Sleep Apnea: Symptoms, Treatment, & Diagnosis

Are you tired during the day, even if you got enough sleep? Do you find yourself waking up in the night feeling like you’re gasping or choking? Maybe your partner complains about your loud snoring. If any of these is true, you may be suffering from sleep apnea, a common condition that affects about 18 million Americans. Only one in five people with sleep apnea is diagnosed so it’s important to know when you should see a doctor. The good news is that sleep apnea can be prevented and treated without medication. Read on to learn about the symptoms and causes of sleep apnea, and what to do to find relief.

What Is Sleep Apnea?

Sleep apnea refers to episodes during which your breathing repeatedly stops and starts as you sleep. These episodes can occur hundreds of times each night and repeatedly interrupt your natural sleep rhythm. Occasionally, you may find yourself waking up with a sensation of choking, gasping, or being smothered, but many sufferers are totally unaware of these short breathing pauses or ‘apneas.’

In fact, many sufferers first discover there’s an issue when a partner or roommate complains about snoring. Sleep apnea does have other symptoms; you may feel tired during the day, or that you find it hard to concentrate. You can easily brush this off as part of your busy life, but these symptoms may be pointing towards sleep apnea, which—over time—can take a serious toll on your physical and mental health.

Causes of Sleep Apnea

Obstructive Sleep Apnea

Obstructive sleep apnea is the most common type of sleep apnea and is often accompanied by loud snoring. It occurs when your airway is blocked due to the temporary relaxation of the muscles that support the soft tissues at the back of your throat, such as your tongue and soft palate. This causes your airway to be narrowed or closed and can stop your breathing for 10 seconds or longer, lowering your blood oxygen levels and building up carbon dioxide. As soon as your brain senses this, it causes you to briefly wake up so that you can reopen your airway with one or two deep breaths. This may cause you to make a snorting, choking, or gasping sound that your bed partner or roommate may hear. This pattern can repeat itself 5-30 times or more each hour, all night long. These disruptions impair your ability to reach the restful phases of the sleep cycle, which is why you may feel sleepy during your waking hours.

Central Sleep Apnea

This is much rarer than obstructive sleep apnea. It occurs when your brain fails to signal the muscles that control breathing. You are unlikely to snore if you have this type of sleep apnea.

Complex Sleep Apnea

This is where you have a combination of obstructive sleep apnea and central sleep apnea.

Sleep Apnea Symptoms

It can be difficult to discover that you have sleep apnea because, apart from daytime fatigue, the main symptoms occur when you’re asleep. If possible, ask your partner or roommate to provide feedback about your sleep habits, or record yourself while you’re asleep.

The following are warning signs that you have sleep apnea:

Main Symptoms

• Loud and chronic snoring nearly every night
• Choking, snorting, or gasping during sleep
• Pauses in your breathing
• Waking up at night short of breath
• Excessive daytime sleepiness, irrespective of how long you were in bed

Other symptoms

• Waking up with a dry mouth or sore throat
• Restless or fitful sleep
• Insomnia or nighttime awakenings
• Trouble focusing and forgetfulness during the day
• Uncharacteristic moodiness, irritability, or depression
• Morning headaches
• Nighttime sweating
• Decreased libido

Sleep Apnea Risk Factors

Anyone can get obstructive sleep apnea, but there are a number of factors that can increase your risk. They include:

Excess Weight

You can develop obstructive sleep apnea no matter how much you weigh. However, people who are overweight are at a significantly higher risk because fat deposits around the upper airway can obstruct breathing.

Being Male or a Post-Menopausal Female

In the general population, men are 3-5 times more likely than women to have obstructive sleep apnea. The reason for this is not very clear, but it may be due to the inherent differences in fat distribution, length, and collapsibility of the upper airway between the sexes, as well as brain and hormonal differences in how breathing is controlled.

The frequency of obstructive sleep apnea increases in women after menopause because of lowered levels of estrogen and progesterone. One job of these hormones is to help keep airways open by maintaining muscle tone in the throat. Hormonal changes can also lead to weight gain and a redistribution of body fat, sending more fat to the throat area and narrowing the air passage.

Genetic Factors

If you have a family history of sleep apnea, you may have a greater likelihood of developing it yourself.

Smoking

If you smoke, you’re more likely to have obstructive sleep apnea. This is likely because smoking causes:

• Upper airway inflammation
• Changes in how your brain controls the muscles of your upper airway
• Disrupted sleep patterns

Of course, there are no shortage of good reasons to quit smoking, and studies clearly show that it causes premature illness and death. In fact, you’re almost three times more likely to die from any medical cause if you’re a smoker than if you’ve never smoked.

