Sleep apnea can be dangerous sleep disorder in which breathing stops during sleep. It's a common disorder that affects about 30% of adults, and is even more common in people over age 65. Here are the symptoms and causes of sleep apnea, as well as how to get diagnosed, the treatment options available and how they work, and who you can contact if you have questions.
types of sleep apnea are:
1. Obstructive sleep apnea. This is the most common type of sleep apnea and occurs when the soft tissue at the back of your throat collapses and closes off your airway during sleep.
2. Central sleep apnea. In central sleep apnea, unlike obstructive sleep apnea, the problem is not with your throat but with how your brain controls breathing while you are asleep.
3. Complex sleep apnea syndrome (variable sleep-related hypoventilation). This is when you have a combination of central and obstructive sleep apnea.
Symptoms:
1. Feeling tired during the day, but not remembering anything that happened the night before
2. Snoring
3. Unwilling to go back to sleep after being awakened from a deep sleep
4. Waking up feeling exhausted or restless
5. Narcolepsy
6. Finding it more difficult to fall asleep at night, despite waking up each morning feeling tired and having trouble falling asleep again
7. Excessive daytime sleepiness, or people often feel tired during the afternoon after they nap or take a short afternoon nap (called "microsleeps")
8. Morning headaches, or other types of discomfort during the day
When to see a doctor?
Ensure that you take your symptoms seriously. Sleep apnea can cause a variety of health problems including a risk of chronic heart failure, severe blood pressure problems, high blood sugar levels and an increased risk for stroke. If you are diagnosed with sleep apnea and find that you still feel exhausted during the day after a night of uninterrupted sleep, this may be a sign that your case is more serious.
Possible causes:
Here are the possible causes of sleep apnea:
1. Hormone deficiencies (hypopituitarism). People who have hormone deficiencies may experience sleep apnea as well. This can occur due to tumors, radiation therapy and other medical conditions.
2. Trauma to your neck, mouth or throat (such as breaking a tooth).
3. Disease of the airway (adenosquamous carcinoma and Benign vocal cord hyperplasia)
4. Lateral sinus dilation (usually occurring in older people). This is when a "sleeping" tumor in the lateral sinus enlarges and blocks the airway and causes snoring. This usually occurs when there is a blockage of the airway as a result of adenoid hypertrophy (a maturing gland). There are treatments to help alleviate this problem, and it is usually benign.
Risk factors:
1. Being male
2. Being over the age of 40
3. Being overweight
4. Having a family history of sleep apnea
5. Using alcohol, sedatives or any other drugs
6. Having a large neck circumference or thick fat around your neck
7. Having a small jaw, mouth or tongue
8. Having enlarged tonsils or adenoids (a part of your nose and throat located at the back of your mouth) in children, which can be due to repeated sinus infections, allergies, asthma and more
9. Having nasal polyps (noncancerous blockages inside your nose)
10. Being a smoker
11. Having patients who have had surgery of the airway (such as tonsil removal, adenoidectomy or adenoid reduction surgery) within the last year. These surgeries can narrow your airway and cause you to stop breathing during sleep.
Tests/procedures:
In order for a doctor to diagnose sleep apnea, you will likely be asked questions about your symptoms and medical history. In addition, you may need to be examined with tests like a cardiac stress test to measure the blood pressure during sleep. If your symptoms relate to other conditions that could be causing some of them (such as heart or lung disease), this may also be checked among other tests needed for diagnosis and treatment.
Treatment for Sleep Apnea
Doctors generally recommend that patients with sleep apnea take the following steps:
1. Use a Continuous Positive Airway Pressure machine (CPAP). This device is a machine that supplies pressurized air through a mask you wear over your nose or mouth while you sleep. The positive pressure keeps the airways open, which allows you to breathe normally while you sleep. You may need to try different masks or pressures before figuring out what works best for you. Some people find that they can't tolerate the device or don't get much relief from it, and many insurance policies only cover the machine itself and not the disposable parts needed to operate it (such as nasal tubes, masks, etc.). It may be best to see a sleep specialist who can help you find the type that's right for you.
2. Lose weight if you are overweight or obese, and have a large neck circumference or thick fat around your neck.
3. Follow a healthy diet, reducing saturated fat and sodium (especially sodium from processed foods), as both can make breathing difficult while you sleep.
4. Reduce your alcohol intake if you drink alcohol regularly, as it can make breathing harder as well as worsen other symptoms of sleep apnea (such as snoring). You may want to quit for at least 2-4 weeks so that you can get used to not drinking it before starting treatment for sleep apnea with CPAP machine.
5. Quit smoking if you smoke regularly, as it can increase the risk for heart disease and make it much harder for your body to keep breathing normally.
6. Stop using any drugs or sedatives that may be causing sleep apnea, as well as alcohol if you are a heavy drinker (which can cause sleep apnea).
7. Learn to live with snoring and take care of any dental issues or dental problems you have (such as implants) that could cause snoring.
8. Try to relax your throat muscles by massaging your neck muscles if possible when awake, or perhaps by swallowing a few times before going to bed if this technique works for you.
9. Try your best to sleep on your back or side, as sleeping on the stomach can make breathing more difficult.
10. Try sleeping with the head of your bed turned down (downhill position), as many people with sleep apnea find they can breathe easier while lying in a downhill position.
