleep but can have a drastic impact on their overall wellbeing. Estimates show that a staggering 23.5 million adults in the U.S suffer from sleep apnea. However, they remain undiagnosed and untreated.
What Is Sleep Apnea?
Sleep apnea is characterized by the repeated obstruction of the pharyngeal or upper airway during sleep. When the muscles in the throat relax, they can no longer support the surrounding tissue. Once this occurs, the airway collapses, making it impossible to breathe. Individuals who suffer from sleep apnea experience this repetitively throughout the night and usually wake up gasping for air as an automatic response from the body requiring oxygen. Hence, CPAP machines and other apnea treatments are employed to supply a continuous flow of oxygen into the airway. There are three types of sleep apnea. The most common, described above, is known as obstructive sleep apnea (OSA). Other forms include central sleep apnea (CSA) and complex sleep apnea.
Central sleep apnea, although not as common as obstructive sleep apnea, is equally as dangerous. It differs in a physiological sense whereby the individual's inability to breathe during sleep is not due to an obstructed airway. Instead, the brain fails to send signals to the body to continue the involuntary respiratory process while the patient sleeps. This specific form of sleep apnea is caused by the brain experiencing difficulties in respiratory regulation.
Complex sleep apnea has also been noted as a rare sleep disorder by which a patient may suffer from both CSA and OSA. When a CPAP machine has been used to provide the airway with oxygen, central sleep apnea will persist and prevent an individual from breathing in the supplied oxygen. Should the disorder seriously inhibit sleep, other treatments, including bilevel positive airway pressure (BPAP) and adaptive servo-ventilation (ASV), may be recommended. They provide a means to physically hold the airway open and supply oxygen to the lungs.
- Sleep apnea fact #1
- Driving while sleep-deprived is just as dangerous as driving while intoxicated. This is because both altered mental states result in a lack of focus, slow reaction time, and an inability to make decisions.
Causes Of Sleep Apnea
So how does sleep apnea occur? It is not unheard of for sleep apnea to occur in young, otherwise healthy patients. According to the University of Cleveland, Ohio, when it comes to analyzing sleep disorders as a whole, we see that narrowing down specific causes is not a straightforward process. Various physiological and psychological factors must be considered, such as our involuntary bodily functions, nightly sleep cycles, and circadian rhythms. These factors are not uniform and unique to each individual. In the rare sleep disorder, central sleep apnea, we have to understand what causes a lack of ventilatory effort or drive to breathe.
Studies have shown that the initial cause of CSA usually begins with a damaged or underperforming brainstem as it has control over many involuntary functions, including heart rate, sleep, and respiration. It is the way in which breathing is impaired that can result in a specific variation of central sleep apnea. These include Cheyne-Stokes breathing, Drug-induced apnea, High-altitude periodic breathing, Treatment-emergent (complex) central sleep apnea, Medical condition-induced central sleep apnea, and Idiopathic (primary) central sleep apnea.
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Medical experts have researched and established our weight and overall health in increasing our chances of developing sleep apnea. Being overweight plays a significant role in obstructive sleep apnea. As discussed previously, OSA is caused by the narrowing and obstruction of the upper airway by the surrounding tissue and muscles. Studies have shown that overweight and obese individuals have excess fat and tissue in their throats, negatively contributing to an obstructed airway.
What's unfortunate is that overweight individuals find it particularly difficult to lose excess weight to improve their condition. Since the condition brings with it extreme fatigue and restlessness, people struggle to incorporate a healthy workout routine into their daily lifestyle. They end up in an unhealthy cycle whereby they continue gaining weight, thus worsening their condition and becoming even more restless.
- Sleep apnea fact #2
- Sleep deprivation weakens the immune system because our body's T-cells, responsible for fighting off disease, decrease following a lack of sleep.
Risk Factors For Developing Sleep Apnea
What are the risk factors that increase our chances of developing sleep apnea? We have established that altered involuntary processes regarding cardiovascular function and respiration can induce central sleep apnea. However, other contributing factors need to be considered. The first is age. Older adults are more likely to develop CSA because of existing medical conditions or sleep patterns already linked to central sleep apnea. Males are shown to have higher chances of developing CSA than females. Sleeping at a higher altitude than what a person may be used to can temporarily cause CSA as well as the extensive use of opioid medications. It is also possible for patients suffering from existing obstructive sleep apnea to develop CSA. It can occur despite the help of CPAP treatment, thus resulting in treatment-emergent central sleep apnea, also known as complex sleep apnea.
The risk factors for OSA are not only dependent on your weight and diet. Middle-aged individuals suffering from conditions such as hyperthyroidism, polycystic ovary syndrome, high blood pressure, asthma, and diabetes all stand an increased chance of getting diagnosed with the sleep disorder. There could be a family history of sleep apnea or naturally narrow airways, which may be passed down through generations. People who smoke also stand an increased risk as research indicates that smoking damages the muscle function of the upper airway.
- Sleep apnea fact #3
- Women experience a more negative impact on health as a result of sleep apnea than men do. This includes developing conditions such as cardiovascular disease and diabetes.
What Are The Long-Term Consequences Of Sleep Apnea?
Individuals living with severe and, in some cases, untreated sleep apnea can find it highly debilitating to navigate their lives on a day-to-today basis. How we perform throughout our day is dependent on how much rest we get from the night before. Hence, it's easy to conclude that constantly waking up due to CSA or OSA can negatively impact a person's daily performance.
