Symptoms and treatment of Sleep apnea

Description

Sleep apnea is a potentially serious sleep disorder in which breathing repeatedly stops and starts. If you snore loudly and feel tired even after a full night of sleep, you may have sleep apnea.

The main types of sleep apnea are:

Obstructive sleep apnea (OSA), which is the more common form that occurs when throat muscles relax and block the flow of air to the lungs
Central sleep Apnea (CSA) , which occurs when the brain does not send proper signals to the muscles that control breathing
Treatment-emergent central sleep apnea , also known as complex sleep apnea, which occurs when someone OSA — diagnosed with a sleep study — that makes the CSA to receive the therapy of OSA

If you think you may have sleep apnea, talk to your health care provider. The treatment can relieve symptoms and may help to prevent heart problems and other complications.

Symptoms

The symptoms of obstructive and central sleep apnea overlap, which sometimes makes it difficult to determine which type of. The most common symptoms of obstructive and central sleep apnea are:

The loud snoring.
Episodes in which you stop breathing during sleep — which would be reported by another person.
Gasping for air during sleep.
Awakening with a dry mouth.
In the morning the headache.
Difficulty staying asleep, known as insomnia.
Excessive sleepiness during the day, known as hypersomnia.
Difficulty paying attention while awake.
Irritability.

When to see a doctor

Loud snoring may indicate a problem that could be serious, but not everyone who has sleep apnea snores. Talk with your health care provider if you have symptoms of sleep apnea. Ask your doctor about any sleep problem that leaves you tired, sleep, and irritability.

Causes

Obstructive sleep apnea

This type of sleep apnea occurs when the muscles in the back of the throat relax. These muscles support the soft palate, the triangular piece of tissue hanging from the soft palate is called the uvula, the tonsils, the side walls of the throat and tongue.

When the muscles relax, your airway narrows or closes as you breathe. You may not obtain sufficient air, which can reduce the level of oxygen in the blood. The brain senses that you can't breathe, and briefly wakes up you so that you can re-open the airway. This awakening is usually so brief that you don't remember it.

You could snort, choke or gasp. This pattern can be repeated in 5 to 30 times or more each hour, all night. This makes it difficult to achieve the deep, restful phases of sleep.

Central sleep Apnea

This less common form of sleep apnea occurs when the brain does not send signals to the breathing muscles. This means that you make no effort to breathe for a short period of time. You may awaken with shortness of breath or have difficulty getting to sleep or staying asleep.

Risk factors

Sleep apnea can affect anyone, even children. But certain factors can increase your risk.

Obstructive sleep apnea

The factors that increase the risk of this form of sleep apnea include:

The excess of weight. Obesity increases the risk of OSA . The fat deposits around the upper airway may obstruct breathing.
The circumference of the neck. People with thicker necks could have more narrows the airways.
A narrowing of the airways. You may have inherited a narrow gorge. The tonsils or adenoids can also increase and block the airway, especially in children.
The fact of being a man. Men are 2 to 3 times more likely to have sleep apnea than women. However, women increase their risk if you are overweight or if you have gone through the menopause.
Be greater. Sleep apnea occurs significantly more often in older adults.
The history of the family. Having family members with sleep apnea may increase the risk.
The use of alcohol, sedatives, or tranquilizers. These substances that relax the throat muscles, which can worsen obstructive sleep apnea.
The habit of smoking. Smokers are three times more likely to have obstructive sleep apnea that they are people who have never smoked. Smoking can increase the amount of inflammation and fluid retention in the upper airway.
Nasal congestion. If you have trouble breathing through the nose — either an anatomical problem or allergies — you are more likely to develop obstructive sleep apnea.
Medical conditions. Congestive heart failure, high blood pressure and type 2 diabetes are some of the conditions that may increase the risk of obstructive sleep apnea. Polycystic ovary syndrome, a hormonal disorder, prior stroke, and chronic lung diseases, such as asthma can also increase the risk.

Central sleep Apnea

Risk factors for this form of sleep apnea include:

Be greater. Middle-aged and older people have a higher risk of central sleep apnea.
The fact of being a man. Central sleep Apnea is more common in men than in women.
The disorders of the heart. Have congestive heart failure increases the risk.
The use of narcotics for the pain. Opioid medications, especially long-acting, such as methadone, increase the risk of central sleep apnea.
Stroke. After having a stroke increases the risk of central sleep apnea.

