Do you have sleep apnea?

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Types of sleep disorders

Sleep apnea is a potentially dangerous condition that occurs when you repeatedly stop and start breathing during sleep. (“Apnea” is the technical term for the suspension of external breathing.) Sleep apnea not only causes chronic exhaustion but it can also lead to heart problems and other complications. There are three different types of sleep apnea:

1. Obstructive sleep apnea, the most common variety, happens because of a blockage in your nose, mouth, or the back of your throat.
2. Central sleep apnea happens because your brain stops sending signals to the muscles that control your breathing.
3. Complex sleep apnea (also known as Complex sleep apnea syndrome) occurs when you have both obstructive and central sleep apnea.

Symptoms of sleep apnea

Obstructive and Central sleep apnea can present in a similar fashion but the most common symptoms include the following:

• Loud snoring
• Lapses in breathing during sleep
• Gasping for air during sleep
• Waking up with a dry mouth
• Morning headache
• Difficulty staying asleep
• Difficulty staying awake during the day
• Difficulty focussing while awake
• General irritability

Effects of sleep apnea

In addition to these symptoms, sleep apnea can affect your life in a number of ways. 

• Fatigue causes an increased risk of being involved in motor vehicle and workplace accidents. You are also more likely to have high blood pressure because of the sudden drops in blood oxygen levels that occur at night and you are more prone to recurrent heart attack, stroke and atrial fibrillation.
• Sleep apnea can also increase the chances that you will develop insulin resistance (aka type 2 diabetes) and a metabolic disorder which can result in higher cholesterol levels. You may even develop nonalcoholic fatty liver disease.
• Due to the breathing problems associated with sleep apnea, you are more likely to have complications after major surgery (especially if you are sedated and lying on your back.)
• Lastly, it’s important to note that your partner may become sleep deprived due to your sleep apnea. If you are snoring loudly, it can prevent those close to you from getting good rest.

Causes of Obstructive Sleep Apnea

There are eight primary factors that contribute to your risk of developing sleep apnea:

1. Being overweight: Obesity increases the chances that you will develop sleep apnea because depostis of fat in your upper airway can obstruct your breathing.
2. Having large a large neck: People with a greater neck circumference may have narrower airways that can contribute to sleep apnea.
3. Having a narrowed airway: If you inherited a narrow airway or if your tonsils or adenoids are enlarged, you may develop obstructive sleep apnea.
4. Being male: Compared to women, men are two to three times more likely to have sleep apnea. (Overweight women have an increased risk of developing sleep apnea compared to women who are not overweight. In addition, the risk increases after menopause.)
5. Being older: The incidence of sleep apnea increases significantly as you age.
6. Using alcohol or sleeping pills: These depressants relax the muscles in your throat which can increase your chances of developing obstructive sleep apnea.
7. Smoking: Smoking increases inflammation in the airway and increases the risk of developing sleep apnea by a factor of 2 to 3.
8. Having nasal congestion: Any conditions which makes it hard to breathe through your nose can contribute to obstructive sleep apnea. These include respiratory allergies and anatomical nasal obstruction such as polyps.

How is obstructive sleep apnea diagnosed?

It can be difficult to know if you have obstructive sleep apnea based on your symptoms alone. Some symptoms, like dry mouth, headaches, and fatigue can be caused by other conditions. Others, like lapses in breathing and snoring, only occur when you are asleep and you are therefore oblivious to them. For these reasons, most people who suffer from sleep apnea don’t even know that they have it. According to the Oshner Journal, 85% of sleep apneas are undiagnosed.

If you suffer from these symptoms it may be wise to consult a sleep apnea specialist like Dr. Caballero, at Advanced Sinus and Allergy Center. In addition to taking a thorough medical history Dr. Caballero will conduct a physical exam which includes a procedure called a “flexible nasopharyngoscopy” which involves examining your upper airway for physical indications of what may be contributing to the obstruction. She may also order a sleep study (also known as a polysomnogram) to confirm the diagnosis. This test, which will more precisely determine the severity of your condition, involves monitoring you over night as you sleep and it may be done at home or at a sleep center.

What is the best treatment for obstructive sleep apnea?

Dr. Caballero offers both nonsurgical and surgical therapies to treat your sleep apnea so you can breathe better and enjoy life again. In all cases, weight loss is of crucial importance. The more weight you lose, the less severe your sleep apnea will become. As part of the treatment plan, Dr. Caballero refers all patients with obstructive sleep apnea to a nutritional and exercise program.

Although it can be cumbersome and annoying to patients, the gold standard treatment for the management of obstructive sleep apnea is still the CPAP mask. CPAP stands for Continuous Positive Airway Pressure. As the name implies, the CPAP mask increases pressure in your airway forcing it to stay open so you have fewer pauses in your breathing. The effectiveness of the CPAP mask (or any sleep apnea treatment) is measured by a reduction in AHI (the Apnea-Hypopnea Index.) These apnea episodes must last at least 10 seconds and must be accompanied by a drop in blood oxygen levels. While effective, CPAP is not the best treatment for all patient because many people have difficulty tolerating the mask due to claustrophobia, air leaking around the mask, gastric bloating and becoming tangled in the hose.

Surgical procedures can directly address the sites of obstruction and may be the best option for patients who can’t tolerate CPAP treatment. For example, a septoplasty can be an effective remedy for a deviated septum, a uvulopalatopharyngoplasty (UPPP) can resolve obstruction caused by large tonsils, and a coblastion of the tongue can eliminate the problems caused by a droopy uvula.

The efficacy of these surgical procedures can be improved by using a dental appliance which is similar to a mouth guard. Such an appliance brings the jaw forward during sleep and keeps the back of the throat open.

Another surgical treatment for sleep apnea involves implanting an electrode which stimulates the hypoglossal nerve the same way a pacemaker stimulates the nerves that control the heart. This treatment, technically known the Hypoglossal Nerve Stimulator but more commonly known by the brand name Inspire®, was approved by the FDA in 2014. The device consists of 3 parts: a sensing lead which gets placed over the chest, a neurostimulator piece that is placed under the clavicle and a stimulation lead that runs from the stimulator to the hypoglossal nerve under the tongue. When the device sends an electronic impulse to activate the nerves the tongue contracts and moves forward and allows the airway to open.

To learn more

If you experience the symptoms of sleep apnea and want to learn which treatment is best for you, schedule a consultation with Dr. Caballero in her Park Ridge, IL office (northwest Chicago area.)  Call (847) 655-7442 or click the Request Appointment button at the top of this page.

References

• Mayo Clinic: Sleep Apnea
• Obstructive Sleep Apnea: A Growing Problem, Ochsner J. 2009 Fall; 9(3): 149–153
  

Author

Randy Schueller Randy is Director of Operations for Advanced Sinus and Allergy Center. He has over 30 years experience in Research and Development and is a member of the National Association of Science Writers.