What is sleep apnea?

Sleep apnea is a potentially serious sleep disorder in which breathing repeatedly stops and starts again. If you snore loudly and feel tired even after a long night’s sleep, you may be suffering from such a health problem.

The main types of sleep apnea are:

  • Obstructive sleep apnea: Older men in particular suffer from obstructive sleep apnea. About 20% of 40 to 60 year olds and up to 60% of 65 to 70 year old men are affected. Due to the different anatomy in the neck area, women are mostly protected until menopause. The incidence between the sexes is generally equalized after menopause.
  • Central sleep apnea: The incidence of central sleep apnea increases with age. One out of every four people over the age of 60 suffers from sleep-related breathing disorders and this is mostly a result of cardiovascular diseases.

What causes sleep apnea?

The causes of sleep apnea may vary depending on the type.

Causes of obstructive sleep apnea

This occurs when the muscles at the back of your throat relax. These muscles support the soft palate, the triangular piece of tissue hanging from the soft palate (small tongue), the tonsils, the lateral walls of the throat, and the tongue.

When the muscles relax, your airway narrows or closes as you breathe. You don’t get enough air, which can lower the oxygen level in your blood. Your brain senses your inability to breathe and briefly wakes you up so you can reopen your airway. This awakening is usually so brief that you don’t remember it.

In short, the way you wake up is when you wake up as if you are suffocating due to the cessation of breathing. This condition can recur all night long and impair your ability to reach deep, restful stages of sleep.

Causes of central sleep apnea

Less common, sleep apnea occurs when your brain does not send signals to your respiratory muscles. This means that you make no effort to breathe for a short time. You may wake up with shortness of breath or have trouble falling asleep or staying asleep.

Who is at risk?

This problem that develops during sleep can affect everyone, even children. However , certain factors increase your risk, such as :

Risk factors in obstructive sleep apnea

Factors that increase the risk of obstructive sleep apnea include:

  • Being overweight: Obesity greatly increases the risk. Fat deposits around your upper airway can interfere with your breathing.
  • Neck circumference: People with thicker necks may have narrower airways.
  • A narrowed airway: A narrow throat may be inherited genetically. Tonsils or adenoids can also widen and block the airway, especially in children.
  • Being a man: Men are two to three times more likely than women to have this condition. However, the risk increases if women are overweight, and their risk also increases after menopause.
  • Getting older: This problem is significantly more common in older adults.
  • Heredity: Having family members with sleep apnea can increase your risk.
  • Alcohol and tranquilizers: These substances can worsen obstructive sleep apnea by relaxing the muscles in your throat.
  • Smoking: Smokers are three times more likely to have obstructive sleep apnea than non-smokers. Smoking can increase the amount of inflammation and fluid retention in the upper airway.
  • Nasal congestion: You’re more likely to develop obstructive sleep apnea if you have trouble breathing through your nose (due to an anatomical problem or an allergy).
  • Medical conditions: Congestive heart failure , high blood pressure , type 2 diabetes , and Parkinson’s disease are some of the conditions that can increase the risk of obstructive sleep apnea. Chronic lung diseases such as polycystic ovary syndrome , hormonal disorders, previous stroke and asthma can also increase the risk.
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Risk factors in central sleep apnea

Risk factors for central sleep apnea include:

  • Getting older: Middle-aged and older people have a higher risk of central sleep apnea.
  • Being male: Central sleep apnea is more common in males than females.
  • Heart conditions: Having congestive heart failure increases the risk.
  • Using narcotic pain medications: Opioid medications, especially long-acting ones like methadone, increase the risk of central sleep apnea.
  • Stroke: Having a stroke can trigger central sleep apnea or central sleep apnea that occurs with stroke treatment.

What are the symptoms of sleep apnea?

The symptoms of obstructive and central sleep apnea are similar, making it sometimes difficult to determine which type you have. The most common symptoms of obstructive and central sleep apnea are:

  • loud snoring
  • Episodes in which you stop breathing during sleep as reported by another person
  • panting during sleep
  • waking up with dry mouth
  • morning headache
  • Difficulty falling asleep (insomnia)
  • Excessive daytime sleepiness (hypersomnia)
  • Difficulty paying attention while awake
  • Irritability

When should you see a doctor?

Loud snoring can indicate a potentially serious problem, but not everyone who snore has to have it. You should talk to your doctor if you have symptoms. You should consult your doctor about any sleep problem that leaves you tired, sleepy and restless.

Which doctor should I go to for sleep apnea?

Depending on the underlying cause of your problem, you may need to see a psychiatrist or an otolaryngologist.

How is sleep apnea diagnosed?

Your doctor can make an assessment based on your symptom and sleep history, with help from someone sharing your bed or house if possible.

You will likely be referred to a sleep disorder center. A sleep specialist there can help you determine your need for further evaluation.

An assessment usually involves monitoring your breathing and other bodily functions during sleep at a sleep center overnight. A home sleep test may also be an option. Tests to detect sleep apnea include:

  • Nocturnal polysomnography: During this test, you are connected to equipment that monitors your heart, lungs, brain activity, breathing patterns, arm and leg movements, and blood oxygen level while you sleep.
  • Home sleep tests: Your doctor can provide you with simplified tests for use at home to diagnose sleep apnea. These tests usually measure your heart rate, blood oxygen level, airflow, and breathing patterns. If the results are abnormal, your doctor may recommend a treatment without further testing. Portable monitors do not detect all cases of sleep apnea, so even if your initial results are normal, your doctor may recommend polysomnography.
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If you have obstructive sleep apnea , your doctor may refer you to an ear, nose and throat doctor to relieve congestion in your nose or throat. Evaluation by a heart doctor (cardiologist) or a doctor who specializes in the nervous system (neurologist) may be necessary to look for causes of central sleep apnea .

