Description

Obstructive sleep apnea is the most common sleep-related breathing disorder. People with obstructive sleep apnea repeatedly stop and start breathing while they sleep.

There are several types of sleep apnea. Obstructive sleep apnea occurs when the throat muscles relax and block the airway. This happens off and many times during sleep. A sign of obstructive sleep apnea is snoring.

Treatments for obstructive sleep apnea are available. A treatment is a device that uses positive pressure to keep the airway open during sleep. Another option is a spray nozzle to push the lower jaw forward during sleep. In some people, surgery may be an option.

Symptoms

The symptoms of obstructive sleep apnea include:

  • Excessive sleepiness during the day.
  • The loud snoring.
  • Observed episodes of cessation of breathing during sleep.
  • Waking up during the night and gasping or choking.
  • Wake up in the morning with a dry mouth or sore throat.
  • Morning headaches.
  • Trouble concentrating during the day.
  • Changes in mood, such as depression or angry easily.
  • The high blood pressure.
  • Decreased interest in sex.

When to see a doctor

Consult a health care professional if you have, or if your partner is observed, the following:

  • Snoring loud enough to disturb your sleep or the sleep of others.
  • Waking up gasping or choking.
  • The pause in breathing during sleep.
  • To have excessive sleepiness during the day. This can cause you to fall asleep during work, watching television or even driving a vehicle.

Snoring doesn't necessarily indicate that something potentially serious, and not everyone who snores has obstructive sleep apnea.

Be sure to talk with a member of your health care team if you snore loudly, especially if the snoring is interrupted by periods of silence. Snoring can be more strong — and the breathing breaks known as apneas may be more common when you sleep on your back.

Ask your health care team about any sleep problem that leaves you tired, sleepy and irritable on a regular basis. Excessive daytime sleepiness may be due to other disorders, such as narcolepsy.

Causes

Obstructive sleep apnea occurs when the muscles in the back of the throat relax too much to allow for proper breathing. These muscles support the back of the roof of the mouth, known as the soft palate. The muscles also support the tongue and the side walls of the throat.

When the muscles relax, the airway narrows or closes as you breathe. This can reduce the level of oxygen in the blood and cause a build-up of carbon dioxide.

The brain detects this impairment of breathing, and, briefly, wake up from your dream, so that you can re-open the airway. This awakening is usually so brief that you don't remember it.

You may awaken with shortness of breath that corrects itself quickly, within one or two deep breaths. Or, you may make a snorting, choking or gasping sound.

This pattern can be repeated in 5 to 30 times or more each hour, all night long. These disruptions affect your ability to get to the deep, restful phases of sleep, and you will probably feel sleepy during your waking hours.

People with obstructive sleep apnea may not be aware of his interrupted sleep. Many people with this type of sleep apnea don't realize that I didn't sleep well all night.

Risk factors

Any person can develop obstructive sleep apnea. However, there are certain factors that put you at increased risk, including:

  • The excess of weight. Most, but not all people with obstructive sleep apnea are overweight. The fat deposits around the upper airway may obstruct breathing. Medical conditions that are associated with obesity, such as hypothyroidism and polycystic ovary syndrome, can also cause obstructive sleep apnea.
  • Advanced age. The risk of obstructive sleep apnea increases with age, but seems to level off after their 60's and 70's.
  • Narrowing of the airways. A close fit of the air is a trait that can be passed on in your family. Or the tonsils or adenoids may become enlarged and block the airway.
  • High blood pressure, known as hypertension. Obstructive sleep apnea is relatively common in people with hypertension.
  • Chronic nasal congestion. Obstructive sleep apnea occurs two times more often in those who have consistent nasal congestion at night, regardless of the cause.
  • The habit of smoking. People who smoke are more likely to have obstructive sleep apnea.
  • Diabetes. Obstructive sleep apnea may be more common in people with diabetes.
  • The male sex. In general, men are 2 to 3 times more likely than premenopausal women to have obstructive sleep apnea. However, the risk of obstructive sleep apnea increases in women after menopause.
  • A family history of sleep apnea. Having family members with obstructive sleep apnea may increase the risk.
  • Asthma. Research has found an association between asthma and the risk of obstructive sleep apnea.

