Sleep apnea is a potentially serious sleep disorder in which breathing repeatedly stops and starts. If you snore loudly and feel tired even after a full night's sleep, you might have sleep apnea.
The main types of sleep apnea are:
• Obstructive sleep apnea, the more common form that occurs when throat muscles relax
• Central sleep apnea, which occurs when your brain doesn't send proper signals to the muscles that control breathing
• Complex sleep apnea syndrome, also known as treatment-emergent central sleep apnea, which occurs when someone has both obstructive sleep apnea and central sleep apnea
The signs and symptoms of obstructive and central sleep apneas overlap, sometimes making it difficult to determine which type you have. The most common signs and symptoms of obstructive and central sleep apneas include:
• Loud snoring
• Episodes in which you stop breathing during sleep — which would be reported by another person
• Gasping for air during sleep
• Awakening with a dry mouth
• Morning headache
• Difficulty staying asleep (insomnia)
• Excessive daytime sleepiness (hypersomnia)
• Difficulty paying attention while awake
• Irritability
This occurs when the muscles in the back of your throat relax. These muscles support the soft palate, the triangular piece of tissue hanging from the soft palate (uvula), the tonsils, the side walls of the throat and the tongue.
When the muscles relax, your airway narrows or closes as you breathe in. You can't get enough air, which can lower the oxygen level in your blood. Your brain senses your inability to breathe and briefly rouses you from sleep so that you can reopen your airway. This awakening is usually so brief that you don't remember it.
You might snort, choke or gasp. This pattern can repeat itself five to 30 times or more each hour, all night, impairing your ability to reach the deep, restful phases of sleep.
Sleep apnea can affect anyone, even children. But certain factors increase your risk.
Factors that increase the risk of this form of sleep apnea include:
• Excess weight. Obesity greatly increases the risk of sleep apnea. Fat deposits around your upper airway can obstruct your breathing.
• Neck circumference. People with thicker necks might have narrower airways.
• A narrowed airway. You might have inherited a narrow throat. Tonsils or adenoids also can enlarge and block the airway, particularly in children.
• Being male. Men are two to three times more likely to have sleep apnea than are women. However, women increase their risk if they're overweight, and their risk also appears to rise after menopause.
• Being older. Sleep apnea occurs significantly more often in older adults.
• Family history. Having family members with sleep apnea might increase your risk.
• Use of alcohol, sedatives, or tranquilizers. These substances relax the muscles in your throat, which can worsen obstructive sleep apnea.
• Smoking. Smokers are three times more likely to have obstructive sleep apnea than are people who've never smoked. Smoking can increase the amount of inflammation and fluid retention in the upper airway.
• Nasal congestion. If you have difficulty breathing through your nose — whether from an anatomical problem or allergies — you're more likely to develop obstructive sleep apnea.
• Medical conditions. Congestive heart failure, high blood pressure, type 2 diabetes and Parkinson's disease are some of the conditions that may increase the risk of obstructive sleep apnea. Polycystic ovary syndrome, hormonal disorders, prior stroke, and chronic lung diseases such as asthma also can increase risk.
Sleep apnea is a serious medical condition. Complications can include:
• Daytime fatigue. The repeated awakenings associated with sleep apnea make normal, restorative sleep impossible, making severe daytime drowsiness, fatigue and irritability likely.
You might have difficulty concentrating and find yourself falling asleep at work, while watching TV or even when driving. People with sleep apnea have an increased risk of motor vehicle and workplace accidents. You might also feel quick-tempered, moody or depressed. Children and adolescents with sleep apnea might perform poorly in school or have behavior problems.
• High blood pressure or heart problems. Sudden drops in blood oxygen levels that occur during sleep apnea increase blood pressure and strain the cardiovascular system. Having obstructive sleep apnea increases your risk of high blood pressure (hypertension).
Obstructive sleep apnea might also increase your risk of recurrent heart attack, stroke and abnormal heartbeats, such as atrial fibrillation. If you have heart disease, multiple episodes of low blood oxygen (hypoxia or hypoxemia) can lead to sudden death from an irregular heartbeat.
• Type 2 diabetes. Having sleep apnea increases your risk of developing insulin resistance and type 2 diabetes.
• Metabolic syndrome. This disorder, which includes high blood pressure, abnormal cholesterol levels, high blood sugar and an increased waist circumference, is linked to a higher risk of heart disease.
• Complications with medications and surgery. Obstructive sleep apnea is also a concern with certain medications and general anesthesia. People with sleep apnea might be more likely to have complications after major surgery because they're prone to breathing problems, especially when sedated and lying on their backs.
