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Obstructive Sleep Apnea; Diagnosis and Treatment

The Greek word “apnea” means “without breath.” Sleep apnea is a sleep disorder experienced by over 12 million people in the U.S. During sleep, breathing can be shallow, with breathing stopping and starting at times. During this sleep pattern, your diaphragm and chest muscles are doing the work to keep your airway open. You usually start to breathe again with a loud gasp, snort, or body jerk. When you wake, you may still feel tired, despite a full night’s sleep. Sound familiar?

The Mayo Clinic explains that there are three main types of sleep apnea:

  • Obstructive sleep apnea, the more common form that occurs when throat muscles relax
  • Central sleep apnea, which occurs when your brain doesn’t send proper signals to the muscles that control breathing
  • Complex sleep apnea syndrome, also known as treatment-emergent central sleep apnea, which occurs when someone has both obstructive sleep apnea and central sleep apnea

Symptoms

Most people associate sleep apnea with an obese person who snores loudly, but this isn’t the only, or even most likely, presentation. According to one study, more than half of all those with high risks for sleep apnea are over the age of 65, yet only 8% were tested. Post menopausal women are at greater risk then pre menopausal women. Men more so then women. And without a doubt obesity and underlying health issues. All ages and sizes can be effected.

The most common signs and symptoms of obstructive and central sleep apneas, as outline by the FDA, are:

  • Loud snoring
  • Episodes in which you stop breathing during sleep — which would be reported by another person
  • Gasping for air during sleep
  • Awakening with a dry mouth
  • Morning headache
  • Difficulty staying asleep (insomnia)
  • Excessive daytime sleepiness (hypersomnia)
  • Difficulty paying attention while awake
  • Irritability
  • Poor blood pressure control on multiple medications

Although snoring is characteristic of obstructive sleep apnea since it is caused by airflow squeezing through the narrowed airway space, many other more subtle concerns can be linked to sleep apnea.

Risk factors

Risk for obstructive sleep apnea are conditions that narrow the upper airway:

  • children with large tonsils and adenoids
  • men with a collar size of 17 inches or more
  • women with a collar size of 16 inches or more
  • large tongue, which can block the airway
  • retrognathia, which is when your lower jaw is shorter than your upper jaw
  • a narrow palate or airway that collapses more easily
  • over 65
  • post menopausal
  • obesity
  • family history
  • smoking, alcohol, narcotic or sedative use
  • men are twice as likely than women
  • conditions such as high blood pressure, diabetes, heart failure, lung disease

Untreated sleep apnea can cause serious health problems, including lowering the flow of oxygen to your organs and an uneven heart rhythm. Sleep apnea increases the risk for hypertension, heart disease, stroke, liver disease, diabetes and possibly even dementia. Research has shown that older adults with excessive daytime sleepiness as well as moderate to severe sleep apnea are twice as likely to die than those without these concerns.

The risk factors are intertwined, which goes to show that wellness cannot be approached with a singular focus. Maintaining a lifestyle that includes a fitness regimen, healthy diet, and preventative care all go hand-in-hand in supporting your body’s health and lowering the risk of developing many health concerns.

Evaluations

Diagnosis is done via a sleep study or polysomnography. This test evaluates multiple sensors on your scalp, temples, chest, legs and finger. These relay information to a computer that monitors brain waves, eye movements, heart rate, breathing patterns and oxygen levels as you sleep.

These studies can be done at home or in a sleep lab. But the home test is only able to diagnose sleep apnea in the most severe cases and drops in oxygenation throughout the night. If you clearly stop breathing, snore loudly, are obese, and over 65 year old, it’s a good bet the test will be accurate. But in a 50 year old, thin woman, it may be inconclusive.

As inconvenient as going to a sleep lab may be it’ll give the most accurate and widespread information possible.

Treatment

Sleep apnea is not something that can be treated with medication, and no drug has been approved by the FDA to treat sleep apnea. Ronald Farkas, M.D., Ph.D., at FDA’s Center for Drug Evaluation and Research, says that doctors sometimes prescribe drugs that promote wakefulness such as Provigil and Nuvigil for patients suffering from the daytime sleepiness caused by sleep apnea—but that these drugs do not treat the nighttime breathing problem.

Overwhelmingly, experts focus on addressing the lifestyle factors that contribute to the risk factors- particularly maintaining a healthy weight. The link between excess weight and sleep apnea is well established. People who are overweight are more likely to have extra tissue in the back of their throat, which can fall down over the airway and block the flow of air into the lungs while they sleep.

What about medical devices?

An additional treatment method is called “continuous positive airway pressure”, or CPAP. CPAP is a mask or device that fits over the nose and mouth. It blows air into the airways to keep them open at night. Often, this is utilized by providers as a primary treatment method due to the difficulty people may have in addressing excess weight .

Although CPAP has been shown to counteract sleep apnea, more than half of people that use the device do not maintain the treatment due to the clunky nature of the device. But, as with other medical devices, as technology changes, comfort and fit improve.

Another option is an oral appliance, meaning a plastic insert that fits into the mouth, helps prevent the tongue and tissues in the back of the throat from collapsing over the airway during sleep.

CPAP and oral appliances treat the symptoms and some of the causes of sleep apnea, but are not cures. While these devices may be used in the immediate, as weight loss requires a shift in lifestyle and consistency, the only way to remedy the condition is to address any excess weight or to surgically remove the excess tissue from the throat. Surgery can have side effects, which is why it’s usually viewed as a last resort.

What about snoring, apart from sleep apnea?

Snoring itself is not a true indicator for sleep apnea. It must be combined with one or more of the symptoms above. But there are ways to help.

  • stay on your side
  • use a rolled up pillow or put a tennis ball in your T-shirt, which can prevent sliding onto your back. This prevents the tongue from falling backwards and blocking the airway.
  • keep your head up. Just four or more inches can take pressure off the airway.
  • avoid alcohol, or make sure several hours pass between your last drink and sleep. Alcohol relaxes muscles in the throat increasing the possibility of snoring
  • stuffy nose? Try nasal strips, a humidifier or over the counter medicines if appropriate.

If these tricks aren’t enough to help, talk to your provider.


Despite the life threatening risks sleep apnea poses, many have no clue they are vulnerable. And too often symptoms are overlooked, especially when subtle, like fatigue, just not feeling well, poor memory, or less energy. Often, it’s a partner who is scared by the moments they stop breathing. Even those whose blood pressure can’t be regulated on multiple meds are suspect. One study found those who used a CPAP machine for 3 months after they were diagnosed with OSA experienced a significant reduction in blood pressure. If any of this sounds like you or someone you know, evaluation is key.


Sources:

https://www.mayoclinic.org/diseases-conditions/sleep-apnea/symptoms-causes/syc-20377631

Weight loss, breathing devices still best for treating obstructive sleep apnea

https://www.fda.gov/consumers/consumer-updates/always-tired-you-may-have-sleep-apnea

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