Complications

Obstructive sleep apnea is considered a serious medical condition. Complications can include:

  • Day of fatigue and drowsiness.Due to the lack of restful sleep at night, persons with obstructive sleep apnea often have severe daytime drowsiness, fatigue and irritability. They may have difficulty concentrating and find falling asleep at work, while watching TV or even when driving. This can put you at greater risk of work-related accidents. Children and young people, people with obstructive sleep apnea may do poorly in school and tend to have attention or behavior problems.
  • Cardiovascular problems.Abrupt in blood oxygen levels that occur during sleep apnea increase blood pressure and strain the cardiovascular system. Many people with obstructive sleep apnea develop high blood pressure, which can increase the risk of heart disease. The worst is obstructive sleep apnea, the greater the risk of coronary heart disease, heart attack, heart failure and stroke. Obstructive sleep apnea also increases the risk of heart rhythm problems known as arrhythmias. Arrhythmias can lower the blood pressure. If there is underlying heart disease, these repeated multiple episodes of arrhythmias can lead to sudden death.
  • Complications with medications and surgery.Obstructive sleep apnea is also a concern with certain medications and general anesthesia. Medications such as sedatives, some prescription of analgesics and general anesthetics, relax the upper airway and can cause obstructive sleep apnea worse. If you have obstructive sleep apnea, having a major surgery can worsen breathing problems. This is especially true if you have been sedated, and you were lying on your back. People with obstructive sleep apnea may be more prone to complications after surgery. Before surgery, tell your surgeon if you have obstructive sleep apnea or the symptoms of the condition. You may need to be tested for obstructive sleep apnea before surgery.
  • Eye problems. Some research has found a relationship between obstructive sleep apnea and certain eye diseases, such as glaucoma. Eye complications can usually be treated.
  • Sleep-deprived partners. Loud snoring can keep those around you from getting a good night's rest, and, finally, to disrupt their relationships. Some partners choose to sleep in another room.

Day of fatigue and drowsiness. Due to the lack of restful sleep at night, persons with obstructive sleep apnea often have severe daytime drowsiness, fatigue and irritability. They may have difficulty concentrating and find falling asleep at work, while watching TV or even when driving. This can put you at greater risk of work-related accidents.

Children and young people, people with obstructive sleep apnea may do poorly in school and tend to have attention or behavior problems.

Cardiovascular problems. Abrupt in blood oxygen levels that occur during sleep apnea increase blood pressure and strain the cardiovascular system. Many people with obstructive sleep apnea develop high blood pressure, which can increase the risk of heart disease.

The worst is obstructive sleep apnea, the greater the risk of coronary heart disease, heart attack, heart failure and stroke.

Obstructive sleep apnea also increases the risk of heart rhythm problems known as arrhythmias. Arrhythmias can lower the blood pressure. If there is underlying heart disease, these repeated multiple episodes of arrhythmias can lead to sudden death.

Complications with medications and surgery. Obstructive sleep apnea is also a concern with certain medications and general anesthesia. Medications such as sedatives, some prescription of analgesics and general anesthetics, relax the upper airway and can cause obstructive sleep apnea worse.

If you have obstructive sleep apnea, having a major surgery can worsen breathing problems. This is especially true if you have been sedated, and you were lying on your back. People with obstructive sleep apnea may be more prone to complications after surgery.

Before surgery, tell your surgeon if you have obstructive sleep apnea or the symptoms of the condition. You may need to be tested for obstructive sleep apnea before surgery.

People with obstructive sleep apnea also may complain of memory problems, morning headaches, and mood swings or depression. You may also need to urinate often during the night.

Obstructive sleep apnea may be a risk factor for COVID-19. People with obstructive sleep apnea have been found to be at increased risk of developing a severe form of COVID-19. May be more likely to need hospital treatment, than those who do not have obstructive sleep apnea.

Diagnosis

A member of your health care team assesses your condition based on your symptoms, a physical exam and tests. You may be referred to a sleep specialist for further evaluation.

