What is sleep apnea?

Sleep apnea is a condition that causes you to stop breathing while you’re sleeping. The word “apnea” comes from the Greek word for “breathless.” Sleep apnea happens because you stop breathing in your sleep. This happens either because of blockage of your airway (obstructive sleep apnea) or because your brain doesn’t correctly control your breathing (central apnea).

The resulting lack of oxygen activates a survival reflex that wakes you up just enough to resume breathing. While that reflex keeps you alive, it also interrupts your sleep cycle. That prevents restful sleep and can have other effects, including putting stress on your heart that can have potentially deadly consequences.

How common is sleep apnea?

Sleep apnea is uncommon but widespread. Experts estimate it affects about 5% to 10% of people worldwide.

How sleep apnea disrupts your sleep cycle

Your brain constantly monitors your body’s status and adjusts your heart rate, blood pressure, breathing, etc. Your blood oxygen levels can drop when you stop breathing because of either apnea or hypopnea.

• Apnea: This is when you stop breathing while asleep or have almost no airflow.

• Hypopnea: This happens when you aren’t breathing enough to maintain oxygen levels in your blood.

Your brain reacts to blood oxygen drops — from either apnea or hypopnea — by triggering a failsafe-like reflex, waking you up enough for you to breathe again. Once you resume breathing, your brain automatically tries to resume your sleep cycle.

What are the symptoms of sleep apnea?

Sleep apnea has many symptoms, some of which are easier to spot than others. The symptoms include:

• Feeling tired or even exhausted when waking up. Even after a full night’s sleep, people with sleep apnea commonly feel extremely tired.

• Daytime sleepiness. In more severe cases, this can cause drowsiness during driving, working or other activities.

• Snoring. This is a common feature with sleep apnea (but it isn’t something that happens in all cases). You can also have sleep apnea without snoring at all.

• Mood changes. Depression and anxiety are common symptoms of sleep apnea.

• Disruptions in brain function. These can include memory loss, trouble concentrating or other brain-related issues.

• Waking up repeatedly in the middle of the night.

• Pauses in breathing while asleep that others witness.A spouse, partner or other loved one may notice these symptoms while you’re asleep.

• Unusual breathing patterns.

• Insomnia.

• Waking up feeling short of breath or like you’re choking.

• Headaches, especially when waking up.

Sleep apnea in children

Sleep apnea in children can happen in slightly different ways. The symptoms of sleep apnea in children include:

• Hyperactivity or trouble focusing or performing poorly in school. This can look like symptoms of attention-deficit/hyperactivity disorder (ADHD).

• Loud snoring.

• Bedwetting.

• Frequent arm or leg movements while asleep.

• Sleeping in unusual positions or sleeping with their neck extended.

• Reflux (heartburn) or night sweats.

Diagnosis and Tests

The most common tests for sleep apnea include:

• Overnight sleep study (polysomnogram). This is an overnight test where you sleep in a medical facility (often known as a “sleep lab”) that’s specially equipped to be as comfortable as possible while still monitoring your sleep. This test involves sensors that monitor your heart rate, breathing, blood oxygen levels, brain waves and more. Experts consider this test the gold standard for diagnosing sleep apnea.

• Home sleep apnea testing. This form of testing allows a person to complete a sleep study from home. It’s similar to an overnight sleep study, but doesn't involve brain wave monitoring. This test can’t diagnose central sleep apnea, and it’s usually not an option when providers suspect more severe sleep apnea, or if you have other sleep disorders or medical conditions. Often, when a home study doesn’t show sleep apnea, experts recommend confirming this with an overnight sleep study.

Management and Treatment

There are many approaches to treating sleep apnea, depending on the specific type of sleep apnea and how severe it is. While none of these is a cure, they can help prevent apnea events or reduce how often they happen or how severe they are.

Many treatments should be a part of your daily (or nightly) routine. That can ultimately reduce or even eliminate sleep apnea’s effects on your life for as long as you use these treatments.

Possible treatments include:

• Conservative (nonmedical) treatments.

• Positive airway pressure and adaptive ventilation devices.

• Oral appliances (mouthpieces).

• Surgery.

