Have you ever seen someone gasp for air mid-sleep and then go back to sleep peacefully as if nothing happened? It is disturbing to look at and more annoying for someone who has to sleep next to them. But the irregular breathing and gasping sound followed by deep sleep are a common sleeping disorder called sleep apnea.
While sleep apnea is often confused with usual snoring problems, it is more complicated and harder to treat. Although not fatal on its own, sleep apnea can lead to life-threatening diseases and even death.
Besides disturbing others while sleeping, even the person suffering from sleep apnea often faces discomfort and irregular sleeping patterns. This condition can lead to fatigue, moodiness, and other underlying diseases of sleep deprivation.
Although sleep apnea is a common disorder, only a few people diagnosed are aware of this condition and seek treatment. There are three types of sleep apnea categorized according to their severity. While some cases are treatable, some are too risky to treat due to other medical conditions.
So if you or someone you know is suffering from sleep apnea, understanding the condition to mitigate the symptoms is essential. Read on to find out everything you need to know about sleep apnea and how you can help someone with the disorder.
So What is Sleep Apnea?
Obstructive Sleep Apnea (OSA) is a sleep disorder in which breathing briefly stops involuntarily during sleep. The pauses or shallow breathing can last a few seconds or even minutes and occurs more frequently than usual.
The word apnea comes from the Greek word “apnous” and “opnoia,” which means “breathless.” In modern times, it can also be called “apnoea,” which refers to a temporary cessation of breathing.
It is characterized by irregular breathing and a loud snoring pattern that ultimately causes “apnea” in which a person momentarily stops breathing. The inability to get a restful sleep can also lead to severe exhaustion and fatigue. In children, it can hamper cognitive abilities or cause hyperactivity.
Types of Sleep Apnea
Two factors can cause sleep apnea. One is due to obstruction of airways. The other reason is a neurological malfunction—both of these cause an imbalance in the blood’s carbon dioxide and oxygen levels. If sleep apnea is not taken care of soon, the condition can impact other underlying health conditions that can lead to severe complications.
Depending on the severity and frequency, an individual can have obstructive sleep apnea (OSA), central sleep apnea (CSA), or a mixture of both.
1. Obstructive Sleep Apnea (OSA)
Obstructive apnea is the most common form. According to studies, 1 to 6 percent of adults and two percent of children suffer from OSA. It is more common in males than females between the ages of 55 to 60.
OSA develops when there is a blockage of the airways. When we breathe, air goes from the nose through the nasopharynx into the laryngopharynx. Then it goes through the larynx and into the trachea. Somewhere along the path, there might be a blockage in the airflow, leading to breathlessness.
Allergies that cause swelling of the nasopharynx tissue may cause the blockage. It can also be due to swollen glands or tonsils because of an infection. Or, severe overbite, which pulls the jaws back, can also block the airway.
Obesity is also another cause. There can be too much weight in the neck’s soft tissue on overweight people, weighing down the air passage, especially when lying down.
Sleep apnea is most evident at night because hormones change at night, and it causes the muscles around the airways to loosen while sleeping. This means that the muscles are weaker in keeping the airways open, making it more likely to obstruct the airways.
2. Central Sleep Apnea (CSA)
On the other hand, Central apnea is due to a problem in the central nervous system. It is less common than OSA and affects only 1% of the world population.
When a person has CSA, the brain stops the lungs from making an effort to breathe for 10 to 30 seconds. The apnea can last for several seconds even after waking up, disrupting the sleep cycle, and causing panic attacks.
Central Sleep apnea begins with an episode of hyperpnea, which happens when the brain causes the lungs to hyperventilate during sleep by increasing the respiratory rate. This rapid breathing causes a drop in blood carbon dioxide levels. When the carbon dioxide level falls below the standard level, the body slips into a state where it makes no effort to breathe and, therefore, taking no oxygen.
This pattern causes the carbon dioxide level to rise back to the average level. As the apnea persists, it keeps increasing to a point where it is called hypercapnia. The high carbon dioxide level triggers hyperpnoea again, and the cycle starts all over.
The respiratory system goes rapidly back and forth between two states: first, it makes no effort to breathe and then hyperventilates with no balance in between.
3. Mixed Apnea
When an individual displays symptoms of both CSA and OSA, the condition is diagnosed under mixed apnea. It is the most common type of sleep apnea.
According to a Mayo Clinic study, 15% of patients who have OSA also exhibit mixed apnea. Sometimes patients are treated with CPAP machines while others with PAP therapy.
Effects of Sleep Apnea
Sleep apnea’s direct effects are not always visible right away but slowly build over time when not treated. The results can be minor or severe, depending on other health factors. Some of the most common and apparent impacts of sleep apnea are as below:
- Severe sleep deprivation
Sleep deprivation is, perhaps, one of the most common and evident effects of sleep apnea for the patient and others.
Sleep Apnea disrupts sleeping patterns because the individual wakes up often and at random hours. Usually, they are not even aware of what woke them up, except for the feeling of breathlessness. It can be a regular occurrence or on random nights.
