Sleep apnea

Symptoms Of Sleep Apnea 

Sleep apnea manifests through various symptoms, affecting sleep quality. These include:

1. Night-time symptoms

• Loud snoring

• Tossing and turning during sleep

• Waking up feeling the urge to urinate

• Breathing through the mouth while sleeping

2. Daytime symptoms

• Dry or sore throat

• Excessive daytime sleepiness

• Trouble with memory or impaired intelligence

• Impotence or decreased sex drive

• Waking up feeling tired

• Headaches upon waking

3. Symptoms of sleep apnea in children

• Breathing through the mouth during sleep

• Coughing or choking

• Night sweats

• Sleepwalking or night terrors

• Sleep talking

• Bedwetting

• Restless sleep and sleeping in unusual positions

• Daytime sleepiness or behavior/learning problems

Types of Sleep Apnea

There are two types of sleep apnea, categorized on the basis of the cause of breathing disruptions. They include:

1. Obstructive sleep apnea (OSA)

It is the most common type of sleep apnea that occurs when the airway is blocked during sleep, making it difficult to breathe. The blockage can be caused by the tongue, tonsils, uvula, excess throat tissue, or relaxed throat muscles.

2. Central sleep apnea (CSA)

It is a less prevalent type of sleep apnea that is linked to central nervous system function. It is caused by a breakdown in communication between the brain and the muscles that control breathing. 

Causes Of Sleep Apnea

Obstructive sleep apnea (OSA) occurs when the upper airway becomes partially or entirely obstructed during sleep. This is because upper airway muscles (i.e. back of the throat) get relaxed and your airway narrows or closes as you breathe in.

This blockage restricts the flow of air, leading to breathing pauses that can last for seconds to minutes and you might snore, snort, choke, or gasp. These pauses cause a drop in blood oxygen levels, leading to brief awakenings to restore normal breathing. 

These breathing disruptions happen repeatedly during sleep and make it hard to reach the deep, restful phases of sleep.

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Risk Factors For Sleep Apnea

There are several both non-modifiable and modifiable risk factors that can contribute to the development of OSA. They include:

A. Non- modifiable risk factors

1. Excessive throat tissue: Generally people with obstructive sleep apnea may have excess throat tissue, which can restrict their airway during sleep. Obesity, large tonsils, or a thick neck can all contribute to an increase in soft tissue in the throat.
   
2. Structural abnormalities: Individuals with a deviated septum, enlarged tonsils, a small jaw, or a large tongue may be more prone to airway blockages during sleep.
   
   
3. Age: Obstructive sleep apnea is more common in middle-aged and older individuals (above 60 years).
   
   
4. Gender: Men are at a higher risk than women, especially in the earlier stages of adulthood. It affects around 13% of men and 6% of women. Nevertheless, the risk for women increases after menopause.
   
   
5. Family history: Having family members with the condition increases the likelihood of developing sleep apnea.
   
   
6. Certain medical conditions: Such as hypertension, diabetes, congestive heart failure, and hormonal disorders like polycystic ovary syndrome (PCOS), are associated with an increased risk of OSA.
   
   
7. Acromegaly: It is a condition in which the body produces an excessive amount of growth hormone (GH). People with acromegaly might experience OSA because they have macroglossia (enlarged tongue) and could develop central sleep apnea as a result of altered respiratory control.

B. Modifiable risk factors

1. Obesity: Excess body weight is a significant risk factor for obstructive sleep apnea. Fat deposits around the upper airway can cause it to narrow, making it more likely to collapse during sleep.
   
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2. Alcohol and sedative use: Consuming alcohol or certain sedatives can relax the muscles in the throat, making it more likely for the airway to collapse during sleep..
   
   

3. Nasal congestion:  Difficulty breathing through the nose has been related to an increased risk of OSA.
   
   

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4. Muscle relaxant drugs (such as opioids): Long-term use of prescribed opioid-based pain medicines can cause problems with how your brain controls sleep increasing your risk of sleep apnea.
   
   

5. Changes in your hormone levels: People who have low levels of thyroid hormones or high levels of insulin or growth hormone have a higher risk of sleep apnea.
   
   

6. Smoking: Smoking can cause inflammation and fluid retention in the upper airway, leading to airway blockages and contributing to sleep apnea.
   
