Sleep Apnea: When Snoring Is More than Snoring
Dec 10, 2020
Sleep disorders are a significant health issue in the United States – affecting productivity, quality of life and affected persons’ overall health outcomes.
One type of sleeping disorder, sleep apnea, is especially prevalent among the U.S. population – affecting at least 25 million Americans. If left untreated, sleep apnea can lead to poor health outcomes and an increased risk for certain severe chronic health conditions, including high blood pressure, type 2 diabetes, heart disease, depression and stroke.(1)
If you think you might have sleep apnea, make an appointment to see your doctor. Treatment can alleviate your symptoms and may help prevent heart problems and other complications. Learn more about sleep apnea, how to get a proper diagnosis and the treatment options available for this condition.
What is Sleep Apnea?
Sleep apnea is a chronic and potentially dangerous sleep condition in which breathing patterns repeatedly start and stop. The irregularity of breathing patterns in sleep apnea happen when the airway is blocked.(2)
There are three primary types of sleep apnea, including:(3)
- Obstructive sleep apnea, which is the most form that happens when throat muscles relax and block the airway during sleep.
- Central sleep apnea, which is the form that occurs when the brain is unable to transmit the signals to muscles responsible for controlling breathing.
- Complex sleep apnea syndrome, also referred to as treatment-emergent sleep apnea, occurs when someone suffers from obstructive sleep apnea and central sleep apnea.
What Are the Symptoms of Sleep Apnea?
All three primary forms of sleep apnea have the same baseline characteristics – mostly stemming from poor sleeping patterns and lower oxygen levels during sleep. These common symptoms include:(2)
- Excessive daytime sleepiness
- Headaches upon waking in the morning
- Labored or otherwise disrupted breathing patterns during which respiration can be difficult or even stop for up to a minute at a time
- Difficulty thinking through things clearly or a limited attention span
Additional symptoms associated with obstructed sleep apnea include
- Snoring, including very loud snoring accompanied by gasping, snorting or choking – sometimes severe enough to wake the person up
- Sore throat or dry mouth in the mornings
- Nocturia, or needing to wake up frequently in the middle of the night to urinate
In many cases, people with sleep apnea are unaware of their breathing issues at night. Chronic snoring is the most common symptom of obstructive sleep apnea, but it usually is not a problem among people with central sleep apnea. Excessive daytime sleepiness is generally the symptom recognized by people that live alone, while others often hear of their breathing problems from a bed partner, family member or roommate.
What Are the Risk Factors and Causes for Sleep Apnea?
There are several causes and risk factors for sleep apnea – some that can be controlled and some that cannot. It is essential to know the full range of factors that can lead to sleep apnea.
Modifiable risk factors for sleep apnea, which center on unhealthy lifestyle habits include:(2)
- Smoking. Smoking causes inflammation in the upper airway that can affect breathing or affect how the brain controls sleep or the muscles involved in the breathing process.
- Alcohol. Drinking alcohol to excess can increase the relaxation of muscles in the throat and mouth, which close the upper airway.
- Diet. Poor eating patterns and not getting enough exercise can lead to being overweight or obese, which can cause sleep apnea.
Adopting these lifestyle habits and behaviors can help reduce the effects of sleep apnea. Causes of sleep apnea not related to lifestyle include:(3)
- Age. The risk for sleep apnea increases with age – with most cases happening among middle-aged and older people.
- Sex. Males are more prone than females to develop central sleep apnea.
- Heart conditions. People with congestive heart failure face a higher risk for sleep apnea.
- Stroke. Having had a stroke can increase the risk for sleep apnea.
How is Sleep Apnea Diagnosed?
A doctor can generally begin diagnosing sleep apnea by reviewing medical history, performing a physical exam and ruling out other potential causes for sleep problems – but ultimately, a sleep study is needed for an accurate diagnosis.
Sleep studies are conducted by a sleep specialist and can be done in either a designated sleep center or at home. Sleep studies can:(2)
- Detect sleep apnea events, or times when breathing stops or slows abnormally
- Detect high or low levels of activity in the muscles that control breathing
- Monitor levels of blood oxygen
- Monitor brain and heart activity during sleep
- Determine the type of sleep apnea, if present
What Treatments Are Available for Sleep Apnea?
Luckily, there is an array of treatment options available for sleep apnea – ranging from conservative to invasive. The right treatment for you will depend on the severity of your condition and how much it affects your quality of life.
Conservative treatment options for milder forms of sleep apnea include:4
- Losing weight. Just a 10% reduction in body weight can provide noticeable symptom improvements in people who are overweight.
- Avoiding alcohol and certain sleep pills. Drinking alcohol before bed or taking certain types of sleep pills can increase the likelihood of airway over-relaxation during sleep, which prompts apneic periods.
- Sleeping in a side position. For some patients with mild sleep apnea, breathing interruptions occur only when they are sleeping on their backs. Using a wedge pillow or another method to help encourage sleeping on the side can help.
- Nasal sprays or breathing strips. The use of these products can help reduce snoring and improve overall airflow in people with sinus conditions or general nasal congestion.
For more advanced cases of sleep apnea, treatment with devices may be the best route. Mechanical and device treatment options for sleep apnea include positive airway pressure (PAP) therapy, stimulator devices or dental appliances. Your doctor and a sleep specialist will evaluate your case and determine whether these options are appropriate for you.(4)
Can Surgery Help Sleep Apnea?
Surgery may be considered in cases where conservative treatment options and a trial of PAP have not been effective in curbing sleep apnea symptoms. Surgery is also appropriate for people with excessive or malformed tissue obstructing airflow through the nose or throat, such as a deviated nasal septum, exceptionally large tonsils or a small jaw with an overbite.
Surgery for sleep apnea can typically be done on an outpatient basis. Surgery types include:4
- Somnoplasty. A minimally invasive procedure to reduce the soft tissue in the upper airway. Radiofrequency energy is leveraged to achieve this.
- Uvulopalatopharyngoplasty. A procedure to remove soft tissue on the back of the throat and palate. This helps widen the airway at the throat opening.
- Tonsillectomy. A procedure to remove the tonsils from the back of the throat. Tonsil issues are particularly common among children with airway obstruction issues.
- Nasal surgery. Procedures to correct a deviated septum or another nasal obstruction.
- Mandibular/maxillary advancement surgery. This surgery corrects certain facial abnormalities or throat obstructions that play a role in obstructive sleep apnea. This procedure is reserved for the most severe sleep apnea cases with head-face abnormalities because it is invasive.
Outlook: Moving Forward in Life with Sleep Apnea
Living with sleep apnea can have effects that go beyond the physical. Difficulties with sleeping can ultimately affect emotional well-being. Studies have established a link between sleep apnea and mental health conditions – including mood disorders like depression, as well as anxiety and post-traumatic stress disorder.(5)
If you have been diagnosed with sleep apnea, it is critically important that you adopt and stick to healthy lifestyle habits and any prescribed treatments. If your symptoms do not improve despite following treatment plans, your doctor can help you work through other options.
- American Academy of Sleep Medicine. Rising prevalence of sleep apnea in the U.S. threatens public health. Published September 29, 2014.
- National Institutes of Health. National Heart, Lung and Blood Institute. Sleep Apnea.
- The Mayo Clinic. Sleep Apnea. Last reviewed July 28, 2020.
- Cleveland Clinic. Sleep Apnea: Management and Treatment. Last reviewed March 3, 2020.
- Kaufmann CN, Susukida R, Depp CA. Sleep apnea, psychopathology, and mental health care. Sleep Health. 2017;3(4):244-249. doi:10.1016/j.sleh.2017.04.003
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