The physical examination includes an examination of the back of the throat, the mouth and the nose. The neck and the circumference of the waist can be measured. Your blood pressure can also be checked.

A sleep specialist can evaluate more away from you. The specialist can diagnose and determine the severity of your condition. The specialist can also plan your treatment. The assessment could involve staying in a sleep center during the night. In the center of the sleep, breathing and other body functions controls the dream.

Tests

Tests to detect sleep apnea include:

  • The polysomnography.During this sleep study, you are connected to a computer that controls the heart, lungs, and brain activity and breathing patterns during sleep. The team also measures arm and leg movements, and blood oxygen levels. You could be monitored during the whole night or part of the night. If you are monitored during part of the night, it is called split-night sleep study. In a split night sleep study, you will be monitored during the first half of the night. If you are diagnosed with obstructive sleep apnea, the members of the staff can wake you up and give you continuous positive airway pressure in the second half of the night, the sleep study can also help you find other sleep disorders that can cause excessive sleepiness during the day, but they have different treatments. The sleep study can uncover the movements of the legs during sleep, known as a movement disorder periodic limb. Or the study can help to evaluate people who have sudden bouts of sleep during the day, known as narcolepsy.
  • Home sleep apnea test. Under certain circumstances, you may have a version of the house of polysomnography for the diagnosis of obstructive sleep apnea. Home sleep apnea testing kits to monitor a limited number of variables to detect pauses in breathing during sleep.

The polysomnography. During this sleep study, you are connected to a computer that controls the heart, lungs, and brain activity and breathing patterns during sleep. The team also measures arm and leg movements, and blood oxygen levels.

You could be monitored during the whole night or part of the night. If you are monitored during part of the night, it is called split-night sleep study.

In a split night sleep study, you will be monitored during the first half of the night. If you are diagnosed with obstructive sleep apnea, the members of the staff can wake you up and give you continuous positive airway pressure in the second half of the night

The sleep study can also help you find other sleep disorders that can cause excessive sleepiness during the day, but they have different treatments. The sleep study can uncover the movements of the legs during sleep, known as a movement disorder periodic limb. Or the study can help to evaluate people who have sudden bouts of sleep during the day, known as narcolepsy.

Treatment

Therapies

  • The positive pressure in the airways.If you have obstructive sleep apnea, you may benefit from positive pressure in the airways. In this treatment, a machine that delivers air pressure through a piece that is placed into the nose or placed over the nose and mouth during sleep. The positive pressure in the airway, reduces the number of times that you stop breathing while you sleep. The therapy also reduces daytime sleepiness and improves your quality of life. The most common type is called a continuous positive airway pressure, also known asCPAP(SEE-pap). With this treatment, the pressure of the air breathed is continuous, constant, and somewhat higher than that of the surrounding air. The pressure of the air is sufficient to maintain the upper airway passages open. This air pressure prevents obstructive sleep apnea and snoring. AlthoughCPAPis the most successful and commonly used method of treatment of obstructive sleep apnea, some people find the mask uncomfortable or loud. However, in newer machines are smaller and less noisy than older computers. And there are a wide variety of mask designs for individual comfort. Also, with a little practice, most people can learn to adjust the mask to get a comfortable and secure fit. You may need to try different types to find the best mask. Several options are available to you, such as nasal masks, nasal pillows, or masks. If you are having difficulty tolerating the pressure, some machines have a special adaptation of the pressure of features to enhance comfort. You could also benefit from using a humidifier along with yourCPAPsystem. CPAPmay be given to a continuous pressure, known as fixed. Or the pressure may be varied, known as autotitrating positive airway pressure (APAP). In fixedCPAP, the pressure is kept constant. In autotitratingCPAP, the pressure level is adjusted if the device detects an increase of the airway resistance. Bilevel positive airway pressure (BPAP) is another type of positive pressure in the airways.BPAPdelivers a preset amount of pressure when you inhale and a different amount of pressure when you exhale. CPAPis more commonly used, as it has been well studied for obstructive sleep apnea, and it has been proven effective to treat the condition. People who have difficulty tolerating fixedCPAPmight want to tryBPAPorAPAP. Do not stop using your machine positive pressure in the airways in case of problems. Check with your health care team to see what adjustments you can do to improve your comfort. In addition, contact your health care team if you still hoarse despite the treatment, if you start to snore again, or if your weight goes up or down by 10% or more.
  • Nozzle, known as oral appliance.Despite the positive pressure in the airway is often an effective treatment, oral appliances are an alternative for some people with mild or moderate obstructive sleep apnea. They are also used for people with severe sleep apnea who can't useCPAP. The devices can reduce sleepiness and improve the quality of life. These devices are designed to keep the throat open. Some devices maintain an open airway by bringing your lower jaw forward, which can sometimes relieve snoring and obstructive sleep apnea. Other devices to keep the tongue in a different position. If you decide to explore this option, you need to see a dentist with experience in dental sleep medicine apparatus for adaptation and monitoring of therapy. A number of devices available. Close follow-up is needed to ensure the success of the treatment and that the use of this device does not cause changes in your teeth. A new device uses electrical stimulation on the tongue. The device helps to improve snoring and breathing during sleep in people with very mild sleep apnea and snoring. This device is not intended to be used in place ofCPAPwhen is recommended for moderate to severe obstructive sleep apnea. It is a removable device that fits around your tongue while you are awake. Provides electrical impulses to improve the muscle tone of the tongue. This helps to prevent the tongue from collapsing and blocking the airway during sleep. The device is used for 20 minutes a day. It takes six weeks to see improvement. A dentist makes a custom device that is suited to you. Only a small number of studies has seen how these devices work. More studies are still needed. Do not use a tongue muscle stimulation device if you have a pacemaker or other implanted electrical device.

