What To Do Next If You Have Sleep Apnea
If you suspect that you or your partner may have sleep apnea, and/or are also experiencing one or more of the above risks of sleep apnea, make an appointment with your doctor as soon as possible.
Your doctor can perform an evaluation and provide you with a referral to a sleep lab where you can be closely monitored for signs of sleep apnea. Alternately, you may be given or prescribed an at-home sleep study test , which you can perform in the comfort of your own home, and the results will help your doctor diagnose sleep apnea.
Obstructive And Central Sleep Apnea: Causes And Risk Factors
by Dr. Sanjiv Khanse | Diseases and Conditions
Apnea is suspension or cessation or a pause in breathing. Since it occurs while you are asleep it is called sleep apnea. The causes and risk factors that make you prone to suffer from both OSA and CSA in men and women are explored.
Obstructive sleep apnea occurs due to the blockage or obstruction of the airway, which can be due to several reasons. In such cases, breathing becomes laborious and you snore loudly.
Central sleep apnea occurs because the brain fails to send signals to the respiratory muscles to function and bring about respiration. This type of sleep apnea is rare.
You should never ignore this condition because it can cause serious health complications.
In normal circumstances, the muscles of the throat around the windpipe keep the airway stiff and open to facilitate proper breathing .
When you sleep these throat muscles are in a more relaxed state but they still keep the windpipe open allowing you to breathe normally.
These muscles support the soft palate, the uvula, the tonsils, and the tongue. In obstructive apnea, this muscle support fails due to certain reasons and is the main cause of sleep apnea.
Secondly, due to less intake of oxygen because of restricted breathing, oxygen levels in the blood fall.
When this fall is excessive, the brain wakes you up because when you awaken, the throat muscles tighten and the airway is opened allowing you to breathe in freely and increase oxygen levels in the blood.
What You Can Do
When you make the appointment, ask if there’s anything you need to do in advance, such as modify your diet or keep a sleep diary.
Make a list of:
- Your symptoms, including any that may seem unrelated to the reason for which you scheduled the appointment, and when they began
- Key personal information, including family history of a sleep disorder
- All medications, vitamins or supplements you take, including doses
- Questions to ask your doctor
Take a family member or friend along, if possible, to help you remember the information you receive. Because your bed partner might be more aware of your symptoms than you are, it may help to have him or her along.
For sleep apnea, some questions to ask your doctor include:
- What’s the most likely cause of my symptoms?
- What tests do I need? Do these tests require special preparation?
- Is my condition likely temporary or long lasting?
- What treatments are available?
- Which treatment do you think would be best for me?
- I have other health conditions. How can I best manage these conditions together?
- Should I see a specialist?
- Are there brochures or other printed material that I can have? What websites do you recommend?
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How Does Apnea Affect Breathing
With apnea, your airways are fully obstructed so that you do stop breathing for 10 seconds or more during the night. With either case, you might wake up many times during your sleep to catch your breath without being aware. Hypopnea has three types: Central hypopnea, when air flow lessens and breathing slows
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Central Sleep Apnea And Obstructive Sleep Apnea
Most discussions of sleep apnea focus on obstructive sleep apnea and its treatment. Sleep apneas, however, come in more than one form.
The sleeper who suffers from OSA periodically struggles to breathe but is unable to inhale effectively because his or her airway has become blocked or collapsed. The sleeper whose problem is central sleep apnea periodically doesnt breathe at all so oxygen intake is ineffectual. In either type of sleep apnea, the lack of oxygen usually causes the patient to wake up or arouse, at least briefly.
To put it another way, the OSA patient has a mechanical problem, one that almost always can be corrected by a continuous positive airway pressure device.
Treatment of CSA is more challenging because the signal to the body to inhale is not being transmitted from the breathing center in the brain, or not received by the body. Sleep experts report that the great majority of central apnea sufferers also experience OSA although the CSA may not be noted until the OSA is treated.
In some cases the sleeping CSA sufferer displays a periodic shallow breathing or under-breathing that alternates with deep over-breathing, a condition known as Cheyne-Stokes breathing Estimates vary as to the frequency of central sleep apnea. Some say it accounts for 20 percent of all cases of sleep apnea.
An online discussion of central sleep apnea prepared by experts at Minnesotas Mayo Clinic breaks the disease down into five types:
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What To Expect From Your Doctor
Your doctor is likely to ask you questions, including:
- Have your symptoms been continuous, or do they come and go?
- How severe are your symptoms?
- How does your partner describe your symptoms?
- Do you know if you stop breathing during sleep? If so, how many times a night?
- Is there anything that has helped your symptoms?
- Does anything make your symptoms worse, such as sleep position or alcohol consumption?
Risk Factors For Obstructive Sleep Apnea :
- Being male
- Overweight: People who are an unhealthy weight or even obese tend to have more fatty tissue in the throat and neck, which can put a strain on the respiratory system, especially at night when the throat muscles relax.
- 50+ Years old: As one ages, the muscles in the body tend to lose their tone and definition. Weaker throat muscles can therefore collapse more easily during sleep.
