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Obstructive sleep apnea is a common and serious sleep disorder that causes you to stop breathing during sleep. The airway repeatedly becomes blocked, limiting the amount of air that reaches your lungs. When this happens, you may snore loudly or making choking noises as you try to breathe. Your brain and body becomes oxygen deprived and you may wake up. This may happen a few times a night, or in more severe cases, several hundred times a night.
In many cases, an apnea, or temporary pause in breathing, is caused by the tissue in the back of the throat collapsing. The muscles of the upper airway relax when you fall asleep. If you sleep on your back, gravity can cause the tongue to fall back. This narrows the airway, which reduces the amount of air that can reach your lungs. The narrowed airway causes snoring by making the tissue in back of the throat vibrate as you breathe.
Sleep apnea can make you wake up in the morning feeling tired or unrefreshed even though you have had a full night of sleep. During the day, you may feel fatigued, have difficulty concentrating or you may even unintentionally fall asleep. This is because your body is waking up numerous times throughout the night, even though you might not be conscious of each awakening.
The lack of oxygen your body receives can have negative long-term consequences for your health. This includes:
- High blood pressure
- Heart disease
- Pre-diabetes and diabetes
There are many people with sleep apnea who have not been diagnosed or received treatment. A sleep medicine physician can diagnose obstructive sleep apnea using an in-lab sleep study or a home sleep test. Sleep apnea is manageable using Continuous Positive Airway Pressure (CPAP), the front-line treatment for sleep apnea, oral appliance therapy or surgery.
Obstructive sleep apnea in adults is considered a sleep-related breathing disorder. Causes and symptoms differ for Obstructive Sleep Apnea in Children, and Central Sleep Apnea.
The symptom most commonly associated with sleep apnea is snoring. Not everyone who snores has sleep apnea. If snoring is paired with choking or gasping sounds, it is likely to be sleep apnea.
Daytime fatigue is another common symptom.
The symptoms of sleep apnea include:
- Loud or frequent snoring
- Choking or gasping while you sleep
- Pauses in breathing
- Morning headaches
- Excessive daytime sleepiness
- Insomnia due to difficulty staying asleep
- Waking up with dry mouth or a sore throat
- Frequent need to urinate during the night
- Trouble concentrating
- Memory or learning problems
- Moodiness, irritability or depression
A common misconception is that sleep apnea only affects older, overweight men. This widely-held assumption is wrong: anyone can have sleep apnea, regardless of gender, age or body type. If you have any of the following traits you may be at increase risk:
- Excess weight – An adult with a BMI of 25 or higher is considered to be overweight. Your risk of sleep apnea increases with the amount of excess body weight.
- Large neck size (>17 inches for men, > 16 inches for women) – A large neck will have more fatty tissue that can block your airway.
- Older age (40+ for men, 50+ for women) – Sleep apnea occurs more often in older adults, especially people older than 60.
- Being male – Men have twice the risk having sleep apnea compared to women
- Smoker – Smokers have a higher risk of sleep apnea
- Hypertensive – High blood pressure is very common in people with sleep apnea
- Family history – Sleep apnea can appear more often among family members. This may be a result of either inherited traits or common lifestyles.
If you answered yes to one or more of the questions below you are at risk for sleep apnea:
1. Do you experience any of these problems?
- Unintentionally falling asleep during the day
- General daytime sleepiness
- Unrefreshing sleep
2. Do you ever wake from sleep with a choking sound or gasping for breath?
3. Has your bed partner noticed that you snore loudly or stop breathing while you sleep?
Other questions you can ask yourself to determine if you are at higher risk for sleep apnea include:
- Have you ever nodded off or fallen asleep while driving?
- Do you often wake up with a headache?
- Do you have a neck size of 17 inches or more?
- Do you have a body mass index (BMI) of 25 or higher?
- Do you have high blood pressure?
- Do you have a family member who has sleep apnea?
The Epworth Sleepiness Scale is often used tell if you have daytime fatigue, a symptom of sleep apnea.
A board certified sleep medicine physician can diagnose obstructive sleep apnea using a home sleep test. A board-certified sleep physician has training and expertise in diagnosing and treating sleep apnea.
The physician will need to know your symptoms, and whether they began when you gained weight or stopped exercising. If you can, ask a partner or roommate or relative if they have ever heard you snore loudly or make choking noises in your sleep.
You may also need to keep a sleep diary for two weeks. This includes information about what time you went to bed each night, when you woke up in the morning and how many times you woke up each night. This will help the doctor see your sleep patterns, which could contain clues about how to diagnose and correct your sleep problem.
