What is Sleep Apnea?
Sleep Apnea is a common sleep disorder in which irregular or interrupted breathing disrupts normal sleep structure. Apnea literally means “without breath;” however, the term refers to the broader concept of a pause or a decrease in breathing that leads to sleep disruption. These disruptions are typically at least 10 seconds in duration, but may be much longer and lead to arousals from sleep to help improve the breathing. The entire process leads to sleep disruption and poor sleep quality as well as other medical consequences.
The most common form of sleep apnea is obstructive sleep apnea (OSA) – so named because closure of the airway leads to an obstruction of airflow. Another less common form of sleep apnea, central sleep apnea (CSA), is caused by a decrease in the drive to breathe. This is usually a result of underlying chronic health conditions such as congestive heart failure or chronic use of respiratory suppressants. When both obstructive and central sleep apnea are present together, it is called mixed or complex sleep apnea.
What Causes Sleep Apnea?
“Obstructive sleep apnea is caused by collapse of the airway when you sleep,” says Sleep Direct founder and Board Certified Sleep Physician Dr. Dan Root. “When you are awake your airway muscles are tighter, which gives tension to the airway wall and keeps it open. But when you fall asleep all those muscles relax, and the airway becomes flexible to the point where it can collapse on itself. Some airway collapse is normal and happens to everyone, but for people with obstructive sleep apnea their airway collapse creates a critical closure so they don’t breathe adequately – or at all.”
These breathing events trigger a physiological response as blood oxygen levels drop and carbon dioxide rises. Sensing these critical imbalances, the brain rouses the body out of sleep to initiate normal breathing. While most of these sleep disruptions occur without stirring the patient into full consciousness, they impact overall sleep quality by constantly interrupting the natural rhythms of sleep – including the restful and rejuvenating cycles of REM and deep sleep.
What are the Signs & Symptoms of Sleep Apnea?
“The most obvious sign of obstructive sleep apnea is if you’re tired when you think you’re getting adequate sleep,” says Dr. Root, adding: “There are also morning headaches and loud disruptive snoring that will be reported by partners. A dry mouth at night is another sign, as it can indicate mouth breathing as a compensation for the airway obstruction.”
The most common signs and symptoms of obstructive sleep apnea include:
- Excessive daytime sleepiness
- Loud snoring (usually reported by the patient’s bed partner)
- Morning headaches
- Waking up with dry mouth or sore throat
- Grogginess, difficulty concentrating or irritability during the day
- Restless sleeping behavior and frequent body movement while asleep
- Difficulty staying asleep
One of the most frustrating aspects about sleep apnea is that the affected patient usually suffers in paradoxical silence, as the breathing events occur primarily while they are asleep and unaware. Most of the time, however, the patient’s bed partner does not suffer in silence! Quite the opposite is true, as they must deal with obstructive sleep apnea’s most tell-tale sign – loud, disruptive snoring. (While most people with sleep apnea snore, not everyone who snores has sleep apnea.) Not only must bed partners endure the patient’s chronic snoring, they also often observe the disconcertingly long silences of apnea breathing pauses, which in severe cases of OSA are typically associated with gasps or choking sounds as the sleeper resumes breathing. It’s no wonder that one of the most common routes to a sleep apnea diagnosis starts with a concerned spouse.
Central sleep apnea may have many of the same signs of OSA; however, CSA may be more common in patients with chronic pain, or neurologic diseases. Snoring may be seen in central sleep apnea, but is not a hallmark characteristic, as the primary issue is not obstruction of the airway, but a decrease in the drive to breathe.
Why Do People Snore?
Snoring is caused by vibration at the base of the tongue and the soft palate and is due to turbulence in the airway. This turbulence is caused by the partial or complete closure of the airway and the impact on the flow patterns if the air. Commonly, more significant closure leads to more turbulence, vibration and louder snoring.
What are the Risk Factors for Sleep Apnea?
The prevalence of sleep apnea is surprisingly common, with estimates of between 10–25% of the adult population experiencing clinically significant obstructive sleep apnea. Tragically, most sleep apnea patients go undiagnosed and subsequently untreated. Sleep apnea is more common in adult men, but women and children can also have it. The misconceptions about sleep apnea may contribute to the findings that more than 90% of women with sleep apnea are never diagnosed.
