Obstructive Sleep Apnea

Sleep apnea is a common breathing problem that happens during sleep. It happens when the muscles in the back of your throat, like your tongue and soft palate, relax too much. This relaxation narrows or completely blocks the airway, causing pauses in your breathing. These pauses happen repeatedly throughout the night.

The most common type of sleep apnea is obstructive sleep apnea. As the name suggests, this happens because the throat muscles relax and briefly block the flow of air. This can happen many times during sleep. One common sign of obstructive sleep apnea is snoring.

Obstructive sleep apnea (OSA) is a sleep disorder where breathing repeatedly stops and starts during sleep. It's often associated with loud snoring. Here are some common signs you might have OSA, or if you notice these signs in a partner:

Symptoms of Obstructive Sleep Apnea:

• Excessive daytime sleepiness: Feeling very tired and sleepy during the day, even after a full night's sleep. This can make it hard to focus at work, while driving, or even watching TV.
• Loud snoring: A very loud, often noisy snoring sound. This is a key symptom, but snoring alone doesn't always mean you have OSA.
• Observed episodes of stopped breathing during sleep: A partner or someone who sees you sleeping might notice periods where your breathing pauses or stops completely. These pauses can last for a few seconds to a minute or more.
• Waking up gasping or choking: During the night, you might wake up gasping for breath or feeling like you're choking. This can happen repeatedly.
• Dry mouth or sore throat in the morning: Waking up with a dry mouth or sore throat can be a sign of OSA.
• Morning headaches: Headaches upon waking are sometimes linked to OSA.
• Difficulty concentrating: Feeling foggy-headed or having trouble focusing during the day.
• Mood changes: OSA can affect your mood, potentially leading to depression, irritability, or other emotional changes.
• High blood pressure: This is a serious health concern, and OSA can be a contributing factor.
• Decreased libido (sex drive): OSA can impact your interest in sexual activity.

When to See a Doctor:

If you're concerned about OSA, or if your partner notices these symptoms, it's important to talk to a healthcare professional. Here are some situations to prompt a visit:

• Loud snoring: If your snoring is loud enough to disturb your sleep or the sleep of others.
• Waking up gasping or choking: If you regularly experience these nighttime awakenings.
• Breathing pauses during sleep: If you notice pauses in your breathing during sleep, even if you don't fully wake up.
• Excessive daytime sleepiness: If you experience excessive daytime sleepiness, especially if it's impacting your daily activities (driving, work, etc.).

Important Note: While snoring can be a symptom of OSA, it's not always a cause for concern. Many people snore without having OSA. If you snore loudly, especially if your snoring is interrupted by periods of silence, it's best to consult a healthcare professional. Sleeping on your back can sometimes worsen snoring and apnea episodes. If you have any sleep problems that leave you unusually tired, sleepy, and irritable on a regular basis, talk to your doctor. Excessive daytime sleepiness could also be a sign of other sleep disorders like narcolepsy.

If you or your partner notice any of these sleep problems, it's important to talk to a doctor:

• Loud snoring: If your snoring is so loud that it disrupts your sleep or the sleep of those around you, it's worth checking out.
• Gasping or choking during sleep: Waking up gasping or choking can be a sign of a serious sleep disorder.
• Breathing pauses during sleep: If you notice your breathing stops for periods during sleep, this is a significant concern.
• Excessive daytime sleepiness: Feeling very sleepy during the day, even when you've had enough sleep, can be a problem. This can lead to falling asleep while working, watching TV, or driving. It's crucial to understand that feeling sleepy all the time isn't normal.

Loud snoring isn't always a cause for alarm, and not everyone who snores has a serious condition called obstructive sleep apnea. However, if your snoring is loud, especially if it stops and starts (interrupted), it's a good idea to talk to your doctor. Snoring tends to be worse and breathing pauses (apneas) are more frequent when you sleep on your back.

If you're regularly feeling tired, sleepy, and irritable, talk to your doctor about any sleep problems you're experiencing. Excessive daytime sleepiness could be caused by other conditions, like narcolepsy. Don't ignore these symptoms; they deserve attention from a medical professional. It's important to get a proper diagnosis and treatment if needed.

Obstructive sleep apnea happens when the muscles in the back of your throat relax too much. These muscles hold up the soft palate (the roof of your mouth), your tongue, and the sides of your throat.

When these muscles relax, your airway gets smaller or even closes off as you breathe in. This cuts down on the amount of oxygen in your blood and makes carbon dioxide build up.

