What is Sleep Apnea?

Sleep apnea is a common disorder that people experience when they sleep. This generally results in an individual’s breathing being stopped or being severely interrupted while they sleep. In severe cases of sleep apnea, individual’s breathing has been known to pause over a hundred times in one night. This affects the quality of sleep an individual gets which has been shown to increase the likelihood of work and auto related accidents as well as impair performance at work and school. If the disorder goes untreated, sleep apnea can also lead to several other ailments that are indirectly affected by the impact sleep apnea has on our bodies. These additional ailments can include increased risk of heart failure, heart attack, stroke, hypertension, cardiomyopathy, and diabetes.

Sleep Apnea Treatment

There are several ways to treat sleep apnea effectively. For mild to moderate cases of sleep apnea, there may be some simple lifestyle changes that can be made that will help reduce or stop sleep apnea symptoms. For more severe cases, the recommendation to resolve sleep apnea may include the use of different tools and strategies. For those that are in danger of serious health implications, there are surgical options that may provide the most effective relief. These options are the most invasive and should only be considered when all other options have failed to provide relief.

Sleep Apnea Masks

• CPAP Masks: The most common solution to sleep apnea is the CPAP (continuous positive airway pressure) machine that helps deliver air through a mask that provides enough pressure to bypass any blockage. Even though it is the most common and successful method of treating sleep apnea, it is often met with resistance due to the mask being uncomfortable to sleep with.
• Auto CPAP Masks: This machine operates much like the normal CPAP but will adjust the necessary air pressure as you sleep to ensure that the air pressure isn’t too much or too little.
• BPAP Masks: This machine supplies a bilevel positive airway pressure that helps provide additional pressure when you inhale vs when you exhale.
• Adaptive Servo Ventilation (ASV): This is a recently approved air flow mask that monitors and stores an individual’s breathing patterns so that the correct amount of pressure is applied when sleeping.

Sleep Apnea Therapies

• Treatment for Associated Medical Issues: There are several factors that can impact central and obstructive sleep apnea so addressing those problems with their own treatments can indirectly relieve sleep apnea.
• Oral Appliances: Instead of using breathing masks, there may be alternative that can help relieve pressure on the upper airway. Some oral appliances, like bite guards can help keep your throat open by aligning your jaw in a position that is conducive to breathing. This can also help reduce snoring and other sleep apnea related symptoms.
• Hyperbaric Oxygen Therapy: This new method of treatment uses pressurized oxygen which can potentially help increase oxygen absorption if an individual is willing to sleep in the hyperbaric chamber.

Sleep Apnea Surgeries

• Tissue Removal: These procedures include uvulopalatopharyngoplasty and somnoplasty which consists of the removal of tissue from the top of your airway. This usually includes the tonsils and adenoids which obstruct the airway and typically cause the snoring associated with sleep apnea. This option is less effective than a CPAP and is usually recommended when people can’t get used to the CPAP machine.
• Tissue Shrinkage: Tissue around your upper airway and the back of your throat can be reduced using radiofrequency ablation. This is generally as effective as tissue removal but with less risks due to their being minimal invasive surgery.
• Implants: There are a few different implant options that range from simple plastic rods that can be attached to the soft palate to reduce vibrations to devices that can stimulate the hypoglossal nerve. The hypoglossal nerve stimulation helps control tongue movement while sleeping which helps keep the airway clear. Both implants need more research to identify how effective these treatment options are.
• Tracheostomy: When all other options fail, a tracheostomy makes an opening that allows an individual to breath through a hole in their neck. This passage is kept covered when awake but is opened at night to bypass airway blockage that occurs at the top of the airway.
• Jaw Repositioning: This procedure is called maxillomandibular advancement which moves the jaw forward which increases the space behind the tongue. This should help reduce the chance of obstruction of the airway when sleeping.
• Weight Loss Surgeries: There are other ways to help reduce the impacts of sleep apnea which involve weight loss surgeries. Since being overweight is a risk factor for sleep apnea, cutting back weight should help reduce the likelihood of sleep apnea.

Sleep Apnea Life-Style Remedies

In mild cases of sleep apnea that are the result of poor lifestyle choices, sleep apnea can be mitigated by improving quality of life and making decisions that prioritize self-care.

• Exercise: Consistent exercise will help reduce obstructive sleep apnea by reducing fat which is a significant contributor to sleep apnea symptoms.
• Avoid alcohol / sleeping pills / muscle relaxers / narcotics: These substances relax the muscles in the back of your throat which make obstruction much more likely.
• Quit smoking: Smoking cigarettes comes with a plethora of significant respiratory risks. By reducing or quitting cigarettes, you can reduce the likelihood of sleep apnea affecting your sleep.
• Sleep on your side: This can be difficult to control without the support of specialized therapy pillows but is shown to be effective against obstructive sleep apnea. Sleeping on your side alleviates the downward pressure gravity applies to your airway.

