We all inherently understand the benefits of a good night of rest. Recent developments in neuroscience have uncovered wide variety of physiological processes which are dependent on optimal sleep. These benefits range from memory consolidation, regulation of emotions, optimal function of the immune system and cellular processes which are critical to maintaining a healthy body and mind.
Unfortunately, many of us are all-too-familiar with poor sleep and, for some, this can be a chronic problem which can be difficult to address. These issues can range from simply not being able to fall asleep or maintain sleep (insomnia), to more disruptive problems which affect the quality of sleep cycles. Often the causes of these are not immediately clear to the individual experiencing them, especially when the disturbance doesn’t arouse complete, conscious awakening, but disrupts the quality of sleep. One particularly prevalent culprit of this is a condition known as ‘sleep apnea’.
What is sleep apnea?
Sleep apnea is a condition in which an individual suffers from abnormalities in the depth and rhythm of their breathing while asleep. Most commonly, this can manifest as period of shallow breathing or pauses in breath throughout sleep. These pauses in breathing can occur multiple times per night and often last a few minutes.
Sleep apnea is often categorized into two forms; obstructive sleep apnea (OSA) and central sleep apnea (CSA). In the case of obstructive sleep apnea, breathing is disrupted by a physical blockage in airflow. Central sleep apnea is slightly more complex, in which regular breathing rhythms which are unconsciously controlled by the ‘limbic’ system of the brain, simply stop without a fully understood cause. Occasionally, patients may suffer with a combination of these two types of sleep apnea.
Signs of sleep apnea
Sleep apnea can often be difficult to diagnose or recognize, especially by the individual suffering from this condition.
A feeling of constant tiredness or fatigue is the most reported key sign of sleep apnea. Since sleep apnea disrupts the natural sleep cycle required for restorative sleep, suffers often report a feeling of constant tiredness or fatigue during waking hours. Despite being in bed and apparently ‘sleeping’ for the recommended eight hours, people with sleep apnea will often awake feeling unrested and groggy due to constant, and sometimes unknown, disruptions to their sleep throughout the night. Sufferers of sleep apnea often experience no ‘slow-wave’ (restorative) sleep and very little REM (rapid eye movement) sleep. REM sleep is vital for memory consolidation and, occasionally, disruption can be so severe that impairments in memory are noticeable in the individual. Moreover, due to the lack of restorative slow-wave sleep, co-ordination can become impaired and individuals may notice that they have more accidents or feel ‘clumsy’ throughout the day.
Other signs of sleep apnea include:
- Restlessness during sleep.
- Physical ailments, including dry mouth, headaches and sore throats.
- Frequent need to urinate or ‘nocturia’. During an episode of sleep apnea there is a decrease in oxygen and increase in carbon dioxide. This results in increase blood acidity and decreased heart rate and causes a ‘false’ urination signal.
- Waking up with the feeling of ‘choking’ or ‘gasping’ for air during sleep.
- Loud snoring or snorting.
Sleep apnea or snoring?
Sleep apnea is commonly confused by those living with someone suffering from sleep apnea as snoring, and is generally assumed to be harmless. This assumption is often made because the period following an episode of disrupted breathing is usually followed by loud snoring; in more extreme cases, a choking of snorting sound is reported until normal breathing resumes.
Unlike sleep apnea, snoring itself is less disruptive to sleep and is not caused by disruptions to breathing. Snoring is caused by vibrations within the nasal and respiratory passages during sleep. When we sleep, all muscles become relaxed (sometimes to the extent of paralysis). This relaxation includes the muscles of the neck and throat. Occasionally, this relaxation can narrow the respiratory passages and increase air pressure within the lungs nose and throat. As a result, vibrations (and that well-know sound of snoring) are produced. Generally, snoring is caused by nasal blockages, tongue positioning or abnormalities in the uvula. Although snoring is seemingly innocuous, some studies have reported that as many as 87% of ‘snorers’ also suffer from sleep apnea.