Your brain notices this and briefly wakes you up so you can breathe again. This waking is usually so quick you don't remember it.

You might wake up feeling short of breath, which quickly goes away with a few deep breaths. Or you might make a snorting, choking, or gasping sound.

This cycle can happen 5 to 30 or more times every hour throughout the night. These interruptions keep you from getting the deep, restful sleep you need, which is why you might feel tired and sleepy during the day.

Often, people with obstructive sleep apnea don't realize how poorly they've slept. They might not notice the many times their breathing was interrupted throughout the night.

Obstructive sleep apnea (OSA) can affect anyone, but some things make you more likely to get it. Here are some risk factors:

Weight: Being overweight is a significant risk factor for OSA. Extra fat in the upper part of your throat can block your airway while you sleep. While many people with OSA are overweight, it's not always the case. Other health problems linked to extra weight, like underactive thyroid (hypothyroidism) or polycystic ovary syndrome (PCOS), can also increase your risk.

Age: Your chances of developing OSA go up as you get older, but this risk seems to slow down after about age 60 or 70.

Narrow Airway: A naturally narrow airway, sometimes passed down through families, can be a problem. Enlarged tonsils or adenoids can also block your airway, increasing your risk.

High Blood Pressure (Hypertension): OSA is quite common in people with high blood pressure.

Nasal Congestion: If you frequently have stuffy noses at night, whether from allergies or other causes, you're more likely to develop OSA. This happens about twice as often in people with consistent nasal congestion.

Smoking: Smoking increases your risk of OSA.

Diabetes: People with diabetes might be more prone to OSA.

Sex: Men are generally 2 to 3 times more likely to have OSA than pre-menopausal women. However, women's risk increases after menopause.

Family History: If you have family members with OSA, you may be at higher risk yourself.

Asthma: Studies suggest a link between asthma and an increased risk of OSA.

Obstructive sleep apnea is a serious health problem. It can lead to many complications, affecting your daily life and increasing your risk of other health issues.

Problems during the day: When you don't get enough quality sleep at night due to obstructive sleep apnea, you're likely to feel very tired and sleepy during the day. This tiredness can make it hard to concentrate, and you might even fall asleep at work, while watching TV, or while driving. This significantly increases the chance of accidents, especially at work.

Children and teenagers with this condition may struggle in school and have trouble paying attention or behaving well. The more severe the sleep apnea, the more likely it is to cause these problems.

Health problems from medicines and surgery: Certain medications, like sedatives and some painkillers, and general anesthesia can relax the muscles in your throat. This can make sleep apnea worse, especially if you have surgery while taking these medications. Having major surgery can be particularly risky for people with sleep apnea, especially if they're sedated and lying on their back, because it can make breathing problems worse. If you have sleep apnea, it's crucial to tell your surgeon before any surgery. You might need testing for sleep apnea beforehand.

Eye problems: Some studies link obstructive sleep apnea to eye conditions like glaucoma, but these eye problems can usually be treated.

Relationship difficulties: Loud snoring, a common symptom of sleep apnea, can disrupt the sleep of others, potentially affecting your relationships. This can lead to issues with partners who may need to sleep in separate rooms.

Increased risk of serious illnesses: Severe obstructive sleep apnea can significantly increase your risk of serious health problems, including heart disease (like coronary artery disease, heart attack, and heart failure), and stroke.

COVID-19 risk: Recent research shows that people with obstructive sleep apnea may be at higher risk of developing a severe form of COVID-19 and needing hospital care.

In summary, obstructive sleep apnea is a significant health concern that can affect many areas of your life and increase your risk of other serious medical issues. If you have symptoms, talk to your doctor to get diagnosed and treated.

To diagnose and treat obstructive sleep apnea, a healthcare professional will first evaluate your symptoms and conduct a physical exam. This exam might include checking your throat, mouth, nose, neck, and waist circumference, as well as your blood pressure. You might be referred to a sleep specialist for a more detailed evaluation.

The sleep specialist can determine the severity of your condition and recommend a treatment plan. Sometimes, this evaluation requires an overnight stay at a sleep center. At the sleep center, sensors monitor your breathing, heart rate, brain activity, and other body functions as you sleep.

