Are You at Risk for Sleep Apnea?

Sleep apnea is a serious sleep disorder that occurs when a person’s breathing is interrupted repeatedly, sometimes hundreds of times, during sleep. There are two types of sleep apnea: obstructive and central.

Obstructive sleep apnea is the most common type of sleep apnea, and occurs when airflow is blocked, usually when the soft tissue in the back of the throat collapses during sleep and air can’t enter the lungs.

According to Dr. Abid Malik, Director for Orlando Health Sleep Medicine, “Obstructive sleep apnea is an often under-recognized diagnosis. There is a need to create awareness about this sleep disorder, which not only affects multiple organ systems, but is treatable.

Who is at risk for obstructive sleep apnea?

Obstructive sleep apnea occurs when there is a physical blockage in the airway. Some of the greatest contributing factors include:

• Being overweight
• Large or thick neck
• Small airways in the nose, throat or mouth
• Swollen or enlarged tonsils (common in children)
• Large tongue

More than 12 million people in the United States have sleep apnea, and of that total, more than half are overweight. It is most common in men of African American, Hispanic, or Pacific Islander descent. Women can also develop obstructive sleep apnea, but usually after menopause. As a person ages, their risk of developing obstructive sleep apnea increases.

Putting on weight increases the tendency for the airway to collapse, however, reasons for such events are not completely known. It could be because fat can accumulate in the tissues surrounding the airway, just as fat accumulates in other parts of the body. This accumulation of fat can change the shape of the airway, rendering it more likely to collapse.

Other risk factors for obstructive sleep apnea include: smoking, high blood pressure and having any of the risk factors associated with heart failure or stroke.

What are the symptoms?

During sleep, muscles throughout the body relax. In normal people, the airway stays open, even when the airway muscles relax. In people with obstructive sleep apnea, however, the airway collapses, or is close to collapsing, when airway muscles relax.

The distress caused by reduced airflow is similar to being choked. This distress awakens the brain, which turns on the airway muscles, permitting normal airflow to occur and ending the distress. Often, the brain will fall right back asleep and there is no memory of the event itself, which is why people with obstructive sleep apnea rarely know they have it. It is not uncommon for a partner to recognize it first. Symptoms include:

• Daytime sleepiness or fatigue
• Difficulty getting up in the mornings
• Dry mouth or sore throat upon awakening
• Headaches in the morning
• Signs of sleep deprivation: trouble concentrating, forgetfulness, depression, or irritability
• Night sweats
• Restlessness during sleep
• Sexual dysfunction
• Snoring
• Sudden awakenings with a sensation of gasping or choking

What conservative treatments are available?

• In overweight individuals, the number one treatment is weight loss. Studies have shown that even a 10 percent weight loss can reduce the number of sleep apnea events for most overweight patients.
• It is important to avoid alcohol or sleeping pills. For those suffering from sleep deprivation, these might seem like a good way to get a good night’s rest, but it’s quite the contrary. Alcohol and sleeping medications relax the body, including the airways, which doesn’t only cause sleep apnea episodes to be more frequent, they can also prolong the interruptions.
• Many people with mild sleep apnea only have interruptions when they sleep on their backs. In this case, there are specially designed pillows and other devices that encourage side sleeping positions.
• In people suffering from sleep apnea due to nasal congestion or allergies, trying nasal sprays or allergy medication can help prevent snoring and improve airflow for more comfortable breathing.

What other treatments are used?

Mechanical therapy –continuous positive airway pressure (CPAP) is the preferred initial treatment for most people with obstructive sleep apnea (when conservative treatments don’t work). Patients wear a mask over their nose and/or mouth and an air blower forces air through the airways.

Mandibular advancement devices – sometimes, dental appliances or oral devices can be used to prevent the tongue from blocking the throat and/or advance the lower jaw forward.

Somnoplasty – a minimally invasive procedure that uses radiofrequency energy to tighten the soft palate at the back of the throat.

UPPP or UP3 (uvulopalatopharyngoplasty) – this procedure removes soft tissue in the back of the throat and palate, which increases the size of the airway.

Mandibular/maxillary advancement surgery - surgically moving the jawbone and face bones forward can make more room in the back of the throat. This procedure is complex and generally reserved for patients with severe sleep apnea and head or face abnormalities.

Nasal surgery – surgical correction of nasal obstructions, such as a deviated septum, can alleviate symptoms of OSV.

Central sleep apnea

Unlike obstructive sleep apnea, where the air passage is physically compromised or blocked during sleep, central sleep apnea is a disorder of the brain, and much less common.

If you think you may be at risk for sleep apnea, or are showing signs of this particular sleep disorder, discuss with your doctor the best next steps in getting the treatment you need.

For more information, please visit the Orlando Health Pulmonary and Sleep Medicine Specialists.