Sleep Apnea Causes

Sleep apnea can be caused or exacerbated by several factors. The type of sleep apnea really determines what causes sleep apnea. In addition to causes, there are several triggers or lifestyle choices that can exacerbate sleep apnea symptoms.

Different Types of Sleep Apnea

The 3 primary types of sleep apnea can be segmented into obstructive and central sleep apnea:

• Obstructive sleep apnea: This type is the more common of the sleep apnea types which occurs when there is complete or partial airway blockage in the upper respiratory tract. During an obstructive sleep apnea occurrence, the lungs, diaphragm, and chest muscles must work much harder to expel air. This usually resolves itself in a violent reaction as your body will fight suffocation and cause your body to jerk to clear the airway. If this occurrence happens frequently, it will impact the quality of sleep as well as minimize the flow of oxygen to vital organs while your body is resting.
• Central sleep apnea: This type of sleep apnea is related to the proper function of the central nervous system. This occurs when the airway is clear, but your brain does not properly regulate the signals that cause the muscles to continue breathing. This type of sleep apnea is most commonly found in patients that have suffered from some sort of central nervous system disorder like patients that have suffered strokes, are suffering from diseases like ALS, or patients that have some other lung or heart disease.
• Complex sleep apnea: This disorder is the result of both central and obstructive sleep apnea affecting your sleep patterns.

Who Gets Sleep Apnea?

Sleep apnea is a relatively common occurrence that affects 1 in 4 men and 1 in 10 women. It can affect all ages from babies and children to the elderly. Certain features and traits are commonly found amongst those that suffer from sleep apnea like:

• People who are overweight
• Those that are impacted by structural anomalies that cut the diameter of the upper respiratory pathways
• Those that suffer from nasal blockages, low hanging palates, or enlarged tonsils
• People who have a severe overbite
• People with parents who suffer from sleep apnea

Is Sleep Apnea Hereditary?

Data that has been collected and analyzed reveal that genetics can also play a large role in if sleep apnea develops in an individual. Although the genetics that can exacerbate obstructive sleep apnea are still in question, it is much more likely that the genetic markers that impact a person’s ability to maintain a healthy weight and the craniofacial structure can play a large role in if someone develops sleep apnea.

Sleep Apnea Symptoms

Sleep apnea symptoms are rarely identified by the person suffering from sleep apnea but rather by their partner who have to deal with the symptoms of sleep apnea. Several indicators of obstructive sleep apnea include:

• Extremely obnoxious snoring
• Daytime fatigue and frequent napping
• Restlessness and inability to sleep through the night
• Sensation of suffocating or choking while sleeping
• Trouble concentrating, confusion, forgetfulness, or irritability are observed in patients with sleep apnea
• Depression or anxiety
• Night sweats
• Frequent need to urinate at night
• Erectile or sexual dysfunction
• Persistent headaches

Sleep Apnea Symptoms in Children

Symptoms of sleep apnea in children can be more difficult to recognize because they can be much more subtle. These symptoms can include:

• Poor performance in school
• Bedwetting
• Daytime sleepiness or falling asleep in class
• Mouth breathing and difficulty swallowing
• Unusual sleeping positions
• Learning disorders like ADHD or hyperactivity

Health Risks & Effects of Sleep Apnea

Increased Risk of Cardiac Problems

Sleep apnea can exacerbate serious health problems like stoke, heart attack, hypertension, arrhythmias, cardiomyopathy, diabetes, and obesity. Since sleep apnea tends to cause high blood pressure, there is a lot of unnecessary pressure that sleep apnea puts on your circulatory system which can lead to several cardiac disorders and problems. This is generally the result of:

• Hypoxia, or when you have low oxygen levels
• High carbon dioxide levels
• Increased inflammation and pressure within the chest

The connection between sleep apnea and serious cardiac problems is so strong that sleep apnea occurs in about 50% of patients that suffer from cardiac failure. This is why it is so critical to sleep apnea diagnosed early so treatment can be applied to provide some relief and mitigate the circumstances that would lead to severe problems.

Cognitive Dysfunction

Sleep apnea inevitably leads to sleep deprivation from constant interruptions of the REM cycle. This can lead to cognitive problems as people with sleep apnea are sleep deprived and often deal with confusion, headaches, irritability, depression, and memory lapses which would not normally happen with a full night’s sleep.

What Happens When You Stop Breathing?

Without a steady supply of oxygen, your heart rate will slow in reaction to what can only be described as suffocation. Once your body recognizes that the supply of oxygen has been cut, your body will involuntarily react causing an individual to wake up so they can start breathing again. Once oxygen is restored, the heart rate will accelerate which causes your blood pressure to rise.

