Of all sleep disorders one can suffer with, obstructive sleep apnea is regarded as one of the most serious ones. There are several types of sleep apnea, but the most common is obstructive sleep apnea. It can cause a person to stop breathing repeatedly during the night due to the throat muscles continuously relaxing and blocking the airway. The most common sign of obstructive sleep apnea is snoring.
Thankfully, there are all kinds of treatments available for obstructive sleep apnea (OSA). For example, a device, using positive pressure, can keep the airway open while the sufferer sleeps. Another example is using a mouthpiece that will push the lower jaw forward while sleeping. In extreme cases, surgery could be a necessity.
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Symptoms Of Obstructive Sleep Apnea
The problem with most of these symptoms is that you’re not likely to recognize them as easily. Instead, your partner is likely to make you aware of them. What are some of the many obstructive sleep apnea symptoms sufferers have?
- Problems getting up in the mornings
- Waking up and gasping for breath (feels like an asthma attack or being choked)
- Problems with sex
- Restlessness during sleep
- Night sweats
- Inability to focus or concentrate
- Morning time headaches
- Sore throat or dry mouth upon waking up
- Fatigue or daytime sleepiness
For children, the symptoms are not so evident, but may include the following:
- Odd sleeping positions
- Breathing pauses
- Restlessness in bed
- Teeth grinding
- Sleepiness (often thought to be laziness in school)
- School-related problems
- Behavioral or learning disorders
- Night sweats
If you or someone you love has any of the above symptoms, it’s imperative to talk with a doctor to learn if they are associated with OSA and get treatment right away.
Why Does Obstructive Sleep Apnea Occur In The First Place?
Obstructive sleep apnea happens when the throat muscles relax too much to allow normal breathing. The muscles in the back of the throat support the soft palate, uvula, the tongue and the tonsils.
When these muscles relax, it causes the airway to narrow or close as you breathe. This can lead to inadequate breathing for 10 or more seconds. This causes oxygen levels in the blood to drop and carbon dioxide to rise. When the brain realizes the impaired breathing, it wakes you up briefly so the airway can reopen. This awakening is usually so brief that for the most part, you won’t even realize it’s happening.
You may wake up gasping for breathing, choking and snorting to restart the breathing process. It’s a pattern that can happen five to 30 times an hour all night long. And, this can keep you from reaching the deep stages of sleep your body needs to feel rested the next day.
People who have OSA are often not aware that they have this sleep disruption. In many cases, people think they’re getting a good night’s rest.
Who Is At Risk For OSA?
Obstructive sleep apnea can affect anybody at any time. There are factors that can increase your risk of developing this sleep disorder, including:
Asthma – Various researches show that having asthma also increases one’s chance of suffering from obstructive sleep apnea.
Family History – If a family member suffers from OSA, other family members may be at increased risk.
Sex – Men are two times as likely to suffer from OSA as premenopausal women. However, women who have gone through menopause see their risk for OSA rise.
Diabetes – People who have diabetes are far more likely to suffer from OSA.
Smoking – Smokers are at greater risk for being diagnosed with OSA.
Chronic Nasal Congestion – People who suffer from chronic nighttime nasal congestion are two times as likely to suffer from OSA. The thought is that narrowed airways are the cause.
Hypertension – High blood pressure (especially untreated hypertension) can lead to OSA.
Narrowed Airway – Genetics can also play a part in OSA. If someone in your family has narrow airways, you may inherit them as well. If your adenoids or tonsils are too large, they can also block your airway.
Excess Weight – The majority of people with OSA are overweight or obese. Breathing is often obstructed by the fat deposits located around the upper airway. Medical conditions tied to obesity – hypothyroidism and polycystic ovary syndrome – can also lead to OSA. Does this mean that everybody who is overweight will have OSA? Not at all! Even thin people can suffer from the disorder as well.
What Are The Complications Of Obstructive Sleep Apnea?
It’s important to understand that obstructive sleep apnea is a very serious medical problem. What are some of the common complications associated with this condition?
Bedroom partners are often sufferers of OSA as well, but only because of the loud snoring that emanates from their partners. It can keep them from getting a good night’s rest and lead to problems in the relationship. They may find themselves sleeping in another room to get good sleep.
According to various research, there is some link between OSA and some eye conditions (glaucoma, for example). However, with treatment, some of these problems can be alleviated.
Surgical and Medication Complications
Obstructive sleep apnea is also concerning for people who take certain medications or need to have surgery with general anesthesia. That’s because some medications, such as general anesthetics, narcotic analgesics, and sedatives, will relax the upper airway. This could make the OSA worse. After a major surgery, you could experience even worse breathing problems and after-surgery complications.