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Diagnosis Of Sleep Apnea

The diagnosis of OSA typically involves the following steps:

1. Physical examination and medical history

 Physical examination may be conducted by your doctor to assess factors such as obesity, enlarged tonsils, or other anatomical abnormalities. 

Your doctor will also ask about your medical history, including your symptoms, sleep patterns, and any underlying medical conditions that may contribute to OSA.

2. Sleep study

A sleep study is essential to diagnose obstructive or central sleep apnea. Tests to detect sleep apnea are:

• Polysomnogram: During this test, multiple sensors are hooked to your body to monitor various parameters including brain activity, eye movements, muscle activity, heart rate, and oxygen levels, to evaluate sleep quality and breathing abnormalities.
  
  
• Home sleep apnea test: This measures your heart rate, blood oxygen level, airflow, and breathing patterns to detect any abnormalities. The results are interpreted by your doctor.
  
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  Once the diagnosis of OSA is confirmed, the healthcare professional will determine the severity of the condition based on the number of apnea and hypopnea events per hour of sleep. This is known as the apnea-hypopnea index (AHI).

  
  

  Note: * Apnea: Apnea is when airflow stops for a period of 10 seconds or longer.

  *Hypopnea: Period of shallow breathing that lasts for at least 10 seconds and causes a drop in the oxygen level in your blood.

  
  

3. Blood tests

It is done to check certain hormone levels to rule out any endocrine disorders. The tests include:

• HbA1c: This blood test measures average blood sugar levels over the past 2-3 months, and it is done for sleep apnea to assess the risk of diabetes and its impact on the condition.

• Thyroid profile: It  is a blood test that assesses thyroid hormone levels, and it may be done for sleep apnea to identify any underlying thyroid dysfunction, which can contribute to sleep disturbances.

• EPO levels: Erythropoietin levels are a blood test used for sleep apnea to assess oxygen levels and potential causes of chronic low oxygen, which can be associated with the condition. 
  
  

4. Pelvic ultrasound

It is done to examine the ovaries and detect cysts, and rule out PCOS. 

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Prevention Of Sleep Apnea

While some risk factors, such as genetic predisposition, cannot be altered, there are several measures you can take to reduce the likelihood of developing or worsening sleep apnea. They include:

1.  Maintain a healthy weight

Manage your weight as obesity can predispose to sleep apnea. Try to stay active, eat healthy to keep your weight in check.

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2. Avoid alcohol and other sedatives

Alcohol and sedatives relax the muscles in the throat and can cause sleep apnea. Limit or avoid their consumption, especially close to bedtime.

3. Break up from smoking

Smoking contributes to airway inflammation that can lead to sleep apnea.

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4. Address nasal congestion

If you have chronic nasal congestion or allergies, seek appropriate medical treatment to improve nasal airflow. You can use a nasal dilator, or saline spray, to keep nostrils open.

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5. Manage underlying medical conditions

Conditions such as hypertension, diabetes, and hypothyroidism can increase the risk of OSA. Consult with your doctor to manage these conditions effectively.

6. Stay away from allergens

Reducing exposure to allergens such as pollen and mold can help alleviate sleep apnea by preventing allergic rhinitis, which narrows the airways and worsens symptoms.

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Doctor To Visit

Specialists who can help you with obstructive sleep apnea (OSA) symptoms and issues include:

• General Physician
• Sleep specialist
• Cardiologist
• Otolaryngologist
• Dietitian
• Pulmonologist
• Neurologist
  

A general physician can assist with sleep apnea by conducting initial evaluations, referring patients for sleep studies, and coordinating treatment plans for the condition.

A sleep specialist is one who is specialized in diagnosing and treating sleep disorders, including sleep apnea.

A cardiologist is one who specializes in cardiovascular diseases and can assist with sleep apnea by identifying its impact on cardiovascular health and recommending appropriate treatment measures. 

An otolaryngologist is one who specializes in disorders of the ear, nose, and throat and manages conditions related to the upper airway in sleep disorders.

A pulmonologist is one who is specialized in the diagnosis and treatment of lung and respiratory conditions and can provide expertise in managing breathing problems during sleep.

