What is Sleep Apnea?

What are the symptoms of sleep apnea?

Sleep apnea has one major tip-off: Loud and harsh snoring interspersed with long pauses when breathing stops for extended periods. This is followed by a violent snort, gasp, or moan when the brain signals a need for more oxygen. These constant disruptions throughout the night, with its reduced levels of oxygen in the blood and increased levels of adrenaline from the autonomic nervous system, are thought to cause unnatural surges in blood pressure experienced by people with sleep apnea.

Not everyone who snores has sleep apnea, but almost everyone who has sleep apnea snores. Common symptoms of sleep apnea include:

  • Awakening due to gasping or choking
  • Restless sleep
  • Memory impairment
  • Morning headaches
  • Morning sore throat or dry mouth
  • Frequent awakening to urinate
  • Erectile dysfunction
  • Spousal complaints of snoring or awakening due to the arousals from apnea

Please take the sleep questionnaire if you suspect that you might be suffering from a sleep-related medical issue.

What is sleep apnea?

Apnea - is derived from the Greek word for “lack of breath”. Sleep apnea is a serious, potentially life-threatening sleep-related breathing disorder that is often linked with loud, heavy snorers.

There are three types of sleep apnea:

  • Central Sleep Apnea is the result of a brain abnormality causing a failure of the brain to activate the muscles involved in breathing. This is relatively rare.
  • Obstructive Sleep Apnea - OSA, is triggered by a complete obstruction of the upper airway, resulting in cessation of breathing thereby disrupting sleep. Partial airway closing is called a sleep hypopnea. Snoring is commonly associated with obstructive sleep apnea.
  • Complex or mixed sleep apnea - a combination of central and obstructive sleep apnea.

Sleep Disordered Breathing (SDB) is common in the United States. The National Commission on Sleep Disorders Research estimated that minimal sleep apnea (RDI) affects 7-18 million people (4% of middle-aged men and 2% of middle-aged women) have the condition. In the United States and that relatively severe cases (RDI > 15) affect 1.8-4 million people. The prevalence increases with age. SDB remains undiagnosed in approximately 92% of affected women and 80% of affected men.

Patients with Obstructive Sleep Apnea (OSA) may experience repetitive episodes of complete upper airway obstruction during sleep as well as partial airway closing, that can last anywhere from a few seconds to minutes and may occur 5 to 30 times or more an hour. The muscle tone of the body ordinarily relaxes during sleep, and at the throat area the human airway is composed of collapsible walls of soft tissue which can obstruct breathing during sleep. Oxygen levels drop and carbon dioxide levels rise in the blood. The reduction in oxygen and increased carbon dioxide alert the brain to resume breathing and cause awakening. The patient awakens with a jolt and resumes breathing. Blood pressure spikes during the apneic event, sometimes by as much as 30 mm Hg systolic.

As the person returns to sleep, typically unaware of having awakened, the throat muscles relax once again, the airway closes, and the sleep apnea pattern is repeated. These subsequent and frequent arousals, although necessary for breathing to restart, prevent the patient from getting restorative, deep sleep.

Individuals with low muscle tone and soft tissue around the airway (e.g., because of obesity) or structural features that give rise to a narrowed airway are at higher risk for OSA. The elderly are also more likely to have OSA than young people. Men are more likely to suffer sleep apnea than women and children are, though it is not uncommon in the last two population groups. The risk of OSA rises with increasing body weight, active smoking and age. In addition, patients with diabetes or "borderline" diabetes have up to three times the risk of having OSA.

Common symptoms of obstructive sleep apnea include loud snoring, restless sleep, and sleepiness during the daytime. Diagnostic tests include home sleep studies or Polysomnography in a sleep clinic.

Treatments involve lifestyle changes, such as avoiding alcohol or muscle relaxants, losing weight, and quitting smoking. Many people benefit from sleeping at a 30-degree elevation of the upper body or higher, as if in a recliner which helps prevent the gravitational collapse of the airway. Lateral positions (sleeping on a side), as opposed to supine positions (sleeping on the back) are also recommended as a treatment for sleep apnea.

People benefit from various kinds of oral appliances to keep the airway open during sleep. Continuous Positive Airway Pressure (CPAP) is the most effective treatment for obstructive sleep apnea. There are also surgical procedures to remove and tighten tissue and widen the airway.

Sleep apnea can have life-threatening cardiovascular consequences by causing high blood pressure, abnormal heart rhythms (arrhythmias), thereby increasing the risk of heart attack and stroke. Sleep experts consider sleep apnea to be as great a risk factor for cardiovascular disease as cholesterol, smoking, hypertension, and diabetes. A study in “The Lancet” medical journal, reported that the risk of a cardiovascular event was three times higher in men with severe apnea than in the general population.

Sleep apnea can also contribute to memory problems and problems at work and automobile/truck-related accidents due to fatigue. Researchers have also linked sleep apnea to erectile dysfunction and obesity.