Interrupted sleep for long days can cause nocturia, which is the excessive need to urinate at night due to stress-induced insomnia. The effects are also visible during the day because the inability to sleep peacefully leads to difficulty performing normal physical functions. The body gets exhausted and even the slight urge to urinate becomes uncontrollable.
- Loud Snoring
Apnea episodes are usually accompanied by loud snoring, which can interrupt the sleep of others as well. The snoring can sometimes be so loud that it often keeps others sleeping in the next room awake. On other nights, it sounds like they are choking for a few seconds, and then it stops again.
Usually, the person with sleep apnea is unaware of the snoring and wakes up only when breathing becomes too difficult. These episodes can happen sometimes or every night but frequently each time.
- Triggering other health problems
A drop in oxygen level during sleep apnea can also trigger other health problems. When there is a shortage of oxygen circulation, it can trigger angina chest pain and irritate heart cells that lead to an irregular heartbeat.
It can also trigger respiratory failure for people with ongoing respiratory problems. In severe cases, this can lead to a stroke or heart attack—even, other risks like heart failure, respiratory failure, diabetes, and certain types of cancer.
Causes of Sleep Apnea
There are many underlying health conditions linked to sleep apnea. Some are genetics and hereditary, while others are due to lifestyle and physical features. The most common causes are:
Excess fat due to obesity is one of the most common factors. Fats deposits around the neck obstruct breathing by weighing down the airways while lying down. It also prevents individuals from positioning the head correctly while sleeping and constrains the air passage.
- Family History
If a family member has sleep apnea, you will likely develop the symptoms because sleep apnea can be hereditary. This factor is due to the genetic composition of physical features such as the jaw structure and obesity that cause sleep apnea.
Pollen, dust, or other types of allergies irritate the nasal and airways causing them to swell. Once these parts swell and get inflamed, breathing becomes difficult and irregular. Nasal congestion due to allergies also dries out the mouth and obstructs the steady airflow further.
- Small Breathing Airways
Some people are born with a smaller airway passage. Sometimes it’s genetics, and other times, it is due to natural physical features. Either way, when the airways are smaller than usual, breathing becomes difficult.
- Enlarged Tonsils or tongue
Enlarged tonsils or tongue due to infections can hamper the way you breathe while sleeping or awake. But when enlarged, the tonsils relax on your throat while sleeping and block the free passage of air, requiring more effort to breathe.
- Gastro reflux
Acid reflux due to gastrointestinal problems is another common cause. The liver, lungs, and airways work overtime to keep the reflux in control, requiring more oxygen and faster breathing. The acid reflux also affects the oesophagus, which is a vital organ to help you breathe properly.
- Deviated Septum
When the nasal bone and cartilage that divides the two nostrils are slightly bent, it obstructs airflow into the lungs. This misalignment is one of the leading causes of snoring when one has sleep apnea. It makes the nose more sensitive and prone to allergies and sinus problems, leading to sleep apnea.
- Misaligned jaw bone
When the upper jaw does not align with the lower jaw, sleeping with a closed mouth becomes uncomfortable. Because of this, people with narrow, small, or recessed jaws often have sleep apnea. Such jaw bone structures tend to create narrow airway paths and cause breathing irregularities while sleeping.
- Large neck circumference (greater than 16 to 17 inches)
The ideal neck circumference for men is 17 inches and 16 inches in women. People with a thicker neck are more prone to OSA because it blocks the air passage when the airways relax during sleep. Larger neck circumference often means more fats around the throat and airways, causing the person to snore or wheeze while sleeping.
Signs and Symptoms of Sleep Apnea
While all the factors mentioned above are some indicators seen in most people, it is not guaranteed that these cause sleep apnea. They can indicate other sleeping disorders and regular snoring. The only way to be sure if it is sleep apnea is through a medical examination.
Other tell-tale signs of sleep apnea are:
- Excessive Daytime Sleepiness (EDS)
Nighttime sleep is when the body regenerates and refuels itself during several hours of sleep. But interrupted sleep prevents the body from repairing and recharging, making the body crave sleep during the daytime.
People with sleep apnea think they are getting 8 hours of sleep, but in fact, they are only sleeping for a few minutes before being interrupted by their breathing. They often wonder why they are always sleepy during the day because they are unaware of the sleep disorder.
- Impaired Alertness
Peaceful sleep refreshes your brain cells, and cognitive functions get sharper. However, people with sleep apnea often complain of impaired alertness. This condition is common both in children and adults. They are unable to concentrate and focus for long without feeling dazed. Their motor and cognitive capacities get slower, and their vision quickly gets blurred even under normal conditions.
- Behavioural changes
People with sleep apnea often display behaviour change. It is usually an adverse reaction as they are bothered by unexpected mood swings throughout the day. They are easily irritated and often prefer being alone as they cannot explain their behaviour, which leads to the next symptom.
- Fatigue and Depression
Being unable to understand the cause of behavioural change and constant fatigue often leads to voluntary isolation. It is common for people with depression to display some levels of sleep apnea. The correlation is evident because depression affects breathing and sleeping patterns, and sleep apnea worsens depression.
If these vital signs and symptoms are apparent, check the sleeping pattern. It could lead to diagnosing early signs of sleep apnea and could save lives.