- Genetics: You could be genetic predisposed to having a narrower throat, an enlarged tongue or weight issues, all of which are risk factors for sleep apnea.
- Tobacco-use: Irritates the soft tissues in the esophagus, lungs and throat, causing fluid retention and inflammation, which can lead to airway blockages and restrictions.
- Alcohol: Relaxes the bodys muscles, including the throat muscles, and can lead to snoring and sleep apnea.
- Having a thick neck: Collar measurements in excess of 15.75 inches or 40 centimeters.
- Being Black, Hispanic, or a Pacific Islander: People of these demographics tend to have more powerful and thicker upper bodies and necks. The extra weight around the throat can cause nocturnal breathing problems.
- High blood pressure
- Enlarged adenoids or tonsils are risk factors for sleep apnea, especially in children and adults who never had their tonsils removed.
- A deviated septum
- Bite malocclusion
- Allergies that cause nasal blockage and congestion
- Throat muscles that relax more than normal.
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What Are Symptoms Of Central Sleep Apnea
Many people with CSA have the following problems:
- Disrupted sleep with frequent awakenings
- Difficulty falling asleep
Other problems often seen include the following:
- Snoring
- Waking up short of breath
A bed partner often can tell how often you snore and if you stop breathing.
Many people with CSA are sleepy during the day. They find that they are still tired even after a nap. When you stop breathing, your body wakes up. It happens quickly so you arent aware of it. This disrupts your sleep. You can stop breathing hundreds of times in one night. This can make you feel very tired the next day.
The medical conditions that cause CSA can also worsen the problems with sleeping and daytime sleepiness.
Does Sleep Apnea Go Away With Weight Loss
Harvard has mentioned that the most effective treatments for sleep apnea are weight loss and breathing devices. In their article they mention that the American College of Physicians emphasizes lifestyle changes for treating obstructive sleep apnea. Heres their recommendation for weight loss:
The ACPs first recommendation centers on weight loss for people who are overweight and obese. The link between excess weight and sleep apnea is well established. People who are overweight have extra tissue in the back of their throat, which can fall down over the airway and block the flow of air into the lungs while they sleep.Though losing weight is easier said than done, it can yield real results. If we can get people to lose weight, it would make both sleep apnea and other health problems go away, says Dr. Epstein. Losing just 10% of body weight can have a big effect on sleep apnea symptoms. In some cases, losing a significant amount of weight can even cure the condition.
I have emphasized the main important things here. if youre overweight, then extra tissue in the back of your throat can obstruct the flow of air. Once you lose weight, this extra tissue can become smaller and this can improve or cure- your sleep apnea.
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How Is Central Sleep Apnoea Syndrome Diagnosed
Breathing difficulties while sleeping can be caused by a variety of medical conditions, so a range of diagnostic tests may be needed to confirm or rule out CSA. Sleep studies are the main method of investigating CSA. A sleep study usually means an overnight stay in a sleep unit, where measurements of the childs breathing during sleep are recorded by technologists/physiologists experienced in working with children. The measurements are recorded using stick-on or wrap-around sensors and include respiratory rate, heart rate, oxygen saturation, chest wall movement, airflow, measurement of CO2, video and sound recording. The results are then interpreted by a paediatric sleep consultant, who can make a diagnosis of CSA.
Obstructive Sleep Apnea Risk Factors
Obstructive sleep apnea occurs when the soft tissues of the upper airways sag, completely blocking the flow of air. A partial obstruction may manifest as snoring, and in fact snoring is an indication that sleep apnea may be occurring.
Being overweight is one of the biggest risk factors for obstructive sleep apnea. There are physiological changes that occur to the airways when the body stores fat. This can narrow the airways enough so that the relaxation that occurs during sleep causes a complete obstruction of airflow.
Drugs like alcohol, opiates, benzodiazepines and other depressants also increase the risk of obstructive sleep apnea.1 These substances cause increased relaxation of the muscles that prevent the airways from becoming obstructed. Unfortunately, some people use these drugs to help them sleep, increasing the risk of obstructive sleep apnea.
There are also simple physiological differences that increase the likelihood of developing sleep apnea. A congenitally narrow airway, a deviated nasal septum, and just being male are all sleep apnea risk factors.
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Diagnosing And Treating Sleep Apnea For Better Health
Its important to treat sleep apnea, because it can have long-term consequences for your health. While there have been some high-profile deaths linked to sleep apneasuch as with Judge Antonin Scalia Jun says that the true risk is from damage done over time.
Obstructive sleep apnea can range from mild to severe, based on a measurement system called the apnea-hypopnea index . The AHI measures the number of breathing pauses that you experience per hour that you sleep.
Obstructive sleep apnea is classified by severity:
- Severe obstructive sleep apnea means that your AHI is greater than 30
- Moderate obstructive sleep apnea means that your AHI is between 15 and 30
- Mild obstructive sleep apnea means that your AHI is between 5 and 15
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Whether or not you need treatment for sleep apnea depends on its severity, whether or not you have symptoms such as sleepiness and other health conditions. For example, if you have risk factors for heart disease, your doctor might opt to treat you even for mild sleep apnea. On the other hand, if you have a severe case of sleep apnea, your doctor might insist on treatment even if youre not sleepy.