While snoring is not always as disruptive to the sleep of the individual producing the noise, it can cause great distress to any partner or family member sleeping nearby… The noise of snoring can range between 40 to 111.6 decibels; those levels range between the equivalent of the hum of people chattering and the sound of a snowmobile! Luckily, there are some easy-to-implement lifestyle and sleep changes which may aid with snoring issues:
- Sleeping on your side. This enables the respiratory airways to remain clear, and can help reduce air pressure within these passages.
- Elevating the head while sleeping can also help to keep air passages clear.
- Check on any existing allergies. Allergies are a common cause of inflammation and disruption to respiratory passages; anyone suffering from allergies may find their airflow restricted or disrupted during sleep, which could lead to snoring.
- Avoiding alcohol before bed has been shown to help reduce episodes of snoring. Alcohol consumption can result in excessive throat muscle relaxation, which can increase air pressure in the respiratory passages and result in excessive snoring – avoiding the glass of wine or whisky before bed may help with a more restful night of sleep.
- Quit smoking. Smoking is a well-known irritant of the sinuses, respiratory pathways and lungs; quitting your tobacco habit will immediately improve night-time breathing and overall health.
But what if you are suffering from sleep apnea; how do you know and what can you do about it?
How do I know if I’m suffering from sleep apnea?
The only professionals that can confirm whether or not you’re suffering from sleep apnea or a bad case of snoring as qualified physicians and sleep scientists. Sleep apnea is usually diagnosed with an overnight sleep study conducted by doctors or qualified sleep scientists. In most cases, this will take place in a lab-based environment using a technique called ‘polysomnography’. Polysomnography records brain waves, blood oxygen levels, heart rate and breathing, as well as eye and leg movements; this allows doctors to identify any breathing abnormalities and sleep disturbances. Sometimes, similar types of monitoring can be done in the patients’ home, with the attachment of a sleep monitor which can track breathing and sleep quality. In most cases, doctors will also ask patients to keep a sleep diary, and also take into consideration pre-existing conditions or risk factors which the individual has.
The severity of the condition is rated using the Apnea-Hypopnea Index (AHI). Apnea is the pause in breathing, while hypopnea is the period of shallow breathing. AHI is the total of the apneas and number of hypopneas every hour on average. AHI is calculated by dividing the total number of events by total hours of sleep. An AHI score of 5-15 is considered a mild sleep apnea, whereas any score over 30 is considered severe.
Sleep apnea risk factors
There are a variety of different medical conditions and risk factors which can elevate the risk of an individual developing sleep apnea. These conditions may often be referred to as ‘co-morbidities’. These risk factors include:
- Conditions which cause irritations to sinus and respiratory airways can increase the likelihood of developing sleep apnea – these may include long-term sinus obstruction or inflammation, and conditions such as allergies
- Obesity is a known risk factor for sleep apnea, with the condition being much more common in those who are overweight or clinically obese. This is likely due to the excessive pressure applied to the throat and respiratory system due to the extra weight carried around the face, neck and jaw.
- Certain medications can elevate risk of sleep apnea. Most commonly these include classes of drugs known as sedatives and hypnotics. Additionally, analgesics, opioid narcotics, general anesthetics, morphine and oxycodone can all increase risk of sleep apnea. These medications all have the ability to affect breathing rate and muscle relaxation, sometimes with negative consequences to sleep. If you’re taking one of these classes of medications and think you may be suffering with sleep apnea, you should discuss this with your doctor.
- There is thought to be a genetic component to sleep apnea, as scientists have demonstrated that family history is a significant risk factor which influences the likelihood of developing the condition.
- Abnormalities in the craniofacial area, such as a small jawbone, enlarged neck circumferences, deviated septum and enlarged tongue and tonsils, have all been linked to increased risk of sleep apnea.