A sleep medicine physician will also try to determine if there is something else that is causing your sleep problems or making the symptoms worse, such as:
- Another sleep disorder
- A medical condition
- Medication use
- A mental health disorder
- Substance abuse
During your next visit, you will receive your sleep test. Polysomnographic testing is used to help the board certified sleep physician evaluate your problem. This may include:
In-lab overnight sleep study
This type of sleep study requires you to stay overnight at a sleep center, in a bed that may resemble a hotel room, or in some cases is an actual hotel room. You will sleep with sensors hooked up to various parts of your body. These record your brain waves, heartbeat, and breathing among other things. Physicians usually recommend this test for more complicated or difficult to diagnose cases, as it is more expensive and requires you to stay overnight. Learn more about an overnight sleep study.
Home sleep test
Some patients with high risk factors for obstructive sleep apnea and no other medical disorders may be appropriate for a home sleep test. This type of sleep study lets you sleep in the comfort of your own home while a machine collects information. The testing equipment differs in that it is less complicated than what is used in an overnight sleep study. A staff member will show you how to hook up the testing equipment yourself. Once you are finished, you can take the device back to the sleep center or send it by mail.
While there are other types of screenings that claim to detect sleep apnea none can accurately detect and diagnose sleep apnea. Beware of apps or other devices that have not been recommended by your sleep medicine physician.
Once you finished your sleep test, a sleep medicine physician will schedule a follow-up appointment to discuss your diagnosis. If you are diagnosed with sleep apnea, your physician will discuss your treatment options with you.
Sleep apnea is a serious sleep disorder that needs to be treated. A board certified sleep physician can help you select a treatment plan that is right for you. Depending on the treatment, he or she may work in collaboration with other members of the sleep team, including dentists, psychologists, physician assistants, nurses and technologists. Your plan may include any combination of these treatments:
CPAP (Continuous Positive Airway Pressure)
CPAP is a machine that uses a steady stream of air to gently keep your airway open throughout the night so you are able to breathe. You sleep with a mask with a hose that is attached to a machine kept at the bedside. Masks and machines may vary depending on your treatment and comfort needs. CPAP is the frontline treatment for obstructive sleep apnea and is recommended for all cases.
Oral Appliance Therapy
An oral appliance is a device that fits in your mouth over your teeth while you sleep. It may resemble a sports mouth guard or an orthodontic retainer. The device prevents the airway from collapsing by holding the tongue in position or by sliding your jaw forward so that you can breathe when you are asleep. Some patients prefer sleeping with an oral appliance to a CPAP machine. A dentist trained in dental sleep medicine can fit you with an oral appliance after you are diagnosed with sleep apnea. Oral appliance therapy is recommended for patients with mild to moderate apnea who cannot tolerate CPAP.
Surgical therapies are not as effective in treating sleep apnea as CPAP and oral appliances. There are a variety of surgical options you can elect to have if CPAP or oral appliance therapy does not work for you. The most common options reduce or eliminate the extra tissue in your throat that collapses and blocks your airway during sleep. More complex procedures can adjust your bone structures including the jaw, nose and facial bones. Weight loss surgery may also be an option. Talk to your sleep medicine physician about what surgery is right for you.
In some cases weight loss can help improve or eliminate your sleep apnea symptoms if you are overweight or obese. Overweight people often have thick necks with extra tissue in the throat that may block the airway. There is no guarantee that losing weight will eliminate your sleep apnea, though it may help. This approach is unlikely to make a difference in patients with a narrow nasal passage or airway.
Positional therapy is a behavioral strategy to treat positional sleep apnea. Some people have sleep apnea primarily when sleeping on their back. This is called the “supine” position. Their breathing returns to normal when they sleep on their side. Positional therapy may involve wearing a special device around your waist or back. It keeps you sleeping in the side position. Another option is a small device that uses “vibro-tactile feedback” technology. Worn on the back of the neck, it gently vibrates when you start to sleep on your back. Without waking you up, the vibration alerts your body to change positions. Positional therapy can be used alone or together with another sleep apnea treatment.
There are a variety of lifestyle changes that you can make to help you reduce your snoring and improve your sleep apnea symptoms. Behavioral changes such as quitting smoking or not drinking alcohol may improve sleep apnea symptoms. Alcohol relaxes your throat muscles which can cause you to snore or for your airway to collapse. If you have allergies, taking a decongestant before you go to bed may help improve airflow through your nose.
If you have difficult staying with your treatment plan or cannot sleep even with treatment, your doctor may recommend Cognitive Behavioral Therapy. A behavioral sleep specialist will help you eliminate the thoughts and behaviors that are preventing you from getting restful sleep or complying with your treatment.
If you think you may have sleep apnea,find a Board Certified Sleep Physician.