Many of us treat snoring as a joke and take it lightly…until it affects us directly. While partners struggle to sleep through the loud noises, those affected can experience daytime fatigue. If you recognize these signs, it might be worth checking in with a doctor since sleep apnea may be an issue, and this is a serious problem.
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What’s sleep apnea?
This disorder leads to pauses in breathing while we sleep. Despite occurring dozens or even hundreds of times every night, you might not be aware of these pauses, but have our sleep pattern disturbed. If you wake up feeling drained, can’t concentrate, and struggle to be productive, this could be a sign of sleep apnea.
Obstructive sleep apnea is the most common type of this disorder. It comes from a blockage in the airway. Due to the nature of the problem (we’re asleep, so can't spot the issue) it’s normally partners and roommates who notice loud snoring and bring it to our attention. At that moment we feel defensive and brush it off with a joke. This is normal, but you should take sleep apnea seriously.
Sadly thousands of people feel an impact on their emotional and physical health as a result of sleep apnea. As the days go by, our bodies and minds are deprived of precious sleep. Over time this increases the risk of accidents, slows our reflexes, and reduces concentration. In more serious cases it can also cause:
- drastic mood swings
- constant irritability
- depression.
On the physical side we’ve seen liver conditions, diabetes, heart disease, and fluctuations in weight. It’s important to note that with the right treatment and some self-care techniques you can deal with the problem and get the sleep you need.
Signs of sleep apnea
Before we delve into potential solutions we will look at the symptoms of sleep apnea. Since central and obstructive sleep apnea have similar symptoms, identification can sometimes be difficult. However, the most common signs include:
- loss of concentration (even on simple tasks)
- loud snoring
- sudden loss of breath or gasping for air in sleep
- headaches
- insomnia
- irritability
- dry mouth
- hypersomnia (sleepiness during the day).
In some cases a partner may notice that you stop breathing in sleep.
Identifying sleep apnea - the types and causes
There are three main types of sleep apnea:
Obstructive sleep apnea
As mentioned, this is the most common disorder. We have soft tissue at the back of the throat. If this tissue relaxes too much during sleep, it can block the airway and this causes snoring.
Normally these muscles will provide much-needed support for the tonsils, soft palate, uvula (small section of tissue shaped like a triangle), the tongue, and the walls of the throat. When we sleep, these muscles aren’t needed and can relax. Unfortunately as the airway narrows, air intake isn’t sufficient, which can lower the oxygen in the blood.
When this happens, the brain cleverly switches to survival mode and briefly wakes us up in order to reopen the airway. Why don’t we remember this in the morning? Because we aren’t awake for long enough. Depending on the seriousness of the issue, this can occur every 15 minutes or even every two minutes. All the while we aren’t reaching the deeper sleep cycle and the body and mind aren’t allowed to relax.
Central sleep apnea
As the name suggests, this disorder relates to the central nervous system and is much less common. The muscles in charge of breathing don’t get the right signals during sleep as the brain fails to send them. We stop breathing. People with this problem rarely snore, can struggle to fall asleep, and experience shortness of breath.
Complex sleep apnea
This is a combination of the two previous types. Each case will be unique.
Potential risk factors
What factors increase your risk of sleep apnea?
Obstructive sleep apnea
- The size of the neck - people with thicker necks run a higher risk of sleep apnea due to a narrower airway.
- Gender - although sleep apnea can occur in both men and women, it is two to three times more common in men. Sleep apnea is a potential issue for women after menopause and when weight increases.
- Excessive weight - breathing can be disrupted by fat deposits around the airway, so obesity is a risk factor.
- Narrow airway - even without excessive weight or a thick neck you might still have a narrow throat. Enlarged adenoids and tonsils can cause problems especially to children.
- Nasal congestion - as a result of allergies or the anatomy of your nose, obstructive sleep apnea occurs in people who naturally struggle to breathe through their nose.
- Age and family history - unfairly, people who have sleep apnea in their family are more likely to experience the issue. It also becomes more likely as we age.
- Smoking - the habit that keeps on giving nasty side effects increases the risk of sleep apnea THREE TIMES. Why? The upper airway retains more fluid while inflammation is also common.
- Alcohol, tranquillizers, sedatives - will relax the muscles in the throat and we’ve described the problem earlier.
Central sleep apnea
Two risk factors are the same - age and gender. And there are three others:
- Narcotic pain medications – methadone, other long-acting medication, and opioids increase the risk significantly.
- Stroke - the risk of central sleep apnea and treatment-emergent central sleep apnea increases after a stroke.
- Heart problems - congestive heart failure can lead to central sleep apnea.
Should I visit the doctor?
