What is Sleep Apnea?
An incurable sleep disorder in which a person stops breathing repeatedly during their sleep for a minute or longer as many as hundreds of times during a single night.
Overview
Sleep apnea is a sleep disorder that affects more than 12 million people in the United States. Sleep apnea can be caused by either complete obstruction or partial obstruction of the airway which causes one to wake up. There are three types of sleep apnea--obstructive, central, and mixed. Obstructive sleep apnea (OSA) is the most common.
Causes
The exact cause of OSA still remains unclear. Although, the site of obstruction in most patients is the soft palate, extending to the region at the base of the tongue. There are no rigid structures, like cartilage or bone, in this area to hold the airway open. Muscles in this region are able to keep the passage wide open during the day. But as a person with OSA falls asleep, the muscles relax to a point where the airway collapses and becomes obstructed. Breathing stops when the airway closes and the sleeper awakens to open the airway. These arousals usually last for only a few seconds, but brief arousals prevent continuous sleep and prevent the person from reaching the deep stages of sleep which the body needs to rest and replenish strength. When normal breathing is restored, the person falls asleep only to repeat the cycle throughout the night.
Risk Factors
Weight gain is the primary risk factor for OSA. The accumulation of fat on the sides of the upper airway causes it to become narrow and prone to closure when muscles relax. Another prominent risk factor is age. If muscle mass decreases in the airway, as it is common with the aging process, it can be replaced with fat leaving the airway narrow and soft. Males have a greater risk for OSA because male hormones can cause structural changes in the upper airway. Other risk factors include:
Anatomic abnormalities, like a receding chin
Enlarged tonsils and adenoids, which are the main cause of OSA in children
Family history of OSA, even though no genetic inheritance has been proven
Use of alcohol and sedative drugs, which relax the musculature in the surrounding upper airway
Smoking, which causes inflammation, swelling, and narrowing of the upper airway
Nasal congestion
Signs and Symptoms
Disruption of the normal sleep architecture
Frequent arousals
Snoring
The inability to achieve or maintain the deeper stages of sleep
Excessive daytime sleepiness
Nonrestorative sleep
Automobile accidents
Personality changes
Decreased memory
Erectile dysfunction
Depression
Diagnosis
The patient will need to undergo a sleep study known as a polysomnography. Numerous monitors are attached to the patient to record nighttime breathing, brain activity, and physical activity. Electrodes are placed on the head, near the outer edges of the eyes, near the nose, mouth, and chin. Special belts are also placed around the patient’s chest and abdomen while a pulse oximeter is attached to the finger. An EEG is attached to the chest to measure heart rate. And finally, numerous instruments are strapped to the lower legs. All of these devices are used to measure the activity of each area of the body while sleeping.
Obstructive sleep apnea is diagnosed if the patient has an apnea index that is greater that five. In other words, the patient has more than five apneic episodes per hour. Obstructive apnea is a complete cessation of airflow for more than 10 seconds with persistent respiratory effort.
Treatment
There are several treatment options for OSA. They include weight reduction, positional therapy, positive pressure therapy, surgical options, and oral appliances. Of these, the continuous positive airway pressure (CPAP) has proven to be the most effective.
CPAP is administered at bedtime through a nasal facial mask held in place by Velcro straps around the patient’s head. The mask is connected by a tube to a small air compressor. The machine sends air under pressure through the tube into the mask, where it sends positive pressure to the upper airways. This helps the airway stay open throughout the whole night and keeps it from collapsing.
Positional therapy has also proven to be cheap and effective in patients with OSA relating to positioning during sleep. Most sleep apnea patients have the worse symptoms when they are lying on their backs. Sewing a sock filled with tennis balls, length-wise down the back of the pajama or shirt is somewhat uncomfortable for the sleeper to stay on its back, so it forces them to lie on their side. Another way would be to use positional pillows to assist in sleeping on the side. This type of therapy is limited but it has proven to be a success in some patients.
If you still want to explore more about sleep apneaClick Here and you will find an in-depth article written by Dr. Lyle D. Victor of Oakwood Hospital specifically pertaining to sleep apnea.
Last modified: May 3, 2005