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Sleep Apnea (Breathing Problems when Asleep)

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Sleep apnea is a condition that can affect any person but is more commonly seen in middle aged adults and seniors. It is a sleep disorder characterized by episodes of very slow breathing, or paused or stopped breathing during sleep. The condition can have serious consequences on a person’s health and even contribute to death in the long term. Sleep apnea can be of two types – obstructive and central. Obstructive sleep apnea, in which throat muscles relax and obstruct the upper airway (nose, throat and pharynx). It is more common in men and in obese people. Central sleep apnea, where changes in brain result in loss of control on breathing patterns. It is less commonly seen.

Symptoms of Sleep Apnea

Obstructive and central sleep apnea present with these common symptoms :

  • Restless sleep
  • Excessive daytime sleepiness or drowsiness
  • Fatigue
  • Morning headaches

Apart from these, the more specific symptoms of the two types include the following:

  • Obstructive sleep apnea: Snoring, frequent awakening with gasping, or choking, and difficulty staying awake. Symptoms often noticed by partner.
  • Central sleep apnea: Abrupt awakening, shallow breath, and long pauses in breathing.

Sleep Apnea Causes and Risks

Muscles of the throat support the soft palate, the uvula (the triangular tissue hanging from the soft palate at the back of the throat), the tonsils, and the tongue. If throat muscles relax, these tissues obstruct the airway and result in obstructive sleep apnea. Due to inadequate oxygen entering the lungs, the level of oxygen in the blood drops. The brain senses this drop and leads to a brief awakening, in which allows for the airways to re-open.

However, in case of central sleep apnea, the brain is unable to control the muscles involved in breathing. This results in awakening with shortness of breath. It also causes difficulty sleeping and staying asleep. A heart failure or a stroke may also result in central sleep apnea.

  • Sleep apnea is more common in obese people, or in people with a thick neck, a narrow airway, swollen tonsils or adenoids.
  • Sleep apnea affects males and elderly more.
  • Use of alcohol also relaxes the muscles in the throat.
  • Sleep apnea is more common in smokers, as smoking increases inflammation and fluid retention in the upper airway.

Treatment of Sleep Apnea

Sleep apnea may lead to complications like high blood pressure, stroke, or heart problems. It also causes daytime fatigue, memory problems, mood swings, and morning headaches.

Obstructive sleep apnea

  • A device called a continuous positive airway pressure (CPAP) keeps airway open by delivering air through a mask placed over the nose while sleeping. The open airway would prevent apnea and snoring. Although effective, a CPAP may be uncomfortable to use.
  • A bilevel positive airway pressure (BPAP) device automatically adjusts the pressure while sleeping.
  • Expiratory positive airway pressure (EPAP) device has a valve for incoming air and small holes for exhaled air. Thus it increases pressure in the airway and keeps it open.
  • Some dental appliances may also be worn to keep the throat open.
  • Surgery is recommended in rare cases, when other treatment options fail. Surgical options may include removal of uvula (uvulopalatopharyngoplasty), tonsils, and adenoids, nasal polyps; repositioning of jaws (maxillomandibular advancement), and insertion of implants in soft palate.

Central sleep apnea

  • Treating underlying heart or neuromuscular disorders.
  • Using supplemental oxygen, CPAP, BPAP while sleeping.
  • Avoiding alcohol, opioids, and other sedatives.

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