Sleep Apnea

Basic Facts

  • Apnea means not breathing. Sleep apnea is a condition in which people experience multiple episodes of during sleep, which disturbs the sleep-wake cycle.
  • Over an eight-hour sleep period, a person can experience hundreds of apneic episodes.
  • People who have sleep apnea are at increased risk for cardiovascular disease, especially if left untreated.
  • Treatment for sleep apnea includes lifestyle changes, and the use of mechanical devices and oral appliances.
What is involved in a sleep study?

 

With sleep apnea, the body reacts to the interruption in breathing by forcing the body to inhale, which partially awakens the patient. The patient does not typically fully wake up, but apneic events are enough to disturb the sleep cycle, resulting in poor sleep quality.  Sleep apnea is common, and an estimated 12 million Americans have the condition.
 
Untreated sleep apnea increases a person's risk for developing and worsens the following conditions:
  • Hypertension (high blood pressure),
  • Arrhythmias (abnormal heart rhythms),
  • Pulmonary hypertension (high blood pressure in the lung’s arteries),
  • Heart failure (inadequate blood flow to the body),
  • Acute myocardial infarction (heart attack), and
  • Stroke (lack of blood supply to the brain).
 There are two types of sleep apnea:
  • Obstructive sleep apnea - Tissue in the upper airway completely or partially collapses intermittently during sleep and blocks or obstructs the airway. 
  • Central sleep apnea - The brain fails to signal the respiratory muscles to breathe.

Both of these conditions can disturb your sleep and cause a drop in your oxygen levels.

 

Symptoms of both types of sleep apnea include:

  • Snoring, coughing, snorting, or gasping for breath during sleep,
  • Awakening not feeling refreshed from sleep,
  • Daytime sleepiness/ drowsy driving,
  • Morning headaches,
  • Forgetfulness,
  • Depressed mood,
  • Gastroesophageal reflux disease,
  • Decreased interest in pleasurable activities, such as sex, 
  • Frequent urination.

 

 

 

Risk factors for obstructive sleep apnea include:

  • Obesity,
  • African American, Pacific islander, or Mexican descent,
  • Age older than 40 years,
  • Alcohol use,
  • A narrow upper airway,
  • Large neck size,
  • Hypertension (high blood pressure),
  • Enlarged tonsils, adenoids, and/or tongue,
  • Family history of sleep apnea,
  • Hypothyroidism,
  • Male gender,
  • Neurological conditions that impair upper respiratory muscle tone,
  • Recessed chin, and
  • Smoking.

Factors that increase a person's risk for central sleep apnea include central nervous system disorders, congestive heart failure or renal (kidney) disorders. Certain drugs can worsen sleep apnea, including alcohol, anti-anxiety medications, antihistamines, sedatives, and other central nervous system depressants. 

 

If sleep apnea is suspected, the physician may recommend a sleep study that is performed at a Virginia Heart Sleep Center. Studies include:

  • Polysomnogram (PSG) – For this overnight test, electrodes are used to monitor electrical activity of the brain, the heart, breathing, and the movements of your muscles and eyes. 
  • Positive Airway Pressure (PAP) Titration -- PAP Titration is a nighttime study using a PAP mask, which blows air through a mask into the nasal passages and prevents upper airway closure during sleep. This test determines the correct pressure measurements to effectively maintain an open airway.
  • Split Night Study – This study follows the same protocol as the PSG study for the first two hours. If in these two hours one meets the criteria for sleep apnea, then a continuous positive airway pressure (CPAP) device is applied and worn through the remainder of the night.
  • Multiple Sleep Latency Test (MSLT) -- MSLT is a daytime study, which involves a series of naps, to assess sleepiness during the day. The equipment used in an MSLT study is less extensive than a nighttime study.



 

 

Treatment of sleep apnea is typically tailored to the individual patient and depends on the severity of the apneic events.
 Devices used to treat sleep apnea include:
  • Continuous Positive Airway Pressure (CPAP) – The patient wears a mask during sleep, which is connected to a pump that sends air through the nasal passages, keeping the airway open.
  • Dental appliances – These appliances reposition the lower jaw and the tongue.
 Surgical procedures are rarely used to treat sleep apnea, but some of these procedures include:
  • Uvulopalatopharyngoplasty removes excess tissue at the back of the throat,
  • Other procedures such as surgical reconstruction of the lower jaw or obesity surgery.

CPAP or oral appliances can make a difference immediately. Lifestyle changes may take weeks or months before the patient notices improvement.

 Lifestyle changes may include:
  • Losing weight, if necessary,
  • Avoiding alcohol, antihistamines, sleep aids, and sedatives,
  • Changing sleeping positions from the back to the stomach or side, and
  • Practicing good sleep habits, called sleep hygiene.