First things first, it doesn’t mean that you have sleep apnea when you snore, so don’t panic yet. However, we recommend making an appointment if you and/or your partner recognize the signs and symptoms mentioned earlier. In particular if loud snoring is coupled with daytime fatigue, loss of concentration, insomnia, etc.
Complications of sleep apnea
Unfortunately sleep apnea is more than just a sleeping problem. It has the potential to cause:
Heart issues and high blood pressure
As we saw earlier, oxygen levels in the blood will decrease in sleep apnea. This causes a strain on the cardiovascular system and blood pressure. As well as causing hypertension (high blood pressure), sleep apnea can increase the risk of:
- abnormal heartbeats (atrial fibrillation)
- heart attacks
- stroke.
The problem is even more serious for people with a heart disease. Known as hypoxia (or sometimes hypoxemia), low blood oxygen can cause an irregular heartbeat and even death.
Fatigue
Life is tough, and we all feel tired from time to time. This being said, you shouldn’t feel drowsy, irritable, and fatigued every single day. Some people even feel depressed and short-tempered with loved ones, friends, and colleagues. These side effects can lead to problems with behavior and performance in children. For adults there’s a risk of accidents while driving or at work.
The metabolic syndrome
The metabolic syndrome includes high blood sugar, distorted cholesterol, difference in waist circumference, and high blood pressure. And it has been linked to risks of heart disease.
Liver complications
Did you know that nonalcoholic fatty liver disease is scarring on the liver? It’s true, and it’s more common in people with sleep apnea. Liver function tests are also more likely to show abnormal results.
Type 2 diabetes
As insulin resistance occurs, type 2 diabetes is a real risk in people with sleep apnea.
Broken relationships
It’s normal to focus on the sufferer. However, loud snoring can lead to frustrated partners and sleeping in separate rooms. Unfortunately this has led to many broken relationships and continues to do so.
Surgery and medication difficulties
As the final complication, the breathing problems that come with sleep apnea can make recovery after major surgery more difficult. Even during surgery we’re sedated and on our backs which can lead to breathing problems. This is why surgeons and doctors need to be aware of sleep apnea before making a decision. General anesthetics and some medications don’t blend well with sleep apnea.
Self-help and lifestyle changes for sleep apnea
Although they should never replace medical advice and may not be effective for more severe cases, these tips certainly won’t cause any harm and can go a long way in reducing sleep apnea.
Exercise
According to experts both resistance and aerobic training can reduce the symptoms of sleep apnea. You can improve breathing and strengthen the muscles around the throat with yoga.
Get lighter
Of course, exercise will help you to get lighter, and this is our next tip. Whenever there’s excessive weight, the extra tissue can fall over the airway and prevent air to and from the lungs. The symptoms of sleep apnea will improve by reducing the amount of tissue around the airway.
Sleep on the side
Some people experience sleep apnea only when they lie on the back. Although it sounds simple, you might alleviate the problem by sleeping on your side and preventing the soft tissues and tongue from blocking the airway.
Become a nonsmoker
Over the years we’ve learned that smoking is good for nobody. As smoking increases fluid retention and inflammation in the upper airway and throat, this is also true for people with sleep apnea.
Add a pillow
Gravity is often the problem, so why not add a pillow to prop your head up? You can use a special cervical pillow or foam wedge from your waist up.
Work the jaw muscles
Tire your jaw by holding a pen between the teeth or chewing a gum before bedtime. It will tighten the muscles designed to keep the mouth shut.
Steer clear of sedatives, heavy meals, sleeping pills, caffeine, alcohol
All these things are bad, and even worse before bedtime. While heavy meals and caffeine keep you awake, the others will relax the throat muscles and cause breathing issues in sleep.
Tennis balls
If you place tennis balls in a pillow and wedge it behind your back, you won’t roll onto your back while you sleep. Stitching a tennis ball or two to the back of your pajamas also works.
More tips
Introduce a regular sleeping pattern. You can open the nasal passages with
- Neti Pot (nasal irrigation system)
- nasal dilator
- breathing strips
- saline spray.
Throat exercises
Strengthen the airway muscles and reduce the risk of them collapsing during sleep. Though results can take weeks, they're worth the effort. Here are some effective exercises:
- Hold your tongue to the roof of your mouth for three minutes.
- Gargle water for five minutes twice a day.
- Breathe in through the nose and out through the mouth with your lips on a balloon. The goal is to inflate the balloon as far as you can. Do this exercise five times.
- With the tongue held firmly against the floor of your mouth, grab a toothbrush and brush the top and sides. Do this exercise five times in a single session in three sessions per day.
- Purse the lips tightly and bring them up and left, then up and right. We recommend ten repetitions with three sessions per day.
