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Sleep Apnea
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Sleep Apnea - from the Basics to Advanced Information.


Sleep Apnea is a disorder of breathing during sleep. Typically it is accompanied by loud snoring. Apnea during sleep consist of brief periods throughout the night in which breathing stops. People with sleep apnea do not get enough oxygen during sleep. There are 2 major types.

Obstructive Sleep Apnea
is the most common type and is due to an obstruction in the throat during sleep. Bed partners notice pauses approx. 10 to 60 seconds between loud snores. The narrowing of the upper airway can be a result of several factors including inherent physical characteristics, excess weight, and alcohol consumption before sleep.


Central Sleep Apnea
- caused by a delay in the signal form the brain to breath . With both obstructive and central apnea you must wake up briefly to breathe, sometimes hundreds of times during the night. Usually there is no memory of these brief awakenings.

Most Common Symptoms

  • Loud Snoring
  • Waking up unrefreshed and having trouble staying awake during the day
  • Waking up with headaches
  • Waking up during the night with the sensation of choking
  • Waking up sweating
  • Frequent trips to the bathroom during the night
  • Insomnia - problem staying asleep
  • Being overweight but not necessary
  • Waking and gasping for air
Books to read:

Go to Sandman's Book Store. Most books that focus
on Apnea are listed in the General and Sleep Apnea Category.

Sleep Apnea and Snoring in Depth

What is Sleep Apnea?

Obstructive Sleep Apnea Syndrome is characterized by repetitive episodes of upper airway obstruction that occur during sleep, usually associated with a reduction in blood oxygen saturation. In other words, the airway becomes obstructed at several possible sites. The upper airway can be obstructed by excess tissue in the airway, large tonsils, a large tongue and usually includes the airway muscles relaxing and collapsing when asleep. Another site of obstruction can be the nasal passages. Sometimes the structure of the jaw and airway can be a factor in sleep apnea.

There is also Central Sleep Apnea. It also is characterized by the cessation of breath due to a lack of effort in breathing during sleep. Central Sleep Apnea is not as common as OSA and is more difficult to diagnose. Typically it is do to some neuromuscular problem but other sources could be the cause.

Symptoms?

  • very sleepy during the day
  • breathing stops frequently during sleep. (usually unaware).

Some Effects of OSA:

  • loud snoring
  • morning headaches
  • chest pulls in during sleep in young children
  • high blood pressure
  • overweight, but not always
  • a dry mouth upon awakening
  • depression
  • difficulty concentrating
  • excessive perspiring during sleep
  • heartburn
  • reduced libido
  • insomnia
  • frequent trips to the bath room during the night
  • restless sleep
  • rapid weight gain

Is this a serious condition?

It is a potentially life-threatening condition that may require immediate medical attention. The risks of undiagnosed obstructive sleep apnea include heart attacks, strokes, impotence, irregular heartbeat, high blood pressure and heart disease. In addition, obstructive sleep apnea causes daytime sleepiness that can result in accidents, lost productivity and interpersonal relationship problems.  The severity of the symptoms may be mild, moderate or severe. 

How does the doctor determine if you have OSA?

A sleep test, called polysomnography is usually done to diagnose sleep apnea. There are two kinds of polysomnograms. An overnight polysomnography test involves monitoring brain waves, muscle tension, eye movement, respiration, oxygen level in the blood and audio monitoring. (for snoring, gasping, etc.) The second kind of polysomnography test is a home monitoring test. A Sleep Technologist hooks you up to all the electrodes and instructs you on how to record your sleep with a computerized polysomnograph that you take home and return in the morning. They are painless tests that are usually covered by insurance.

How is Sleep Apnea Treated?

Mild Sleep Apnea is usually treated by some behavioral changes. Losing weight, sleeping on your side are often recommended. There are oral mouth devices (that help keep the airway open) on the market that may help to reduce snoring in three different ways. Some devices (1) bring the jaw forward or (2) elevate the soft palate or (3) retain the tongue (from falling back in the airway and blocking breathing). Sleep Apnea is a progressive condition (gets worse as you age) and should not be taken lightly.

