When you sleep, the muscles that control your upper airways relax. When they relax too much, you begin to snore and may even experience breathing difficulties. You are likely unaware of the sleep disturbance at the time it occurs, but you’ll see the signs in the next day—a morning headache, excessive daytime sleepiness and/or trouble focusing your thoughts. These are symptoms of sleep apnea.
In a given night, a person with sleep apnea may stop breathing 20 to 60 or more times per hour. In addition to these apneic events, people may experience:
- Snoring. (Note: not everyone who snores has this condition.)
- Gasping or choking sensations
- Daytime sleepiness
- Early morning headaches
When breathing stops, the sleeper is awakened just enough to inhale and resume breathing, often without being aware of the sleep disruption. In fact, most people with sleep apnea may be unaware of the problem.
Early recognition and treatment of sleep apnea is important because it may be associated with irregular heartbeat, high blood pressure, heart attack, and stroke.
Sleep apnea occurs in all age groups and both sexes. People most likely to have or develop sleep apnea include those who snore loudly and also are overweight, or have high blood pressure, or have some physical abnormality in the nose, throat, or other parts of the upper airway. Sleep apnea seems to run in some families, suggesting a possible genetic basis.
Sleep Apnea (OSA) occurs in all age groups and in both sexes. People most likely to have or develop Sleep Apnea include those who snore loudly, are overweight, have high blood pressure, or have some physical abnormality in the nose, throat, or other parts of the upper airway. Sleep Apnea seems to run in some families, suggesting a possible genetic basis. Even children can have Sleep Apnea. Certain factors may put you at increased risk:
- Obstructive Sleep Apnea
- Excess weight.
Fat deposits around your upper airway may obstruct your breathing. However, not everyone who has sleep apnea is overweight. Thin people may have Sleep Apnea too.
- Neck circumference.
The size of your neck may indicate whether or not you have an increased risk of Sleep Apnea. That's because a thick neck may narrow the airway and may be an indication of excess weight. A neck circumference greater than 17.5 inches (44 centimeters) is associated with an increased risk of Obstructive Sleep Apnea (OSA).
- High blood pressure (hypertension).
Sleep apnea is common in people with hypertension. Those patients that take one or more medications to control high blood pressure should be evaluated for OSA.
- A narrowed airway. You may inherit a naturally narrow throat. Or, your tonsils or adenoids may become enlarged, which can block your airway.
- Being male.
Men are twice as likely to have sleep apnea as women are. However, women increase their risk if they're overweight, and the risk also appears to rise after menopause due to hormonal shifts that occur during this life change.
- Being older.
Sleep apnea occurs two to three times more often in adults older than 65.
- Family history.
If you have family members with Sleep Apnea, you may be at increased risk.
- Use of alcohol, sedatives or tranquilizers.
These substances relax the muscles in your throat.
Smokers are three times as likely to have OSA than are people who've never smoked. Smoking may increase the amount of inflammation and fluid retention in the upper airway. This risk likely drops after you quit smoking.
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- Mechanical and structural problems in the airway
- Throat muscles that relax during sleep and partially block the opening of the airway
- Obesity-when an excess amount of tissue in the airway causes it to be narrowed
With a narrowed airway, the person continues his or her efforts to breathe, but air cannot easily flow into or out of the nose or mouth. Unknown to the person, this results in heavy snoring, periods of no breathing, and frequent arousals (causing abrupt changes from deep sleep to light sleep). Ingestion of alcohol and sedatives increases the frequency and duration of breathing pauses in people with sleep apnea.
How is Normal Breathing Restored During Sleep?
During the apneic event, the person is unable to breathe in oxygen and to exhale carbon dioxide, resulting in low levels of oxygen and increased levels of carbon dioxide in the blood. That chemical reaction alerts the brain to resume breathing, often with a loud snort or gasp.
This pattern repeats itself several times throughout the night, preventing the patient from getting enough restorative, deep sleep.
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The consequences of sleep apnea range from annoying to life-threatening. Because of the serious disturbances in their normal sleep patterns, people with sleep apnea often experience:
- Sleepiness during the day
- Poor concentration and daytime performance
- Sexual dysfunction
- Learning and memory difficulties
- Falling asleep while at work, on the phone or driving
- High blood pressure
- Risk of heart attack or stroke
Untreated sleep apnea patients are 3X (or more) likely to have automobile accidents; CPAP treatment reverses the increased risk.
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North Dakota Center for Sleep conducts a sleep study using Polysomnography (PSG), a test that records a variety of body functions during sleep, such as the electrical activity of the brain, eye movement, muscle activity, heart rate, respiratory effort, air flow and blood oxygen levels.
Learn more about the process
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The specific therapy for sleep apnea is tailored to the individual patient based on medical history, physical examination and the results of polysomnography. Medications are generally not effective in the treatment of sleep apnea. Oxygen is sometimes used in patients with central apnea caused by heart failure. It is not used to treat obstructive sleep apnea.
Physical or Mechanical Therapy
Nasal continuous positive airway pressure (CPAP) is the most common therapy for sleep apnea. With this therapy, the patient wears a mask over the nose during sleep and pressure from a blower forces air through the nasal passages preventing the throat from collapsing during sleep.
Occasionally, our doctor may suggest other therapies such as
- Weight loss
- Behavioral changes
- Dental appliances
- Other procedures
Behavioral changes are an important part of the treatment program. In mild cases, behavioral therapy may be all that is needed.
- Weight loss -Even a 10 percent weight loss can reduce the number of apneic events for most patients.
- Behavioral changes -Individuals with apnea should avoid the use of alcohol, tobacco and sedatives, which make the airway more likely to collapse during sleep and prolong the apneic periods.
- Sleep changes -In some patients with mild sleep apnea, breathing pauses occur only when they sleep on their backs. Using pillows and other devices that help them sleep in a side position may be all they need to overcome their sleep apnea.