Sleep apnea is a sleep disorder which causes breathing to completely stop and then restart. There are two main types of sleep apnea; obstructive and central. Some individuals may have a combination of the two which is called complex sleep apnea.
The symptoms of obstructive sleep apnea and central sleep apnea are similar which can make it difficult to determine the root cause of the disorder in individual patients. Symptoms include:
- Awakening abruptly with shortness of breath – typically indicates central sleep apnea
- Awakening with a dry mouth
- Awakening with a sore throat
- Breathing cessation during sleep – usually observed by a family member
- Excessive sleepiness during the day
- Loud snoring – typically worse with obstructive sleep apnea
- Morning headaches
While most people do not perceive snoring as being serious, sleep apnea can be very dangerous. Snoring is one of the most easily recognizable symptoms of sleep apnea and severe snoring, especially accompanied by periodic pauses in breathing, should be reported to a physician. However, not all people who snore have sleep apnea.
The causes of obstructive sleep apnea and central sleep apnea are different.
• Central sleep apnea – This is the less common of the two forms. With central sleep apnea the brain fails to send the appropriate signals to the muscles that control breathing. Patients may wake up short of breath and may have difficulty falling or staying asleep. The most common cause is heart disease but it may also be caused by stroke. People with this form of sleep apnea are more prone to remember waking up during the night.
• Obstructive sleep apnea – This is the more common of the two forms of sleep apnea. Obstructive sleep apnea is caused by the relaxation of the muscles in the back of the throat. The muscles are supposed to support the soft palate, tongue, and tonsils. When those muscles relax it causes the airway to constrict as the patient inhales which causes breathing to stop momentarily. This can lower oxygen levels enough to briefly awaken patients who then resume breathing normally. This period of wakefulness is so brief most patients do not remember it. However, as the process may repeat up to 30 times a night it will lead to sleep deprivation and causes the above mentioned symptoms.
Physicians typically recommend a sleep study to determine if a patient has sleep apnea. These are usually conducted in a sleep center but a simplified version can be undertaken in the home.
• Nocturnal polysomnography – This test is usually performed in a sleep center. The patient goes to a facility at night where their heart, brain, and lung activity will be monitored. Additionally breathing patterns, blood oxygen levels, and arm and leg movements will also be monitored.
• Home testing – Portable monitoring devices can be sent home with a patient to monitor blood oxygen levels, heart rate, and breathing patterns. Individuals with sleep apnea will show decreased oxygen levels that rise when the patient awakens. Abnormal results can lead to a diagnosis or may indicate further testing at a sleep center is needed.
Mild cases of sleep apnea may be resolved with weight loss or smoking cessation. Moderate to severe sleep apnea may require medical intervention.
• Medical devices – There are several medical devices that can increase air pressure entering the airways of the patient in order to keep air passages open and effectively preventing both snoring and sleep apnea.
- CPAP – A continuous positive airway pressure device
- BPAP – Bilevel positive airway pressure
- Oral appliances – these are less effective but easier for some patients to use
• Surgery – Obstructive sleep apnea may be treated by removing excess tissue from the throat or nose which may be blocking air passages.
- UPPP – During uvulopalatopharyngoplasty tissue from the top of the throat and rear portion of the mouth are removed. The adenoids and tonsils may also be removed during this procedure.
- Tracheostomy – This type of treatment is reserved for patients with sleep apnea that is life-threatening that has been unresponsive to other forms of treatment. A tube is surgically inserted into the neck to assist with breathing. The opening is kept covered during the day and uncovered at night to allow air to freely flow in and out of the lungs.
- Maxillomandibular advancement – During this operation the jaw is surgically moved forward to enlarge the space behind the soft palate and tongue to reduce the likelihood of airway obstruction.
While sleep apnea can be a severe condition, most patients are able to resolve their sleep disturbances with minimally invasive devices or lifestyle changes.