SLEEP APNEA BASICS:
Obstructive sleep apnea is a disorder in which breathing is briefly and repeatedly interrupted during sleep. The "apnea" in sleep apnea
refers to a breathing pause that lasts at least ten seconds. Obstructive sleep apnea occurs when the muscles in the back of the throat fail
to keep the airway open, despite efforts to breathe. Another form of sleep apnea is central sleep apnea, in which the brain fails to
properly control breathing during sleep. Obstructive sleep apnea is far more common than central sleep apnea.
Obstructive sleep apnea, or simply sleep apnea, can cause fragmented sleep and low blood oxygen levels. For people with sleep apnea,
the combination of disturbed sleep and oxygen starvation may lead to hypertension, heart disease and mood and memory problems.
Sleep apnea also increases the risk of automobile crashes. Sleep apnea can be life-threatening and you should consult your doctor
immediately if you feel you may suffer from it.
More than 18 million American adults have sleep apnea. It is very difficult at present to estimate the prevalence of childhood OSA
because of widely varying monitoring techniques, but a minimum prevalence of 2 to 3% is likely, with prevalence as high as 10 to 20% in
habitually snoring children. OSA occurs in all age groups and both sexes, but there are a number of factors that increase risk, including
having a small upper airway (or large tongue, tonsils or uvula), being overweight, having a recessed chin, small jaw or a large overbite, a
large neck size (17 inches or greater in a man, or 16 inches or greater in a woman), smoking and alcohol use, being age 40 or older, and
ethnicity (African-Americans, Pacific-Islanders and Hispanics). Also, OSA seems to run in some families, suggesting a possible genetic
Sleep Apnea: Symptoms
Chronic snoring is a strong indicator of sleep apnea and should be evaluated by a health professional. Since
people with sleep apnea tend to be sleep deprived, they may suffer from sleeplessness and a wide range of
other symptoms such as difficulty concentrating, depression, irritability, sexual dysfunction, learning and memory
difficulties, and falling asleep while at work, on the phone, or driving. Left untreated, symptoms of sleep apnea
can include disturbed sleep, excessive sleepiness during the day, high blood pressure, heart attack, congestive
heart failure, cardiac arrhythmia, stroke or depression.
Sleep Apnea: Treatment
If you suspect you may have sleep apnea, the first thing to do is see your doctor. Bring with you a record of your sleep, fatigue levels throughout the day, and any
other symptoms you might be having. Ask your bed partner if he or she notices that you snore heavily, choke, gasp, or stop breathing during sleep. Be sure to take
an updated list of medications, including over the counter medications, with you any time you visit a doctor for the first time. You may want to call your medical
insurance provider to find out if a referral is needed for a visit to a sleep center.
One of the most common methods used to diagnose sleep apnea is a sleep study, which may require an overnight stay at a sleep center. The sleep study monitors
a variety of functions during sleep including sleep state, eye movement, muscle activity, heart rate, respiratory effort, airflow, and blood oxygen levels. This test is
used both to diagnose sleep apnea and to determine its severity. Sometimes, treatment can be started during the first night in the sleep center.
The treatment of choice for obstructive sleep apnea is continuous positive airway pressure device (CPAP). CPAP is a mask that fits over the nose and/or mouth,
and gently blows air into the airway to help keep it open during sleep. This method of treatment is highly effective. Using the CPAP as recommended by your
doctor is very important. For more information about how to use a CPAP, see "Coping."
Second-line methods of treating sleep apnea include dental appliances, which reposition the lower jaw and tongue, and upper airway surgery to remove tissue in
the airway. In general, these approaches are most helpful for mild disease or heavy snoring.
Lifestyle changes are effective ways of mitigating symptoms of sleep apnea. Here are some tips that may help reduce apnea severity:
- Lose weight. If you are overweight, this is the most important action you can take to cure your sleep apnea (CPAP only treats it; weight loss can cure it in the
- Avoid alcohol; it causes frequent nighttime awakenings, and makes the upper airway breathing muscles relax.
- Quit smoking. Cigarette smoking worsens swelling in the upper airway, making apnea (and snoring) worse.
- Some patients with mild sleep apnea or heavy snoring have fewer breathing problems when they are lying on their sides instead of their backs.