Complications

Sleep apnea is a serious medical condition. Complications of OSA can include:

Daytime fatigue.Awakenings repeated associated with sleep apnea typical, restorative sleep impossible, in turn making severe daytime drowsiness, fatigue, and irritability likely. You may have difficulty concentrating and is falling asleep at work, while watching TV or even when driving. People with sleep apnea have an increased risk of motor vehicle and work accidents. You might also feel irritable, moody or depressed. Children and adolescents with sleep apnea may perform poorly in school or behavioral problems.
High blood pressure or heart problems.Abrupt in blood oxygen levels that occur duringOSAincrease of the blood pressure and the stress on the cardiovascular system. HavingOSAincreases the risk of high blood pressure, also known as hypertension. OSAmight also increase your risk of recurrent heart attack, stroke, and irregular heartbeats, such as atrial fibrillation. If you have heart disease, multiple episodes of low oxygen levels in the blood (hypoxia or hypoxemia) can lead to sudden death from an irregular heartbeat.
Type 2 diabetes. Having sleep apnea increases the risk of developing insulin resistance and type 2 diabetes.
The metabolic syndrome. This disorder, which includes high blood pressure, abnormal cholesterol levels, high blood sugar and an increased waist circumference is linked to an increased risk of heart disease.
Complications with medications and surgery.Obstructive sleep apnea is also a concern with certain medications and general anesthesia. People with sleep apnea may be more likely to have complications after major surgery because they are prone to breathing problems, especially when sedated and lying on his back. Before surgery, tell your doctor about sleep apnea and how they are treated.
Liver problems. People with sleep apnea are more likely to have irregular results on liver function tests, and their livers are more likely to show signs of healing, known as non-alcoholic fatty liver.
Sleep-deprived partners. Loud snoring can prevent someone who is sleeping close to getting a good night's sleep. It is common for a couple to have to go to another room, or even to another floor of the house, to be able to sleep.

Daytime fatigue. Awakenings repeated associated with sleep apnea typical, restorative sleep impossible, in turn making severe daytime drowsiness, fatigue, and irritability likely.

You may have difficulty concentrating and is falling asleep at work, while watching TV or even when driving. People with sleep apnea have an increased risk of motor vehicle and work accidents.

You might also feel irritable, moody or depressed. Children and adolescents with sleep apnea may perform poorly in school or behavioral problems.

High blood pressure or heart problems. Abrupt in blood oxygen levels that occur during the OSA increased blood pressure and the stress on the cardiovascular system. Have OSA increases the risk of high blood pressure, also known as hypertension.

OSA may also increase your risk of recurrent heart attack, stroke, and irregular heartbeats, such as atrial fibrillation. If you have heart disease, multiple episodes of low oxygen levels in the blood (hypoxia or hypoxemia) can lead to sudden death from an irregular heartbeat.

Complications with medications and surgery. Obstructive sleep apnea is also a concern with certain medications and general anesthesia. People with sleep apnea may be more likely to have complications after major surgery because they are prone to breathing problems, especially when sedated and lying on his back.

Before surgery, tell your doctor about sleep apnea and how they are treated.

Complications of CSA may include:

Fatigue.The repeated awakening associated with sleep apnea causes typical, restorative sleep impossible. People with central sleep apnea often have severe fatigue, daytime sleepiness, and irritability. You may have difficulty concentrating and is falling asleep at work, while watching tv, or even while driving.
Cardiovascular problems.Abrupt in blood oxygen levels that occur during central sleep apnea can affect the health of the heart. If there is underlying heart disease, these repeated multiple episodes of low blood oxygen, known as hypoxia or hypoxemia — worsen the prognosis and increase the risk of irregular heart rhythms.

Fatigue. The repeated awakening associated with sleep apnea causes typical, restorative sleep impossible. People with central sleep apnea often have severe fatigue, daytime sleepiness, and irritability.

You may have difficulty concentrating and is falling asleep at work, while watching tv, or even while driving.

Cardiovascular problems. Abrupt in blood oxygen levels that occur during central sleep apnea can affect the health of the heart.

