Sleep Apnea- An Introduction

Definition

What is the definition?Sleep Apnoea is a sleeping disorder that results in breathing “pauses” or a combination of shallow breaths.

It was first described in 1965.

These pauses can last from a few seconds to a few minutes.

 

The 3 Types of Sleep Apnoea

3 Types of Sleep Apnea

There are three types of sleep apnoea- obstructive, central and complex.

 

Obstructive Sleep Apnoea (OSA)

OSA is when the walls of the throat relax and narrow causing interrupted breathing (or snoring.)

This in turn can happen in two ways; apnoea and hypopnoea.

Apnoea happens when the walls of the throat totally block the airway for 10 seconds or more.

Hypopnoea occurs when over 50% of the airway is blocked for 10 seconds or more.

A sufferer of OSA might well experience both apnoea and hypopnoea within the same night.

90% of people diagnosed with sleep apnoea have OSA.

Interestingly, OSA can be found quite frequently in children aged between three years old and six years old when their adenoids and tonsils grow faster than the rest of their bodies and blocks the flow of air into their lungs.

Central Sleep Apnoea (CSA)

What is CSA?CSA is when the brain fails to send signals to the breathing muscles whilst we are asleep.

CSA is much rarer than OSA fortunately, affecting less than 1% of the population.

Mixed Sleep Apnoea (MSA)

MSA or Complex Sleep Apnoea (CSA) is when a person suffers from a combination of OSA and CSA.

Prevalence

How Many People Have OSA?

Officially in the USA, 4% of men and 2% of women have sleep apnoea but that is only those sufferers who have a diagnosis.

If you were to include all adults who are living with it, then it could be as many as 14% of adults who are affected. http://worldsleepday.org/sleep-apnea.

It is twice as common in men as it is in women and it occurs most commonly in 55 year old -60 year old age group.

The 7 Symptoms of OSA

What are the symptoms?

There are around a half dozen tell tale symptoms that someone suffers from OSA. They are;

  1. Excessive Daytime Sleepiness (EDS)*
  2. Loud snoring which is interrupted by periods of pauses in breathing.
  3. Sudden awakenings followed by gasping or choking.
  4. Suffering from a sore throat or dry mouth first thing in the morning.
  5. Headaches.
  6. Inability to concentrate.
  7. Irritability and short temperedness.

*EDS is a persistent sleepiness that causes some people to act as if they are intoxicated and other people to try and take naps at inappropriate times such as at work or whilst driving.

Diagnosis of OSA

How is OSA diagnosed?

One of the toughest aspects of OSA is that it will more likely be the bed partner (wife, girlfriend or boyfriend) and not the sufferer themselves who are the first to know that a problem exists.

It is the bed partner who first observes episodes of “intermittent breathing”, choking noises or very loud snoring.

The sufferer may  not know why they are feeling so rough during the day as they start the day with a sore throat and a headache, feel incredibly sleepy and just cannot concentrate.

For some people continually feeling less than 100% will be enough to get an appointment with their physician.

For other people, it will take an observation by a bed partner of a collection of breathing pauses and choking episode before they will think of visiting their physician.

Regardless a good physician will talk you through your symptoms.

They should also take your blood pressure and possibly take a blood sample so that they can rule out other conditions that could explain your condition (such as hypothyroidism.)

If your physician suspects that you might be suffering from sleep apnoea, the next step is to set up an assessment which normally would be at a sleep lab but might also occur at home.

Sleep Assessment

 

What is a sleep assessment?The sleep assessment is called a polysomnogram (PSG). It is not just used to detect sleep apnoea but a range of sleep disorders such as narcolepsy.

A PSG records your blood pressure, eye movements, heart rate, and brain activity.

It also records the amount of oxygen in your blood, air movement through your nose while you breathe, snoring, and chest movements.

Essentially, there will be a lot of wires connected to different parts of your body whilst you sleep.

The 10 Possible Causes of OSA

There is a long list of “risk factors” associated with sleep apnoea.

I  shall split these factors into two groups.

Group 1 includes causes that you can do nothing about. Group 2 contains risk factors that you can change.

Group 1

Being male

Being male

You are twice as likely to have sleep apnoea if you are a man.

 

 

Over 40 years old

Most commonly in people aged between 55 and 60 years old

Having an  unusual neck structure

Unusual neck structure

Some people have a narrow airway at the back of their throat, a smaller lower jaw,  large tonsils or tongue. All of which can lead to breathing complications.

 

The menopause

Women who are going through the menopause are more at risk because of the falling levels of hormones a consequence of which is decreased muscle tone in the throat.

Stuffy nose or Nasal Congestion

Nasal congestion

 

The swelling and inflammation of the upper airway passages also contributes to an obstruction.

 

Family history of OSA.

If a member of your family has had OSA, you are more likely to suffer from it- as many as a quarter of all diagnosis might be due to a genetic disposition.

What this means is that you have inherited some physical traits that make you more at risk of developing OSA, such as a narrower lower jaw or a larger tongue.

Group 2

Being overweight

Overweight

Obese adults could be up to 7 times more at risk than their peers with normal weight.

Airways are reduced by fatty deposits around the neck and reduced muscle tone in the throat. Excess weight constricts the airway.

