Sleep Apnea: Symptoms, Causes and Treatment

Sleep apnea stops your breathing while you’re asleep, prompting your brain to wake you up slightly to start breathing again. But this interrupts good sleep, causing potential health issues over time.

The two main types are obstructive sleep apnea (airway gets blocked during sleep) and central sleep apnea (communication problem between brain and breathing muscles).

These interruptions harm sleep quality and, if untreated, can lead to serious health problems. But managing it with prescribed treatments can make a big difference.

What is Sleep Apnea?

Sleep apnea is a sleep problem where your breathing acts up while you’re asleep. It’s grouped under sleep-related breathing disorders and happens when your breathing pauses. There are two main types:

  1. Obstructive Sleep Apnea (OSA): This happens when your throat muscles relax during sleep and block your airway, causing pauses in breathing.

  2. Central Sleep Apnea (CSA): Here, your brain doesn’t send the right signals to control breathing while you sleep.

When breathing pauses, your body’s survival mode kicks in, waking you up slightly so you start breathing again. This interrupts your sleep cycle, preventing restful sleep and can stress your heart, which isn’t good in the long run.

If someone has OSA and starts therapy, sometimes it can switch to CSA, called treatment-emergent central sleep apnea or complex sleep apnea.

It’s important to address sleep apnea since it can impact your health, especially your heart, due to disrupted sleep and lowered oxygen levels.

Symptoms of Sleep Apnea

Symptoms of obstructive and central sleep apneas can be similar, which can make it tricky to figure out which type you might have.

Some common symptoms of obstructive sleep apnea include:

  • Feeling very tired during the day
  • Loud snoring with gasping or choking sounds
  • Restless sleep, waking up often at night
  • Morning headaches that last a while
  • Waking up with a dry mouth
  • Needing to urinate frequently at night
  • Feeling easily irritated or frustrated
  • Having trouble staying focused

Sometimes, people with this type might not notice their own snoring or breathing problems until someone else points it out.

Here are the main symptoms linked with central sleep apnea:

  • Breathing irregularities during sleep, like pauses or changes in speed
  • Waking up during the night
  • Morning headaches
  • Feeling very tired during the day
  • Suddenly feeling out of breath or having chest pains at night
  • Trouble staying focused

Similar to obstructive sleep apnea, people with central sleep apnea might not realize their breathing issues unless someone else notices or they have a caregiver who points it out.

Causes of Sleep Apnea

The causes for breathing problems is different in obstructive sleep apnea compared to central sleep apnea.

Causes of Obstructive Sleep Apnea

Obstructive Sleep Apnea is caused by relaxed throat muscles. These muscles support various parts like the soft palate, uvula (the dangly tissue), tonsils, throat walls, and the tongue.

When these muscles relax, the airway gets narrower, leading to snoring. But when the airway is completely blocked, it disrupts oxygen flow, causing brief awakenings to restore normal breathing.

During this, you might make snorting, choking, or gasping sounds. This cycle can happen frequently throughout the night, from 5 to over 30 times an hour. It makes it tough to achieve deep, restful sleep.

Causes of Central Sleep Apnea

Central Sleep Apnea (CSA) is less common and happens when your brain doesn’t signal your breathing muscles properly. In CSA, the brain stem, responsible for monitoring carbon dioxide levels during sleep, doesn’t work as it should. This can cause you to wake up feeling short of breath or make it hard to fall asleep or stay asleep.

Risk factors

Sleep apnea can impact anyone, including kids. However, some factors make it more likely for you to experience it.

Obstructive sleep apnea

Factors that raise the risk of obstructive sleep apnea (OSA) include:

  • Extra weight: Being overweight increases the chances. Fat around the airway can block breathing.
  • Age: Older adults are more likely to experience sleep apnea.
  • Being male: Men are more prone, but overweight women or those in menopause also have higher risk.
  • Neck size: A thicker neck might mean a narrower airway.
  • Narrow airway: Inherited narrow throat or enlarged tonsils/adenoids, especially in kids.
  • Family history: Having family members with sleep apnea can up your risk.
  • Substances: Alcohol, sedatives, or tranquilizers relax throat muscles, worsening OSA.
  • Smoking: Smokers are three times more likely to have OSA due to throat inflammation and fluid retention.
  • Nasal issues: Trouble breathing through the nose, whether from allergies or anatomical problems, increases the risk.
  • Medical conditions: Congestive heart failure, high blood pressure, type 2 diabetes, polycystic ovary syndrome, hormonal disorders, prior stroke, and chronic lung diseases like asthma can all raise the risk of OSA.

Central sleep apnea

Central sleep apnea usually happens because of other health issues, like brain stem problems, heart or kidney failure, stroke, or excessive growth hormone production. Some factors can increase the chances of having this type of sleep apnea:

  • Age: People over 65 have a higher chance of having trouble breathing while sleeping, which is linked to central sleep apnea.
  • Gender: It’s more common in men or people assigned male at birth, which might be connected to certain hormones.
  • Medications: Long-term use of opioid drugs or some prescription meds can affect breathing and increase the risk of central sleep apnea.
  • High Altitude: Being at high altitudes where there’s less oxygen can also be linked to central sleep apnea because of the lower oxygen levels there.