One common test used to diagnose obstructive sleep apnea is polysomnography, often called a sleep study. During this test, sensors are attached to you to measure your brain waves, heart rate, breathing, oxygen levels, and leg and arm movements. This information shows how your body functions during sleep. The entire night's sleep may be monitored, or, in some cases, only part of the night. If diagnosed with obstructive sleep apnea during a full-night study, you may be woken up and given a continuous positive airway pressure (CPAP) mask during the second half of the night to help you breathe more easily.

A split-night sleep study is a variation. In this, you're monitored during the first half of the night. If obstructive sleep apnea is suspected, you might be woken up and given a CPAP mask during the second half of the night to help you breathe. The sleep study can also identify other sleep disorders, like periodic limb movement disorder (jerky leg movements during sleep) or narcolepsy (sudden sleep attacks).

In some situations, a home sleep apnea test may be an option. These tests are less comprehensive than a full sleep study, but they can still help detect breathing pauses during sleep. Home tests usually monitor fewer variables, like breathing patterns, compared to a full sleep study. This test is simpler and less involved than a full sleep study.

Mayo Clinic has a team of specialists who are experienced in treating obstructive sleep apnea. They can provide personalized care and support throughout your treatment journey.

Treating Obstructive Sleep Apnea: A Variety of Options

Obstructive sleep apnea (OSA) is a condition where breathing repeatedly stops and starts during sleep. This can lead to daytime sleepiness, reduced energy levels, and other health problems. Fortunately, several effective treatments are available, ranging from simple lifestyle changes to more complex surgical procedures. Let's explore some common options.

Continuous Positive Airway Pressure (CPAP):

CPAP is a widely used treatment for OSA. A CPAP machine gently pushes air into your airways through a mask, keeping your airways open while you sleep. This prevents the pauses in breathing that characterize OSA. Different mask types and sizes are available to suit various face shapes and preferences. Finding the right mask can take some trial and error. Your doctor or a sleep specialist can help you choose the best fit.

• Types of CPAP Masks:

  • Nasal pillows: These small cushions fit inside your nostrils, making them a good choice for those who feel claustrophobic with full face masks or who want to wear glasses or have facial hair.
  • Nasal masks: These masks cover only your nose. They might be a better option if you need a higher air pressure setting, or if you move around a lot during sleep.
  • Full-face masks: These masks cover both your nose and mouth. They're often recommended if you have trouble breathing through your nose or tend to breathe through your mouth at night.

• Different CPAP Modes:

  • Fixed CPAP: Delivers a constant air pressure.
  • Auto-titrating CPAP (APAP): Adjusts the air pressure automatically based on your breathing needs.
  • Bilevel positive airway pressure (BPAP): Delivers different pressures during inhalation and exhalation. This can be helpful if you find fixed CPAP uncomfortable.

Oral Devices:

These devices are worn in the mouth during sleep and gently reposition the jaw and tongue to keep the airway open. This can help reduce or eliminate snoring and OSA symptoms.

• Types of Oral Devices:
  • Jaw repositioning devices: These devices push the lower jaw forward.
  • Tongue retaining devices: These devices hold the tongue in a forward position.
  • Electrical tongue stimulation devices: These newer devices use mild electrical impulses to improve tongue muscle tone, helping prevent airway blockage.

Surgery:

In some cases, surgery may be an option, often as a last resort if other treatments haven't worked.

• Uvulopalatopharyngoplasty (UPPP): This surgery removes tissues in the back of the mouth and throat to enlarge the airway.
• Upper airway stimulation: An implanted device stimulates a nerve that controls tongue movement, helping to keep the airway open.
• Jaw surgery (maxillomandibular advancement): This surgery moves the upper and lower jaw forward to create more space in the airway.
• Tracheostomy: This involves creating an opening in the neck and inserting a tube to allow breathing around the blocked airway. This is typically only considered for severe cases.
• Nasal surgery: May be needed to treat nasal obstructions like polyps or a deviated septum.

Important Considerations:

• Finding the right treatment: It's crucial to work closely with a healthcare professional (doctor, dentist specializing in sleep medicine, or sleep specialist) to determine the best course of action for your specific needs. They can assess your condition and recommend the most appropriate treatment.
• Consistency: Success in treating OSA often depends on consistent use of the prescribed treatment.
• Follow-up care: Regular check-ups are essential to monitor your progress and make any necessary adjustments to the treatment plan. Report any changes in your symptoms or concerns to your healthcare provider.

This information is for educational purposes only and does not constitute medical advice. Always consult with a healthcare professional for diagnosis and treatment of any medical condition.