Other Medical Conditions

Obstructive sleep apnea is relatively common in people with hypertension (high blood pressure). The condition also occurs twice as often in people who have consistent nasal congestion at night, regardless of the cause. What’s more, if your tonsils or adenoids become enlarged, this may block your airway. You’re also at risk if you have medical conditions that are associated with obesity, such as hypothyroidism and polycystic ovary syndrome. Lastly, obstructive sleep apnea is more common in people with diabetes or asthma.

How Sleep Apnea Is Diagnosed

Your doctor may suspect the diagnosis after chatting about your symptoms and medical history and performing a physical examination to look at the back of your throat, mouth, and nose to check for any extra tissue or abnormalities. Your doctor will also be looking for risk factors for obstructive sleep apnea, and will likely check your blood pressure and measure the circumference of your neck and waist. However, most patients will get a definitive diagnosis by going to a specialized sleep center where an expert health care team carries out further diagnostic tests for sleep apnea.

These tests include:

Polysomnography

This is where specialists monitor your sleep overnight by hooking you up to equipment that monitors your heart, lung and brain activity, as well as breathing patterns, arm and leg movements, and blood oxygen levels. This may be for the whole night or for a split-night sleep study. In the latter case, you’ll be monitored just for the first half of the night. If you’re diagnosed with obstructive sleep apnea, staff may wake you and give you continuous positive airway pressure (CPAP) for the second half of the night, which will prevent any further breathing disruptions.

Polysomnography can also help rule out other sleep disorders that can cause excessive daytime sleepiness but require different treatments, such as leg movements during sleep (periodic limb movements) or sudden bouts of sleep during the day (narcolepsy).

Home Sleep Apnea Testing (HSAT)

If necessary, you may be able to have polysomnography conducted in the comfort of your home with HSAT. This test is a very simplified breathing monitor that tracks your breathing, oxygen levels, and breathing effort while worn. It does not fully capture what is monitored with an overnight sleep study where a more thorough assessment of sleep issues is carried out but it can see if you likely have sleep apnea.

Sleep Apnea Treatment Options

There are a few ways that obstructive sleep apnea is generally managed or treated. The most common sleep apnea treatments include CPAP therapy, surgical procedures, and significant lifestyle changes such as weight loss, quitting smoking, and reducing alcohol intake. Each treatment type has pros and cons, and you can work with your doctor to find the best choice

for your sleep apnea.

CPAP Therapy

Continuous positive airway pressure (CPAP, pronounced SEE-pap) therapy acts to help open up a blocked airway, and prevent breathing and sleep disruptions. A machine delivers air pressure through a piece that fits next to or inside your nostrils or is placed over your nose and mouth while you sleep. The device ensures that the pressure of the air you breathe is continuous, constant, and sufficiently high that your upper airway passages always remain open. This fixed CPAP has been shown in many studies to be effective in treating obstructive sleep apnea and snoring, and is the most common therapy for people with the condition.

If you are not able to tolerate it, your doctor may give you auto-titrating or varied CPAP, where the machine automatically adjusts the air pressure level if it senses increased airway resistance. Another option is bilevel positive airway pressure (BPAP), which delivers a preset amount of pressure when you breathe in and a different amount of pressure when you breathe out.

It may take you a while to get used to sleeping with a mask, and you may find it cumbersome, uncomfortable, and noisy. Don’t give up! Let your doctor know or check on Internet support groups or bulletin boards to learn about the different options of CPAP masks. Experiment with different designs of masks, such as those with nasal pillows, and make sure you have a mask that fits you well. Try to invest in one of the newer machines, which are both smaller and quieter than older models. You may also find it more comfortable to use a humidifier with your CPAP system. It may take you weeks to find the best CPAP solution, but it’s important to persevere for your health.

Contact your doctor if you still snore despite treatment, if your snoring reoccurs, or if your weight goes up or down by 10% or more. Your doctor may adjust your CPAP treatment or, in some cases, consider surgery.

Surgery

Surgery is only used to treat sleep apnea when all other therapies have been unsuccessful. There are several types of operations that can treat obstructive sleep apnea. These include:

Uvulopalatopharyngoplasty (UPPP)

This is where a surgeon removes tissue from the back of your mouth and the top of your throat while you’re under general anesthetic. Your tonsils and adenoids may be removed as well. This procedure can be carried out with a laser (laser-assisted uvulopalatoplasty) or with radiofrequency energy (radiofrequency ablation). Your snoring lessens because your upper air passages are now free of physical anatomic obstructions. Some doctors will also perform nasal surgery to clear your air passages by removing polyps, or straightening a crooked partition between your nostrils (deviated septum).