If there is underlying heart disease, these repeated multiple episodes of low blood oxygen, known as hypoxia or hypoxemia — worsen the prognosis and increase the risk of irregular heart rhythms.

Diagnosis

Your health care provider can do an evaluation based on the symptoms and a sleep history, which you can provide with help from someone who shares your bed or your family, if possible.

You is likely to be referred to a sleep disorders center. There, a sleep specialist can help determine your need for further evaluation.

An evaluation often involves overnight monitoring of your breathing and other body functions during sleep testing in a sleep center. Home sleep testing can also be an option. Tests to detect sleep apnea include:

Nocturnal polysomnography. During this test, you are connected to equipment that monitors your heart, lung and brain activity, breathing patterns, arm and leg movements, and blood oxygen levels during sleep.
Home to roost pruebas.Su health care provider might provide simplified tests to be used in the home to diagnose sleep apnea. These tests usually measure your heart rate, blood oxygen level, airflow and breathing patterns. Your provider is more likely to recommend polysomnography in a sleep testing facilities, in place of a home sleep test, if central sleep apnea is suspected. If the results are not typical, your doctor may be able to prescribe a therapy without more evidence. Portable monitoring devices sometimes miss the sleep apnea. So that your health care provider may recommend polysomnography even if your first results are within the standard range.

Home sleep tests. Your health care provider might provide simplified tests to be used in the home to diagnose sleep apnea. These tests usually measure your heart rate, blood oxygen level, airflow and breathing patterns. Your provider is more likely to recommend polysomnography in a sleep testing facilities, in place of a home sleep test, if central sleep apnea is suspected.

If the results are not typical, your doctor may be able to prescribe a therapy without more evidence. Portable monitoring devices sometimes miss the sleep apnea. So that your health care provider may recommend polysomnography even if your first results are within the standard range.

If you have obstructive sleep apnea, your doctor may refer you to an ear, nose, and throat specialist to rule out an obstruction in the nose or throat. An evaluation by a specialist of the heart, known as a cardiologist or a physician who specializes in the nervous system, called a neurologist, it may be necessary to search for the causes of central sleep apnea.

Treatment

In mild cases of sleep apnea, your doctor may recommend only lifestyle changes, like losing weight or quitting smoking. You may need to change the position in which you sleep. If you have nasal allergies, your medical professional may recommend a treatment for allergies.

If these measures don't improve your symptoms, or if your apnea is moderate to severe, a number of other treatments are available.

Some devices may help to open up a blocked airway. In other cases, surgery may be necessary.

Therapies for OSA

Continuous positive airway pressure (CPAP).If you have moderate to severe obstructive sleep apnea, you may benefit from the use of a machine that delivers air pressure through a mask while you sleep. WithCPAP(SEE-pap), the air pressure is somewhat higher than that of the surrounding air and it is just enough to keep your upper airway passages open, preventing apnea and snoring. AlthoughCPAPis the most common and reliable method of treatment of sleep apnea, some people find it awkward or uncomfortable. Some people give in theCPAPmachine. But with practice, most people can learn to adjust the tension of the straps of the mask to get a comfortable and secure fit. You may need to try more than one type of mask to find one that is comfortable. Do not stop using theCPAPmachine if you have problems. Check with your health care provider to see what changes you can make to increase your comfort. In addition, please contact your provider if you're still snoring or begin to snore again, despite treatment. If your weight changes, the pressure settings of theCPAPmachine need to be adjusted.
Another airway pressure devices. If you use a CPAP machine continues to be a problem for you, you might be able to use a different type of airway pressure device that automatically adjusts the pressure while you're sleeping (auto - CPAP ). Supply units of bilevel positive airway pressure (BPAP) are also available. These provide more pressure when you inhale and less when you exhale.
Oral appliances.Another option is the use of an oral appliance designed to keep the throat open.CPAPis more reliably effective than oral appliances, but oral appliances may be easier to use. Some are designed to open your throat by bringing the jaw forward, which can sometimes relieve mild snoring and obstructive sleep apnea. A number of devices are available from your dentist. You might need to try different devices before you find one that works for you. Once you find the correct setting, you will need to follow up with your dentist several times during the first year and then regularly after that, to ensure that the fit is still good and to reconsider their symptoms.