Moderate to severe Sleep Apnea is usually treated with a C-PAP (continuos positive airway pressure).  CPAP is a machine that blows air into your nose via a nose mask, keeping the airway open and unobstructed. For more severe apnea, there is a Bi-level (Bi-PAP) machine. The BI-level machine is different in that it blows air at two different pressures. When a person inhales, the pressure is higher and in exhaling, the pressure is lower. Your sleep doctor will "prescribe" your pressure and a home healthcare company will set it up and provide training in its use and maintenance.

Some people have facial deformities that may cause the sleep apnea. It simply may be that their jaw is smaller than it should be or they could have a smaller opening at the back of the throat. Some people have enlarged tonsils, a large tongue or some other tissues partially blocking the airway. Fixing a deviated septum may help to open the nasal passages. Removing the tonsils and adenoids or polyps may help also. Children are much more likely to have their tonsils and adenoids removed.

There are several other surgical treatments. Usually a surgeon will ask the patient to be on CPAP for at least month to see if they get better. If CPAP cannot help then surgery is probably not the right thing to do. These treatments include, removing excess tissue to clear the airway, moving the tongue forward, and moving the upper and lower jaw forward. There and other procedures try to increase the size of the upper airway.

Snoring in Depth

I'm sure just about everyone is somewhat familiar with snoring. You probably know at least one person who snores. It could be your bed partner, your parents, grandparents, even Uncle Ned or Aunt Sophie who may snore at various sound levels. Some laugh and make jokes about it, but it can be a symptom of a serious disorder called obstructive sleep apnea. And if it is obstructive sleep apnea, then it is no laughing matter, and that individual needs to get evaluated by a sleep specialist. Information on apnea is available at the above link.

Snoring is a noise produced when an individual breathes (usually produced when breathing in) during sleep which in turn causes vibration of the soft palate and uvula (that thing that hangs down in the back of the throat). The word "apnea" means the absence of breathing.

All snorers have an partial obstruction of the upper airway. Many habitual snorers have complete episodes of upper airway obstruction where the airway is completely blocked for a period of time, usually 10 seconds or longer. This silence is usually followed by snorts and gasps as the individual fights to take a breath. When an individual snores so loudly that it disturbs others, obstructive sleep apnea is almost certain to be present.

There is snoring that is an indicator of obstructive sleep apnea and there is also primary snoring.

Primary Snoring, also known as simple snoring, snoring without sleep apnea, noisy breathing during sleep, benign snoring, rhythmical snoring and continuous snoring is characterized by loud upper airway breathing sounds in sleep without episodes of apnea (cessation of breath).

How Does Primary Snoring Differ from Snoring with OSA?

  • You wake up feeling refreshed
  • No evidence of insomnia
  • You do not experience excessive sleepiness during the day

A polysomnogram (sleep study) that shows:

  • Snoring and other sounds often occurring for long episodes during the sleep period
  • No associated abrupt arousals, arterial oxygen desaturation (lowered amount of oxygen in the blood) or cardiac disturbances
  • Normal sleep patterns
  • Normal respiratory patterns during sleep
  • No signs of other sleep disorders

What can be done about Primary Snoring?

First of all, it is absolutely necessary to rule out obstructive sleep apnea or other sleep disorders. Be wary of any doctor who says it is not necessary. Behavioral and lifestyle changes may be suggested.  Losing weight, sleeping on your side, refraining from alcohol and sedatives are often recommended.

There are mouth/oral devices (that help keep the airway open) on the market that may help to reduce snoring in three different ways.

  • Some devices:
    • bring the jaw forward or
    • elevate the soft palate or
    • retain the tongue (from falling back in the airway and thus decreasing snoring).

There is also surgery. There is uvulopalatopharyngoplasty (UPPP) or Laser-Assisted Uvulopalatoplasty (LAUP), that involves removing excess tissue from the throat.

The newest surgery, approved by the FDA in July 1997 for treating snoring is called somnoplasty and uses radio frequency waves to remove excess tissue.

I hope you found this information useful. If you have any questions please go to The Sleep Apnea Homepage. You may also try the Sleep Test and see how you score for OSA.


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