Sleep Apnea

What is Sleep Apnea?

Imagine when you're sleeping, your breathing is supposed to be smooth and steady. With sleep apnea, your breathing repeatedly stops and starts throughout the night.

Think of it like this: it's as if someone is briefly pressing the "pause" button on your breathing while you're asleep. These pauses can last for a few seconds to more than a minute, and they can happen many times an hour.

There are two main types, but the most common one is Obstructive Sleep Apnea (OSA).

  • Obstructive Sleep Apnea (OSA): This is the more common type. It happens when the muscles in the back of your throat relax too much during sleep. These muscles support your soft palate (the soft part at the roof of your mouth), your uvula (the dangly thing at the back of your throat), your tonsils, and your tongue. When they relax, your airway can narrow or even close completely, blocking air from getting into your lungs, even though your body is still trying to breathe. It's like a temporary physical blockage in your throat's air passage.

  • Central Sleep Apnea (CSA): This type is less common. Here, the problem isn't a physical blockage. Instead, your brain doesn't send the right signals to the muscles that control your breathing. So, for brief periods, your body just doesn't even try to breathe.

Why is this a problem?

When your breathing stops, the oxygen level in your blood can drop. Your brain senses this and briefly wakes you up (often so quickly you don't remember it) to restart your breathing. This can happen over and over all night long. Even if you don't fully wake up, it severely disrupts your sleep quality.

This can lead to:

  • Feeling very tired during the day, even if you think you slept a long time.

  • Loud snoring (often with gasps or choking sounds when breathing restarts).

  • Morning headaches.

  • Difficulty concentrating.

  • Irritability.

  • More serious health problems over time, like high blood pressure, heart problems, stroke, diabetes, and depression.

How is Sleep Apnea Diagnosed?

If you or your sleep partner suspect sleep apnea, a doctor will usually take these steps:

  1. Talking About Your Symptoms and Sleep Habits: The doctor will ask you questions like:

    • Do you snore loudly? Has anyone told you that you stop breathing or gasp during sleep?

    • Do you feel tired and unrefreshed when you wake up?

    • Are you excessively sleepy during the day?

    • Do you have morning headaches?

    • They'll also ask about your medical history and lifestyle.

  2. Physical Exam: The doctor will examine your mouth, nose, and throat to look for any physical issues that might be contributing, like large tonsils, a deviated septum, or a large tongue.

  3. Sleep Study (Polysomnography): This is the main way to diagnose sleep apnea.

    • In-Lab Sleep Study: This is the most comprehensive test. You'll spend a night at a sleep center. While you sleep, sensors will be attached to your body to monitor things like:

      • Your brain waves (to see your sleep stages)

      • Your heart rate and rhythm

      • Your blood oxygen levels

      • Your breathing patterns (including when you stop breathing)

      • Your eye movements

      • Your leg movements

      • Snoring

    • Home Sleep Apnea Test (HSAT): For some people, especially those with a high likelihood of moderate to severe obstructive sleep apnea and no other major health issues, a home sleep study might be an option. You'll be given a portable monitor to wear while you sleep in your own bed. It records fewer things than an in-lab study (usually breathing, oxygen levels, and heart rate) but can be very effective for diagnosing OSA.

The sleep study results will show how many times your breathing stops or becomes very shallow per hour (this is called the Apnea-Hypopnea Index or AHI) and how much your oxygen levels drop. This helps determine if you have sleep apnea and how severe it is.

What are the Different Ways Sleep Apnea Can Be Treated?

The goal of treatment is to keep your airway open so you can breathe continuously during sleep. Here are the common approaches:

  1. Lifestyle Changes (Often the first step, especially for mild cases):

    • Weight Loss: If you're overweight, losing even a small amount of weight can make a big difference because excess weight can contribute to the narrowing of your airway.

    • Positional Therapy: Some people only have sleep apnea when they sleep on their back. Special pillows or devices can help you stay on your side.

    • Avoiding Alcohol and Sedatives: These can relax your throat muscles more, making apnea worse. Try to avoid them, especially close to bedtime.

    • Quitting Smoking: Smoking can worsen swelling in the upper airway.

    • Treating Nasal Congestion: If you have allergies or sinus problems, treating them can help you breathe better through your nose.

  2. Positive Airway Pressure (PAP) Therapy: This is the most common and effective treatment for moderate to severe sleep apnea.

    • CPAP (Continuous Positive Airway Pressure): You wear a mask over your nose, or nose and mouth, while you sleep. The mask is connected by a hose to a small machine that 1 gently blows air into your airway. This constant stream of air acts like an "air splint" to keep your airway open. It doesn't breathe for you, but it prevents the airway from collapsing.  

      1. medlineplus.gov

      medlineplus.gov

    • Other PAP devices: There are variations like APAP (which adjusts the pressure automatically) or BiPAP (which provides different pressures when you inhale and exhale).

  3. Oral Appliances (Mandibular Advancement Devices):

    • These are custom-fitted mouthpieces, a bit like a sports mouthguard or orthodontic retainer, that you wear while sleeping.

    • They work by moving your lower jaw slightly forward and/or holding your tongue in place. This helps keep the airway open.

    • They are usually best for mild to moderate sleep apnea, or for people who can't tolerate CPAP. A dentist or orthodontist with special training in sleep medicine usually fits these.

  4. Surgery: Surgery is usually considered if other treatments haven't worked or aren't suitable. The goal of surgery is to remove or shrink tissue that's blocking the airway, or to reposition the jaw. There are several types:

    • UPPP (Uvulopalatopharyngoplasty): Removes tissue from the back of your mouth and top of your throat (like tonsils, uvula, and parts of the soft palate). It's less common now due to variable success rates.

    • Maxillomandibular Advancement (MMA): This is a more complex surgery that moves your upper and lower jaw forward to make more space behind your tongue and soft palate. It can be very effective but has a longer recovery.

    • Nasal Surgery: If a blocked nose (like a deviated septum) is a major factor, surgery to fix it might help, though it usually doesn't cure sleep apnea on its own.

    • Hypoglossal Nerve Stimulation (Upper Airway Stimulation): This is a newer approach where a small, implantable device (like a pacemaker) stimulates the nerve that controls tongue movement. During sleep, it gently pushes the tongue forward to keep the airway open.

  5. Other Therapies:

    • Expiratory Positive Airway Pressure (EPAP): These are small, disposable valves you place over your nostrils before sleep. They let air in easily but make it a bit harder to breathe out, which helps keep the airway open.

    • Myofunctional Therapy (Orofacial Exercises): Exercises for the tongue, mouth, and throat muscles might help strengthen them and reduce collapsibility, though more research is needed on this as a standalone treatment.

The best treatment depends on the type and severity of your sleep apnea, your physical structure, other health conditions you might have, and your personal preference. It's something you'd discuss thoroughly with your doctor or a sleep specialist.

Home sleep study… now easier than ever.