WHAT IS SLEEP APNEA?
Have you been waking up frequently during the night or experiencing insomnia (inability to sleep)? Is your partner irritated by your snoring problem? Has waking up in the morning become a nightmare for you? If, by any chance, you see these symptoms in your sleeping activity, do not worry. It could be mild sleep apnea or some the sleep-related disorder. What you first need to do is understand- what is sleep apnea, work out its symptoms and look for an appropriate treatment and that all you will get here.
Sleep apnea is a very common sleep disorder, affecting roughly over 100 million people globally and is estimated to be undiagnosed 80-90% of the time. It is a condition in which the breathing of the sufferer ceases, periodically a few times a night. When their breathing ceases for a while, the sufferer is partially awakened, as their brain tries to get out of sleep to resume the breathing process again. The sufferer might experience irritability or sleeplessness in the morning. Do not ignore these signs and get a good diagnosis as soon as possible.
TYPES OF SLEEP APNEA:
OSA or Obstructive Sleep Apnea
OSA is the most common type of sleep apnea and occurs during sleep when the walls of the upper airway (including the tongue) relax and either completely block (an apnea) or partially restrict (a hypopnea) the airway.
- In many cases, the weight of the patient affects their apnoeic condition. People who are overweight or obese are more likely to have sleep apnea than those that maintain a healthy weight. Sleep apnea can often be caused by excess fatty tissues that become built up in the neck and throat. This can lead to restrictions in airflow as the upper respiratory system’s pathway is narrowed during sleep.
- With aging, the muscles start to lose their tone. The throat muscles become weaker and are likely to collapse in the airway during sleep.
- Consumption of alcohol also acts as a cause of OSA. The muscles relax enough to block the airway of the respiratory tract/tube.
- Smoke is an irritant to the lungs, throat, and windpipe. It can cause inflammation in the upper airways that can obstruct airflow.
CSA or Central Sleep Apnea
Unlike OSA, CSA does not physically block the upper airway. Central apnea occurs when the brain “forgets” to tell the body to breathe. It is caused by a malfunction in the brain’s respiratory center. Central sleep apnea is uncommon, occurring in 1% of the total population.
- Parkinson’s’ disease
- Narcotic painkillers
- Heart failure
- Medical conditions that affect the brain stem including brain infection and stroke
Complex or Mixed Sleep Apnea
Mixed sleep apnea is a combination of obstructive sleep apnea and central sleep apnea. Often the central apnea will occur first, followed by an obstructive apnea or hypopnea.
SYMPTOMS OF SLEEP APNEA:
- Stopping breathing or irregular breathing during sleep.
- Shortness of breath leading to awakenings
- Excessive daytime drowsiness
- Chronic fatigue
- Morning headaches
- Poor/Restless Sleep
- Difficulty in concentrating
- Mood changes
Sleep Apnea And Snoring: The Difference
Snoring usually occurs when the tissues of the throat relax. While breathing, these relaxed tissues vibrate and make a loud noise – the snore. But remember, not all people who snore have sleep apnea, though most people with sleep apnoea have snore. Snoring is a common symptom of sleep apnea, however, sleep apnea snoring is different from regular snoring.
Regular snoring partially blocks your airway but does not cause any significant breathing problems. Sleep apnea snoring is the result of a partial or full obstruction of the airway. These obstructions severely restrict or stop your breathing, starving your body of oxygen, hence can become a life-risk. They are called apneas and hypopneas.
What one must remember is that a person’s snoring cannot be judged by the person himself – rather, the concerned person’s partner is at a better position. Therefore, one must never shy from telling about the problems being faced and get diagnosed on time. As soon as the symptoms of apnea are visible, consult a disorder specialist!
DANGERS OF SLEEP APNEA:
Sleep is a critically important component of human existence. On an average, humans spend about 25%-35% of their lives sleeping. Sleep allows both the body and brain to rest and recovers from the stress of daily life. Troubles in sleeping can cause a range of health problems, and if left untreated, can cause death.
The prevalence in India is about 24 percent of men (mostly over 40 years) and 9 percent of women. As mentioned earlier, with age, the body’s muscle loses its tonality, especially among men with little physical activity. Growing obesity, changing lifestyle patterns, overeating, a sedentary life, smoking, consumption of alcohol causes, explains Vijay Krishnan P, Secretary of the Indian Association of Surgeons for Sleep Apnea (IASSA).
There is a suspicion that Indians are genetically predisposed to sleep apnea, doctors say. Obstructive sleep apnea (OSA) raises the risk of sudden cardiac death (SCD) by 300–400% depending on the severity of OSA.
Sleep Apnea And Hypertension:
Researchers believe that OSA can be recognized as a secondary cause of Hypertension as they have common pathogenic associations including hyperaldosteronism (a medical condition wherein too much aldosterone is produced by the adrenal glands), and obesity. OSA keeps blood pressure levels elevated at night, which increases the risk of Hypertension. Approximately 50% of patients with OSA have hypertension, compared with only 30% of the general public.
