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Sleep apnea is a significant and dangerous sleeping condition in which breathing is paused or interrupted. People experiencing symptoms stop breathing fully (apnea) or partially (hypopnea), then resume breathing multiple times per hour during sleep. Snoring commonly suggests apnea but it is not required to make the diagnosis; the absence of snoring does not exclude apnea.
When breathing decreases, the brain does not receive sufficient oxygen. This condition causes the brain to move from DEEP sleep in which the brain rests and recovers and forces it into SUPERFICIAL sleep (or awake gasping for air). When the brain is punished this way every night, consequences are severe. They include:
To easily visualize a single apnea event, picture a person shoving a pillow over your face while in a deep sleep. The pillow stays until just before you wake up. This occurs 10, 20, 50 or even 100 times per hour depending on apnea severity. The brain simply cannot handle such repetitive lack of oxygen without harsh consequences.
There are three types of sleep apnea:
1. Obstructive sleep apnea (OSA)
This is the most common type. In obstructive sleep apnea, the airway narrows and blocks off when the throat muscles relax, and the tongue falls back in the throat. It occurs more frequently in people who are overweight but can occur in thin individuals based on body build. Large tonsils will also cause obstructive sleep apnea, especially in children.
2. Central sleep apnea
In this type of apnea, airway blockages are not involved. Instead, the brain fails to transmit signals telling the body to continue breathing. It is a result of a failure in the respiratory control area of the brain.
3. Complex (Mixed) sleep apnea
It is a combination of both obstructive sleep apnea and central sleep apnea.
Common signs of sleep apnea include:
Sleep studies diagnose sleep apnea. Health professionals record the apnea events per hour to determine the gravity of the condition. Oxygen levels in the blood are also an indicator of the severity of sleep apnea. Although the oxygen levels may drop to worrisome levels for many minutes or even hours each night, treating sleep apnea will often fix the oxygen deficit without needing to add oxygen overnight.
Home Sleep Apnea Test (HSAT)
This version of testing is commonly preferred by patients and insurance payers, given the convenience and cost (typically 75% cheaper than the PSG). With HSAT, a patient receives a small kit and easy to follow instructions.
Testing is done at home for three nights – in your own bed. Three sensors are placed to detect oxygen and apnea events, 1) nasal cannula, 2) respiratory elastic strap around the chest, and 3) fingertip cover for pulse oximetry. After completing 3 nights, the kit is returned. Two sample videos are available here: https://www.youtube.com/watch?v=Aw8ZwXHzpg4 or https://www.youtube.com/watch?v=awa4z2fFn7A.
Polysomnogram (PSG)
It involves spending the night in a medical facility in a sleep lab bed. The polysomnogram measures the activity of the body functions associated with sleep. While disadvantages include only obtaining one night of data, increased cost, and sleeping in a strange bed, advantages include having a sleep technician monitor your sleep to reattach any dislodged cables and additional test modalities such as measurement of abnormal limb movements (kicking) or brain activity (EEG). The PSG may be preferred for people with significant COPD, heart failure, or prior stroke.
Treatment of sleep apnea will have a positive impact on the life of a person. The person may enjoy the following benefits:
Several therapies to manage sleep apnea are available. All will fundamentally ensure that the airways stay clear during sleep, allowing the brain adequate oxygen and deep sleep recovery.
1. Weight loss
Obesity is a leading cause of sleep apnea. Weight loss will reduce or eliminate sleep apnea in many patients and lead to a more comfortable life.
2. Oral appliance therapy
Specially trained dentists can customize mouthguards that keep the jaw moved forward at night, preventing the tongue from blocking the airway. It is best for obstructive apnea patterns that are mild or moderate in severity.
3. Continuous Positive Airway Pressure (CPAP)
CPAP is preferred for moderate/severe apnea, especially if long periods of low oxygen are found. A CPAP machine uses moderated air pressure to ensure that the airways stay open and unobstructed while a person is asleep. A CPAP unit includes:
CPAP treatment is safe and effective when applied correctly. Of critical note, an excellent respiratory therapist (RT) is crucial to successful adoption of CPAP. Having an experienced RT to spend the extra time required to find the right mask and work closely with your physician to fine tune the machine settings can make all the difference between quality sleep and letting the machine gather dust on the shelf.
4. Other Positive Airway Pressure
BiPAP machines (bi-level) are for the treatment of obstructive sleep apnea, where CPAP has proved ineffective at higher pressures. BiPAP machines have different inspiratory and expiratory settings and are responsive to a person’s breathing.
ASV machines (adaptive servo-ventilation) use different programming that specifically helps people with central pattern apnea.
5. Nerve stimulation
A common type is the Inspire brand hypoglossal nerve stimulator. This option requires surgery to insert a device that controls the nerve in charge of tongue movement. The nerve signals generated by the machine keep the tongue from relaxing into the airway. It is AWFULLY expensive, and payers are extremely reluctant to spend such sums. Criteria typically requires a body mass index (BMI) less than 32, and AHI (stop breathing score) above 15. Also, CPAP must be tried first.
6. Surgery
Surgery is the last resort in sleep apnea. Examples include Uvulopalatopharyngoplasty (UP3) or tracheostomy. Other surgical procedures also improve the structure of the airway wall, for example the Pillar Procedure. It can be performed under local anesthesia as an outpatient. It may help with snoring and mild cases of sleep apnea. Pillar places three polyester rods in the soft palate. The rods cause inflammation in palate soft tissues that results in scarring and a mild stiffening of the soft palate. Long term side effects include dry mouth, trouble swallowing, and foreign body sensation.
If you are suffering from symptoms of sleep apnea, come see our sleep apnea doctor in Meridian today to discuss diagnosis and treatment options. You don’t have to be tired all the time, a night of restful sleep can be reclaimed!