Before you have surgery, tell your doctor about your sleep apnea and how it's being treated.
• Liver problems. People with sleep apnea are more likely to have abnormal results on liver function tests, and their livers are more likely to show signs of scarring (nonalcoholic fatty liver disease).
• Sleep-deprived partners. Loud snoring can keep anyone who sleeps near you from getting good rest. It's not uncommon for a partner to have to go to another room, or even to another floor of the house, to be able to sleep.
Your doctor may make an evaluation based on your signs and symptoms and a sleep history, which you can provide with help from someone who shares your bed or your household, if possible.
An evaluation often involves overnight monitoring at a sleep center of your breathing and other body functions during sleep. Home sleep testing also might be an option. Tests to detect sleep apnea include:
• Nocturnal polysomnography. During this test, you're hooked up to equipment that monitors your heart, lung and brain activity, breathing patterns, arm and leg movements, and blood oxygen levels while you sleep.
• Home sleep tests. Your doctor might provide you with simplified tests to be used at home to diagnose sleep apnea. These tests usually measure your heart rate, blood oxygen level, airflow and breathing patterns.
If the results are abnormal, your doctor might be able to prescribe a therapy without further testing. Portable monitoring devices don't detect all cases of sleep apnea, however, so your doctor might still recommend polysomnography even if your initial results are normal.
For milder cases of sleep apnea, your doctor may recommend only lifestyle changes, such as losing weight or quitting smoking. If you have nasal allergies, your doctor will recommend treatment for your allergies. Sleeping on the side. If these measures don't improve your signs and symptoms or if your apnea is moderate to severe, several other treatments are available. Certain devices can help open a blocked airway. In other cases, surgery might be necessary.
• Continuous positive airway pressure (CPAP). If you have moderate to severe sleep apnea, you might benefit from using a machine that delivers air pressure through a mask while you sleep. With CPAP (SEE-pap), the air pressure is somewhat greater than that of the surrounding air and is just enough to keep your upper airway passages open, preventing apnea and snoring.
Although CPAP is the most common and reliable method of treating sleep apnea, some people find it cumbersome or uncomfortable. Some people give up on the CPAP machine, but with practice, most people learn to adjust the tension of the straps on the mask to obtain a comfortable and secure fit.
You might need to try more than one type of mask to find one that's comfortable. Don't stop using the CPAP machine if you have problems. Check with your doctor to see what changes can be made to increase your comfort.
Additionally, contact your doctor if you're still snoring or begin snoring again despite treatment. If your weight changes, the pressure settings of the CPAP machine might need to be adjusted.
• Other airway pressure devices. If using a CPAP machine continues to be a problem for you, you might be able to use a different type of airway pressure device that automatically adjusts the pressure while you're sleeping (auto-CPAP)
• Oral appliances. Another option is wearing an oral appliance designed to keep your throat open. CPAP is more reliably effective than oral appliances, but oral appliances might be easier to use.
• Treatment for associated medical problems. Possible causes of central sleep apnea include heart or neuromuscular disorders and treating those conditions might help.
You'll likely read, hear, or see TV ads about different treatments for sleep apnea. Talk with your doctor about any treatment before you try it.
Surgery is usually only an option after other treatments have failed. Generally, at least a three-month trial of other treatment options is suggested before considering surgery. However, for a small number of people with certain jaw structure problems, or large tonsils, it's a good first option.
Surgical options might include:
• Tissue removal. During this procedure (palatopharpyngoplasty), your doctor remodels tissue from the rear of your mouth and top of your throat. Your tonsils and adenoids usually are removed as well. Removing tissues in the back of your throat with radiofrequency energy (radiofrequency ablation) might be an option if you can't tolerate CPAP or oral appliances.
• Tissue shrinkage. Another option is to shrink the tissue at the rear of your mouth and the back of your throat using radiofrequency ablation. This procedure might be used for mild to moderate sleep apnea.
• Jaw repositioning. In this procedure, your jaw is moved forward from the remainder of your face bones. This enlarges the space behind the tongue and soft palate, making obstruction less likely. This procedure is known as maxillomandibular advancement.
• Nerve stimulation. This requires surgery to insert a stimulator for the nerve that controls tongue movement (hypoglossal nerve). The increased stimulation helps keep the tongue in a position that keeps the airway open. More research is needed.
• Creating a new air passageway (tracheostomy). You may need this form of surgery if other treatments have failed, and you have severe, life-threatening sleep apnea. In this procedure, your surgeon makes an opening in your neck and inserts a metal or plastic tube through which you breathe.