| Types of Adult Sleep Apnea
In all cases of sleep apnea some part of the respiratory system narrows, impairing oxygen intake. Lowered blood oxygen levels then trigger the brain to prompt the intake of breath. The sleeper gasps, jump-starting the breathing process--until the next halt. But doctors distinguish three
variations on this theme:
Obstructive Sleep Apnea
The typical person suffering from this most common and severe form of apnea is an overweight male between 35 and 50 who usually has a small jaw, a small opening to the airway at the back of the throat, and a large tongue or tonsils. During sleep, the muscles of the soft palate and at the base of the tongue and the uvula (the "punching bag" structure hanging in the throat) relax and sag, blocking the airway, which collapses. As breathing stops, the diaphragm and chest muscles strain until the block is literally uncorked, and a noisy gasp--the snore--is taken. When breathing stops, blood oxygen levels fall, forcing the heart to work harder. As a result, blood pressure rises, and the heartbeat may even become irregular. Obstructive sleep apnea is made worse by drinking alcohol or taking tranquilizers, antihistamines, or sleeping pills.
Central Sleep Apnea
In this rarer form of the disorder, the airway remains open, but the diaphragm and chest muscles temporarily fail. The dropping blood oxygen levels signal the brain, which prompts the person to awaken and gasp in a breath. Because the airway is typically open, this apnea sufferer does not snore loudly but does have daytime sleepiness. Central sleep apnea is more common among people over 60, and is often seen in nursing homes and among the ill.
Mixed Apnea
Some people experience long periods of obstructive sleep apnea interspersed with brief periods of central sleep apnea.
What Causes Sleep Apnea?
Certain mechanical and structural problems in the airway cause the interruptions in breathing during sleep. In some people, apnea occurs when the throat muscles and tongue relax during sleep and partially block the opening of the airway. When the muscles of the soft palate at the base of the tongue and the uvula (the small fleshy tissue hanging from the center of the back of the throat) relax and sag, the airway becomes blocked, making breathing labored and noisy and even stopping it altogether.
Sleep apnea also can occur in obese people when an excess amount of tissue in the airway causes it to be narrowed. With a narrowed airway, the person continues his or her efforts to breathe, but air cannot easily flow into or out of the nose or mouth. Unknown to the person, this results in heavy snoring, periods of no breathing, and frequent arousals (causing abrupt changes from deep sleep to light sleep). Ingestion of alcohol and sleeping pills increases the frequency and duration of breathing pauses in people with sleep apnea.
Treating Sleep Apnea
The specific therapy for sleep apnea is tailored to the individual patient based on medical history, physical examination, and the results of polysomnography. Medications are generally not effective in the treatment of sleep apnea. Oxygen administration may safely benefit certain patients but does not eliminate sleep apnea or prevent daytime sleepiness. Thus, the role of oxygen in the treatment of sleep apnea is controversial, and it is difficult to predict which patients will respond well. It is important that the effectiveness of the selected treatment be verified; this is usually accomplished by polysomnography.
Behavioral Therapy
Behavioral changes are an important part of the treatment program, and in mild cases behavioral therapy may be all that is needed. The individual should avoid the use of alcohol, tobacco, and sleeping pills, which make the airway more likely to collapse during sleep and prolong the apneic periods. Overweight persons can benefit from losing weight. Even a 10 percent weight loss can reduce the number of apneic events for most patients. In some patients with mild sleep apnea, breathing pauses occur only when they sleep on their backs. In such cases, using pillows and other devices that help them sleep in a side position is often helpful.
Physical or Mechanical Therapy
Nasal continuous positive airway pressure (CPAP) is the most common effective treatment for sleep apnea. In this procedure, the patient wears a mask over the nose during sleep, and pressure from an air blower forces air through the nasal passages. The air pressure is adjusted so that it is just enough to prevent the throat from collapsing during sleep. The pressure is constant and continuous. Nasal CPAP prevents airway closure while in use, but apnea episodes return when CPAP is stopped or used improperly.
Variations of the CPAP device attempt to minimize side effects that sometimes occur, such as nasal irritation and drying, facial skin irritation, abdominal bloating, mask leaks, sore eyes, and headaches. Some versions of CPAP vary the pressure to coincide with the person's breathing pattern, and others start with low pressure, slowly increasing it to allow the person to fall asleep before the full prescribed pressure is applied.
Obstructive Sleep Apnea – Risks and Effects
In the adult, obstructive sleep apnea (OSA) can lead to impaired work performance, mood disturbances, and an increased risk for motor vehicle accidents. In children, OSA may compromise school performance by leading to reductions in attention and memory.
Obstructive sleep apnea may contribute to stroke, hypertension, and heart disease, as well as exacerbate existing medical conditions. For example, OSA represents a stress that promotes insulin resistance, a known risk factor for atherosclerosis. In addition, in medically treated patients with heart failure, treatment of coexisting OSA by continuous positive airway pressure (CPAP) reduces systolic blood pressure and improves left ventricular systolic function.
Obstructive sleep apnea (OSA) is caused by a blockage of the airway, usually when the soft tissue in the rear of the throat collapses and closes during sleep. In central sleep apnea, the airway is not blocked but the brain fails to signal the muscles to breathe. Mixed apnea, as the name implies, is a combination of the two. With each apnea event, the brain briefly arouses people with sleep apnea in order for them to resume breathing, but consequently sleep is extremely fragmented and of poor quality.
Sleep apnea is very common, as common as adult diabetes, and affects more than twelve million Americans, according to the National Institutes of Health. Risk factors include being male, overweight, and over the age of forty, but sleep apnea can strike anyone at any age, even children. Yet still because of the lack of awareness by the public and healthcare professionals, the vast majority remain undiagnosed and therefore untreated, despite the fact that this serious disorder can have significant consequences.