A study done by the American Thoracic Society focused on the long-term effects of sleep apnea on children, which, if left untreated, were predicted to have implications lasting into adulthood. As a result of the sleep deprivation associated with sleep apnea, a child would experience a decreased quality of life with the risk of developing depression. This is based on the condition causing restlessness, excessive sleepiness, and mental fatigue leading to increased irritability, impaired concentration, and a lack of interest in daily activities. It was seen that due to daily sleep deprivation, lifestyle factors such as relationships with family and peers would be negatively affected. Similar findings regarding their neurocognitive functions suggest that the child's academic performance would also begin to decline as a result of impaired concentration, leading to further frustration and feelings of restlessness.
Aside from the severe mental strain caused by sleep apnea, studies have found that living with the condition can have serious implications for cardiovascular health. This is due to weight gain and recurrent episodes of hypoxia and arousals during sleep. Hypoxia, characterized by an insufficient oxygen supply, occurs during the obstruction of the upper airway. Multiple episodes of low blood oxygen can result in various cardiovascular diseases, including strokes, abnormal heartbeat, recurring heart attacks, and even congestive heart failure. Low blood oxygen as a result of hypoxia has been shown to increase blood pressure and place further strain on the cardiovascular system. Hence, it has also shown that having sleep apnea increases your risk of hypertension.
- Sleep apnea fact #4
- Sleep deprivation increases your chances of developing mental illnesses such as Alzheimer's and dementia. This is because your brain is naturally cleared of specific toxins during sleep. If proper sleep does not occur, neither can this vital process.
Diagnosing and Treating Sleep Apnea
If you fear that you might be suffering from sleep apnea, our LOOKEE® Sleep Monitors will allow you to consistently monitor and record your sleeping patterns throughout the night. These readings can be taken to a sleep specialist to confirm whether or not you have a sleep apnea disorder.
When it comes to diagnosing whether or not an individual may be suffering from a form of sleep apnea, the first step would be consulting a local physician. When it comes to common symptoms of sleep apnea, many report difficulties in sleep leading to daytime sleepiness, insomnia, nightmares, sleep deprivation, and in many cases, excessive snoring. Respiratory symptoms include episodes of no breathing, waking up gasping for air, breathing through the mouth, or loud breathing. Other symptoms include depression, impaired focus, weight gain, dry mouth, dry throat, restlessness, irritability, mood swings, or headaches.
Based on their observations, a physician would recommend undergoing a sleep study, also known as a polysomnogram. This would be performed by a somnologist, i.e., a doctor who specializes in diagnosing and treating sleep disorders. The sleep study includes a range of tests. An electroencephalogram (EEG) is done to measure electrical activity in the brain. An electrooculogram (EOG) measures eye and chin movements as they signal different sleep stages. An electrocardiogram (EKG) measures heart rate and rhythm. Lastly, a respiratory inductance plethysmography measures breathing patterns and lung volume. Throughout all of these tests, the somnologist uses sensors to continuously monitor oxygen and co2 levels in the blood. After the sleep study is done, the doctor will analyze the data, and the results will show whether or not a sleep disorder is present.
If the results return positive for a specific form of sleep apnea, the condition will be treated accordingly. Sleep apnea treatments include lifestyle changes, breathing machines, oral appliances, and surgery in extreme cases.
More than 30% of individuals suffering from sleep apnea are overweight. As mentioned previously, this contributes to excess tissue in the throat, making it difficult to breathe. Hence losing weight can help improve OSA symptoms. Extensive use of cigarettes, alcohol, and sleeping pills has been shown to damage/ decrease muscle tone in the upper airway and worsen snoring. Which is why it is advised to avoid these substances. Unfortunately, sleep apnea symptoms can prevail despite lifestyle changes; therefore, sleep specialists encourage the use of breathing machines that ensure oxygen reaches the lungs and respiration takes place.
The most common treatment for sleep apnea is continuous positive airway pressure (CPAP), which uses a mask that supplies a constant flow of air through the nose. This airflow keeps the upper airway open so that a patient can continue breathing while asleep. Bilevel positive airway pressure (BiPAP) is another treatment used. It is similar to CPAP; however, the airflow changes when the patient breathes in and out. A mask connected to the BiPAP machine uses pressure to push air into the lungs. This is done so that when normal breathing takes place, the diaphragm is pushed down to fill the lungs with air. When sleep apnea persists despite the use of a CPAP machine, an automatic positive airway pressure (APAP) machine may be prescribed. This machine physically props the airway open to prevent any narrowing or obstruction.
In specific cases, an oral appliance can also be used to keep the airway open while a patient is sleeping. If the disorder continues to inhibit sleep despite undergoing many treatments, surgery will have to be considered. This is usually done by individuals born with a narrow airway, enlarged tonsils, jaw deformities, or a deviated nasal septum.
You might need surgery if you have a medical condition that makes your throat too narrow. These conditions include enlarged tonsils, a small lower jaw with an overbite, or a deviated nasal septum.
Doctors who help with sleep apnea:
Sleep Apnea Treatments:
Pediatric Obstructive Sleep Apnea Complications, Management, and Long-term Outcomes:
Complex Sleep Apnea Syndrome:
Sleep Apnea and Its Causes:
American College of Cardiology - Basics of Central Sleep Apnea:
What is obstructive sleep apnea?:
The Effects of Sleep Apnea on the Body:
AASM Sleep Foundation. Six facts about sleep apnea:
Intermittent hypoxia, cardiovascular disease and obstructive sleep apnoea: