Sleep Apnea Contributions by FoundHealth

Sleep apnea is a condition in which breathing stops for brief periods of time while a person is sleeping. These episodes of interrupted breathing last anywhere from 10-30 seconds at a time, and may occur up to 20-30 times per hour. Over the course of a single night’s sleep, this can mean up to 400 episodes of interrupted breathing. Over 18 million Americans have sleep apnea, and the majority of these people are overweight.¹

Normal Upper Airway During Sleep

Every time you stop breathing, you interfere with the normal patterns of deep sleep. Without realizing it, sleep apnea sufferers awaken regularly in order to resume breathing. Sleep apnea is one cause of insomnia, because quality of sleep is seriously impaired. This results in severe daytime sleepiness, road safety impairment, and overall difficulty thinking and functioning.

Blocked Airway

Some of the risks associated with sleep apnea include:

• Increased risk of accidents (especially car accidents) due to inattention and inability to stay alert during normal waking hours
• Higher risk of heart disease
• Increased risk of stroke
• Increased risk of lung disease
• Increased risk of hypertension
• Increased risk of diabetes

There are three different kinds of sleep apnea:

Obstructive Sleep Apnea

This is the most common type of sleep apnea, commonly known as OSA or OSAS (Obstructive Sleep Apnea Syndrome). It is caused by a temporary partial or complete airway obstruction. Obstructive sleep apnea can occur when the tissues of your throat relax too much and cave in on each other. In overweight sleep apnea sufferers, excess tissue puts pressure on your airway, causing it to collapse.
Other possible structural causes of sleep apnea are

• Deviated septum
• Nasal polyps
• Large tonsils
• An elongated soft palate and uvula that obstruct the airway during sleep.

For children, the most common reason for obstructive sleep apnea is enlarged tonsils and adenoids.

Central Sleep Apnea

This occurs when the lower brain stem neglects to send signals to the muscles that control breathing. Conditions that cause problems with the lower brain stem include:

• Polio
• Encephalitis
• Stroke
• Brain tumors
• Other degenerative diseases affecting the brain and central nervous system.

Mixed Sleep Apnea

This form is a combination of both obstructive and central sleep apnea.

Who gets sleep apnea?

Overweight people over 40 are the most likely to develop sleep apnea. Children develop it only rarely, and generally it is caused by enlarged tonsils or adenoids. CPAP devices are available in special sizes for children.

[What are the risk factors for sleep apnea?

[What are the symptoms of sleep apnea?

[How is sleep apnea diagnosed?

What are the treatments for sleep apnea?

[Are there screening tests for sleep apnea?

[How can I reduce my risk of sleep apnea?

[What questions should I ask my doctor?

What is it like to live with sleep apnea?

Where can I get more information about sleep apnea?

Sleep apnea is a condition in which breathing stops for brief periods of time while a person is sleeping. These episodes of interrupted breathing last anywhere from 10-30 seconds at a time, and may occur up to 20-30 times per hour. Over the course of a single night’s sleep, this can mean up to 400 episodes of interrupted breathing. Over 18 million Americans have sleep apnea, and the majority of these people are overweight.¹

Normal Upper Airway During Sleep

Every time you stop breathing, you interfere with the normal patterns of deep sleep. Without realizing it, sleep apnea sufferers awaken regularly in order to resume breathing. Sleep apnea is one cause of insomnia, because quality of sleep is seriously impaired. This results in severe daytime sleepiness, road safety impairment, and overall difficulty thinking and functioning.

Blocked Airway

Some of the risks associated with sleep apnea include:

• Increased risk of accidents (especially car accidents) due to inattention and inability to stay alert during normal waking hours
• Higher risk of heart disease
• Increased risk of stroke
• Increased risk of lung disease
• Increased risk of hypertension
• Increased risk of diabetes

There are three different kinds of sleep apnea:

Obstructive Sleep Apnea

This is the most common type of sleep apnea, commonly known as OSA or OSAS (Obstructive Sleep Apnea Syndrome). It is caused by a temporary partial or complete airway obstruction. Obstructive sleep apnea can occur when the tissues of your throat relax too much and cave in on each other. In overweight sleep apnea sufferers, excess tissue puts pressure on your airway, causing it to collapse.
Other possible structural causes of sleep apnea are

• Deviated septum
• Nasal polyps
• Large tonsils
• An elongated soft palate and uvula that obstruct the airway during sleep.

For children, the most common reason for obstructive sleep apnea is enlarged tonsils and adenoids.

Central Sleep Apnea

This occurs when the lower brain stem neglects to send signals to the muscles that control breathing. Conditions that cause problems with the lower brain stem include:

• Polio
• Encephalitis
• Stroke
• Brain tumors
• Other degenerative diseases affecting the brain and central nervous system.

Mixed Sleep Apnea

This form is a combination of both obstructive and central sleep apnea.

Who gets sleep apnea?

Overweight people over 40 are the most likely to develop sleep apnea. Children develop it only rarely, and generally it is caused by enlarged tonsils or adenoids. CPAP devices are available in special sizes for children.

What are the risk factors for sleep apnea?

What are the symptoms of sleep apnea?

How is sleep apnea diagnosed?

What are the treatments for sleep apnea?

Are there screening tests for sleep apnea?

How can I reduce my risk of sleep apnea?

What questions should I ask my doctor?

What is it like to live with sleep apnea?

Where can I get more information about sleep apnea?

ep apnea: References:

¹Agus, David. The End of Illness. (New York: Free Press, 2011): 250.

²American Sleep Apnea Association website. Available at: http://www.sleepapnea.org/resources/pubs/evaluated.html . Published May 2005. Accessed September 17, 2008.

³Botros N, Concato J, Mohsenin V, et al. Obstructive sleep apnea as a risk factor for type 2 diabetes. Am J Med. 2009;122(12):1122-1127.

⁴Cecil R, Goldman L, Benett JC. Cecil Textbook of Medicine.21st ed. Philadelphia, PA: WB Saunders Company; 2000.

⁵NINDS sleep apnea information page. National Institute of Neurological Disorders and Stroke website. Available at: http://www.ninds.nih.gov/disorders/sleepapnea/sleepapnea.htm . Updated June 2008. Accessed September 17, 2008.

⁶Sleep apnea: key points. National Heart, Lung, and Blood Institute website. Available at: http://www.nhlbi.nih.gov/health/dci/Diseases/SleepApnea/SleepApnea_Summary.html . Accessed September 17, 2008.

A risk factor is something that increases your likelihood of getting a disease or condition.

It is possible to develop sleep apnea with or without the risk factors listed below. However, the more risk factors you have, the greater your likelihood of developing sleep apnea. If you have a number of risk factors, ask your doctor what you can do to reduce your risk.

Risk factors for sleep apnea include:

Smoking

Heavy smokers —people who smoke more than two packs per day—are 40 times more likely to develop sleep apnea than nonsmokers.

Alcohol

Some studies have shown that people who use alcohol regularly have an increased risk of sleep apnea.

Sedative Medications

Using sedative medications can increase your risk of sleep apnea.

Medical Conditions

The following conditions may increase your risk of obstructive sleep apnea:

• Obesity
• Pregnancy
• Diabetes
• Polycystic ovary syndrome
• High blood pressure
• Facial deformities
• Hypothyroidism
• Esophageal reflux
• Enlarged tonsils or adenoids
• Chronic respiratory tract conditions, such as:

• Asthma
• Allergies
• Chronic bronchitis
• Chronic obstructive pulmonary disease

The following conditions may increase your risk of central sleep apnea:

• Bulbar poliomyelitis
• Encephalitis
• Neurodegenerative diseases
• Stroke
• Problems after cervical spine surgery
• Primary hypoventilation syndrome
• Brain tumors
• Down’s syndrome due to a large tongue and a thick neck

Gender

Men are thought to be 2 to 4 times more likely to develop sleep apnea than women. However, some researchers have suggested that this difference might actually be because women are underdiagnosed with the condition.

Genetic Factors

The tendency to develop sleep apnea appears to run in certain families.

Ethnic Background

Sleep apnea is more common among:

• African Americans
• People of Mexican origin
• Pacific Islanders

Physical Characteristics

You have an increased risk of developing sleep apnea if you have the following physical characteristics:

• Thick neck
• Obstructed nasal passages
• Large tongue
• Narrow airway
• Receding chin
• Overbite
• Certain shapes and increased rigidity of the palate and jaw

You also have an increased risk of developing sleep apnea if you breathe through your mouth while sleeping, or if you snore.

References:

American Sleep Apnea Association website. Available at: http://www.sleepapnea.org/resources/pubs/evaluated.html . Published May 2005. Accessed September 17, 2008.

Cecil R, Goldman L, Benett JC. Cecil Textbook of Medicine. 21st ed. Philadelphia, PA: WB Saunders Company; 2000.

NINDS sleep apnea information page. National Institute of Neurological Disorders and Stroke website. Available at: http://www.ninds.nih.gov/disorders/sleepapnea/sleepapnea.htm . Updated June 2008. Accessed September 17, 2008.

What are the risk factors for sleep apnea? Health Cares website. Available at: http://neurology.health-cares.net/sleep-apnea-risk-factors.php . Updated July 2005. Accessed September 17, 2008.

What is sleep apnea? National Heart, Lung, and Blood Institute website. Available at: http://www.nhlbi.nih.gov/health/dci/Diseases/SleepApnea/SleepApnea_WhatIs.html . Updated February 2008. Accessed September 17, 2008.

The actual symptoms of sleep apnea when it’s occurring are:

• Very loud snoring
• Episodes of long pauses of interrupted breathing during sleep
• Possibly struggling, snorting, gasping, choking, and partially or completely awakening in an attempt to restart breathing

Symptoms that occur as a result of these episodes of sleep apnea include:

• Disturbed rest
• Daytime sleepiness
• Problems staying alert or paying attention
• Irritability
• Poor memory
• Difficulty learning
• Decreased energy
• Headache
• Sexual problems
• Depression
• Mood swings
• Anxiety
• Weight gain
• Hyperactivity in children
• High blood pressure
• Heart disease and heart attack
• Stroke
• Confusion
• Increased risk of sudden infant death syndrome (SIDS) in babies

References:

Being evaluated for sleep apnea. American Sleep Apnea Association website. Available at: http://www.sleepapnea.org/resources/pubs/evaluated.html . Published May 2005. Accessed September 17, 2008.

Cecil R, Goldman L, Benett JC. Cecil Textbook of Medicine.21st ed. Philadelphia, PA: WB Saunders Company; 2000.

Fact sheet: could my child have sleep apnea? American Academy of Otolaryngology—Head and Neck Surgery website. Available at: http://www.entnet.org/HealthInformation/Could-Child-Have-Sleep-Apnea.cfm . Accessed September 17, 2008.

NINDS sleep apnea information page. National Institute of Neurological Disorders and Stroke website. Available at: http://www.ninds.nih.gov/disorders/sleepapnea/sleepapnea.htm . Updated June 2008. Accessed September 17, 2008.

What is sleep apnea? National Heart, Lung, and Blood Institute website. Available at: http://www.nhlbi.nih.gov/health/dci/Diseases/SleepApnea/SleepApnea_WhatIs.html . Updated February 2008. Accessed September 17, 2008.

If your doctor suspects that you have sleep apnea, you will need a thorough examination of your mouth, nose, throat, and neck to make sure that there are no problems with those tissues or structures.

Your doctor will ask you about sleep habits—if you snore and if your bed partner witnesses that you stop breathing. You will also be asked about daytime sleepiness, fatigue, and if you easily fall asleep. The doctor may complete a screening form such as the Epworth Sleepiness Scale (ESS).

There are two tests that can help in the diagnosis of sleep apnea: the polysomnogram and the multiple sleep latency test. A sleep specialist usually administers both of these tests in an overnight sleep laboratory.

Polysomnogram Test (Sleep Study)

For this test, you spend the night in a sleep center. Tiny electrodes are attached to various areas of your body in order to closely monitor your heart rate, eye movements, brain waves, and muscle activity throughout the night. Monitors also record your pulse rate, information about your breathing, changes in the concentration of oxygen in your blood, and your body position. An EKG machine keeps track of whether you have any changes in your heart’s rhythm during sleep. The number of apnea events is recorded.

Read more about Polysomnography.

Multiple Sleep Latency Test

This test is usually done the day after the polysomnogram. With the same set of electrodes still attached, you are asked to take a series of 20-minute naps, every two hours throughout the day. The electrodes provide information about how quickly you fall asleep and how quickly you reach various levels of sleep, particularly the level called REM (rapid eye movement) sleep. This test can help determine your level of daytime sleepiness, which is a result of apnea episodes causing insomnia. If you fall asleep in five or fewer minutes, it may be an indication of extreme sleepiness due to sleep apnea. This test is most often performed to evaluate for other sleep disorders such as narcolepsy, and is often not necessary in the evaluation of sleep apnea.

If you have obstructive sleep apnea, you may undergo the same test again, while wearing a face mask that provides positive pressure. This is called continuous positive airway pressure (CPAP). This mask is supposed to prevent the collapse of your airway and maintain your breathing during the night. At times, evaluation with CPAP can occur during the second half of the night after evaluation without CPAP. This is called a split-night study.

Other Tests

If you’re suspected of having central sleep apnea (which is much less common than obstructive sleep apnea), you may need a variety of other tests to diagnose an underlying medical condition. Your doctor will have to determine what other symptoms you have and use these symptoms to guide his choice of further studies.

Possible other tests include:

• Blood tests
• Echocardiogram
• MRI or CT scans of your brain
• Electroencephalogram (EEG) studies—brain wave studies
• Electromyogram (EMG) studies—studies of electrical conduction along nerves

References:

American Academy of Otolaryngology-Head and Neck Surgery website. Available at: http://www.entnet.org/ . Accessed September 17, 2008.

American Sleep Apnea Association website. Available at: http://www.sleepapnea.org/resources/pubs/evaluated.html . Published May 2005. Accessed September 17, 2008.

Cecil R, Goldman L, Benett JC. Cecil Textbook of Medicine.21st ed. Philadelphia, PA: WB Saunders Company; 2000.

NINDS sleep apnea information page. National Institute of Neurological Disorders and Stroke website. Available at: http://www.ninds.nih.gov/disorders/sleepapnea/sleepapnea.htm . Updated June 2008. Accessed September 17, 2008.

What is sleep apnea? National Heart, Lung, and Blood Institute website. Available at: http://www.nhlbi.nih.gov/health/dci/Diseases/SleepApnea/SleepApnea_WhatIs.html . Updated February 2008. Accessed September 17, 2008.

There are a few things you can do to lower your risk of sleep apnea. These include:

Maintain an Appropriate Weight

Obesity is the number one risk factor for sleep apnea. If you are overweight, you may be able to prevent the development of sleep apnea by talking to your doctor about a weight loss program. If you’re not overweight, try to maintain an appropriate weight through proper diet and exercise.

Limit Alcohol Intake

Drinking alcohol can increase the number of sleep apnea episodes you have each night. Therefore, limit your intake of alcohol.

Avoid Taking Sedative Medications

Sedative medications can exacerbate sleep apnea. Try to avoid use of these medications.

Don't Smoke

Heavy smokers are 40 times more likely to develop sleep apnea than nonsmokers. If you smoke, quit .

References:

Being evaluated for sleep apnea. American Sleep Apnea Association website. Available at: http://www.sleepapnea.org/resources/pubs/evaluated.html . Published May 2005. Accessed September 17, 2008.

Cecil R, Goldman L, Benett JC. Cecil Textbook of Medicine.21st ed. Philadelphia, PA: WB Saunders Company; 2000.

NINDS sleep apnea information page. National Institute of Neurological Disorders and Stroke website. Available at: http://www.ninds.nih.gov/disorders/sleepapnea/sleepapnea.htm . Updated June 2008. Accessed September 17, 2008.

Surgical management of obstructive sleep apnea. American Academy of Otolaryngology-Head and Neck Surgery website. Available at: http://www.entnet.org/Practice/policySurgicalMgmtApnea.cfm . Accessed September 17, 2008.

What is sleep apnea? National Heart, Lung, and Blood Institute website. Available at: http://www.nhlbi.nih.gov/health/dci/Diseases/SleepApnea/SleepApnea_WhatIs.html . Updated February 2008. Accessed September 17, 2008.

The purpose of screening is early diagnosis and treatment. Screening tests are usually administered to people without current symptoms, but who may be at high risk for certain diseases or conditions.