The positive pressure in the airways. If you have obstructive sleep apnea, you may benefit from positive pressure in the airways. In this treatment, a machine that delivers air pressure through a piece that is placed into the nose or placed over the nose and mouth during sleep.

The positive pressure in the airway, reduces the number of times that you stop breathing while you sleep. The therapy also reduces daytime sleepiness and improves your quality of life.

The most common type is called a continuous positive airway pressure, also known as CPAP (SEE-pap). With this treatment, the pressure of the air breathed is continuous, constant, and somewhat higher than that of the surrounding air. The pressure of the air is sufficient to maintain the upper airway passages open. This air pressure prevents obstructive sleep apnea and snoring.

Although CPAP is the most successful and commonly used method of treatment of obstructive sleep apnea, some people find the mask uncomfortable or loud. However, in newer machines are smaller and less noisy than older computers. And there are a wide variety of mask designs for individual comfort.

Also, with a little practice, most people can learn to adjust the mask to get a comfortable and secure fit. You may need to try different types to find the best mask. Several options are available to you, such as nasal masks, nasal pillows, or masks.

If you are having difficulty tolerating the pressure, some machines have a special adaptation of the pressure of features to enhance comfort. You could also benefit from using a humidifier along with your CPAP system.

CPAP can be given to a continuous pressure, known as fixed. Or the pressure may be varied, known as autotitrating positive airway pressure (APAP). Fixed CPAP , the pressure is kept constant. In autotitrating CPAP , the pressure level is adjusted if the device detects an increase of the airway resistance.

Bilevel positive airway pressure (BPAP) is another type of positive pressure in the airways. BPAP offers a preset amount of pressure when you inhale and a different amount of pressure when you exhale.

The CPAP is most commonly used, as it has been well studied for obstructive sleep apnea, and it has been proven effective to treat the condition. People who have difficulty tolerating fixed CPAP may want to try BPAP or APAP .

Do not stop using your machine positive pressure in the airways in case of problems. Check with your health care team to see what adjustments you can do to improve your comfort.

In addition, contact your health care team if you still hoarse despite the treatment, if you start to snore again, or if your weight goes up or down by 10% or more.

Nozzle, known as oral appliance. Despite the positive pressure in the airway is often an effective treatment, oral appliances are an alternative for some people with mild or moderate obstructive sleep apnea. They are also used for people with severe sleep apnea who can't use CPAP . The devices can reduce sleepiness and improve the quality of life.