A neurologist is one who is specialized in disorders of the nervous system, including sleep-related neurological conditions.

When to see a doctor?

Here are some indications of when you should see a doctor:

• Chronic loud snoring
• Excessive daytime sleepiness
• Symptoms such as an unexplained sore throat or morning headaches
• Insomnia (difficulty falling or staying asleep)
• Witnessed stoppages of breathing during sleep
• Waking up with choking, gasping sounds, or shortness of breath

If you are facing such an issue, seek advice from our professionals. 

Treatment Of Sleep Apnea

The treatment of obstructive sleep apnea (OSA) depends on the severity of the condition. Here are some common approaches to treating OSA:

1. Breathing devices

Positive airway pressure (PAP) uses a continuous positive airway pressure (CPAP) device. This device sends a constant stream of air into a sleeper’s airway to keep it from collapsing. 

It involves wearing a mask over the nose or nose and mouth while sleeping. The mask is connected to a CPAP machine that delivers a continuous flow of air, keeping the airway open.

There are other types of PAP devices, such as

• Bi-level positive airway pressure (BiPAP) - This device provides higher pressure while breathing in and a lower pressure while breathing out. BiPAP is sometimes used for individuals who have difficulty tolerating CPAP.
  
  
• Auto-adjusting positive airway pressure (APAP)-  This device provides different pressure levels throughout the night. This device automatically adapts to your breathing patterns and sets a pressure that is most suitable.
  
  
• Nasal expiratory positive airway pressure (EPAP)- In this treatment, valves are placed in the nostrils before sleep that uses a person’s natural breathing to create air pressure that keeps the airway open.
  
  
• Adaptive servo-ventilation (ASV)-  It provides air pressure levels that constantly adapt to a sleeper’s needs. It is used in individuals with central sleep apnea who cannot tolerate CPAP.

2. Oral devices

Certain oral devices are custom fit that you typically wear in your mouth while you sleep such as:

• Mandibular advancement devices: It helps keep the airway open by repositioning the jaw and tongue during sleep.

• Tongue retaining devices: This device keeps the tongue forward to prevent it from blocking the upper airway.

3. Surgery

Surgery may be considered in cases where other treatments have failed or for individuals with specific anatomical abnormalities contributing to OSA. Surgical options include:

• Uvulopalatopharyngoplasty (UPPP): Removal of the uvula (a small piece of flesh hanging from the top inside of the mouth, right above the throat) or excess tissue from the throat.

• Maxillomandibular advancement (MMA): Repositioning of the upper and lower jaws to enlarge the airway.

• Adenotonsillectomy: Removal of tonsils and adenoids (soft areas located at the rear of the nose and throat).

• Tracheostomy: It may be considered as a surgical option when other treatments have not been effective in managing severe, life-threatening sleep apnea. During this procedure, a surgical opening is created in the neck, and a metal or plastic tube is inserted to provide a new airway for breathing.

4. Hypoglossal Nerve Stimulation (HNS)

This treatment consists of an implanted medical device and remote control. The device works by stimulating the hypoglossal nerve (the nerve that supplies the muscles of the tongue) or upper airway dilator muscle during apneas, which controls tongue movement to prevent airway obstruction. 

Home care For Sleep Apnea

Some home remedies, that can help with sleep apnea include:

1. Chamomile: It can be beneficial as it contains compounds that aid in relaxing muscles and nerves, promoting sleepiness. 

How to use it? 

To prepare a chamomile tea, simply add two tablespoons of chamomile to hot water and steep for five minutes.

2. Lavender: It is renowned for its anxiety-reducing properties and individuals with sleep apnea, struggling to fall asleep, might find lavender essential oil beneficial.

How to use it?

Try diffusing lavender essential oil in the bedroom or use a few drops on a cloth placed near your pillow to enjoy its calming effects and potentially improve sleep quality.

3. Honey (Shahad): It alleviates sleep apnea, as its anti-inflammatory properties can potentially reduce airway blockages caused by swelling.

How to use it?

Soothe your throat with a teaspoon of honey before going to sleep. 