How is Sleep Apnea Diagnosed?

Your doctor will first check for other possible causes of your symptoms before confirming sleep apnea. They’ll:

  • Ask about medications you take, like opioids, that might affect sleep
  • Explore other medical reasons or conditions causing your symptoms
  • Inquire about recent travel to high-altitude areas, as low oxygen there could mimic sleep apnea for a few weeks

Several things help diagnose sleep apnea:

  1. Medical History: Your doctor will consider your signs, symptoms, family history of sleep disorders, risk factors, and related complications (like heart issues or diabetes).

  2. Physical Exam: They’ll check for obesity, airway narrowing, large tonsils, neck size, and jaw and tongue structure, while also examining your heart, lungs, and nervous system for related problems.

  3. Sleep Studies: These tests, done at a specialized facility or home, detect sleep events linked to apnea, muscle activity, blood oxygen levels, and monitor heart/brain activity.

Based on sleep test results, doctors diagnose:

  • Mild (5-14 events/hour)
  • Moderate (15-29 events/hour)
  • Severe (30+ events/hour) sleep apnea.

Additional tests may be ordered to explore underlying medical conditions. Blood tests check hormone levels for endocrine disorders, and a pelvic ultrasound might identify issues like PCOS by examining the ovaries.

Learn more: At-Home Sleep Apnea Tests

Sleep Apnea Complications

Sleep apnea, if untreated, can cause serious health problems. It messes with sleep quality and lowers oxygen levels in your body. This can lead to:

  • Daytime fatigue: You might wake up often, making it hard to sleep well. This can make you feel tired and moody during the day, increasing the chances of accidents at work or while driving.
  • Mood issues: Irritability and a higher risk of depression can be linked to sleep apnea.
  • Heart problems: The drop in oxygen levels during sleep strains your heart and can lead to high blood pressure, heart attacks, strokes, or irregular heartbeats.
  • Type 2 diabetes: Sleep apnea might make you more likely to develop insulin resistance and type 2 diabetes.
  • Metabolic syndrome: This includes high blood pressure, abnormal cholesterol, high blood sugar, and a larger waistline, raising the risk of heart disease.
  • Liver complications: Abnormal liver tests and scarring are more common in those with sleep apnea.
  • Pulmonary hypertension: High blood pressure in the lung arteries puts extra stress on the heart.
  • Medication and surgery issues: Breathing problems during anesthesia or lying on your back can occur due to sleep apnea.

Central sleep apnea’s complications depend on the underlying medical issue causing the breathing problems.

Treatments for Sleep Apnea

The aim of treating sleep apnea is to lessen breathing problems and enhance sleep. The way we treat it depends on whether it’s obstructive sleep apnea or central sleep apnea.

Treatments for Obstructive Sleep Apnea

Most people with obstructive sleep apnea get treated with something called positive airway pressure (PAP) therapy. This involves using a machine that pumps air through a mask worn on the face to keep the airway open while sleeping.

There are different types of PAP therapy. One is CPAP, where the air pressure stays steady. Others like BiPAP and APAP can change the air pressure levels.

Some people with milder cases might use mouthpieces to adjust their jaw or tongue position while sleeping. These don’t work as well as PAP therapy but can help with snoring and might suit those uncomfortable with PAP devices. There are also some anti-snoring devices you may try.

In certain cases, surgery can help. It might involve removing throat tissue or using an implanted device to stimulate a breathing-controlling nerve.

Lifestyle changes can also make a big difference, like losing weight, exercising regularly (which can help even without weight loss), avoiding sleeping on your back, and cutting down on alcohol.

Treatments for Central Sleep Apnea

When someone has central sleep apnea, treating the main health issue causing the breathing problem is key. If it’s not too bad, fixing that issue might be enough. But if the problems stick around or get really bad, they might suggest extra treatments to help with breathing and tackle the root problem.

They might use devices like PAP machines to keep breathing steady during sleep. Other options could be giving extra oxygen or using medicine to help breathe faster.

Living with Sleep Apnea

People with sleep apnea can take practical steps to manage the condition and its health effects.

  • Talk to Your Doctor: If you’re having trouble using your PAP device for sleep apnea, speak with your primary doctor. They can help fix issues with the mask or settings so you can sleep better.

  • Take Care of Your Devices: Whether you use a PAP machine or a mouthpiece, keeping them clean helps the treatment work well and avoids problems.

  • Avoid High-Risk Activities: If you’re tired during the day because of sleep apnea, avoid doing risky things like driving or using heavy machines.

  • Change How You Sleep: Some special products might help if you try not to sleep on your back. They could make your sleep apnea symptoms better.

  • Cut Down on Alcohol: Drinking less alcohol can be part of treating sleep apnea. Even drinking during the day can make breathing problems worse at night.

  • Keep Up with Check-ups: It’s important to see your doctor as they recommend. Regular visits early on can make sure your treatment is working well.

Need professional help to diagnose and address your sleep problems? Schedule an online consultation with sleep specialist Dr. John Williams.

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