Sleep Apnea

1 What is Sleep Apnea?

Sleep apnea is a chronic condition characterized by breathing pauses or shallow breathing during sleep. Pause in breathing may last for few seconds to minutes and occur for more than 30 times in an hour.

Normal breathing will start after this episode, usually marked by a loud snort. Breathing pauses affects the quality of the sleep and make the person sleepy in the morning.

Sleep apnea remains undiagnosed in many cases as there are no specific tests to confirm the diagnosis. There are three main types of sleep apnea:

  • Obstructive sleep apnea – this occurs when the muscles of the throat relax. It is the most common form of sleep apnea
  • Central sleep apnea – this type of sleep apnea is caused by a dysfunction in which the brain does not send signals to the muscles that control breathing
  • Complex sleep apnea syndrome – it is a complex condition in which a person has both obstructive and central sleep apnea. It is also called as treatment-emergent sleep apnea.

Treatment alleviates the symptoms of sleep apnea and prevents complications like heart problems.

2 Symptoms

One of the most common symptoms of sleep apnea is loud snoring. Breathing pauses occur in between snoring and this is usually followed by a gasp.

SleepApnea

Position of sleep determines the loudness of snoring, with the loudest when one sleeps on the back and less noisy on the sides. Initially, snoring may not be present every night. But as the condition progresses, the frequency increases and snoring gets louder.

Breathing pauses are observed by the partner or another family member. Shortness of breath may be present when one gets up suddenly in between sleep. Very often the person gets up with a dry mouth. Other common symptoms include:

3 Causes

Causes of sleep apnea vary depending on its type.

Obstructive sleep apnea is caused by the relaxation of the muscles at the back of the throat. Relaxation narrows the airway and reduces airflow.

This difficulty in breathing is sensed by the brain which sends signal to briefly arouse the person. Awakening is accompanied by a gasping or snorting sound. This pattern of breathing pause and awakening happens more than 30 times in an hour, throughout the night.

Disruptions in sleep affect the quality of sleep and converts deep sleep into a light one. The person may not feel rested even after a full night sleep. This makes them feel sleepy during the day.

Central sleep apnea is caused by the disruption of signals to the breathing muscles. In this type of sleep apnea, the person may not breathe for a very short period of time. They have difficulty in staying asleep and/or to fall asleep.

Major risk factors for sleep apnea include:

  • Being overweight
  • Increased neck circumference
  • Narrow airways
  • Family history
  • Use of alcohol
  • Use of sedatives or tranquilizers
  • Smoking
  • Nasal congestion
  • Heart disorders
  • Certain medications like opioid drugs
  • Stroke

The risk of developing sleep apnea is more among males and it increases with age. It is prevalent among older adults.

4 Making a Diagnosis

Diagnosis of sleep apnea is based on signs and symptoms. It may need overnight monitoring of breathing and other functions during sleep. Tests used to detect sleep apnea include:

  • Nocturnal polysomnography – in this test an equipment monitors heartbeat, lung and brain functioning, breathing patterns, movements of arms and legs, and oxygen levels in blood during sleep.
  • Sleep tests – in this test, heart rate, blood oxygen levels, airflow, and breathing patterns are monitored at home during sleep. Drop in oxygen level followed by awakenings indicate sleep apnea.

Tests are recommended to check for throat or nose blockage, and brain functions.

5 Treatment

Mild forms of sleep apnea are treated by lifestyle changes like losing weight and quitting smoking. Treating allergies clears the airways and reduces sleep apnea. Blockage of airways are cleared by using devices or surgery. Treatments include:

  • Continuous positive airway pressure (CPAP) – a small machine provides air pressure that is just enough to clear the block and keep the passage open. People need a certain amount of practice to get used to the mask while sleeping.
  • Airway pressure devices – auto-CPAP adjusts the pressure automatically while the person is asleep. It is more commonly used in case of obstructive sleep apnea.
  • Oral appliances – these devices keep the throat open for free passage of air. There are different types of devices and one needs to find the device that is most comfortable and convenient for the person.
  • 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.
  • Treating the underlying conditions like neuromuscular disorders improves the symptoms of sleep apnea. Central sleep apnea can be controlled by using supplemental oxygen therapy.
  • Adaptive servo-ventilation (ASV) is a device which stores the breathing pattern of a person in a digital format and uses the information to control air pressure during sleep, preventing sleep apnea.
  • ASV is recommended for improving central sleep apnea. CPAP is also useful in treating this form of the condition.
  • 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.

6 Prevention

Controlling the risk factors help to prevent 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

Depending on the specific symptoms and causes of sleep apnea the following homeopathic remedies are used: 

  • arsenicum album,
  • lachesis,
  • opium,
  • sambucus,
  • spongia,
  • Sulphur  

Weight loss and exercise are effective treatment for controlling sleep apnea. Flower remedy or essence therapy is sometimes suggested for improving sleep and to control sleep pauses.

Using serotonin precursors like 5-HTP is also considered to be useful or people suffering from this condition. Behavioral treatments including breathing techniques and sleeping postures may help to alleviate the symptoms to certain extent.

8 Lifestyle and Coping

Lifestyle modifications are necessary in order to cope with sleep apnea.

Self-management is the most ideal way to control symptoms of sleep apnea. This includes:

  • losing excess weight,
  • exercise,
  • avoiding alcohol and certain medications,
  • and quitting smoking.

9 Risks and Complications

Sleep apnea result in complications like:

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