Obstructive sleep apnea, or OSA, is the most common type of sleep apnea which involves involuntary breathing pauses during sleep. The air flows smoothly from the mouth and nose into the lungs continuously, but when the breathing stops the periods are known as apnea or apneic episodes. OSA is a condition in which the air flow stops repeatedly throughout the night, usually because the area of the throat is too narrow.
Snoring is considered to be characteristic of this condition and it is usually caused by airflow squeezing through the narrowed airway space. If left untreated, obstructive sleep apnea can trigger a number of serious health issues, including diabetes, heart disease, stroke, and hypertension. Thus, here is everything there is to know about OSA.
Most people experience a set of symptoms which are usually typical for OSA, such as:
- drowsiness or fatigue
- feeling grumpy
- morning headaches
- loss of interest in sex
- poor job and school performance
- worsening depression
- leg swelling
- dry mouth or sore throat in the morning
- night sweats
- restlessness during sleep
- trouble concentrating
- waking up suddenly and feeling like you’re gasping or choking
- trouble getting up in the mornings
The symptoms in adults might be quite obvious, but the symptoms in children aren’t so clear. Some of the most common symptoms of obstructive sleep apnea in children include choking or drooling, bedwetting, night sweats, behavior disorders, school issues, sleepiness, snoring, restlessness, teeth grinding, pauses or absence of breathing, and unusual sleeping positions.
This sleep disorder occurs when the muscles in the back of the throat relax excessively to allow normal breathing. These muscles are responsible for supporting the triangular piece of tissue hanging from the soft palate (uvula), the back of the roof of your mouth (soft palate), the tongue and the tonsils. Hence, when these muscles relax, the airway narrows or closes and breathing may be inadequate for 10 seconds or longer. When this happens, you might experience lower oxygen levels which can trigger a buildup of carbon dioxide.
This impaired breathing is immediately noticed by the brain which briefly rouses you from sleep so that you can reopen your airway. However, this awakening is extremely brief that most people don’t even notice it but you usually make a choking, snorting, or gasping sound.
A person can experience five to thirty times per hour during the duration of sleep. So, these sleep disruptions can prevent you from getting adequate sleep and make you feel sleepy throughout the day. As most people aren’t aware that they had these disruptions, they think that they had a good night’s sleep.
Besides obstructive sleep apnea, which is the most common, there are other types of sleep apnea, including central and mixed sleep apnea. In central sleep apnea, there is no blockage of the airway, but the brain doesn’t signal the respiratory muscles to breathe. On the other hand, the mixed type is a combination of obstructive and central sleep apnea.
The risk of OSA increases in cases where there are conditions or features that narrow the upper airway. Some of the most common risk factors of obstructive sleep apnea include:
- a collar size of 16 inches or more in women
- a collar size of 17 inches or more in men
- large tonsils and adenoids in children
- large tongue, which can block the airway
- a narrow palate or airway that collapses
- retrognathia, a condition when your lower jaw is shorter than your upper jaw
- high blood pressure
Obstructive sleep apnea can be easily diagnosed. In fact, the diagnosis starts with visiting your physician who will perform a complete history and physical examination. Some of the most important clues are snoring and excessive daytime drowsiness. Additionally, your health provider will examine your neck and head to determine whether there are any physical factors which might attribute to the sleep disorder.
You might be required to fill out a questionnaire about your sleep habits, quality of sleep and excessive fatigue. However, in order to determine your condition for certain, your doctor will probably perform one of the following tests:
Polysomnogram, a test which requires you to stay in a sleep study center or hospital overnight. So, this test measures the activity of your organs while you sleep. Some of the organ systems associated with sleep which will probably be monitored include eye movement, brain waves, muscle activity, heart rate and rhythm, oxygen levels in your blood, and arterial blood gas analysis.
EEG and EOM, tests during which the brain waves and your eye movements are recorded before, during, and after sleep. This requires electrodes to be attracted to your scalp, one centimeter above the outer corner of the right eye, and another is placed 1 centimeter below the outer corner of the left eye. These two, the eye movements and brain waves, will show the timing of the different phases of sleep, such as non-REM (non-rapid eye movement) and REM (rapid eye movement).
EMG, a test which uses who electrodes, which are placed on your chin, to detect the electrical activity generated during muscle movements. So, this test demonstrates when your muscles move and relax during sleep.
EKG, a very common test which shows if there is any kind of heart disease. Doctors use this test to monitor the heart rate and rhythm and discover whether there are cardiac disturbances that occur during episodes of apnea.