Your doctor may give you a test, such as the Berlin Questionnaire or the Epworth sleepiness scale, to gain information about your symptoms. The American Academy of Pediatrics recommends that children are screened for sleep apnea by asking about snoring.

References:

Cecil R, Goldman L, Benett JC. Cecil Textbook of Medicine.21st ed. Philadelphia, PA: WB Saunders Company; 2000.

Being evaluated for sleep apnea. American Sleep Apnea Association website. Available at: http://www.sleepapnea.org/resources/pubs/evaluated.html . Published May 2005. Accessed September 17, 2008.

NINDS sleep apnea information page. National Institute of Neurological Disorders and Stroke website. Available at: http://www.ninds.nih.gov/disorders/sleepapnea/sleepapnea.htm . Updated June 2008. Accessed September 17, 2008.

Obstructive sleep apnea. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated September 2008. Accessed September 17, 2008.

Snoring. American Academy of Otolaryngology-Head and Neck Surgery website. Available at: http://www.entnet.org/HealthInformation/snoring.cfm . Accessed September 17, 2008.

What is sleep apnea? National Heart, Lung, and Blood Institute website. Available at: http://www.nhlbi.nih.gov/health/dci/Diseases/SleepApnea/SleepApnea_WhatIs.html . Updated February 2008. Accessed September 17, 2008.

You have a unique medical history. Therefore, it is essential to talk with your doctor about your personal risk factors and/or experience with sleep apnea. By talking openly and regularly with your doctor, you can take an active role in your care.

General Tips for Gathering Information

Here are some tips that will make it easier for you to talk to your doctor:

• Bring someone else with you. It helps to have another person hear what is said and think of questions to ask.
• Write out your questions ahead of time, so you don't forget them.
• Write down the answers you get, and make sure you understand what you are hearing. Ask for clarification, if necessary.
• Don't be afraid to ask your questions or ask where you can find more information about what you are discussing. You have a right to know.

Specific Questions to Ask Your doctor

About Sleep Apnea

• Could my daytime sleepiness be due to sleep apnea?

• How can I (or my sleep partner) tell if I’m having apnea episodes?

• Is it safe for me to continue to drive?

• Is it safe for me to operate heavy machinery?

• Is it safe for me to continue to participate in my usual activities?

• Is sleep apnea the only reason for my symptoms? What else could be causing my fatigue?

About Your Risk of Developing Sleep Apnea

• Since I'm overweight, could I develop sleep apnea?

• Do I have any other risk factors for this condition?

• Are there other measures I can take to lower my risk?

About Treatment Options

• Are there any new trials of medications for sleep apnea that you would recommend?

• Are there dental or orthodontic devices that might be helpful for my degree of sleep apnea?

• Is my condition severe enough that you would recommend surgery in order to avoid potential complications?

• What are the success rates of the different types of surgical interventions?

About Lifestyle Changes

• How much weight should I lose in order to reduce my risk of sleep apnea?

• What weight loss program would you recommend?

• Are there pillow systems to help me stay sleeping on my side?

• Should I discontinue using alcohol and sedatives?

• Can you recommend a program to help me quit smoking?

About Outlook

• What kinds of sleep apnea complications might I be at risk for?

• Does sleep apnea tend to stay the same, or grow progressively worse?

• How severe does sleep apnea have to be to produce serious complications?

• What signs of complications should I be alert for?

References:

Being evaluated for sleep apnea. American Sleep Apnea Association website. Available at: http://www.sleepapnea.org/resources/pubs/evaluated.html . Published May 2005. Accessed September 17, 2008.

Cecil R, Goldman L, Benett JC. Cecil Textbook of Medicine.21st ed. Philadelphia, PA: WB Saunders Company; 2000.

NINDS sleep apnea information page. National Institute of Neurological Disorders and Stroke website. Available at: http://www.ninds.nih.gov/disorders/sleepapnea/sleepapnea.htm . Updated June 2008. Accessed September 17, 2008.

What is sleep apnea? National Heart, Lung, and Blood Institute website. Available at: http://www.nhlbi.nih.gov/health/dci/Diseases/SleepApnea/SleepApnea_WhatIs.html . Updated February 2008. Accessed September 17, 2008.