Sleep apnea is a disorder of interrupted breathing during sleep. It usually occurs in association with fat buildup or loss of muscle tone with aging. These changes allow the windpipe to collapse during breathing when muscles relax during sleep. This problem, called obstructive sleep apnea, is usually associated with loud snoring (though not everyone who snores has this disorder). Sleep apnea also can occur if the neurons that control breathing malfunction during sleep.
During an episode of obstructive apnea, the person's effort to inhale air creates suction that collapses the windpipe. This blocks the air flow for 10 seconds to a minute while the sleeping person struggles to breathe. When the person's blood oxygen level falls, the brain responds by awakening the person enough to tighten the upper airway muscles and open the windpipe. The person may snort or gasp, then resume snoring. This cycle may be repeated hundreds of times a night. The frequent awakenings that sleep apnea patients experience leave them continually sleepy and may lead to personality changes such as irritability or depression. Sleep apnea also deprives the person of oxygen, which can lead to morning headaches, a loss of interest in sex, or a decline in mental functioning. It also is linked to high blood pressure, irregular heartbeats, and an increased risk of heart attacks and stroke. Patients with severe, untreated sleep apnea are two to three times more likely to have automobile accidents than the general population. In some high-risk individuals, sleep apnea may even lead to sudden death from respiratory arrest during sleep.
An estimated 18 million Americans have sleep apnea. However, few of them have had the problem diagnosed. Patients with the typical features of sleep apnea, such as loud snoring, obesity, and excessive daytime sleepiness, should be referred to a specialized sleep center that can perform a test called polysomnography. This test records the patient's brain waves, heartbeat, and breathing during an entire night. If sleep apnea is diagnosed, several treatments are available. Mild sleep apnea frequently can be overcome through weight loss or by preventing the person from sleeping on his or her back. Other people may need special devices or surgery to correct the obstruction. People with sleep apnea should never take sedatives or sleeping pills, which can prevent them from awakening enough to breathe.
There are two types of apnea, obstructive sleep apnea (OSA) and central sleep apnea (CSA). OSA is caused by airway obstruction. Physiological risk factors for OSA include obesity, large neck girth, male gender, and conditions with narrow the airway. Medical conditions that increase the incidence of OSA included heart failure, chronic obstructive pulmonary disorder, and hypothyroidism. CSA is a result of central dysfunction.
Overview of Sleep Apnea:
Excessive daytime sleepiness (EDS), mood disturbances, feeling unrefreshed after a night’s sleep and reports from the partner of breathing cessation, choking or gasping for air, and snoring.
A careful history and physical exam as well as an overnight polysomnogram (PSG) by a trained specialist. Further testing involving a split night study can be done to achieve optimal symptomatic control.
The severity of sleep apnea will determine course of treatment. Weight loss in some cases may be sufficient. However, in other cases, dental implant devices can be used to prevent airway obstruction secondary to tongue obstruction. In more severe cases, your sleep specialist will order a continuous positive airway pressure (CPAP) machine which is worn while sleeping to maintain a patent airway.