Obstructive Sleep Apnea

1 What is Obstructive Sleep Apnea?

Obstructive sleep apnea is a common sleep disorder in which the breathing pauses during sleep due to narrowing of airway. This condition is caused by the failure of the muscles at the back of throat to keep the airway open.

Obstructive sleep apnea affects the quality of sleep and reduces the level of oxygen in blood. This combination of sleep deprivation and reduced oxygen levels may result in hypertension, heart disease and memory problems. It also increases sleepiness during daytime.

It is most commonly seen in older adults and people who are obese. Treatment methods include appliances or devices to keep the airway open for smooth flow of air.

Surgical procedure may also help to change the structure of nose, throat, jaw, or mouth, and keep the airways open.

2 Symptoms

Symptoms of obstructive sleep apnea is usually noticed by the partner or another family member. Pause in breath is the most common symptom of obstructive sleep apnea.

The person is awakened suddenly from sleep due to lowering of oxygen levels in blood. The awakening is usually characterized by a snort or gasping sound. People with obstructive sleep apnea usually snore loudly.

Other common symptoms of the disorder include:

Snoring is generally not considered to be a serious condition. In people with obstructive sleep apnea, loud snoring may be punctuated by breath pauses.

3 Causes

Obstructive sleep apnea occurs when the muscles in the back of your throat relax. This lowers the amount of oxygen in blood. Reduced levels of oxygen in blood is sensed by the brain, and it rouses the person.

This awakening is not usually not registered. The airway opens again and blood flow becomes normal. Awakening is usually accompanied by a gasping or snorting sound. The pattern of breath pause followed by awakening repeats about 30 times or more in an hour.

This disruption of sleep affects the quality of life and the person feels sleepy during daytime. Some of the factors that increase the risk of obstructive sleep apnea are: 

It is most commonly found in males in adults in the age group of 16-60 years.

4 Making a Diagnosis

Diagnosis of obstructive sleep apnea is based on signs and symptoms, and tests. Physical examination reveals the abnormalities in throat, jaws, or nose that result in obstructive sleep apnea. Additional tests are recommended based on severity of the condition.

Overnight monitoring of breathing pattern, airflow, and other functions is done through polysomnography. In this method, an equipment connected to the body evaluates and monitors activities of vital organs, breathing patterns, arm and leg movements, and oxygen levels in blood.

This may be done in two ways – split-night study or full-night study. In split-night study, the person is monitored during the first half of the night. If obstructive sleep apnea is diagnosed, continuous positive airway pressure (CPAP) is applied for the second half of the night.

Polysomnography is helpful in differentiating other sleep disorders like narcolepsy.

Oximetry is a method to measure levels of oxygen in the blood during sleep. Frequent drop in oxygen level followed by subsequent increase indicates sleep apnea.

This is usually followed by polysomnography for confirmatory diagnosis. Portable monitoring can be done at home to diagnose the condition. Portable monitoring involves evaluation of airflow, breathing pattern, and oxygen levels in blood.

5 Treatment

Mild cases of obstructive sleep apnea is treated by appropriate lifestyle changes. This includes:

  • maintaining optimum body weight,
  • regular exercise,
  • moderate use of alcohol,
  • quitting smoking,
  • use of nasal decongestant.

Certain devices help to open up the narrow airway.

Positive airway pressure – in this method, air pressure is delivered through a device placed over the nose and mouth during sleep. It reduces the frequency of breathing pauses and improves the quality of sleep.

The most common form of positive airway pressure device is CPAP. This device provides air pressure that is slightly higher than the surrounding areas which is just enough to keep the airway open.

Some people may be uncomfortable wearing the mask, and they may need to get adjusted to the machine or device after many trials. A humidifier can be used along with the CPAP.

There are two types of CPAP – fixed pressure and auto-titrating CPAP.

Fixed CPAP keeps the pressure constant, while auto-titrating CPAP adjusts the level of pressure according the airway resistance.

Bilevel positive airway pressure (BiPAP) is a device that creates a higher pressure during inhalation and lowers it during exhalation. This helps to improve the weak sleeping pattern of central sleep apnea.

Oral devices are suggested for people with mild or moderate form of obstructive sleep apnea. These devices help to keep the airway open either by keeping the jaw forward or by keeping the tongue in a different position. Medications are used to reduce sleepiness in some people.

Surgery – this is recommended only when the person does not respond to devices and appliances. The airway is enlarged by surgery. There are different types of surgery for controlling sleep apnea.

In uvulopalatopharyngoplasty, tissue from the top of the throat and from the back of throat is removed. Tonsils and adenoids are also removed during the procedure.

In jaw repositioning, the jaw is moved forward to increase the space behind the tongue and soft palate. Implants like plastic rods are also used to remove obstruction. The implants are generally placed in the soft palate.

Life-threatening forms of sleep apnea is treated by creating a new passage way through tracheostomy. In this method, a small opening is made in the neck to insert a metal or plastic tube for breathing.

Nasal surgery helps to correct the deviated septum and to remove polyps, both of which obstruct the flow of air. Weight loss surgery and surgery to remove adenoids are also helpful in controlling sleep apnea.

6 Prevention

Controlling the risk factors help to prevent obstructive sleep apnea. Avoid alcohol and sedatives before sleep as they slow down breathing. Maintaining optimum body weight and quitting smoking are also effective in preventing sleep apnea.

7 Alternative and Homeopathic Remedies

Arsenicum album, Lachesis, opium, sambucus, spongia, and Sulphur are recommended homeopathy remedies, depending on the specific symptoms and causes of sleep apnea.

Flower remedy or essence therapy is sometimes suggested for improving sleep and to control sleep pauses. Honey, chamomile, cinnamon, lavender, garlic, and peppermint are the home remedies for improving sleep.

8 Lifestyle and Coping

Maintaining a healthy lifestyle is the best way to control symptoms of sleep apnea. This includes:

  • losing excess weight,
  • exercise,
  • avoiding alcohol,
  • quitting smoking.

9 Risks and Complications

There are several risks and complications associated with obstructive sleep apnea.

Obstructive sleep apnea increases the risk of cardiovascular problems like

They also have an increased risk of developing abnormal heart patterns. People with this form of sleep apnea show excessive daytime fatigue and irritability.

Complications with the use of medications and surgery increases in people with obstructive sleep apnea. Eye problems, memory problems, headaches, mood swings and nocturia are other complications of this disorder.

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