These devices are designed to keep the throat open. Some devices maintain an open airway by bringing your lower jaw forward, which can sometimes relieve snoring and obstructive sleep apnea. Other devices to keep the tongue in a different position.

If you decide to explore this option, you need to see a dentist with experience in dental sleep medicine apparatus for adaptation and monitoring of therapy. A number of devices available. Close follow-up is needed to ensure the success of the treatment and that the use of this device does not cause changes in your teeth.

A new device uses electrical stimulation on the tongue. The device helps to improve snoring and breathing during sleep in people with very mild sleep apnea and snoring. This device is not intended to be used in place of CPAP when it is recommended for moderate to severe obstructive sleep apnea.

It is a removable device that fits around your tongue while you are awake. Provides electrical impulses to improve the muscle tone of the tongue. This helps to prevent the tongue from collapsing and blocking the airway during sleep. The device is used for 20 minutes a day. It takes six weeks to see improvement. A dentist makes a custom device that is suited to you.

Only a small number of studies has seen how these devices work. More studies are still needed. Do not use a tongue muscle stimulation device if you have a pacemaker or other implanted electrical device.

Surgery or other procedures

The surgery is usually considered only if other treatments have not been effective or have not been the appropriate options for you. Surgical options may include:

  • The surgical removal of tissue. Uvulopalatopharyngoplasty (UPPP) is a procedure in which a surgeon removes the tissue from the back of the mouth and the upper part of the throat. The tonsils and adenoids can be removed. UPPP is usually done in a hospital and requires a medicine that puts you in a sleep-like state. This medicine is called a general anesthetic.
  • Upper airway stimulation.This new device is approved for use in people with moderate-to-severe obstructive sleep apnea who can't tolerateCPAPorBPAP. A small, thin pulse generator, known as a stimulator of nerve hypoglossal, is implanted under the skin in the upper chest. When you inhale, the device stimulates the nerve that controls the movement of the tongue. The tongue moves forward instead of moving backward and blocking the throat. Studies have found that the stimulation of the upper respiratory tract greatly improves obstructive sleep apnea symptoms and quality of life.
  • Surgery of the jaw, known as the promotion. In this procedure, the upper and lower parts of the jaw is moved forward in comparison with the rest of the bones of the face. This enlarges the space behind the tongue and soft palate, causing the obstruction is less likely to occur.
  • Surgical opening in the neck, known as a tracheotomy.You may need this type of surgery if other treatments have failed and put in danger the lives of obstructive sleep apnea. During a tracheostomy, a surgeon makes an opening in the neck and inserts a metal or plastic tube for breathing. The air goes in and out of the lungs, preventing the blockage of air passage in your throat.

Upper airway stimulation. This new device is approved for use in people with moderate-to-severe obstructive sleep apnea who cannot tolerate CPAP or BPAP .

A small, thin pulse generator, known as a stimulator of nerve hypoglossal, is implanted under the skin in the upper chest. When you inhale, the device stimulates the nerve that controls the movement of the tongue. The tongue moves forward instead of moving backward and blocking the throat.

Studies have found that the stimulation of the upper respiratory tract greatly improves obstructive sleep apnea symptoms and quality of life.

Surgical opening in the neck, known as a tracheotomy. You may need this type of surgery if other treatments have failed and put in danger the lives of obstructive sleep apnea.

During a tracheostomy, a surgeon makes an opening in the neck and inserts a metal or plastic tube for breathing. The air goes in and out of the lungs, preventing the blockage of air passage in your throat.

Other types of surgery may help to reduce snoring and sleep apnea by clarification or expansion of the air passages, including:

  • Nasal surgery to remove polyps or straighten a partition twisted between the nostrils, called a deviated septum.
  • The surgery to remove the tonsils or adenoids.