Conservative treatments

These nonmedical treatments or approaches can typically improve obstructive sleep apnea or resolve it. They aren’t cures, but they can reduce apnea to the point where it stops happening or isn’t severe enough to cause symptoms. These include:

• Weight loss. A 10% decrease in body weight can significantly improve sleep apnea for people who have excess weight or obesity.

• Position changes while sleeping and sleep aid items. Sleeping on your back makes sleep apnea more likely to happen. Special support pillows and similar items can help change the position in which you sleep, keeping you off your back so soft tissue doesn’t press on your windpipe and block breathing.

• Nasal sprays, adhesive strips, etc.These over-the-counter products improve breathing by making it easier for air to travel through your nose. While they can’t help moderate or severe sleep apnea, they can sometimes help snoring and mild sleep apnea.

• Treating the underlying condition.Treating conditions such as heart failure can often improve central sleep apnea.

• Medication changes.Working with your doctor to decrease or stop opioid pain medications may be able to improve or even resolve central sleep apnea.

Positive airway pressure (PAP) and adaptive ventilation

Positive airway pressure is a method that uses a specialized device to increase the air pressure inside of your airway while you inhale. This method can treat obstructive, central and mixed sleep apneas.

Pushing pressurized air down your windpipe keeps it open so you can breathe. These devices push air through a hose that attaches to a special mask you wear on your face while you sleep. Masks can cover your nose, mouth or both, and there are many different types and styles to choose from.

The best-known PAP device is the Continuous Positive Airway Pressure (CPAP) machine. However, there are other types of PAP machines, too (see our CPAP Machine article for more about the different types of devices, including adaptive servo-ventilation devices). These devices increase the air pressure inside of your airway and lungs when you inhale, keeping surrounding tissue from pressing your airway shut.

Oral devices

Obstructive sleep apnea happens when soft tissue in your head or neck, especially around your mouth and jaw, press downward on your windpipe. Special mouthpiece devices can help hold your jaw and tongue in a position that keeps pressure off your windpipe. Dentists and sleep medicine specialists often work together to make these for people who need them.

Nerve stimulators

The hypoglossal nerve (the name comes from Greek and means “under the tongue”) is what controls your tongue’s movements. A nerve stimulator attached to this nerve can stimulate it, pushing your tongue slightly forward when you breathe while you’re sleeping. That keeps your tongue from relaxing and pressing backward on your windpipe while you sleep, which is one of the ways that obstructive sleep apnea happens.

An electrode attaches to the nerve under your jaw and connects to a device implanted under the skin in your chest. You can turn the stimulator on before you sleep and turn it off after you wake up. The electrical current is strong enough to keep your tongue from relaxing too much, but mild enough that it’s not uncomfortable.

A similar kind of nerve stimulation is also possible with central sleep apnea. This type of stimulation affects the phrenic nerves. This pair of nerves connect your spinal cord to the diaphragm, a layer of muscle underneath your lungs that controls your ability to inhale and exhale. Stimulating the phrenic nerve causes those muscles to flex, helping you breathe.

Surgery

Surgeries on your nose, mouth and throat can help prevent blockages of your nose, throat and windpipe. However, the impact of these in adults is usually limited and varies from person to person. These surgeries include:

• Somnoplasty. This procedure uses radiofrequency (RF) to reduce soft tissue around the upper parts of your windpipe.

• Tonsillectomy/adenoidectomy. Removing your tonsils and adenoids can widen the opening where your mouth, throat and nasal passages connect. That makes it easier for air to pass through and reduces soft tissue that can block your breathing. This procedure is most helpful for children with obstructive sleep apnea.

• Uvulopalatopharyngoplasty (UPPP). This procedure removes your uvula (the teardrop-shaped soft tissue that hangs at the back of your mouth). It also removes soft tissue from your soft palate and pharynx. These widen the area where your mouth and throat meet, making it easier for air to pass through.

• Jaw surgery. Different surgery procedures can subtly change the position of your jaw so soft tissue can’t easily press back on your airway. These procedures are especially helpful for people who have sleep apnea for structural reasons like micrognathia.

• Nasal surgery. One common form of nasal surgery is septoplasty, which straightens the soft tissue in your nose, making it easier for air to travel through your nose and nasal passages.

If you think you might be suffering from sleep apnea, call Dr. Cait Smiles today to schedule a consultation with Dr. Cait so that she can diagnose any sleep apnea and recommend treatment.