Be sure to make your doctor aware, before surgery, that you suffer from OSA or have OSA-related symptoms. They may test you for it before the surgery takes place.
When your blood isn’t getting enough oxygen, it can increase your blood pressure levels and put a strain on the body’s cardiovascular system. It’s not uncommon for OSA sufferers to be diagnosed with hypertension (high blood pressure). This also increases the chance of heart disease.
The more serious the OSA is, the higher the chance of suffering from coronary artery disease, heart failure, heart attacks and strokes.
OSA is also responsible for causing abnormal heart rhythms (also called arrhythmias), which can lead to a lower blood pressure. If you have undiagnosed and untreated heart disease, these repeated multiple episodes of arrhythmias can raise the risk of sudden death.
Daytime Fatigue and sleepiness
While you may not realize you’re constantly waking up during the night from the OSA, it’s causing the body to not get the normal, restorative sleep it needs to feel rejuvenated for the next day. If this happens, you may likely feel very sleepy the next day. You’ll be grouchy, and even little things may get on your nerves.
You may have problems keeping your focus on tasks at hand. You may fall asleep watching TV or driving. It also increases your risk of having an at-work accident.
Children and adolescents who suffer from OSA may not do poorly in school or may be thought to have behavioral or attention problems.
When It’s Time To See A Doctor
It’s important to talk to your doctor if you or your partner notice any of the following issues:
- Snoring so loud it’s bothersome to you and the other members of your household
- Gasping or choking for breath while sleeping, causing you to wake up
- Recurrent pauses in your breathing while sleeping
- Extremely tired and lethargic in the day, which can cause you to fall asleep while you’re driving, working, etc.
Most people don’t see snoring as an issue, and not everybody who has OSA will snore. Always be sure to talk to your doctor about your snoring that interrupts the silence. People who have OSA may snore louder when they’re on their back and will quiet down when sleeping on their side.
If you’re constantly feeling tired and are irritable, it’s time to see your doctor. If OSA is not the cause, your doctor can learn if you have another sleep disorder, such as narcolepsy.
How Is Obstructive Sleep Apnea Diagnosed?
The first thing your doctor will do is take a thorough history and do a physical exam. The first significant clues of OSA are snoring and the history of excessive daytime sleepiness. Your doctor will examine your neck and head to see if there is anything physically wrong that can account for the sleep apnea. You will be asked to fill out a questionnaire about your sleeping habits, sleep quality, daytime drowsiness, etc. On top of that, your doctor may conduct a series of tests such as:
If your doctor suggests a polysomnogram, it often means an overnight stay in a sleep study center or hospital. The test will occur all through the night. While you sleep, the polysomnogram measures the activity of various bodily organs that are tied to sleep. The devices you’ll be hooked up to include:
- Arterial blood gas analysis (ABG)
- Pulse oximetry test – measures the changes in blood oxygen levels
- Electrocardiogram (EKG or ECG) – heart rate and rhythm measurement
- Electromyogram (EMG) – muscle activity measurement
- Electro-oculogram (EOM) – eye movement measurement
- Electroencephalogram (EEG) – brain wave measurement
Arterial Blood Gas (ABG)
For this study, the doctor will draw arterial blood to measure for the following:
- Bicarbonate levels
- Partial pressure of carbon dioxide
- Partial pressure of oxygen
- Oxygen saturation
- Oxygen content
With this test, the doctor will get a clearer idea of about the amount of carbon dioxide, oxygen, and the acid-base balance of your blood. This will also help them to know if your blood needs more oxygen.
A pulse oximeter will be attached to a thin area of the body that has a good blood flow (earlobe or fingertip). It uses red and infrared LEDs to gauge how much oxygen is in the blood. Oxygen levels will decrease during sleep apnea episodes. A normal oxygen saturation level is between 95 and 100 percent. Your doctor will interpret your results.
The 12-lead EKG will help the doctor find out if you have heart disease. If you have persistent high blood pressure, it can show up on the EKG. By monitoring and recording the heart rhythm and rate, doctors can find out if there are cardiac issues while you’re suffering from sleep apnea.
For the EMG, two electrodes will be put on your chin – one under and the other above the jawline. Two electrodes will be also placed on each shin. These electrodes will measure the activity in muscle movements. Since deep muscle relaxation is supposed to occur while you’re sleeping, the EMG will note when your muscles move and relax while sleeping.
EOM and EEG Measurements
For the EEG, electrodes will be placed on your scalp, monitoring the brain waves before, during and after your sleep. The EOM will keep track of your eye movements. Two tiny electrodes are placed one centimeter under the outer corners of both eyes. Movement is recorded when the eyes move from the center.
These movement and waves give doctors some idea of the timing of each sleep phase – REM and non-REM (rapid eye movement). In the REM sleep phase, you dream and have decreased muscle movement and tone.