Pulse Oximetry, a test which measures how much oxygen is there in your blood. Your physician will place a pulse oximeter onto a thin area of your body, such as the fingertip or earlobe. This small device measures the amount of oxygen, known as oxygen saturation, which has a tendency of decreasing during episodes of apnea. The normal range for oxygen saturation is around 95-100 percent.
Arterial Blood Gas, a study which uses a syringe to obtain blood from an artery. This study measures several factors in arterial blood, such as oxygen saturation, the partial pressure of carbon dioxide, oxygen content, partial pressure of oxygen, and bicarbonate levels.
Home sleep apnea testing is probably the most common and most convenient tests available. So, you are given an at-home version of polysomnography to diagnose the sleep disorder. The test measures the breathing patterns, the airflow, the blood oxygen levels, and the snoring intensity.
Treatment of Obstructive Sleep Apnea
There are plenty of treatment options available for OSA and they all aim at ensuring the airflow isn’t obstructed during sleep. First, if you have a mild case of obstructive sleep apnea, you are likely to be recommended some lifestyle changes, including weight loss, quit smoking, moderate alcohol drinking, changing the sleeping position, using a nasal decongestant, taking allergy medications, and avoid taking sleeping pills and anti-anxiety drugs.
Self-case is crucial if you want to deal with your sleep disorder. Therefore, if you are overweight or obese, shedding the extra pounds is of crucial importance. It won’t only help you relieve constriction of your airway, but will also improve your overall health and quality of life.
Additionally, you might also consider doing regular physical exercises, such as strength training and aerobics. You should also avoid alcohol consumption and medications, which can only worsen your condition.
It is recommended to sleep on your stomach or your side as sleeping on your back can make your tongue and soft palate to rest against the back of your throat and block your airway. In case you have nasal congestion, use a saline nasal spray, nasal decongestants or antihistamines.
Nevertheless, if these lifestyle changes don’t seem to improve your sleep or if you have moderate to severe OSA, you are probably going to need some other treatments, such as certain devices or even surgery.
Continuous Positive Airway Pressure (CPAP)
CPAP therapy is the first line of treatment for this sleep disorder. It has shown to be a very common and highly effective treatment, which is administered through a facemask that’s worn at night. You will get a steady positive airflow through the mask which will keep your airways open throughout the night.
Besides the fact that CPAP is the most commonly used and most successful method in treating OSA, there are people who just cannot get used to the machine or the face mask. However, these days the machines are quite small and almost silent that make it easier to grow accustomed to using the therapy. You can also reap the benefits of a humidifier along your CPAP system.
An oral device, also known as a mouthpiece, is an excellent alternative treatment for people who have mild or moderate obstructive sleep apnea. Such devices are designed to keep your throat and airway open. Hence, they can improve the quality of your life, decrease sleepiness, and relieve snoring. In order to get such a device, you will need to see a dentist with whom you’ll discuss this option as there are several such devices available.
Bilevel Positive Airway Pressure (BiPAP or BPAP)
In case CPAP therapy is not effective or you cannot adapt to it, your physician or sleep specialist will probably suggest using bilevel positive airway pressure machine. The BiPAP machines feature settings, high and low, which respond to your breathing. Thus, the pressure is different when inhaling and when exhaling.
OSA is a condition which can deteriorate if you are sleeping on your back, which is known as supine position. So, that’s when positional therapy is suggested, which involves learning how to sleep in a different position. That’s why you will have to visit and discuss this method with a professional at a sleep center.
Probably the least used option on the list is surgery, which used to be a very popular solution in the past. Some of the suggested surgery procedures include:
Uvulopalatopharyngoplasty (UPPP) which is a removal of extra tissues from the back of the throat. It helps with reducing snoring, but doesn’t eliminate OSA completely. Plus, it comes with plenty of unwanted complications.
Tracheostomymay is a procedure which is performed if nothing else helps and it involves making an opening in the windpipe that bypasses the obstruction in the throat.
There are also other surgical procedures, especially if CPAP therapy doesn’t help in relieving sleep apnea. In fact, most children get relief from surgery if they have sleep apnea due to enlarged tonsils. That’s why the American Academy of Pediatrics recommends the surgical removal of tonsils and adenoids as the treatment of choice for children with sleep disorders.
Thus, if you experience any of the above-mentioned symptoms, don’t hesitate to pay your doctor a visit. By getting a proper and timely diagnosis, you can get adequate management of your condition.