This continued back and forth of increasing and decreasing blood pressure can have an extremely detrimental effect on your heart. What this does is cause your heart walls to bulk up to accommodate the increased workload which causes the structure of your heart to become less flexible. This can lead to atrial and ventricular arrhythmias as well as limit the function of the heart, so it loses efficiency when doing its job.

Sleep Apnea Diagnosis

Sleep apnea diagnosis will require a series of evaluations to determine if sleep apnea is a problem. The first will require a physical exam with a doctor to discuss your symptoms and sleep patterns. If it is determined that sleep apnea may be a risk, then further evaluation is typically recommended. This usually requires an individual to partake in an overnight study that is held at a sleep facility where certain body functions are closely monitored during an individual’s sleep cycle.

Sleep Studies

The primary test being used during sleep studies is called nocturnal polysomnography which hooks a person up to machines that monitors their heart, lung, and brain activity, movements, breathing, and oxygen levels. This test will identify any irregularities and determine if there is enough deviation from the norm to indicate if a problem is being caused by sleep apnea.

That being said, this method of testing can be intimidating for individuals that deal with anxiety or insomnia as it places them in a new setting which can disrupt sleep under normal conditions. Instead, new home testing has been recently introduced that can help diagnose sleep apnea. These tests can measure heart rate, breathing, and blood oxygen levels which can at least give a doctor an idea if further testing is needed. It might also be beneficial to enlist the help of a smart watch or Fitbit to track your sleeping patterns and monitor any abnormal sleeping behaviors.

Routine Upper Airway Evaluations

Sleep studies can typically identify if sleep apnea is problematic but further examinations maybe required to identify areas of obstruction. Both nasopharyngoscopy and sleep endoscopy use a fiberoptic endoscope to observe the craniofacial structures that could be impacting the obstruction which will help determine the best treatment option for the collapse in the upper airway.

Preparing For Your Sleep Apnea Appointment

If you suffer from sleep apnea and have scheduled an appointment to see a doctor there are a few things that you can do to prepare for your appointment. Be sure to:

• When making the appointment, ask if there are any special demands that will help the doctor with their diagnosis. Things like modifying diet can be important to an accurate diagnosis.
• Track things that have been happening and symptoms and the date they started.
• Have personal information ready including family history of similar problems.
• Make a list of the different medications, supplements, and vitamins that are being taken and the dosages in which they are taken.
• Be sure to document everything that the doctor says so you can recall later on if you have had sleep deprivation related memory problems.

What to Expect from Your Doctor?

Having things ready prior to the appointment will help you answer the doctor’s questions in a way that is thought out and detailed to provide as much useful information as possible. If an individual has a partner that can join, they may also be able to provide valuable insight as they likely have a much better idea of severity of symptoms. Be sure to prepare answers for:

• When did symptoms start and have they been chronic or episodic?
• How severe would you say sleep apnea symptoms are?
• How would your partner describe your symptoms of sleep apnea?
• How frequently does beathing stop?
• Has anything helped reduce or prevent sleep apnea symptoms?
• Has anything triggered or made sleep apnea symptoms worse?

What to Ask Your Doctor About Sleep Apnea?

In addition to being prepared, asking the right questions will also help provide clarity and guidance. Sometimes you won’t think to ask something until it’s too late and the doctor is unavailable so here’s a few questions to keep in mind if they apply to your situation.

• What is most likely causing or triggering my symptoms?
• What other test will help diagnose the problem?
• How long should I expect symptoms to persist?
• How long should symptoms persist after treatment is completed?
• What treatment options are the most successful and available to me?
• Does this impact other health conditions that I’m currently dealing with?
• Are the available resources that I can use to learn more about sleep apnea?

How to Prevent Sleep Apnea

If sleep apnea symptoms are mild, there may be a chance to take action to prevent them from happening. The following things are important to remember to reduce the impacts of sleep apnea symptoms:

• Avoid substances like alcohol, drugs, and medications that make you tired.
• Do your best to sleep on your side or use a pillow to prop yourself up to stay off your back while sleeping.
• Avoid irritants that disrupt normal respiratory function. Being exposed to smoke can help increase the risk that sleep apnea symptoms become more prevalent.
• Exercise: Getting some exercise will help improve respiratory and circulatory function which is critical to reducing indirect impacts that might arise from sleep apnea like circulatory system dysfunction.

Contact a Sleep Apnea Specialist Today to Schedule an Appointment

If you or a loved one are suffering from sleep apnea and want to discuss effective treatment options, call the Headache TMJ Los Angeles Pain Clinic at (310) 422 – 4246 to schedule an appointment today. Dr. Kathy Omrani is an experienced sleep apnea specialist who can provide you with a customized treatment plan designed to stop the symptoms and impacts of sleep apnea.