What Kinds Of Treatments Are Suggested For OSA?
OSA treatments can range from lifestyle changes to surgery. Since OSA is a lifetime condition, lifelong treatments are necessary.
Soft Palate Implants
Soft palate implants are designed to stiffen the soft palate, so it doesn’t vibrate and cause an obstruction. The implants are placed in the soft palate while you’re under local anesthesia.
The National Institute for Health and Care Excellence has deemed them to be safe, but there is little evidence of their effectiveness. However, it’s often advised in cases where snoring has been tied to OSA.
Surgery for obstructive sleep apnea is considered the last resort and usually not as effective as the CPAP in treating and controlling the symptoms. There are also more risks behind it. It’s only done when every other treatment options have failed, and your quality of life is severely impacted.
What are some surgical options to treat obstructive sleep apnea?
Uvulopalatopharyngoplasty – This is very rare surgery (once popular) where the doctors would remove the extra throat tissue to increase the airway space.
Bariatric Surgery – If you have been unable to lose weight, the doctor may perform a stomach reduction surgery to help you lose the weight and improve your sleep apnea.
Tracheostomy – This is when a tube is placed right into the neck for easier breathing even if you have blocked airways.
Adenoidectomy – This is when the small lumps of tissues at the back of your throat (known as adenoids) are huge and blocking the flow of air while sleeping.
Tonsillectomy – The doctor will remove the tonsils if they discover they are too big and are blocking the airway while sleeping.
Again, surgery is usually last resort since the CPAP and other methods are considered far more effective in treating OSA symptoms. In some cases, the use of a CPAP device is impossible after certain types of surgery.
Mandibular Advancement Device (MAD)
They are not advised for severe cases but can be useful if you cannot tolerate a CPAP device. The MAD device is a dental appliance – similar to the gum shield – that can be used in mild cases of OSA.
The MAD device is worn over the teeth while sleeping. It’s created to hold the jaw and tongue forward, increasing the space at the back of the throat and decreasing the chance for airway narrowing that leads to snoring.
When is a MAD device not advised?
- Severe OSA case
- Dental caps
- Little to no teeth
If you have any of the above, be sure to talk with the dentist before you go this route for your treatment of OSA.
Be sure to have the MAD device outfitted for you by a trained dentist who has sleep apnea treating experience. It’s possible your insurance company will pay for this, but in many cases, you will need to pay out of pocket.
While you can purchase over-the-counter MAD devices on specialty websites, experts are advising people against them. A poor-fitting MAD device will actually worsen symptoms.
Continuous Positive Airway Pressure (CPAP)
CPAP devices are considered the best, most effective therapy for severe OSA cases. A CPAP device is a small pump that will provide them with a constant compressed air supply via a mask covering both the nose and mouth or just the nose. The compressed air keeps the airway open.
The CPAP device can help reduce the symptoms of both tiredness and snoring while also decreases the risk of OSA complications (high blood pressure, strokes, etc.)
Now, there are potential side effects that come with using the CPAP device such as:
- Flatulence and stomach pain
- Ear pain
- Problems breathing through the nose
- Nasal congestion, irritation, runny nose, etc.
- Mask discomfort
When the CPAP device was first introduced, people often suffered from nasal and throat dryness. Today’s versions are much better, often coming with a humidifier to address those issues.
Many novice CPAP users may not feel comfortable with the device, but once acclimated to it, they usually see an improvement in their symptoms. If the CPAP device you are using causes your problems, be sure to talk to your doctor or the treatment staff. It may be that a modification is needed. For instance, you could need a CPAP device that will start with a low amount of pressure but gradually increases the air supply as you get to sleep.
Changes In Your Lifestyle
The first thing your doctor may suggest is making some lifestyle changes, such as losing weight if you are overweight or obese. They may also suggest you stop smoking or limit how much alcohol you consume, especially before bed. Your doctor may advise you against using sleeping tablets or sedatives to help you sleep.
Researches and studies have shown that limiting the alcohol, quitting smoking and reducing your weight can all help in alleviating the OSA symptoms. Doctors are unsure of why quitting smoking can help with OSA, but even if it’s not suggested, it’s best if you do it for general health reasons anyway.
Another pragmatic way to alleviate OSA symptoms is to sleep on your side instead of your back.
What To Keep In Mind About OSA…
If you or someone you love has OSA, it’s imperative to see your doctor. If you have any of the above symptoms – daytime lethargy, sleeping problems, concentration issues, etc. – be sure to talk to them about OSA and see what treatment options are useful for you. There are many treatment options that can make living with the condition better and manage the symptoms. Your doctor will come up with a treatment plan that could include both therapy and a change in your lifestyle.