Continuous positive airway pressure (CPAP). If you have moderate to severe obstructive sleep apnea, you may benefit from the use of a machine that delivers air pressure through a mask while you sleep. With CPAP (SEE-pap), the air pressure is somewhat higher than that of the surrounding air and it is just enough to keep your upper airway passages open, preventing apnea and snoring.

Although CPAP is the most common and reliable method of treatment of sleep apnea, some people find it awkward or uncomfortable. Some people give in to the CPAP machine. But with practice, most people can learn to adjust the tension of the straps of the mask to get a comfortable and secure fit.

You may need to try more than one type of mask to find one that is comfortable. Do not stop using the CPAP machine, if you have problems. Check with your health care provider to see what changes you can make to increase your comfort.

In addition, please contact your provider if you're still snoring or begin to snore again, despite treatment. If your weight changes, the pressure settings of the CPAP machine may need to be adjusted.

Oral appliances. Another option is the use of an oral appliance designed to keep the throat open. The CPAP is more reliably effective than oral appliances, but oral appliances may be easier to use. Some are designed to open your throat by bringing the jaw forward, which can sometimes relieve mild snoring and obstructive sleep apnea.

A number of devices are available from your dentist. You might need to try different devices before you find one that works for you.

Once you find the correct setting, you will need to follow up with your dentist several times during the first year and then regularly after that, to ensure that the fit is still good and to reconsider their symptoms.

It is likely that read, listen to or watch the TV ads about the different treatments for sleep apnea. Talk with your health care provider about any treatment before you try it.

Surgery for OSA

Surgery may be an option for people with OSA , but usually only after other treatments have failed. Usually, in less than three months trial of other treatment options, it is suggested before considering surgery. However, for a small number of people with certain problems related to the structure of the jaw, surgery is a good first option.

Surgical options may include:

Removal of tissue.During this procedure (uvulopalatopharyngoplasty), a surgeon removes the tissue from the back of the mouth and the upper part of the throat. The tonsils and adenoids are usually removed. This type of surgery may be successful in stopping the throat structures vibrate and cause snoring. It is less effective thanCPAPand is not considered an effective treatment for obstructive sleep apnea. The removal of the tissues in the back of the throat with the energy of radio frequency (rf) could be an option for those who can't tolerateCPAPor oral appliances.
Tissue shrinkage. Another option is to reduce the tissue in the back of the mouth and the back of the throat using radiofrequency ablation. This procedure can be used for mild to moderate cases of sleep apnea. A study found that it has similar effects to that of the removal of the tissue, but with less surgical risk.
The repositioning of the jaw. In this procedure, the jaw is moved forward from the rest of the facial bones. This enlarges the space behind the tongue and soft palate, causing the obstruction is less likely to occur. This procedure is known as promotion.
Implants. Soft rods, usually made of polyester or plastic, are surgically implanted in the soft palate after numbing with a local anesthetic. More research is needed to determine how well implants work.
The stimulation of the nerve. This requires surgery to insert a stimulator to the nerve that controls movement of the tongue (the nerve hypoglossal). The increase of the stimulation helps to keep the tongue in a position that keeps the airway open. More research is needed.
The creation of a new air, known as a tracheotomy.You may need this type of surgery if other treatments have failed and have severe, life-threatening sleep apnea. In this procedure, the surgeon makes an opening in the neck and inserts a metal or plastic tube through which you breathe. Maintain the openness of the deck during the day. But in the night, they discover, to allow the passage of air in and out of your lungs, avoiding the blockage of air passage in your throat.

Removal of tissue. During this procedure (uvulopalatopharyngoplasty), a surgeon removes the tissue from the back of the mouth and the upper part of the throat. The tonsils and adenoids are usually removed.

This type of surgery may be successful in stopping the throat structures vibrate and cause snoring. It is less effective than CPAP, and is not considered an effective treatment for obstructive sleep apnea.

The removal of the tissues in the back of the throat with the energy of radio frequency (rf) could be an option for those who do not tolerate CPAP or oral appliances.