- Pull the inner side of your cheek out with your finger. Simultaneously pull the cheek muscle inwards (against your finger). Repeat ten times on each side three times a day.
- Hold your tongue between the teeth and swallow a few times five times a day.
Medical treatment options
We’ve explored home remedies and self-help, but what about more serious cases? You may have tried some of the home remedies only to be left disappointed. The good news is that treatment for sleep apnea is now much better than it used to be.
For complex and central sleep apnea the goal will be to resolve the underlying medical problem while offering a breathing device for sleep. Common underlying health issues include neuromuscular disorders and heart problems.
For obstructive sleep apnea there are five main treatments:
CPAP
Short for Continuous Positive Airflow Pressure, most moderate to severe cases will lead to this mask-like device being offered to the patient. Worn during sleep, a CPAP keeps the breathing passages open and provides supplemental oxygen.
We know what you’re thinking, especially if you tried CPAP machines long ago - they’re uncomfortable. This was true, but the technology of these machines has advanced significantly. Today they are more comfortable, quieter, and lighter. Countless people nowadays enjoy immediate relief and a boost to their physical and mental energy.
The topic of CPAP machines often leads to questions and confusion, so we’ve compiled some tips below.
- You’re likely to miss sleeping with freedom, but the improvement of the quality of sleep and duration is worth persuing.
- Above all else, check the fit with your doctor so that you don't experience unnecessary discomfort.
- Replace the CPAP and humidifier filters as instructed, keep everything clean, and this will keep the results positive.
- The noise can be a sticking point, so why not hide the machine under your bed or find another way to mask the noise? (You can play white noise or relaxing music on your phone.)
- Like anything in life, there’s nothing wrong with easing your way into it. Gradually increase the air pressure as you grow comfortable with the process.
- If you’re experiencing dryness or skin irritation, buy a moisturizer and ensure that your device has a built-in humidifier.
- Using a CPAP is a personal and unique experience, so have it customized to your needs. Need a chinstrap to reduce irritation in the throat? Want pads to reduce irritation? Interested in reducing discomfort of the nose with nasal pillows? Just ask your doctor.
- If you’re experiencing nasal congestion, try a nasal decongestant or saline spray.
Oral appliances
As they improve, we’re also seeing more and more custom-made oral appliances. Compared to breathing devices, they’re generally more comfortable, quieter, and portable. Some of the ones approved for treatment of sleep apnea will fit in the mouth like a mouth guard, others fix the jaw position by fitting around the chin and head.
The two most popular devices from our experience are:
- Tongue retainer
- Mandibular advancement device.
This opens the airway by lowering the jaw or bringing the tongue forward. If you try an oral appliance, we urge you not to give up if the first device doesn’t work as expected. There are so many devices that it’s worth experimenting and finding the one that works for you. It’s also important to see a dentist accustomed to cases of sleep apnea who can correct all problems, and the mouthpiece can be adjusted whenever required.
Some side effects are likely when the device isn’t fitted correctly. They include a buildup of saliva, soreness, and permanent changes of the position of the teeth, mouth, or jaw.
Breathing devices
Other breathing devices are:
- Bilevel Positive Airway Pressure (BPAP/BiPAP) - If you struggle to get used to the CPAP, or have a weak breathing pattern, this may be offered. This machine works by adjusting pressure while you sleep. Your inhales and exhales are handled as needed. The more advanced units even deliver breaths when one hasn’t been detected for a set time.
- Expiratory Positive Airway Pressure (EPAP) - these single-use devices fit over the nostrils and keep the airway open in a less intrusive way. If your obstructive sleep apnea is mild to moderate, this may be recommended.
- Adaptive Servo-Ventilation (ASV) - suitable for obstructive and central sleep apnea, this device is extremely clever because it stores information about your normal breathing pattern. Airflow pressure is applied automatically to prevent pauses in breathing.
Implants
Although still a new treatment option, it’s worth mentioning the pacemaker system designed to keep the airway open by stimulation of muscles. For those with moderate to severe obstructive sleep apnea the FDA has now approved such treatments; some studies have suggested its effectiveness for central sleep apnea. This is still a new field and therefore an expensive one to try.
Surgery
The width of the airway can be increased with surgery as a last resort. Depending on the case, specialists may remove excessive tissue or even the tonsils or adenoids. We’ve also seen plastic rods implanted into the soft palate and jaw reconstruction surgery. Of course, the risk of complications and infection is much higher with surgery. And although this is rare, the symptoms can get worse.
As you’ve probably noticed, we didn’t include medication on this list This is because they can only help with the associated sleepiness, not sleep apnea itself.