SLEEP APNEA TREATMENTS:
The first thing that a patient needs to do is to bring about behavioral and lifestyle modifications which include weight loss program, avoiding alcohol, sedatives, maintaining a healthy diet, use of a muscle relaxant, quitting smoking, and practicing yoga. These are the primary steps to treating Sleep Apnea. The secondary and major treatment procedures include:
- Continuous Positive Airway Pressure or CPAP
A CPAP device includes a breathing mask that sleep apnea sufferers wear when sleeping. Just enough air pressure is delivered through the mask in order to keep the muscles from collapsing in the airway. This muscle collapse can otherwise cause breathing cessation (stoppages) and snore. CPAP devices are effective in treating sleep apnea but do not cure the disorder.
- Bi-level Positive Airway Pressure or BiPAP
BiPAP is similar to CPAP, but it differs in the way it functions. It automatically adjusts the air pressure according to the patient’s need of inhalation (breathing in) and exhalation (breathing out). During inhalation, an electronic sensor tells the BiPAP to send more air through the mask to clear the apnea-causing obstruction. When the user exhales, the air pressure is reduced. This decrease is helpful for those patients who have a rough time in exhaling.
- Automatic Positive Airway Pressure or APAP
APAP machines automatically adjust the pressure using an algorithm. This algorithm senses when the muscles are about to collapse during sleeping and automatically adjust the air pressure to keep the airways open. The correct pressure for therapy is automatically calculated and also controls other factors like drinking alcohol. APAP machines may require visiting labs for adjustment.
- Oral Appliances (OA)
Most of these oral appliances are acrylic and fit completely inside the mouth. Some others help in adjusting the position of the lower jaw in order to prevent any blockages and are fitted around the head and chin of the patient. Two common oral devices are the ‘mandibular repositioning device’ and the ‘tongue retaining device’. These devices are only effective in cases of mild sleep apnea. Some troubling side effects include soreness, nausea and permanent change in the position of the lower jaw. It’s essential to get these devices fitted by a dentist specializing in sleep apnea and to see the dentist on a regular basis to monitor the issues faced.
- Surgical Treatments
Surgical treatment can be considered once a patient has failed the CPAP/BiPAP therapy. It is helpful in permanent correction of the anatomy of the patient and includes:
- Nasal Surgery: it is helpful in treating those patients that suffer from nasal obstructions and is only required to treat mild or moderate sleep apnea.
- Surgeries of the tongue: patients of sleep apnea might suffer from swollen basal tongue due to fat accumulation. The surgical removal of tongue base tissue creates an increase in the airway capacity in the area behind the tongue, thus, reducing sleep apnea.
- Craniofacial surgery: it is helpful in changing the palatial structure and advancement of the facial skeleton, which pulls the muscles and widens the airway.
- Uvulopalatopharyngoplasty (UPPP): this procedure involves the removal of the tonsils that might act as an obstruction in the airway.
What the patient needs to remember is that these surgeries can tamper with the structure of the palate, jaw, and head permanently and, thus, require careful judgment and decision-making.
You will find low-cost snoring aids on the market that may be worth trying. These provide an easy but effective means of reducing snoring, which in turn equates to quality sleep. The problem with some of these is they do not treat your sleep apnea permanently. Instead, they delay the disorder and provide aid in sleeping well. These aids include:
- Snoring Nose Vents
- Nasal Strips
- Acupressure Anti-Snore Device
- Snore Stopper and
- Nasal Dilators
The National Centre for Biotechnology Information (NCBI) has conducted a series of experiments on each of these aids. It has concluded that these aids were effective for patients due to the fact that nasal obstruction was the contributing factor in causing their sleep apnea. Nevertheless, it is important to have snoring and possible sleep apnea evaluated by a medical professional.
Your physician might request a sleep study, which will let him know your respiratory disturbance index (RDI), among other things. When left untreated, sleep apnea places the patient at a higher risk of developing life-threatening illnesses and mortality.
OVERVIEW OF TREATMENTS:
Choosing the right therapy should be part of a careful discussion that includes the advice of your sleep physician and other specialists, such as surgeons, sleep-certified dentists, and others. Considerations besides effectiveness and comfort when choosing from these alternatives should include risk-benefit considerations, overall costs, your qualifications as a patient, how choosing these options could impact your activities of daily living, and the availability of these treatments in your area.
All patients should opt the CPAP or APAP therapy in the beginning. These are the best treatment procedures and do not, in any way, alter the anatomy of the patient. If these therapies fail, in case of severe apnea, then the patient must be introduced to Oral Appliances (OAs). At times, Oral Appliances (OAs) is rejected by the body of the patient in severe cases and must resort to the surgical procedure.
All interventions to improve tolerance of CPAP/APAP/BiPAP therapy should be attempted prior to deciding that treatment has failed in a particular patient. OAs may be considered first-line therapy for patients with mild OSA, only if they are unwilling to try nasal CPAP/APAP/BiPAP therapy.
Patients should opt surgical options.in whom non-invasive medical therapy (e.g., CPAP, BiPAP, OAs) fails. Patients should be made aware of the success rates for each surgical procedure. They should be informed that they might require more than one surgical procedure, some fairly extensive, to cure OSA.
Sleep apnea is a common disorder and should not be overlooked in any case. It requires care and proper treatment. Start by modifications in your lifestyle and it might never come to the surgical option. What one needs to remember is that it should be treated before it worsens, for it can cause the patient’s life!