Not very relaxing, right? Luckily, its treatable.
Apnea Test In Determining Brain Death
A recommended practice for the clinical diagnosis of formulated by the hinges on the conjunction of three diagnostic criteria: , absence of reflexes, and apnea . The apnea test follows a delineated protocol. Apnea testing is not suitable in patients who are hemodynamically unstable with increasing vasopressor needs, metabolic acidosis, or require high levels of ventilatory support. Apnea testing carries the risk of arrhythmias, worsening hemodynamic instability, or metabolic acidosis beyond the level of recovery and can potentially make the patient unsuitable for organ donation. In this situation a confirmatory test is warranted as it is unsafe to perform the apnea test.
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Central Sleep Apnea In Association With Heart Failure: Cheyne
Central sleep apnea in heart failure is manifest by aCheyne-Stokes respiration pattern. CSR can, however, happen during sleep and wakefulness. Because this chapter focuses on central apnea during sleep, CSR with central apneas during sleep is referred to as CSR-CSA. CSR-CSA is distinguished from other forms of CSA and periodic breathing by its characteristic crescendo-decrescendo pattern of tidal volume in which hyperpneas are markedly prolonged compared to those in patients without heart failure owing to reduced cardiac output and prolonged lung-to-chemoreceptor circulation time . Therefore, a finding of CSR-CSA on a polysomnogram is highly suggestive of low cardiac output it is seen most often in patients with reduced ejection fractions and rarely affects the nonheart failure population.80 Mechanisms that mediate CSR-CSA remain incompletely understood. However, as in all other forms of nonhypercapnic CSA, central to the process is respiratory control instability resulting from the dependence of the sleep state on metabolic control of ventilation, especially Paco2.2 A proposed pathophysiologic scheme for CSR-CSA is illustrated inFigure 121.6.
- 1.
David P. White, in, 2005
What Are The Symptoms Of Central Sleep Apnea
Most people with central sleep apnea present with disturbed sleep, such as excessive daytime sleepiness, fragmented sleep, waking up feeling unrefreshed, or having morning headaches. As you can imagine, these symptoms are quite non-specific, and one should seek a healthcare professional for further evaluation if these symptoms are present.
In some cases, central sleep apnea can present because a bed partner notices quiet pauses in breathing. In contrast to OSA, snoring is not a common symptom for central sleep apnea.
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Continuous Positive Airway Pressure Machines
In many cases of sleep apnea, doctors will suggest using a continuous positive airway pressure machine as a first line of treatment.
CPAP machines move air through a mask and into the persons airways. This can help reduce the likelihood of sleep apnea, as the force of the air helps keep the airways open and air moving through them.
That said, CPAP machines may not be effective in people with central sleep apnea. A study in the Journal of the American College of Cardiology notes that CPAP is only effective in about 50% of people with central sleep apnea.
If CPAP does not improve symptoms, it is important to seek an alternative treatment option.
Summary And Future Perspectives
Research in recent decades has improved our understanding of the various pathophysiological components underlying the different phenotypes of central breathing disturbances during sleep. They differ in terms of increased or dampened respiratory drive but also in comorbidities and underlying diseases. Proceedings of medical therapy have led to new clinical phenomena, such as opioid-induced CSA or treatment-emergent CSA. It has become obvious that a precise description of the polysomnographic pattern on the one hand and the clinical situation on the other hand is crucial. However, due to a lack of sufficient evidence, several questions on the impact of central breathing disturbances during sleep and optimal treatment remain open, including:
1) prognostic relevance of CSA
2) indication for treatment of CSA
3) differential therapy based on pathophysiological components and
4) long-term efficacy of PAP therapies and long-term outcome of untreated patients with different phenotypes.
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How Is Central Sleep Apnea Different From Obstructive Sleep Apnea
In obstructive sleep apnea, a person makes a notable effort to breathe, but the airway in the back of the throat is blocked. The blockage in the back of the throat causes an obstruction to our windpipe, which leads to sleep fragmentation and a disturbed oxygen balance in the body.
In central sleep apnea, the problem isnt a blocked airway. Instead, pauses in breathing occur because the brain and the muscles that control breathing arent functioning properly. As a result, there is no normal respiratory effort, which is in clear contrast to OSA.
While OSA and CSA are separate conditions, they can arise at the same time in what is known as mixed sleep apnea. In addition, treatment of OSA with continuous positive airway pressure , can induce central sleep apnea, and this is called treatment-emergent central sleep apnea.
What Are The Signs Of Sleep Apnea In Babies
Its important to know the signs of sleep apnea in babies.
If your baby is making grunting or snoring sounds while sleeping, has pauses during breathing for 15 seconds at a time, and/or wakes up gasping after these episodes it could be an indication that they have this condition.
How common are cases? Its estimated to affect about one out every five hundred babies.
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