The advice is very specific regarding neck sizes and OSA.

In men there is an increased risk of suffering from OSA if your neck size is greater than 17” or 43cm (in circumference.)

In women the risk increases if your neck is larger than 16” or 41cm (in circumference.)

Medication

Medications that make you drowsy, potentially relaxes all your muscles, including your throat muscles which could collapse causing a partial obstruction.

Alcohol

Is alcohol causing you to snore?

Alcohol has a similar effect on the body as medications do- acting as a muscle relaxant and so the throat muscles are at risk of collapse and causing a partial obstruction.

 

Smoking

Smokers are three times more likely to suffer from OSA than someone who has never smoked.

Smoking might inflames areas of the throat and as a smoker you are more likely to retain fluid in the area around your throat.

Both possibilities increase the risk of a blockage in or restriction of the airway.

The 3 Levels of OSA

OSA, like most conditions, is measured on a continuum. There are essentially three different levels of OSA; mild, moderate and severe.

These different levels are measured by the polysomnogram (PSG) which was discussed earlier and they relate directly to the number of apnoea and hypopnoea incidents that occur every hour.

So let us just recap. Apnoea happens when the walls of the throat totally block the airway for 10 seconds or more.

Hypopnoea occurs when over 50% of the airway is blocked for 10 seconds or more.

Mild OSA is when the combined totals of apnoea and hypopnoea every hour is between 5 and 15.

Moderate OSA is when the combined totals of apnoea and hypopnoea every hour is between 15 and 30.

Severe OSA is when the combined totals of apnoea and hypopnoea every hour is greater than 30.

The 4 Treatments for OSA

There are four main treatments for OSA;

  1. Continuous Positive Airway Pressure (CPAP).

The first treatment is CPAP. A sufferer wears a nasal mask or a mouth and nose mask.

The mask is connected to a pump which delivers a constant supply of air through your nose (if you use it with a nasal mask) or through your nose and mouth (if you use it with a mouth and nose mask.) The supply of air prevents the throat from closing.

CPAP should be used by people who suffer from moderate to severe OSA. CPAP does have a long list of side effects and many people do find it uncomfortable and opt to use other treatments.

2. Mandibular Advancement Device (MAD) & Tongue Stabilisation Devices (TSD)

A MAD could be the solution

MADs and TSDs are oral appliances, much like gum shields, that fit in your mouth. A MAD maintains an unrestricted airway at the back of the throat by moving the lower jaw forward.

MADs can be custom built through a series of appointments with your orthodontist for about $1900 or bought over the counter from several online shops for about $100.

A TSD prevents the throat from closing by holding the tongue in place or pulling it slightly the forward.

Both of these devices are only suitable for people who have mild OSA.

3. Surgery

surgery is an option

Surgery is used as a last resort for sufferers of OSA. It is recommended only if all other options have failed and a sufferer’s quality of life is being severely affected.

Common surgeries include; tonsillectomy (removal of tonsils), adenoidectomy (removal of the adenoids, which are small lumps of tissue at the back of the nose and tracheotomy (an incision made in the neck in order to open up the windpipe.)

The 9 Complications of OSA

Developing high blood pressure (hypertension)

blood-pressureThis occurs due to the drop in oxygen levels in the blood caused by the pauses in breathing.

 

Having a stroke or heart attack

OSA increases the risk of a stroke or a heart attack possibly due to the low levels of blood oxygen. It could also be because many people who have OSA are overweight and therefore have existing heart conditions.

Developing an irregular heartbeat (arrhythmia)

Research (http://www.stopafib.org/newsitem.cfm/NEWSID/211)has shown that the risk of having episodes of arrhythmia are 18 times higher after a person has had an “apnoea” episode in their sleep. The OSA can be mild, moderate or severe in order for this to happen.

Developing type 2 diabetes

diabetes

Up to 83% (http://www.grandlakenews.com/news/20161006/health-watch-why-sleep-apnea-is-bad-for-your-health) of people with type 2 diabetes have OSA.

However, it is not known if OSA causes type 2 diabetes. There is speculation that the body’s ability to control glucose levels weaken as OSA becomes more severe.

Liver problems

Low night time oxygen levels have been found to accelerate the accumulation of fatty cells in the liver https://www.sciencedaily.com/releases/2016/08/160805154939.htm

Sleep deprived partners

sleep deprivedOSA doesn’t just negatively affect the sleep of the sufferer, without treatment it will ruin the sleep of any partners that they share a bed with.

If the snoring is very loud, the sleep of other family members will be disturbed as well.

Increased risk of having a car accident

A study in 2015 showed that people with OSA were 2.5 times more likely to have a car accident than someone without.

Increased risk of complications from taking medications

This is the potential effect that sedative medication could have your breathing. Your airway could become smaller as the muscles in your throat relax and collapse even more.

Increased risk of having surgery

Much like the effect that medication has, which was described above.

Sleep Apnoea Myths

Sleep apnoea is just snoring

Only older people get OSA.

Alcohol helps you sleep.

OSA is rare in kids

Surgery is the best cure.

OSA is a harmless medical condition

Adults without tonsils will not get OSA.

People who don’t sleep on their backs

I cannot be assessed for OSA at home.

 

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