Everything you need to know about Sleep Apnea



Sleep apnoea is a sleep disorder where a person’s breathing stops and restarts multiple times during sleep. Normally when a person sleeps, air flows smoothly from the nose & mouth up to the lungs, however, in apnoea or apnoeic episodes breathing completely stops for a few seconds followed by abrupt awakening and gasping for breath.

It is a potentially serious condition as it results in reduced oxygen supply to your body especially to the brain, eventually leading to a number of health problems including excessive daytime sleepiness. Men are more commonly found to have sleep apnoea; however, the occurrence is relatively common in older, obese, post-menopausal women as well.

RISK FACTORS

There are a few factors that are more commonly associated with sleep apnea like

  • Obesity
  • People with narrow airway or thick neck eg enlarged tonsils or adenoids
  • Older age and male sex are known to have a higher risk
  • Anatomical variations like people with a smaller jaw, large soft palate, or tongue
  • Nasal block or congestion
  • Diabetes mellitus or Hypertension
  • Family history
  • Recent travel to high altitudes

    • TYPES

    The three major types of sleep apnoea are

    Obstructive sleep apnea: it is the most common type of apnoea and occurs due to the excessive relaxation of the throat muscles that results in narrowing of the airway and reduced oxygen levels in the body. This reduced oxygen level is recognized by the brain causing the person to wake up gasping or choking for air. Depending on the level of airway narrowing, symptoms can vary from snoring to very poor quality of sleep and increased health complications.

    Central sleep apnea: it is a relatively rare type of sleep apnoea that occurs due to the inability of the brain to regulate normal sleep and the reduced brain signals to the muscles involved in breathing thereby resulting in a very shallow sleep pattern, pauses in sleep and repeated awakening in the night. This type of sleep apnoea is generally associated with other disease conditions like congestive heart failure, stroke, and ingestion of certain drugs like benzodiazepines, opioids, etc.

    Mixed or complex type: this is a type of apnea that has been recently widely recognized and has features of both obstructive and central sleep apnea. Patients initially diagnosed with obstructive sleep apnea but not showing any improvement with appropriate treatment are generally categorized into this type. However, the exact cause of complex sleep apnea or the lines of management for improvement of symptoms is still being explored.

    SYMTPOMS & COMPLICATIONS

    The most common symptom seen in apnea is loud snoring, especially in the obstructive type which occurs due to partial narrowing of the airway. The other symptoms that may be associated are excessive daytime sleepiness, dry mouth on waking, morning headaches, reduced concentration throughout the day, memory disturbances, reduced daytime energy, sexual dysfunction, depression or anxiety, restlessness, night sweats, or increased nighttime urination.

    People with long-term sleep apnea can eventually have serious complications like heart disease or attacks, atrial fibrillation, impotence, GERD, hypertension, diabetes mellitus, liver disorders, stroke, dementia, and increased risk of road traffic accidents, and premature death.

    INVESTIGATIONS

    The different investigations used to evaluate sleep apnea is once again based on the different types and presenting symptoms of a person.

  • General physical examination and detailed history taking by your doctor, help elicit the presence of the major risk factors associated with sleep apnoea.
  • Blood investigations are done in order to rule out other systemic diseases. Eg thyroid hormones, FSH or LH, etc.
  • Nose and throat evaluation by an ENT doctor to look for anatomical abnormalities eg enlarged tonsils or adenoids
  • Home sleep studies like monitoring pulse rate, oxygen levels, number of nighttime awakenings, or maintaining a daily sleep diary which is used to document further details to help diagnose the exact type of apnea.
  • Nocturnal polysomnography which is an overnight sleep study generally done at a center for sleep studies and monitors your breath rate or pattern, heart rate, body movements, oxygen levels, and brain activity, and a detailed report of the same is generated for further management.

    • TREATMENT

    The approach to treatment for sleep apnea can be divided into conservative or surgical based on the severity of symptoms or type of apnea.

  • The different conservative options available are reduction in weight, avoiding drugs that increase the risk of apnoea, proper control of diabetes or hypertension, nasal sprays to reduce congestion, and better sleeping positions like left lateral positions.
  • Mechanical methods like Continuous positive airway pressure (CPAP), which is a device that blows air through the mask attached to the mouth and nose, making it less likely for the airway to collapse during sleep. This device is considered the gold standard treatment for obstructive sleep apnoea. Sometimes other devices like BiPAP, APAP(automatic positive airway pressure), and ASV (adaptive ser-ventilation) are also used.
  • Mandibular advancement devices are used for people with smaller jaws and help the tongue from blocking the airway.
  • Surgical methods available remain the last resort in patients with persistent apnoea despite multiple attempts at conservative treatment. The different surgical options are adenoidectomy or tonsillectomy, uvulopalatopharyngoplasty, mandibular or maxillary advancement surgeries, and nasal surgeries like septoplasty or polypectomy.

    • PREVENTION

    Small changes in our day to day life can greatly reduce the risk of developing sleep apnea like

  • Regular exercise
  • Maintain a healthy lifestyle
  • Quit smoking
  • Avoid alcohol or other sleep-inducing medications
  • Better sleeping position - like left lateral position
  • Avoid sleeping in a room with dry air

    • Although these changes can help reduce the overall occurrence of apnoea, people with worsening symptoms or certain other types like central sleep apnea require an immediate visit to the doctor for further management.