Sleep Apnea: Causes, Symptoms, & Treatments

Sleep Apnea

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Expert Verified By: Dr. Amita Fotedar, Ph.D

Overview

Sleep Apnea is a serious medical condition in which the sleep quality of an individual is affected due to interruption in breathing during sleep.

If left untreated, symptoms get worsened it could eventually result in fatal health issues. People experiencing it stop breathing repeatedly during their sleep, sometimes hundreds of times.

Basically, Sleep Apnea disorder involves interruption of oxygen flow to the brain and the body.

The main cause of Sleep Apnea or temporary pause in the breathing process is the collapse of the tissue situated in the back of the throat.

The upper air passage muscles relax when you are in slumber. The gravity causes the tongue to fall back when you sleep on your back.

As a result, there is an interruption in the flow of air reaching the lungs due to the narrowing of the airways. The vibration of the throat tissue in the back of the throat and loud snoring is also caused because of the narrowed airways as you breathe.

Sleep Apnea impacts sleep quality and cause fatigue because of inadequate sleep. When you are tired, it is difficult to focus and concentrate and you may even unintentionally fall asleep.

Inadequate oxygen your body receives can have adverse long-term effects on your health and well-being. This includes:

  • Heart problems
  • High blood pressure
  • Depression
  • Stroke
  • Diabetes

In many cases, the problem of Sleep Apnea remains undiagnosed and many people do not receive any treatment. It is important to consult a sleep physician. A sleep physician can effectively diagnose OSA – Obstructive Sleep Apnea using sleep study or in-lab sleep study.

With the right treatment and some natural strategies and remedies, sleep apnea symptoms can be reduced and snoring can be controlled. Right treatment also helps to get your sleep back on track, improves your sleep quality, and feel refreshed and alert during the day.

The most common treatment for Sleep Apnea is manageable using CPAP therapy (Continuous Positive Airway Pressure therapy), oral appliance therapy or surgery.

Alleviating sleep apnea symptoms and normalizing breathing has the following impacts:

  • It prevents heart problems that happen as a result of the excess strain of improper breathing
  • It removes daytime fatigue
  • It prevents unwanted mental health changes caused due to inadequate sleep or apnea.

The present article highlights the causes, symptoms, risk factors, complications and best treatment options available for Sleep Apnea.

What is Sleep Apnea?

Sleep Apnea is a sleep disorder in which the sleep quality is impacted due to interruption in breathing pattern. The breathing process repeatedly stops and starts again, throughout the night, resulting in significant disruptions to sleep.

Sleep Apnea is of three types;

  1. OSA – Obstructive Sleep Apnea
  2. CSA – Central Sleep Apnea
  3. Complex sleep apnea 

1. Obstructive Sleep Apnea

Obstructive Sleep Apnea

Obstructive Sleep Apnea occurs because of the relaxation of the muscles located in the back of your throat relax.

These are the muscles that offer support to the sidewalls of the tongue and the throat, uvula (the triangular piece of tissue hanging from the soft palate), the soft palate, and the tonsils.

The airways through which you breathe closes or narrows down due to the relaxation of the muscles. As a result, the oxygen level in your blood reduces.

The brain is signaled of your difficulty and inability to breathe and briefly forces you to wake up in order to reopen your air passage. Basically, the time duration of your being awake is so short that you do not even remember.

You might feel choked and gasp for breath, and even snore loudly. These activities can repeat 5 – 30 times or even more throughout the night, causing destruction in your ability to get into deep and restful phases of sleep.

Another reason could be the restriction of airflow due to the thickened tissue or excessive fat stores around the airways. As a result, the air is squeezed as it passes through the narrow airways causing the loud snoring typically associated with OSA.

2. Central Sleep Apnea

Central Sleep Apnea is associated with obstruction in signals reaching the brain muscles that control your breathing.

In CSA, breathing is totally diminished or absent and the neurological controls for breathing are altered, triggering the control and rhythm of breathing to malfunction.

Conditions that lead to CSA – central Sleep Apnea include: severe obesity, medicines such as narcotic painkillers, issues that impact the brainstem like stroke, neck (cervical spine) conditions and brain infection.

People suffering from CSA seldom make snoring noise. This process keeps repeating multiple times throughout the night when you are asleep, and you may not be even conscious of the problem.

3. Complex sleep apnea

It is a combination of obstructive sleep apnea and central sleep apnea.