Sleep Apnea: Coping
The most important part of treatment for people with OSA is using the CPAP whenever they sleep. The health benefits of this therapy can be enormous, but only if
used correctly. If you are having problems adjusting your CPAP or you're experiencing side effects of wearing the appliance, talk to the doctor who prescribed it
and ask for assistance.
Getting adequate sleep is essential to maintaining health in OSA patients. If you have symptoms of insomnia such as difficulty falling asleep, staying asleep, or
waking up unrefreshed, talk to your doctor about treatment options. Keep in mind that certain store-purchased and prescription sleep aids may impair breathing in
OSA patients. One exception is ramelteon, which was studied in mild and moderate OSA patients and found to not harm their breathing.
American Sleep and Epilepsy Centers
In the 2005 Sleep in America poll, 8% of respondents experienced or had been observed having pauses in their breathing during sleep at least three nights per
week. Adults in the poll were also given the Berlin questionnaire, a standardized test assessing risk for sleep apnea. Based on the questionnaire, 26% of all poll
respondents were at risk. Of those at risk, 70% said that they snored, slept on average 6.4 hours/weeknight (compared to overall mean of 6.8 hours); 66% were
experiencing daytime sleepiness at least 3 days per week and over half (58%) were obese. Of adults in this population who had been diagnosed with high blood
pressure or depression, almost half were also at risk for sleep apnea. 33% of those who drink 4 or more caffeinated beverages daily are designated at risk for
The condition is even more undiagnosed in women than in men, yet the symptoms are the same: daytime fatigue, tiredness, feeling
run down, low energy, depression, elevated blood pressure, a need to take naps, frequent awakenings during the night, heartburn,
difficulty staying awake, and a feeling that you aren't getting any rest.
For younger women, snoring is a sign of pregnancy-induced hypertension and a risk for growth retardation of the fetus. Infants born to mothers who have habitual
snorers more frequently had lower birth weight.
About 30% of pregnant women snore because of increased swelling in their nasal passages. This may partially block the airways. Snoring can also lead to high
blood pressure, which can put both the mother and fetus at risk.
For older women, the rate of sleep apnea is three times higher in women following menopause than before it.
If you, or a loved one, suffers from snoring, remember that it's more than just a "social nuisance." Snoring is an indicator that you're having difficulty breathing
during sleep-and it's putting a burden on your heart and blood pressure. Women who snore regularly are 33% more likely to suffer from stroke and heart disease
than women who don't snore.
How Serious is Snoring and Sleep Apnea?
If you have a snoring problem, you are not alone.
Millions of men and women around the world have this condition. But snoring may also be symptomatic of a potentially lethal problem known as "Sleep Apnea".
Just in the United States, as many as 18 million people suffer from Obstructive Sleep Apnea and should be tested.
Yet, over 95% of the population remains undiagnosed and without treatment or therapy.
Obstructive Sleep Apnea (OSA) is a serious and potentially life threatening chronic condition that is far more common than generally
understood. As many people have undiagnosed Sleep Apnea as Diabetes or Asthma.
Caused by a weakening, collapse or blockage of the airway, people with OSA suffer from involuntary breathing pauses that occur while you
are sleeping. The result? You never get the important restful sleep you need.
Of greater concern is that Obstructive Sleep Apnea is associated with Higher Accident Rates, Diabetes, High Blood Pressure (Hypertension),
Congestive Heart Failure, Cardiovascular Disease, Erectile Dysfunction, Stroke and even Death.
How do I Know if I Have OSA?
OSA can occur in men, women and children of all ages and sizes. Most people who have OSA do not realize they suffer from the condition. Often, it is the bed
partner who notices the first signs of OSA.
If you or someone you know snores regularly and has one or more of the following symptoms, it may be OSA. Check all of the following that apply, and share this
list with your doctor.
Key signs and symptoms include:
- Excessive daytime sleepiness
- Loud or disruptive snoring
- Gasping or choking during sleep
Other common symptoms include:
- Grogginess and morning headaches
- Frequent urination at night
- Depression and irritability
OSA is more common in people who:
- are obese
- have a large neck or crowding of the upper air.
What Happens if I Have OSA and I Don't Treat it Properly?
People who do not seek diagnosis and treatment for OSA may increase their risk for:
- High blood pressure
- Irregular heart rhythms or heart disease
- Heart attack
- Driving or work-related accidents