Treatments for sleep apnea
There are currently a variety of treatments available for sleep apnea, ranging from minimally invasive to more extensive interventions. Ordinarily, patients will be advised to begin with altering lifestyle factors which may contribute to the condition; this may involve losing weight, quitting smoking or cutting back on alcohol consumption. Doctors also often recommend patients try to implement light exercise (such as yoga) into their routine. In most cases, doctors will also try to find and treat the root cause of the condition; for example, they may test for underlying allergies or sinus problems which could be exasperating or causing episodes of sleep apnea.
If sleep apnea persists, there are other at-home interventions which are available to help with the condition. Firstly, sleeping position can have a significant effect on sleep quality and reducing episodes of sleep apnea. In particular, sleep scientists and doctors recommend sleeping on your side (either left of right) or sleeping on your stomach. Sleeping on your back is the least helpful position for sleep apnea, due to the pressure which this position can put on the throat and respiratory pathways. However, if this is the only position which an individual can comfortably sleep in, then doctors recommend keeping the head elevated to keep airways unobstructed.
Following research regarding sleep position, some companies have begun to create and produce pillows which are aimed at helping those with sleep apnea. These pillows are particularly useful and can be implemented easily into a patients’ pre-existing sleep routine. The pillows are designed to help in the maintenance of an optimal side-ways sleeping position, with the aim of aligning the shoulder and head to keep airways open. These pillows are often referred to as ‘anti-snore’ pillows, and are widely commercially available.
Sleep apnea machine are another intervention which have become popular over recent years. These machines have been developed to keep airways open and maintain constant airway pressure throughout sleep. There are a variety of these machine available:
- CPAP (Continuous positive airway pressure). These machines help to maintain constant airflow pressure during inhalation and exhalation; the pressure is fixed throughout inhalation and exhalation. (Price range: $200-800)
- BiPAP machine (bi-level positive airway pressure). The concept is similar to the continuous positive machines, however the BiPAP machine allows for differential pressure settings of airflow to be made. This means that different pressures can be set for when the user is inhaling and exhaling, allowing for a more tailored respiration aid. These two different pressures are pre-set by the user. (Price range: $800-1700).
- APAP machine (automatic airway pressure). Similar to the BiPAP machine, APAPs have differential pressures for when the user is inhaling and exhaling. However, this pressure is automatically adjusted ‘on-the-fly’ by the machine, and is not set by the user. Hence, over the course of a night’s sleep, the pressure may change multiple times, adjusting to the users’ needs. These machines are particularly good for individuals who may require different pressures during different sleep cycles. (Price range: $350 – 900)
A final, much more invasive measure, which can be taken to treat sleep apnea is surgery. In extreme cases, where all other treatments haven’t provided tangible benefits, doctors may recommend surgeries to clear airway obstructions or correct abnormalities which are contributing to sleep apnea. These procedures include:
- Somnoplasty: the removal of excess soft tissues in the throat
- Tonsillectomy: the removal of the tonsils from the throat
- Adenoidectomy: the removal of the adenoids from the throat
- Uvulopalatopharyngoplasty: the removal of soft palette tissues
- Weight loss surgeries: in cases of extreme obesity, where diet and exercise changes have not worked or are not possible
Considering the amount of available treatments for sleep apnea, the outlook after diagnosis is very positive. The most important part of the treatment process is proper identification and diagnosis of the condition. Sleep apnea can be dangerous if left untreated, particularly because prolonged periods of paused breathing can lead to heart attack and stroke. If left untreated, research has shown that sleep apnea can result in a 3-fold higher rate of premature death. In the longer term, there are also a variety of conditions such a diabetes and depression which are relation to sleep disruption.
It’s important to remember, sleep apnea is extremely treatable and interventions are often very easy and cost-effective. Sometimes, lifestyle changes are enough to aid with the condition. However, the consequences can be large if the condition is left undiagnosed. If you think you or a loved one is suffering from sleep apnea, please contact a doctor right away.