Causes of Sleep Apnea

The primary causes of Sleep Apnea include:

  1. Large neck size
  2. Genetics (Family History)
  3. Gender
  4. Ageing
  5. Endocrine disorders
  6. Body Mass Index
  7. Abnormalities of the Head and the Neck
  8. Post-menopause
  9. Smoking
  10. Medications
  11. Alcohol
  12. Race

Common symptoms of Sleep Apnea

Common symptoms of Sleep Apnea include:

  • Loud or frequent snoring
  • Waking up with a dry mouth or sore throat
  • Choking or gasping sounds
  • Unrefreshing sleep
  • Insomnia and restless or fitful sleep
  • Forgetfulness
  • Daytime sleepiness or fatigue
  • Irritability
  • Silent pauses in breathing
  • Morning headaches
  • Difficulty concentrating
  • Decreased sexual desire
  • Memory loss
  • Nocturia (waking during the night to go to the bathroom)

Risk Factors

  • Obesity: approximately 2/3rds of people with Obstructive Sleep Apnea are overweight or obese
  • Family history of OSA or snoring
  • Large neck circumference
  • Consumption of alcohol at bedtime
  • Small lower jaw and certain other facial configurations
  • Nasal obstruction due to a deviated septum, allergies, or sinus problem
  • Male gender
  • Post-menopausal (for women)
  • Large tonsils or adenoids
  • Low level of thyroid hormone (Hypothyroidism)
  • Increase in levels of growth hormone (Acromegaly)
  • Supine (flat on back) sleeping
  • Recent weight gain
  • Down syndrome
  • Smoking
  • Recessed chin or large overbite

Effects of Sleep Apnea

If left untreated, Sleep Apnea can increase the risk of health problems, including:

  • High blood pressure
  • Memory loss and mental confusion
  • Stroke
  • Heart failure, irregular heartbeats, and heart attacks (Strokes and atrial fibrillation — a fast, fluttering heartbeat)
  • Adult asthma and breathing troubles
  • Weakened immune system
  • Diabetes
  • Abnormal cholesterol
  • Depression
  • Decreased sexual desire
  • Acid reflux
  • Worsening of ADHD
  • Headaches
  • Poor performance in everyday activities, such as at school and work, motor vehicle crashes, and academic underachievement in children and adolescents.

Sleep apnea in children

While OSA can be common in children, it is not easy to get diagnosed. In addition to reduced sleep quality and continuous loud snoring, children with this sleep disorder may;

  • Exhibit daytime sleepiness and fatigue
  • Pause breathing while sleeping, snort, or gasp
  • Suffer from excessive perspiration at night, bedwetting, or night phobias and terrors
  • Adopt weird and strange sleeping positions
  • Develop behavioral problems or declining grades

If these symptoms are identified in children, it is very important to consult a child pediatrician, who specializes in sleep disorders immediately.  Left untreated, sleep apnea can result in negative effects on child’s growth, mood, learning, and overall health.

Treatment for Sleep Apnea

Treating Sleep Apnea at Home

Several ways which can help in treating and reducing symptoms of the medical condition called Sleep Apnea include:

1.    Yoga and mindful meditation – Regular meditation enhances and improves your energy levels, strengthen heart performance and improve Sleep Apnea

2.    Maintain a healthy weight – Too much of weight increases fat around the neck that aggravates the Sleep Apnea conditions. Doctors commonly recommend people with Sleep Apnea to lose weight

3.    Make changes in your sleeping pattern and positions – Scientific studies have proved that sleeping in a supine position (that is sleeping on the back) worsens Sleep Apnea symptoms. For some adults, sleeping on the side can help breathing return to normal

4.    Use a humidifier – If you are on Sleep Apnea CPAP therapy, adding a humidifier can maximize airflow quality. A humidifier is effective in humidifying your body much better in comparison to the body doing it on its own. Humidifiers are also helpful in reducing/eliminating the number of times you wake up from a dry, burning sensation in the nose

5.    Avoid alcohol and smoking before bedtime – You should avoid alcohol at least 2 hours before you go to bed. This helps you to get a sound sleep as the alcohol gets ample time to metabolize through your system. Also, research has shown that more alcohol consumption, the worse you make your Sleep Apnea symptoms.

6.    Use oral appliances – Oral appliances reduce Sleep Apnea symptoms by keeping your airway open while you are asleep. These appliances basically reposition your jaw or tongue and move then forward, in order to decrease obstruction in the airflow at the back of your throat. The 2 devices mostly used include mandibular advancement devices and tongue stabilizing devices.