Another common misconception regarding sleep apnea is that obesity is the main cause. Indeed there is an association between obesity and sleep apnea, with increased weight usually resulting in an increase in the severity of symptoms. However, obesity is not an exclusive risk factor, as patients with regular or below-average weight also exhibit OSA. Instead, the biggest contributing factor in developing obstructive sleep apnea seems to be a condition that all of us face – aging. And OSA usually presents itself in men and women during middle-age.
“Sleep apnea tends to get more prevalent as we get older, and that probably has to do with changes in the airway and loss of muscle tone,” explains Dr. Root. “While it can be associated with weight, not everyone with obstructive sleep apnea is overweight. Even in normal weight people, it can just be the narrow airways or narrow nasal passages that cause the airway blockage.”
There is a strong association between sleep apnea and high blood pressure and heart disease, as well as other chronic health conditions.
“If you have high blood pressure at an early age, you should be screened for sleep apnea,” says Dr. Root. “If you snore and have high blood pressure or heart disease of any sort, then the incidence of sleep apnea is very high. If you have high blood pressure and type 2 diabetes, the crossover of having sleep apnea is also quite high.”
What are the Negative Health Consequences of Sleep Apnea?
“Simply put, sleep Apnea makes people tired,” says Dr. Root, describing the myriad of negative impacts sleep apnea can have a patient’s day-to-day life. “It can lead to poor decision making, and people may struggle with poor work performance. It can also contribute to depression. Another side effect is sleep apnea can actually make it difficult to stay asleep, so people start to complain of insomnia and wind up getting on sleeping pills. Patients can also experience excessive daytime sleepiness, making them drowsy, so they fall asleep in a meeting. And there are even more serious acute risks from issues like driving while sleeping and auto accidents.”
Chronic sleep apnea can also contribute to a number of long-term negative health consequences. Some of these long-term issues stem from the heart and circulatory system having to work harder to compensate for the apnea-induced lowered oxygen levels. The body’s reaction to the apnea episodes themselves also cause issues, as adrenaline surges into the bloodstream during the apneas, which raises blood pressure and fluctuates heart rate. The cumulative effect of these responses can contribute to a number of cardiovascular conditions, as explained by Dr. Root:
“Sleep apnea can lead to high blood pressure. So if you have mild sleep apnea, you’re twice as likely to develop high blood pressure. And if you have moderate to severe sleep apnea, you’re four times more likely to develop high blood pressure. Sleep apnea can also contribute to coronary artery disease, abnormal heart rhythms, cognitive decline, insulin resistance and stroke risk.”
Along with these serious long-term health impacts, there are a number of quality of life issues impacted by sleep apnea. Probably the most common issue is the sleep quality of a patient’s spouse or bed partner, whose long-suffering of the aforementioned snoring and alarming apnea breathing patterns can disrupt their own sleep and create anxiety. In some cases their partner’s sleep apnea symptoms necessitate sleeping in a different bed, or another bedroom entirely.
And speaking of the bedroom… sleep apnea can have an extremely adverse impact on the patient’s sex life. Driving a concerned lover into a separate bed or bedroom is a problem in and of itself, but sleep apnea can contribute to sexuality issues with decreased libido as well as erectile dysfunction.
How Do You Treat Obstructive Sleep Apnea?
Considering its prevalence and serious negative health outcomes, obstructive sleep apnea should not be ignored or downplayed. Fortunately, the science of modern sleep medicine can readily diagnose and treat obstructive sleep apnea.
Therapy for sleep apnea is focused on improving breathing during sleep by helping to keep the airway open. That may include lifestyle changes such as losing weight or avoiding alcohol or sedatives before bedtime. Another easy approach is side sleeping, as this may help many patients. When these things do not work, more impactful therapies are in order. Specialty mouthpieces that help keep the airway open while asleep are another option, and may be effective for mild OSA. Surgical options include removal of excess tissue contributing to the airway blockage or facial reconstruction of the bones to improve airway size, but surgery is usually the last resort after less invasive treatments fail. But luckily there is another option, preferred by sleep physicians and patients. The safest and most predictably effective treatment for sleep apnea is Positive Airway Pressure or PAP therapy – also commonly known as CPAP or Continuous Positive Airway therapy.
NEXT: What is CPAP Therapy, and How Does It Work?