Lifestyle and home remedies

In many cases, self-care can be the most appropriate way to treat obstructive sleep apnea. Try these tips:

  • To lose weight. If you are overweight or obese, even moderate weight loss can help to relieve the constriction of the airways. Losing weight can improve your health and quality of life and may reduce sleepiness during the day.
  • Exercise. The exercise, such as aerobic exercise and strength training, can help improve your condition. For the exercise of 150 minutes per week, and in general, try to exercise most days of the week.
  • Do not drink alcohol or use some anti-anxiety medications, or sleeping pills. The Alcohol, some anti-anxiety medicines, and some sleeping pills can worsen obstructive sleep apnea and sleepiness.
  • Sleep on your side or face down, instead of on his back.Sleeping on your back can cause your tongue and soft palate rest against the back of your throat and block the airway. To avoid sleeping on your back, try sewing a tennis ball in the back of your pajamas or put pillows behind you to keep you sleeping on your side.
  • Keep the nasal passages open while you sleep. If you have congestion, the use of a saline nasal spray to help keep the nasal passages open. Talk with a member of your health care team about the use of nasal decongestants or antihistamines, because some medications can be recommended only for short-term use.

Sleep on your side or face down, instead of on his back. Sleeping on your back can cause your tongue and soft palate rest against the back of your throat and block the airway.

To avoid sleeping on your back, try sewing a tennis ball in the back of your pajamas or put pillows behind you to keep you sleeping on your side.

Preparing for your appointment

If you suspect that you have obstructive sleep apnea, it is likely that you first consult your primary care physician or other health care professional. You may be referred to a sleep specialist.

Here's some information to help you prepare for your appointment.

What you can do

  • Be aware of pre-application appointment.When you make your appointment, ask if there is something that you need to do in advance, such as keeping a sleep diary. In a sleep diary, record your sleep patterns, such as bedtime, the number of hours to sleep, nighttime awakenings, and awake time. You can also record your daily routine, naps and how you feel during the day.
  • Write down your symptoms, including any that may seem unrelated to the reason of his appointment, and when they began.
  • Write down key personal information, including new or ongoing health problems, the major stresses or recent life changes.
  • Bring a list of all medications, vitamins or supplements that you take, including over-dose. Include anything that you've taken to help you sleep.
  • Take your bed partner along, if possible. Your partner can provide information about how much and how you're going to sleep. If you can't bring your partner with you, ask about how well you sleep and if you snore, and then share this information in your citation.
  • Write down your questions. Prepare a list of questions can help you make the most of your time during your appointment.

Be aware of pre-application appointment. When you make your appointment, ask if there is something that you need to do in advance, such as keeping a sleep diary.

In a sleep diary, record your sleep patterns, such as bedtime, the number of hours to sleep, nighttime awakenings, and awake time. You can also record your daily routine, naps and how you feel during the day.

For obstructive sleep apnea, some basic questions to ask include:

  • What is the most likely cause of my symptoms?
  • What tests do I need? I need to go to a sleep clinic?
  • What treatments are available and what you recommend for me?
  • I have other health conditions. How can I best manage these conditions?

Do not hesitate to ask other questions.

What to expect from your doctor

A key part of the evaluation of obstructive sleep apnea is a detailed history, in the sense of your health care team will ask you many questions. These may include:

  • When did you first notice the symptoms?
  • The symptoms been off and on, or always?
  • Do you snore? If so, your snoring disturbing anyone's sleep?
  • Do you snore at all positions to sleep or just when you sleep on your back?
  • Did you ever stop snoring, snort, gasp, or drown yourself awake?
  • Has anyone seen you stop breathing during sleep?
  • How to update what do you feel when you wake up? You're tired during the day?
  • Do you have a headache or dry mouth when you wake up?
  • Do you sleep or have trouble staying awake while sitting in silence or driving?
  • Do you nap during the day?
  • Do you have family members with sleep problems?

What you can do in the meantime

  • Try sleeping on your side. Most forms of obstructive sleep apnea are more mild than when you sleep on your side.
  • Do not drink alcohol close to bedtime. Alcohol makes obstructive sleep apnea worse.
  • If you are drowsy, do not drive. If you have obstructive sleep apnea, daytime sleepiness can put you at greater risk of motor vehicle accidents. To be sure, schedule breaks. If a friend or family member tells you that you appear sleepier than you feel, don't drive.
Symptoms and treatment of Obstructive sleep apnea