7.    Use lavender oil – Lavender has anti-inflammatory properties and it is a natural sedative.  Just a few drops on towel that you can keep under your pillow relaxes you and makes you fall asleep. You can even add a few drops of lavender oil in boiling water and inhale the steam.

8.    Throat exercises – One thing that is helpful in facilitating proper airflow is a few throat exercises like;

  • Position the tongue on the same spot and make a clicking sound “tsk, tsk” for several minutes
  • Press your tongue against the floor of your mouth in a flat position.
  • Practice chewing a gum before going to sleep. Continue chewing until the jaw is tender. Chewing tighten the muscles that are responsible for opening and closing the mouth.
  • Practice blowing up a balloon using deep breaths, as recommended by the American Sleep Apnea Organization (ASAO) also helps in reducing sleep apnea symptoms. Try not to take the balloon out of your mouth between breaths. Repeat 5 times daily to improve airflow. 

9.    Open your nasal passages at night by using a saline spray (distilled water, salt, baking soda), breathing strips, a nasal valve dilator that manually widens the nasal valve, or a nasal irrigation system.

Continuous Positive Airway Pressure (CPAP)

CPAP also termed as Continuous Positive Airway Pressure — is a form of positive airway pressure ventilator that delivers mild air pressure to the upper air passage to ensure that the airway remains open and the person is able to breathe normally while he is asleep. CPAP is beneficial in treating breathing problems such as OSA – Obstructive Sleep Apnea and chronic snoring.

Sleep Apnea Pillow

Many pillows are available nowadays that are helpful in relieving sleep apnea symptoms. These pillows come in different styles and are constructed for use with a Continuous Positive Airway Pressure machine. These pillows elevate the upper body for a relaxing and better sleeping position. Sleep apnea pillows elevate the body from the waist up and prevent the airway from getting blocked and collapsing. American Sleep Apnea Association recommends using foam wedges, not soft pillows.

Sleep Apnea Dental Devices

Oral appliance therapy is a non-invasive treatment that helps to reduce Sleep Apnea symptoms to a great extent. These devices can be customized or even bought over the counter. You need to consult your dentist to have any of these devices fitted.

Advantages of Oral Appliance Therapy include;

  • Comfortable
  • Easy to wear
  • Portable
  • Quiet
  • Convenient for travel
  • Easy to care for

Two such devices include;

  • MAD – Mandibular Advancement Device – This device is useful in opening the airway by moving the lower jaw (mandible) forward. Basically, MAD snaps over the upper jaw (maxilla) and the lower jaw dental arches and possesses metal hinges that facilitates the movement of the lower jaw to be eased forward. This tightens the soft tissue, muscles of the upper airway and stabilizes your tongue and soft palate to prevent obstruction of the airway during sleep. 
  • Tongue retaining device – It is a kind of customized monobloc oral appliance that keeps your tongue in one position and this helps in keeping the airway open. It is not mostly recommended because of its limitation to get used to and less comfortable.

Sleep Apnea Surgery

Common surgeries that are helpful in treating sleep include uvulopalatopharyngoplasty (UPPP). In this surgery, the excess tissue from the pharynx and soft palate are removed so that there is no obstruction in the airflow while you are sleep.

Sleep apnea implants

These implants involve the insertion of a pacemaker system that keeps the throat muscles stimulated in order to keep them open for preventing any interruption in the breathing process. This is mostly recommended for people with moderate to severe obstructive sleep apnea.

Tennis balls

Research shows that sleeping on your side reduces sleep apnea symptoms. One of the methods recommended by doctors to alleviate symptoms includes rolling onto your back while you are in slumber. For this, pin a tube sock filled with a couple of tennis balls and place it on the back of your pajama top.

Other breathing devices

In addition to CPAP, other treatments and devices recommended for treating sleep apnea treatment include;

Bilevel positive airway pressure (BiPAP or BPAP) – This device automatically adjusts the pressure while you are asleep, offering more pressure when you breathe in (inhale), less when breathe out (exhale).

Expiratory positive airway pressure (EPAP) – This device is beneficial to people who have mild-to-moderate obstructive sleep apnea. EPAP easily fits over the nostrils and ensures that the airway is not blocked. These devices, in comparison to CPAP machines, are smaller in size and less intrusive.

Adaptive servo-ventilation (ASV) – This device is useful in treating both OSA and CSA. The device is useful in storing information associated to your normal breathing pattern and automatically makes use of airflow pressure to ensure there is no interruption in flow of oxygen while you are in sleep.

