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Sleep Apnea: Symptoms, Causes and Treatments

More than 12 million Americans suffer from sleep apnea, and that number may even be higher, according to the National Institutes of Health. Apnea, which means "without breath," can affect people of any age, but it is most common in men older than 40. The disorder can lead to serious health problems.

Insomnia is the most common sleep complaint at any age. It affects almost half of adults 60 and older, according to the National Institutes of Health.
Credit: © Marcin Kempski |Dreamstime.com"

Symptoms & Causes

Symptoms of sleep apnea can occur during the day or night. At night, individuals may snore loudly with periodic episodes where breathing completely stops. In fact, the American Sleep Apnea Association notes that some individuals may stop breathing hundreds of times in one night.

Individuals can be awoken when the brain reflexively rouses them to begin breathing again. Some individuals won't remember waking up, while others may have difficulty staying asleep through the night.

In the morning, people with sleep apnea may have a sore throat or headache. They also may feel tired throughout the day because of inadequate sleep the previous night.

Sleep apnea is categorized as obstructive, central or mixed (also called complex). With obstructive sleep apnea, tissues in the back of the throat — the tonsils, tongue and muscles attached to the soft palate — fail to stay open during sleep. This closes the airway and impedes breathing.

Less common than obstructive sleep apnea is central sleep apnea, which is caused when the brain doesn't properly control breathing. Central sleep apnea is often due to heart disease. Individuals are also more likely to remember waking up with central sleep apnea.

 

Diagnosis & Tests

Loud snoring does not automatically mean an individual has sleep apnea. However, individuals often fail to seek treatment because they think snoring is benign. Furthermore, many individuals have no idea that they are having trouble breathing throughout the night. For these reasons, sleep apnea is both under-diagnosed and hard to detect in a routine trip to the doctor. A family member is often the first to notice a problem.

Doctors may make a diagnosis based on symptoms, or individuals may be referred to a sleep specialist. At a sleep center, individuals will typically spend the night for observation. For example, they may undergo a test called nocturnal polysomnography that measures heart, lung and brain function. This test also analyzes breathing and body movements.

Some tests can also be done at home. With a portable monitoring device, things like heart rate and breathing patterns can be measured. Still, nocturnal polysomnography may still be required to confirm diagnosis.

In addition to these tests, individuals may see a cardiologist or a neurologist to evaluate the exact causes of central sleep apnea.

Treatments & Medications

In some cases, medication may not be needed. Lifestyle changes such as losing weight and smoking and drinking less can improve symptoms.

There are also devices that can assist with breathing throughout the night. For example, a continuous positive airway pressure machine is essentially a mask that uses higher air pressure to force the airway to remain open during sleep. There are also machines, called bilevel positive airway pressure machines, which can adjust pressure during sleep.

Less effective are oral devices that keep the airway open by moving the jaw forward. These devices can be obtained through a dentist.

If devices are unsuccessful, surgery may be necessary to get rid of tissues that are obstructing the airway. There are several types of surgical procedures that can be done.

During an uvulopalatopharyngoplasty, the tonsils, adenoids and tissues from the back and top of the throat are removed. A maxillomandibular advancement moves the jaw forward to open up space in the throat. In severe cases, a tracheostomy is performed. This procedure involves placing through the neck a permanent tube into the airway. The opening stays covered during the day.

Coping

Successful treatment can improve sleep quality, as well as quality of life. Still, individuals should continue to visit their physician to ensure that therapy is working.

Individuals using a continuous positive air pressure machine may need to follow-up with a physician if the device isn't comfortable. Individuals using an oral device will need regular checkups with a dentist.

Maintaining a healthy weight can prevent symptoms from worsening or requiring further adjustments to any devices being used.

Finally, individuals with sleep apnea should always inform doctors before surgery. Surgeons may need to take particular steps to ensure the airway remains open throughout surgery, according to the National Heart, Lung and Blood Institute.

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