Sleep Apnea Risk Groups
While sleep apnea can affect anyone, there are some people more vulnerable to the condition than others. Some of the vulnerable groups of people more likely to develop sleep apnea are:
Studies show that out of the population diagnosed with sleep apnea, the majority of them are males. The reason is still under debate, but most people believe it is due to the difference in lifestyle and life choices. Sleep apnea is more prominent in males too, because they snore louder, and it gets easier to diagnose them.
- Age over 65
People over sixty-five have weaker throat muscles and are more prone to other health issues causing sleep disorder. This problem arises because sleep apnea is a result of physical and neurological imbalances that weakens with age.
- Heart and lung Disorder
People with heart and lung diseases have difficulty converting carbon dioxide, and oxygen like ordinary people do. Heartbeat rate and lung functions become slower and obstruct breathing, which leads to sleep apnea.
- High Blood Pressure
A sudden drop in blood oxygen level and a sudden rise in carbon dioxide accompanies sleep apnea. This extreme high and lows cause hypertension or high blood pressure, which can sometimes lead to a stroke. So people with high blood pressures are at a very high risk of developing conditions related to sleeping disorders.
Is it Sleep Apnea or Just Snoring?
While many people confuse sleep apnea as loud snoring, it is, in fact, quite different. Note that even though snoring is a symptom of sleep apnea, all snorers do not have a sleeping disorder.
The reason that people snore while sleeping is almost the same as sleep apnea. But sleep apnea is far more severe and disturbing.
While both snoring and sleep apnea can be equally disturbing for other sleepers, sleep apnea affects the individuals differently. Snoring is non-life threatening, whereas sleep apnea triggers many other health conditions that can even cause death in the long run.
If someone is snoring too frequently or at an alarming pace, it can indicate other physical conditions or sleep apnea. So snoring is not something we should overlook. If the snoring rates either cause discomfort and match the other symptoms of sleep apnea, act quickly. Call a doctor and have a sleep study to determine the cause as soon as possible.
Diagnosing Sleep apnea
Diagnosing sleep apnea requires a professional sleep study to identify sleep apnea episodes. To diagnose a sleeping pattern as sleep apnea, the person must display at least five apnea episodes while asleep- the more episodes, the more severe the sleep apnea.
Since people with the condition are usually unaware, family members are generally the first to notice it. The asleep study usually involves getting monitored overnight with a polysomnogram. It is a medical instrument that tracks brain movements, oxygen and carbon dioxide blood levels, vital signs, and outwards symptoms like snoring and movement.
Treating Sleep Apnea
Treating sleep apnea starts with eliminating depressant things like sleeping pills, alcohol, and other respiratory obstructing medications. Avoiding these things is essential because they can relax the throat muscles around the airways and make the airways more likely to weaken and collapse during sleep.
Though avoiding several things can lessen the symptoms, treating sleep apnea is more complicated. However, some of the effective measures for treating sleep apnea are:
- Lifestyle changes
Since the effects of sleep apnea are sleeping disorder and respiratory obstruction, making positive lifestyle changes to eliminate these effects should be a priority. Eat a healthier diet and exercise, wash up before sleep to clear the nasal passage, and improve personal hygiene to prevent allergies. Taking these precautions can mitigate snoring and help you sleep better.
- Losing weight
Obesity is also another cause of airway passage obstruction. The only way to prevent severe condition is by losing weight. Practising neck movement and strengthening neck muscles to get the excess weight off the neck.
- Quit Smoking
Besides the many reasons to quit smoking, individuals with sleep apnea should consider leaving the cigarettes. It irritates the respiratory system and worsens many other health conditions.
- Sleep on Side
Instead of lying on the back, sleeping on the side also helps because it allows better airflow into the lungs. Since the lungs are on our bodies’ backs, the sideway sleeping posture takes the bodyweight away.
- CPAP device
For severe sleep apnea, people can use a Continuous Positive Airway Pressure (CPAP) device. This CPAP machine forces the airways by supplying a steady stream of pressurized air. The air passes through a nasal prong or plastic face mask. When used correctly and continuously, it is beneficial. But many people eventually stop using it after some time because they find these masks annoying or difficult to wear, so the problem persists.
Some people with OSA can benefit from a custom made oral mouthpiece that helps improve airflow during sleep.
Sometimes surgical procedures can treat OSA. For example, surgeons can remove excess adenoid tissue from the throat and widen it. The realignment of jaw bones is also an option that some people with severe apnea require. However, surgical procedures are complicated because anaesthesia and surgical swelling can worsen sleep apnea in the short term.
To sum up, sleep apnea is a minor health issue with grave consequences when untreated. Even though the symptoms and causes vary for each individual, the lifelong effects are the same. The main concern about both types of sleep apnea is the long pauses between breaths that interrupt the regular sleeping pattern.
Since individuals with sleep apnea conditions are usually unaware of their symptoms, it can go untreated for a long time. However, with the observation of family members and scientific instruments, diagnosing sleep apnea is possible.
Treatment of sleep apnea is both simple and complicated, so knowing the severity and the cause is vital for treating it. The trick is to diagnose it correctly as soon as possible.