Few key points about Sleep Apnea are;(Source)

  • Sleep Apnea medical condition is an independent risk factor for high blood pressure (hypertension).
  • Around one in five adults have mild symptoms of OSA – Obstructive Sleep Apnea, while one in fifteen have moderate-to-severe symptoms.
  • Menopausal and postmenopausal women have an increased risk of Obstructive Sleep Apnea
  • While Sleep Apnea is more prevalent in those aged fifty years and above, it can impact people of all ages, including children.

FAQ – Summary

a. What is Sleep Apnea?

Sleep Apnea, also spelled Sleep Apnea is a condition that involves cessation of breathing during sleep. There is shallow breathing periods and intermittent pauses in breathing during sleep as a result of this disorder.

b. What is OSA – Obstructive Sleep Apnea?

Obstructive Sleep Apnea is defined as intermittent airflow blockage during sleep.

c. What is CSA – Central Sleep Apnea?

Central Sleep Apnea takes place when your nervous system does not send proper signals to the muscles responsible for controlling your breathing.

d. How do you decipher abbreviations and acronyms associated with Sleep Apnea?

Common acronyms or abbreviations associated with Sleep Apnea include:

  • SA: Sleep Apnea
  • CSA: Central Sleep Apnea
  • CPAP: Continuous Positive Airway Pressure
  • PAP: Positive Airway Pressure
  • BiPAP: Bilevel Positive Airway Pressure
  • OSA: Obstructive Sleep Apnea
  • AHI: Apnea-Hypopnea Index
  • APAP: Auto-titrating Positive Airway Pressure

e.    How common is Sleep Apnea?

  • One in every five adults has at least a mild form of Sleep Apnea (Twenty percent)
  • Two to three percent of children are likely to have Sleep Apnea
  • One of every fifteen adults have at least moderate Sleep Apnea (7 percent)
  • Over one in four (twenty-six percent) Canadian adults have a high risk of having or developing Obstructive Sleep Apnea.

f. What negative effects can Sleep Apnea cause?

Sleep Apnea reduces your quality of sleep, which can have a cumulative effect. It can increase the risk of health problems, including High blood pressure, atrial fibrillation, stroke, heart failure, irregular heartbeats, arterial hypertension, ischemic heart disease, and heart attacks. Other effects include mood disturbances, memory problems, trouble concentrating. It can also increase your chances of having an accident while driving.

g. What is the best treatment for Sleep Apnea?

Continuous Positive Airway Pressure (CPAP) therapy (a form of positive airway pressure ventilator) is the best and common treatment for mild and severe Obstructive Sleep Apnea. CPAP is delivered through a nasal or full-face mask attached to a tiny Continuous Positive Airway Pressure that delivers pressurized air to the upper airway, preventing the airway from collapsing during sleep. Although CPAP is very effective at treating Sleep Apnea, other options are also available including Sleep Apnea dental devices and surgery for Sleep Apnea.

h.    How to cure Sleep Apnea naturally at home without CPAP?

Some natural remedies to cure Sleep Apnea include;

  • Acupuncture
  • Excessive weight loss can help Sleep Apnea significantly and reaching a healthy weight can cure it
  • Take honey frequently as it helps in reducing inflammation around the throat area
  • Use lavender oil. Lavender has therapeutic properties, serves as a relaxant that calms and soothes, effectively clears airways in the throat and sinuses, is an anti-inflammatory and works as a natural sedative, helping you to fall asleep easier.
  • Completely avoid sleeping on your back
  • Sleeping with your head in an elevated position can significantly alleviate the symptoms of Sleep Apnea (Source)

Conclusion

Sleep apnea or sleep disorder condition is a serious problem. It should not be left untreated as it could result in some fatal health diseases. Fortunately, many treatment options are available due to advancements in the medical industry. The most common treatment includes CPAP therapy that prevents the airway from collapsing while you are asleep.

Apart from medical treatments, some natural and home treatments are also recommended that are helpful in alleviating sleep apnea symptoms. These include changes in sleeping patterns, lifestyle changes, weight management, throat exercises, etc.

Though sleep apnea is a scary sleep disorder, yet the solace is that it is a treatable condition.

Additional Resources

Best Pillow For Sleep Apnea

Infographic: 22 Proven Tips That Help You Sleep Better

Sleep Deprivation: Symptoms, Effects, Treatments, & Prevention

Why Do We Sleep?

Best Mattress For Sciatica

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