11. Ask your doctor about surgery if you are having difficulty managing your symptoms, but keep in mind that surgery is not a cure and you may have to have it repeated at some point in time if you have it again in the future. This is usually most successful when there are tonsil and/or adenoid problems involved in addition to a small airway.
12. Work with your doctor to create a plan to address any potential health conditions that are causing or worsening your sleep apnea.
13. Discuss using a device called an oral appliance with your dentist to help you breathe easier while you sleep. This is similar to a splint, and a dentist can make one that fits you best.
14. Ask your doctor about using nasal strips if nasal obstruction is making it hard for you to breathe as well as snoring and obstructive sleep apnea, since they can reduce the amount of air coming through the nose while you are sleeping and may help improve breathing while asleep by keeping your nostrils from becoming blocked during the night.
What can you do to prevent sleep apnea?
If you're diagnosing and treating yourself, there are some things that you can do to help your body deal with the condition so that it doesn't turn into a chronic problem:
1. Lose weight if your weight is contributing to problems with breathing while sleeping or cause snoring. This will help keep your airway open and healthy while sleeping, as becoming overweight can make breathing more difficult. If you are overweight, losing just 10% of your total body weight (or 10 pounds) may help improve symptoms in many cases.
2. Stop smoking if you have been smoking heavily for a long time.
3. Reduce or quit alcohol use, as it can make breathing more difficult as well as cause snoring in many cases.
4. If you have allergies or sinus problems with nasal congestion, try some useful tips for dealing with allergies and sinus infections to help keep your nasal passages clear and breathing easy while you sleep.
5. Stay away from any recreational drugs or alcohol if possible. Taking any drugs or sedatives that induce sleepiness can worsen sleep apnea in many cases, while drinking alcohol can make your respiratory problems worse while you are sleeping, increasing the risk that you will stop breathing at night (falling into a deeper sleep).
6. Get plenty of exercise throughout the day, as it can help keep your throat muscles toned and healthy while you sleep.
7. Try to relax before going to bed, using methods such as meditation (see my page on the best ways to meditate for more information), breathing exercises, or even soaking in a warm tub before going to bed (preferably without an electronic device in the bathroom with you).
8. Find out if allergies or sinus conditions are causing your symptoms, as this may reduce some of your symptoms while you try to deal with an underlying health condition that's causing sleep apnea.
9. If you have congestive heart disease, making sure that your blood pressure is under control and that your heart is healthy can help reduce the risks of developing sleep apnea.
10. If you have a history of heart problems, use electrocardiograms (EKGs) to monitor your heart rate while you are sleeping, as many sleep apnea cases are associated with an abnormally fast or slow heartbeat or getting sleepy during the middle of the night.
What if my symptoms worsen when I am sleeping?
If your symptoms get worse when you are sleeping, this may be due to a condition other than sleep apnea itself. Some other possible causes include:
1. Anemia. If you have anemia, this can sometimes cause shortness of breath while you are sleeping (even if your doctor doesn't feel that your anemia is severe enough to cause high blood pressure or heart problems). Anemia is a lack of red blood cells in the blood, and symptoms include feeling tired or weak, dizzy spells, headaches, and more. It is usually treated by getting more iron in your diet and/or by taking iron supplements to restore the correct balance of red blood cells to your body. Having mild anemia can make sleep apnea worse in some cases.
2. Heart disease. If you have high blood pressure (hypertension), it can cause breathing difficulty and snoring. Sleep apnea can make some cases of hypertension worse in some people, so if your doctor doesn't seem to be concerned about this, this may be something to ask about when you go for a checkup. However, high blood pressure is relatively common in the US and other countries, so it's important not to assume that sleep apnea would cause an increase in your blood pressure since most cases of sleep apnea don't turn into hypertension.
3. Cervical artery disease (CAD) or carotid artery disease (CAV). Often, CAD and CAV are referred to as "stroke" since abnormalities in these arteries or the blood vessels that supply your brain can cause short term or long term damage to your brain and nerves, which may result in memory problems, loss of limb control, or even death. There is some evidence that sleep apnea may cause CAD and CAV in some cases, so if you have any signs or symptoms of stroke or a history of stroke in your family it's important to get checked for this.
4. Sinus problems. If you have sinus inflammation (from allergies or other causes) it may make breathing while sleeping more difficult than usual.
5. Cancer. Cancer treatments can sometimes make it more difficult to breathe while sleeping, which can cause sleep apnea and lead to snoring or worse breathing in some cases. If you have had cancer or are currently being treated for the disease, talk to your doctor about any possible causes of snoring or breathing problems that may be related to the treatment you've been given.
6. High blood pressure. If your blood pressure is too high, this may be causing your symptoms even if your doctor doesn't feel that it is high enough to cause heart problems.
7. Hyperthyroidism. If you have hyperthyroidism, the excess thyroid hormone that's released by your thyroid gland can cause sleep apnea symptoms in some cases. If you feel that your symptoms are worse since you were diagnosed with hyperthyroidism, talk to your doctor.
8. Sleep disorders (such as narcolepsy). If you were diagnosed with narcolepsy at some point in the past or if you use stimulants such as caffeine or methamphetamine more than once a week, this may be causing sleepiness during the day and sleep disturbances when you are asleep.
9. IBS. If you have irritable bowel syndrome (IBS), this may cause some of your sleep apnea symptoms, including low blood sugar during the day and difficulty breathing, snoring, and more while you are asleep.