Upper Airway Stimulation

Patients with moderate to severe obstructive sleep apnea who can’t tolerate CPAP or BPAP, can benefit from a hypoglossal nerve stimulator. This is a pacemaker-like device that is surgically implanted under the skin of the upper chest, monitors breathing patterns, and is activated during sleep to stimulate the hypoglossal nerve, which controls the muscles in your upper airway. Studies have found that upper airway stimulation leads to significant improvement in obstructive sleep apnea symptoms and improvements in quality of life.

Jaw Surgery (Maxillomandibular Advancement)

In this operation, a surgeon moves the upper and lower parts of your jaw by about a centimeter forward from the rest of your facial bones. This makes the space behind your tongue and soft palate larger so breathing is less likely to be obstructed. Studies have shown that it significantly reduces the number of times you have apneas during sleep and has a better improvement rate than UPPP. However, the operation is much more complicated than UPPP and takes a longer time to recover from.

Sleep Apnea Prevention – What You Can Do at Home

There are various changes you can make to your lifestyle that will not only help you to beat sleep apnea, but will also act to increase your overall well-being and ensure you are fresh and alert during the day:

• Lose weight if you’re overweight.
• Exercise regularly.
• Drink alcohol moderately, if at all, and don’t drink several hours before bedtime.
• Quit smoking.
• Use a nasal decongestant or allergy medications.
• Sleep on your side rather than your back.
• Avoid taking sedative medications such as anti-anxiety drugs or sleeping pills.

Sleep Apnea Complications and Related Conditions

Sleep apnea chronically deprives you of restful sleep, which can result in daytime sleepiness, slow reflexes, poor concentration, memory problems, and an increased risk of accidents. What’s more, it can affect your mental health causing you to feel moody, irritable, and even depressed. Further complications include morning headaches and a need to urinate frequently at night (nocturia).

Sleep apnea is considered a serious medical condition because it can lead to other serious health problems such as diabetes, heart disease, stroke, and weight gain.

Cardiovascular Problems

When you stop breathing because of obstructive sleep apnea, the oxygen level in your blood drops suddenly. This can increase blood pressure and result in hypertension (high blood pressure) and strain your heart. The more often these breathing disruptions occur, the more severe the sleep apnea, and the greater the risk of coronary artery disease, heart attack, heart failure, and stroke. Obstructive sleep apnea also increases the risk of abnormal heart rhythms called arrhythmias. If there’s underlying heart disease, these repeated multiple episodes of arrhythmias may be fatal.

Complications After Surgery

Certain medications, such as sedatives, narcotic analgesics, and general anesthetics, relax your upper airway and therefore worsen your obstructive sleep apnea. If these medications are required during surgery, you may be more prone to complications after surgery. This is further compounded by the fact that you may have been lying on your back during the operation.

Eye Problems

Research has found a connection between obstructive sleep apnea and certain eye conditions, such as glaucoma. The good news is that if caught in time, eye complications can usually be treated.

Sleep-Deprived Partners

Another problem with obstructive sleep apnea is that you’re often not the only one losing quality sleep. Your loud snoring can deprive your partner of sleep causing them to also feel sleepy during the day and irritable and moody. Some partners may even choose to sleep in another room. So get yourself checked for the sake of your loved one too.

When to See a Doctor for Sleep Apnea

Go to see your doctor if you experience, or if your partner observes, any of the symptoms of loud snoring, waking up gasping or choking, or intermittent pauses in your breathing during sleep. This is particularly important if you are so sleepy during the day that you are making unnecessary mistakes, are in danger of falling asleep at the wheel, or are at risk of having an industrial accident at work.

Did you know

• 20% of fatal accidents in the U.S. involve a drowsy driver.
• Individuals who snored, or slept 6 or fewer hours per day were more likely to report falling asleep while driving.
• 4% of drivers reported falling asleep while driving at least once in the previous 30 days.

It’s true that your loud snoring may have nothing to do with obstructive sleep apnea, but if it is accompanied by periods of silence, or lessens when you turn on your side, it is a good idea to get checked out by your doctor.

Since there are other conditions that can leave you chronically fatigued, sleepy and irritable, let your doctor know if you have any other sleep problems or symptoms.