The creation of a new air, known as a tracheotomy. You may need this type of surgery if other treatments have failed and have severe, life-threatening sleep apnea. In this procedure, the surgeon makes an opening in the neck and inserts a metal or plastic tube through which you breathe.

Maintain the openness of the deck during the day. But in the night, they discover, to allow the passage of air in and out of your lungs, avoiding the blockage of air passage in your throat.

Other types of surgery may help reduce snoring and help for the treatment of sleep apnea by clarification or expansion of the air passages:

The surgery to remove the tonsils or adenoids.
Weight-loss surgery, also known as bariatric surgery.

Therapies for CSA

Treatment for medical problems associated with it. Possible causes of central sleep apnea include heart or neuromuscular disorders, and the treatment of these conditions may help. Other therapies that can be used for CSA include supplemental oxygen, CPAP , BPAP , and adaptive servo-ventilation (ASV).
Medication changes. You may be prescribed medicines to help control your breathing, such as acetazolamide. If medications are the worsening of your CSA , such as opioids, your healthcare provider may change your medicines.
Supplemental oxygen. The use of supplemental oxygen during sleep can help if you have central sleep apnea. Various forms of oxygen are available with devices to provide oxygen to their lungs.
Adaptive servo-ventilation (ASV).This more recently adopted the air flow device learns the typical breathing pattern, and stores the information into a computer. After falling asleep, the machine uses the pressure to regulate the breathing pattern and avoid pauses in your breathing. ASVmay be an option for some people with treatment-emergent central sleep apnea. However, it might not be a good option for people with a predominance of central sleep apnea and heart failure advanced. AndASVis not recommended for those with severe congestive heart failure.

Adaptive servo-ventilation (ASV). This more recently adopted the air flow device learns the typical breathing pattern, and stores the information into a computer. After falling asleep, the machine uses the pressure to regulate the breathing pattern and avoid pauses in your breathing.

ASV may be an option for some people with treatment-emergent central sleep apnea. However, it might not be a good option for people with a predominance of central sleep apnea and heart failure advanced. And ASV is not recommended for people with severe heart failure.

Lifestyle and home remedies

In some cases, self-care might be a way of coping with obstructive sleep apnea and possibly central sleep apnea. Try these tips:

Losing the excess weight. Even a small weight loss can help to relieve the constriction of the throat. In some cases, sleep apnea can be resolved if you go back to a healthy weight, but may re-occur if you regain weight.
Exercise. Regular exercise can help to relieve the symptoms of obstructive sleep apnea, even without weight loss. Try to do 30 minutes of moderate activity, like brisk walking, most days of the week.
Avoid alcohol and certain drugs such as tranquilizers and sleeping pills. These relax the muscles in the back of the throat, which interferes with breathing.
Sleeping on your side or abdomen rather than on your back. Sleeping on your back can cause your tongue and soft palate rest against the back of your throat and block the airway. To keep rolling on his back while you sleep, try attaching a tennis ball to the back of your pajamas. Also there are commercial devices that vibrate when you roll on his back in the dream.
Do not smoke. If you are a smoker, find resources to help you quit smoking.

Preparing for your appointment

If you or your partner suspects you have sleep apnea, contact your primary care provider. In some cases, you may be referred immediately to a sleep specialist.

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

What you can do

When you make the appointment, ask if there is something that you need to do in advance, such as modifying your diet or maintain 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 that you take, including over-dose.
Questions to ask your doctor.

Have a friend or family member, if possible, to help you remember the information that you receive. Because your bed partner might be more aware of your symptoms that you can help your partner along.

For sleep apnea, some questions to ask your doctor include:

What is 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-term?
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?
You should see a specialist?
Are there brochures or other printed material I can have? What sites do you recommend?

What to expect from your doctor

Your health care provider is likely to ask questions such as:

The symptoms been continuous or come and go?
How severe are the symptoms?
How is your partner to describe their symptoms?
Do you know if you stop breathing during sleep? If so, how many times in the night?
There is something that has helped your symptoms?
Does anything make your symptoms worse, such as sleep position, or the consumption of alcohol?

What you can do in the meantime

Try sleeping on your side.
Avoid alcohol consumption for 4 to 6 hours before bedtime.
Do not take medicines that cause drowsiness.
If you are drowsy, avoid driving.