Other tips to follow

• Get some steam in to open up your airways.
• Maintain regular sleep hours
• Exercise regularly
• Eat a well-balanced diet and cut down on inflammatory food
• Incorporate a high-fiber diet into your everyday routine
• Change your sleeping position and try to sleep on your side.
• Elevate your head up while sleeping
  

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Complications Of Sleep Apnea

Sleep apnea can lead to various complications and health risks if left untreated. Some of them include: 

1. High blood pressure: Repeated episodes of interrupted breathing can cause blood pressure to rise, increasing the risk of cardiovascular problems.

2. Heart disease: Sleep apnea increases the risk of heart conditions, including coronary artery disease, heart attacks, heart failure, and abnormal heart rhythms due to disruptive blood flow. It can also increase the risk of stroke due to the disruption of oxygen supply to the brain during apnea episodes.

3. Type 2 diabetes: Sleep apnea has been linked to insulin resistance and glucose intolerance, increasing the risk of developing type 2 diabetes.

4. Mental health changes: Sleep disturbances can impact daily functioning and can contribute to mood disorders like depression and anxiety. 

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5. Obesity: It increases the risk of developing sleep apnea, and sleep apnea, in turn, can contribute to weight gain and difficulty losing weight.

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6. Complications during pregnancy: Sleep apnea in pregnant women can increase the risk of complications such as gestational diabetes, high blood pressure (preeclampsia), and preterm birth.

7. Daytime fatigue and impaired concentration: Frequent interruptions in sleep due to apnea episodes can lead to excessive daytime  seepiness, fatigue, and difficulty concentrating.

8. Increased risk of accidents: Individuals who have obstructive sleep apnea (OSA) or central sleep apnea (CSA) frequently experience feelings of exhaustion increasing the likelihood of being involved in a car accident or making other serious errors.

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Alternative Therapies For Sleep Apnea

Complementary and alternative therapies can be used as adjuncts to traditional treatment approaches for snoring and sleep apnea. However, it's important to consult your physician before you start any of them. They include:

1. Positional therapy

It involves training a person to sleep in a different position. Sleeping on your back increases the likelihood of your tongue and soft tissues blocking the airway during sleep. 

2.  Orofacial therapy

As per studies, it has been found that exercises for your mouth and facial muscles, also called orofacial therapy, may help treat sleep apnea in children and adults. This therapy improves your tongue's posture and strengthens the muscles that regulate your lips, tongue, upper airway, and face.

3. Acupuncture

It involves the insertion of thin needles into certain areas of the body. It may help promote relaxation, reduce snoring, and one of the studies shows it potentially improves sleep quality in some individuals.

4. Yoga and breathing exercises

Certain yoga postures, along with deep breathing exercises (pranayama), can help strengthen the muscles involved in breathing and promote relaxation. These practices may have a positive impact on snoring and mild cases of sleep apnea.

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Living With Sleep Apnea

Obstructive sleep apnea (OSA) can significantly impact various aspects of your life. By following these concise steps, you'll be actively managing your sleep apnea and optimizing your overall well-being. They include

1. Stay connected with your doctor: Keep in touch with your primary care doctor or sleep specialist, sharing any ongoing symptoms or treatment challenges to adjust your sleep apnea management plan.

2. Care for your treatment devices: Properly clean and maintain your PAP device or mouthpiece to maximize treatment effectiveness and minimize unwanted side effects.

3. Avoid risky activities: Be cautious of daytime sleepiness. If you have untreated sleep apnea, steer clear of tasks like driving or operating heavy machinery when feeling drowsy.

4. Explore different sleeping positions: 

• Elevate the head of the bed by four to six inches, or
• Elevate your body from the waist up with a foam wedge or
• Use a special cervical pillow.

Sleep apnea in children

Pediatric Obstructive sleep apnea (OSA) is a fairly common childhood disorder, affecting 1 to 5% of all children. It is associated with adverse health consequences such as heart health, impaired growth, learning difficulty, behavior problems, hyperactivity, etc. 

Tips for Parents

• Consult a pediatrician or sleep specialist for a proper diagnosis and treatment plan
• Follow the recommended treatment
• Ensure a consistent sleep schedule and create a comfortable sleep environment
• Watch for signs of improvement or worsening of symptoms 
• Encourage a healthy lifestyle with regular exercise and a balanced diet
• Educate family members and caregivers about the condition and its management
• Provide emotional support and reassurance to the child during the treatment process.