How to heal sleep apnea?

For milder cases, your doctor may only recommend lifestyle changes, such as losing weight or quitting smoking. If you have nasal allergies, your doctor will also recommend treatment for your allergies.

If these measures do not improve your symptoms or if your problem is moderate to severe, a number of other treatments are available. Some devices can help open a blocked airway. In other cases, surgery may also be necessary.

Continuous positive airway pressure (CPAP) therapy

If you are moderately to severely affected by this problem, you may benefit from using a machine that pressurizes air through a mask while you sleep. With CPAP, the air pressure is slightly higher than the surrounding air, and its purpose is to prevent sleep apnea and snoring and to keep the airway open.

Although CPAP is the most common and safe method of treating this problem, some people find it inconvenient or uncomfortable. Some people don’t want a CPAP machine, but with a little practice most people learn to adjust the tension of the straps on the mask to achieve a comfortable and secure fit.

You may need to try more than one type of mask to find one that’s comfortable. If you experience problems, you should not stop using the CPAP machine immediately. You can ask your doctor what changes can be made to increase your comfort.

Treatment with other airway pressure devices

If using a CPAP machine continues to be a problem for you, you can use a different type of airway pressure device (auto CPAP) that automatically adjusts the pressure while you sleep. Units that provide bi-level positive airway pressure (BPAP) are also available. These provide more pressure when you inhale and less when you exhale.

Treatment with oral instruments

Another option is to use an oral device designed to keep your throat open. CPAP is more reliably effective than oral devices, but oral devices may be easier to use. Some are designed to open your throat by bringing your chin forward, which can sometimes alleviate snoring and mild obstructive sleep apnea.

Various devices are available from your dentist. You may need to try different devices before you find the one that works for you.

Once you find the right fit, you will need to follow up with your dentist regularly during the first year to make sure the fit is still good and to reassess your symptoms.

Treatment of associated medical conditions

Possible causes of central sleep apnea include cardiac or neuromuscular disorders . Treating these conditions can help with sleep apnea.

Ek oksijen

If you have central sleep apnea, supplemental oxygen while you sleep may help. Various types of oxygen are available with devices to deliver oxygen to your lungs.

Adaptive servo ventilation (ASV)

This more recently approved airflow device learns your normal breathing pattern and saves the information to an onboard computer. After you fall asleep, the machine uses pressure to normalize your breathing and prevent pauses in your breathing.

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ASV appears to be more successful in treating some people than other forms of positive airway pressure. However, it may not be a good choice for people with predominant central sleep apnea and advanced heart failure.

Surgical treatment

Surgery is usually an option only after other treatments have failed. In general, it is recommended that other treatment options be tried for at least three months before considering surgery. However, for a small number of people with certain jaw structure problems, it is a good first choice.

Surgical options may include:

  • Tissue removal: During this procedure, also known as uvulopalatopharyngoplasty, your doctor removes tissue from the back of your mouth and from the top of your throat. Your tonsils and adenoids are also usually removed. This type of surgery can be successful in preventing throat structures from vibrating and causing snoring.
  • Tissue reduction: Another option is to shrink the tissue in the back of your mouth and throat using radiofrequency ablation. This procedure can be used for those who are mildly to moderately affected.
  • Repositioning the chin: In this procedure, your chin is moved forward from the rest of your facial bones. This widens the space behind the tongue and soft palate, reducing the chance of blockage. This procedure is known as maxillomandibular advancement.
  • Implants: Soft sticks, usually made of polyester or plastic, are surgically implanted into the soft palate after you receive local anesthesia.
  • Nerve stimulation: This requires surgery to insert a stimulator for the nerve (hypoglossal nerve) that controls tongue movement. The increased stimulation helps keep the tongue in a position that keeps the airway open.
  • Creating a new airway (tracheostomy): You may need this form of surgery if other treatments have failed and you have severe, life-threatening sleep apnea. In this procedure, your surgeon makes a hole in your neck and inserts a metal or plastic tube to allow you to breathe.

Removing enlarged tonsils and adenoids and other similar types of surgery can also help reduce snoring. It can contribute to the treatment of sleep apnea by clearing or widening the airways.

What is good for sleep apnea?

Things that are good for sleep apnea include:

  • Losing the extra pounds: Even a slight weight loss can ease the constriction of your throat. In some cases, your problem may improve if you return to a healthy weight, but it may recur if you regain weight.
  • Exercising: Regular exercise can help relieve obstructive sleep apnea symptoms, even without weight loss. You can try to do 30 minutes of moderate activity, such as brisk walking, most days of the week.
  • Avoiding certain medications, such as alcohol, tranquilizers, and sleeping pills: These relax the muscles in the back of your throat, preventing breathing.
  • Sleeping on your side or stomach rather than on your back: Sleeping on your back can cause your tongue and soft palate to sit against the back of your throat and block your airway. You can try placing a tennis ball behind your pajama top to avoid sleeping on your back. There are also commercial devices that vibrate when you turn your back during sleep.
  • Not smoking: If you smoke, you can look for resources to help you quit. You can ask for help on this subject from

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