Untreated, sleep apnea can cause high blood pressure and other cardiovascular disease, memory problems, weight gain, impotency, and headaches. Moreover, untreated sleep apnea may be responsible for job impairment and motor vehicle crashes. Fortunately, sleep apnea can be diagnosed and treated. Several treatment options exist, including the use of Continuous Positive Airflow Pressure (CPAP) products.
What is Sleep Apnea?
Sleep Apnea is a sleep disorder that causes people to stop breathing for 10 to 30 seconds at a time while they are sleeping. These short stops in breathing can happen up to 400 times every night! If you have sleep apnea, the periods of not breathing may make you wake up from deep sleep. If you are waking up all night long, you aren't getting enough rest from your sleep.
There are two kinds of sleep apnea: obstructive apnea and central apnea. Obstructive sleep apnea is the most common type. Nine out of 10 people with sleep apnea have this type of apnea. If you have obstructive apnea, something is blocking the passage or windpipe (called the trachea) that brings air into your body. You keep trying to breathe, but you can't get enough air because of the blockage. Your windpipe might be blocked by your tongue, tonsils or uvula (the little piece of flesh that hangs down in the back of your throat). It might also be blocked by a large amount of fatty tissue in the throat or even by relaxed throat muscles.
Central sleep apnea is rare. This type is called central apnea because it is related to the function of the central nervous system. If you have this type of apnea, the muscles you use to breathe don't get the "go-ahead" signal from your brain. Either the brain doesn't send the signal, or the signal gets interrupted.
All About Snoring
WHAT IS SNORING?
Snoring is a cry for help. It's the sound of someone strangling as he struggles for air. Snoring is the noise made during sleep when the sleeper attempts to force air past any obstructions in the upper airway. Breathing causes turbulence in the upper air passages. This air pressure makes the surrounding tissues vibrate. The larger the obstruction, the louder the snoring. Forty-five percent of adults snore. Although more common in males, females do snore as well. Even small children snore.
WHAT ARE THE CAUSES?
There are many things that cause snoring. Some of these causes are intrinsic, a part of the body structure. Intrinsic causes could be the structure of the jaw, an enlarged tongue or a flabby uvula or soft palate. Another cause is enlarged tonsils or adenoids.
Other causes of snoring are obesity, smoking and alcohol. Allergies that affect the sinuses are also culprits. Also, the use of sedatives relaxes the body, including the tissue in the throat, and this can aggravate snoring.
PROBLEMS AND COMPLICATIONS
Snoring can disrupt your sleep. Sometimes the noise and the effort to breathe can bring you out of the deepest slumber. You wake up with a dry mouth and a sore throat. Snoring also disrupts the sleep of others in your bed, your room, or even your house. People have been asked to leave hotel rooms because their snoring bothered the people in adjoining rooms.
But, far worse than the social inconvenience, snoring is often a precursor of sleep apnea. Sleep Apnea can cause high blood pressure, stroke and heart attack.
WHAT CAN YOU DO?
Try to lose weight, especially if you are obviously obese. Avoid the use of alcohol and stop smoking. Exercise is an excellent pastime and will improve your general health as well as help with any weight problems. If at all possible, avoid the use of sedatives such as tranquilizers or sleeping pills. Set regular bedtime habits like a set hour for going to sleep, and try to sleep on your side.
TREATMENT
There are dozens of over-the-counter remedies offered to prevent snoring. Some are mechanical devices. Some are herbal tonics and sprays. Talk to your Dentist, he may have some advice about dental devices and snoring.
If none of these alternatives help your condition, check with your doctor about having a sleep study done. He may advise the use of a CPAP machine, or he may suggest one of the many surgical procedures available to alleviate the snoring problem.
Sleep Apnea Relief Utilizing a Continuous Positive Airway Pressure (CPAP) Mask
A physician can diagnose sleep apnea and suggest treatment based on the patient's complaints of daytime sleepiness, insomnia, awareness of obstructed breathing during sleep, snoring, and headache or dry mouth on waking. The physician examines the bones of the face and jaw and throat structures such as the palates, uvula and tonsils while the patient is in various positions, to see the sizes of spaces through which inhaled air can pass.
Definitive diagnosis of sleep apnea depends upon the results of a battery of tests, called polysomnography, run in a sleep lab. A diagnosis of sleep apnea is made when polysomnography indicates more than five apnea episodes, of 10 seconds or longer duration per hour of sleep, plus an irregular heartbeat, frequent arousal during sleep, or dips in arterial oxygen saturation.
For mild obstructive sleep apnea, treatment often consists of avoiding sleeping on one's back. People have a significant problems when the nose is congested, so decongestant therapy may be helpful for them. A more drastic treatment, if the patient is very overweight, is weight reduction.
Most serious sleep apnea cases can be relieved by a treatment called nasal continuous positive airway pressure, or CPAP. CPAP uses a small mask held onto the nose by straps, and has pouches that insert into the nostrils. The mask is connected to a motor that regulates the amount and pressure of air sent into the nose, exerting pressure to keep the nasal passages open. The pressure is determined by polysomnography. CPAP works by holding open the nose and the back of the throat.
CPAP usually brings immediate relief. Snoring stops. A smooth breathing pattern is restored. Blood oxygen levels stabilize. During the first week of CPAP therapy, the sleep pattern may still be grossly abnormal, but with peaceful stretches of sleep gradually growing, as if the body is trying to catch up. Sleep eventually settles down to a more normal pattern, often for the first time in years.
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