Breathing Disorder During Sleep
Sleep apnea refers to non-breathing episodes during sleep, which may occur as
frequently as several hundred times per night. Loud, irregular snoring occurs as the
person attempts to breathe at the end of each apnea. Although you may have had a full
night's sleep, you may still feel tired during the day.
Sleep apnea is a surprisingly common sleep disorder which can progress in severity and
cause serious health problems if not detected and properly treated. The risk of developing
OSA increases with advancing age and it is seen most commonly in overweight men.
Sleep apneas can cause serious health problems. With each apnea, oxygen content of the
blood decreases causing blood pressure to rise and the heart to slow down. In order to
resume breathing, the apnea sufferer will subconsciously arouse to regain muscle tone and
open his or her airway. This strategy to breathe means that the individuals sleep is
frequently disrupted, causing daytime sleepiness. Sleep apnea can cause personality
changes related to the sleep deprivation and has been associated with hypertension and an
increased risk of heart attacks and strokes.
Three Types of Sleep Apnea
Obstructive Sleep Apnea (most common) is caused by a closing of the upper airway
(blocking airflow) during sleep. Many factors can contribute to this blockage including
nasal obstruction, enlarged tonsils, excessive tissue in the back of the throat and an
enlarged tongue. During sleep, the airway muscles relax which contributes to this
blockage. A person with OSA continues to try to breathe, but cannot pass air through the
obstructed upper airway.
Central Sleep Apnea occurs when a person no longer tries to breathe. There seems to be
no signal from the brain to keep breathing.
Mixed Sleep Apnea refers to a combination of central and obstructive apnea.
Diagnosis and Treatment
The diagnosis of OSA may be suspected, based upon a suggestive history and certain
characteristics seen on physical examination by your physician. Proper diagnosis, however,
can only be made by special monitoring of the individuals sleep, by a polysomnogram.
Treatment for snoring and sleep apnea depends on what type of apnea you have and how
serious it is. This information can only be obtained through a sleep study (polysomnogram
or PSG). Based on the results of the sleep test, the physician can prescribe the
appropriate treatment. This can be any of the following:
- Behavior changes such as losing weight, avoiding alcohol and exercising regularly.
Proper Sleep Hygiene is crucial.
- A Continuous Positive Airway Pressure device (CPAP) that splints the airway open so one
breathes steadily and normally. The flow of the air pushes on the collapsed tissues and
muscles, leaving the airway open.
- An oral device worn in the mouth to change the position of the jaw and tongue. This
helps open the airway.
- Surgery to increase the size of the upper airway (where obstruction occurs).
Air Pressure Devices
An air pressure device has a soft plastic (silicone) mask that fits around the nose.
Wearing this mask may feel odd at first, but most people get used to it very quickly with
some help from our Sleep Lab staff.
The most commonly used type of air pressure device is CPAP (Continuous Positive Airway
Pressure). It literally blows air through the nasal passages and throat, keeping the
airway open. Snoring is prevented. Breathing is maintained. This is the preferred
treatment for most patients with significant OSA.
People with sleep apnea often snore very loudly. But not everyone who snores has sleep
apnea. If one snores, and then stops breathing, then makes snorting, gasping or choking
sounds, one may have sleep apnea.
Find out what the snoring patterns are. Ask ones bed partner to watch and take
notes. If a bed partner is not available, set up a tape recorder.
These hints may quiet or lessen snoring:
Sleep in a lateral position. Sleeping on your back may increase snoring. Tissues in the
throat block the airway causing snoring. These tissues are more likely to collapse
downward when supine. To avoid this, sew a pocket or pin a sock on the back of a pajama
shirt. Place a tennis ball in the sock. This will prevent rolling supine.
Clear your nose. Allergies and colds can block the nasal passages, increasing snoring
and sleep apnea. Consider nasal sprays and humidity.
Avoid alcohol. This further relaxes the muscles in the throat, increasing the
likelihood of collapse and airway blockage. When this happens, snoring and sleep apnea are
Lose weight. Increased body mass leads to larger tissues in the nose and throat,
increasing the chance of blocked airways, leading to snoring and sleep apnea. Exercise
Snoring may not be a problem for the patient, but it can be a problem for the bed
partner, others in the home and sometimes even the neighbors!