Sleep apnea literally means sleeping without breath. The condition is as common as adult diabetes and affects more than 12 million Americans. Three types of apnea include central, obstructive and mixed. A person who suffers from sleep apnea will repeatedly cease breathing during their sleep, rousing briefly to start breathing again.
This pattern of difficulty breathing leads to lower oxygen in the blood, a higher amount of carbon dioxide, fragmented sleep, and contributes to other health issues, including headaches, obesity, and more.
Overweight men, over the age of 40 are at the highest risk for sleep apnea, but it can affect anyone including children. In children, the condition may be treated by removing the tonsils and adenoids. Many who suffer from sleep apnea go undiagnosed due to a lack of awareness by many healthcare professionals and general knowledge with regard to the sleep disorder.
Obstructive Sleep Apnea: Causes, Symptoms & Treatment
Obstructive sleep apnea is related to enlarged tissue in the throat area. The enlarged area of soft tissue collapses, blocking the passage of air through the throat. Some physicians suggest that losing weight may alleviate some of the issues associated with too much tissue and that surgery to remove excess tissue may be an option if more non-invasive methods are unsuccessful in treating sleep apnea.
Weight and Obstructive Sleep Apnea
Obesity is a lot more than just an issue for aesthetic reasons. In adults, excess weight is considered the strongest predictor of OSA (Obstructive Sleep Apnea). Those with BMI levels between 25 - 30 and above.
The more you weigh, the higher your chances of developing sleep apnea. Every BMI unit increase comes with a 14% increased risk for OSA, and a 10% increase in weight increases the odds of getting OSA by seven times. However, the impacts of BMI become less significant to obstructive sleep apnea after the age of 60.
Demographics & Obstructive Sleep Apnea
Obstructive sleep apnea (OSA) is a highly prevalent chronic respiratory condition. Global estimates suggest that almost 1 billion people aged 30-69 years have OSA, with 425 million having moderate to severe disease. Around 28 percent of men and 37% of women are affected by sleep apnea. Meaning, more than 4 out of 10 adults will experience an episode in their lifetime.
Complications Related to Obstructive Sleep Apnea
Untreated sleep apnea can increase the likelihood that a patient will have a heart attack, diabetes, heart failure, hypothyroidism, gastroesophageal reflux disease, high blood pressure (hypertension), stroke, nocturnal angina, and an abnormal heart rhythm. About half of sleep apnea patients have hypertension, and untreated obstructive sleep apnea increases the risk of heart-related illness and death.
Other Risk Factors for Obstructive Sleep Apnea
It's possible to suffer from sleep apnea for an extended time and never suspect you have the condition. Mostly, patients suffering from obstructive sleep apnea are usually not the ones who notice its signs. The person sleeping next to the patient or within the room often notices it first. Many people with OSA may not even complain about having any problem with sleeping.
Here is a complete list of symptoms that are primarily noticed in middle-aged people and the elderly suffering from obstructive sleep apnea:
- A sore throat or dry mouth upon waking up after sleep
- Morning headaches right after waking up
- Night excessive sweating
- Difficulty in waking up in the morning
- Sleepiness during daytime or fatigue
- Restlessness during sleeping
- Loud or excessive snoring
- Sensation with sudden awakenings due to gasping or choking-like feelings
- Intellectual impairment like irritability, forgetfulness, etc.
- Lack of concentration and a drop in performance at work, school etc.
- Feelings of depression and also mood swings
- Not feeling fresh upon waking
- Insomnia – Difficulty falling asleep
- Mood swings
- Sexual dysfunction
In children, the symptoms of obstructive sleep apnea include snoring loudly, being constantly tired in school, during the day or at night, and snoring while awake as well. Other OSA symptoms found in children that may not be as obvious as that of adults include:
- Difficulty in swallowing
- Too much sweating during sleeping
- Bedwetting
- Unusual sleeping positions – with neck hyper-extended, sleeping on knees and hands.
- Behavioural disorders
- Difficulty in concentrating and learning causing poor performance
- Grinding of teeth
- Repeated pauses in breathing
- Daytime mouth breathing
- Sleepiness or sluggishness
- Drooling or choking
- An inward motion of the ribcage when inhaling
It is complicated to diagnose OSA because some of the symptoms do not automatically translate to a sleep disorder. The best way to proceed is to speak with your doctor if you suspect you have some of these common sleep apnea symptoms.
What is the Treatment for Obstructive Sleep Apnea?
The treatment for OSA include:
- Mouth and Throat Exercises
- Reduce alcohol consumption & Stop smoking
- Change sleep position
- Weight loss
- Boosting your vitamins
We've discussed in detail all the sleep apnea treatments here.
Central Sleep Apnea: Causes, Symptoms, Dangers & Treatment
Central sleep apnea is distinct because it is neurologically based. The brain fails to send the correct messages to the muscles that control a person’s breathing. CSA is also related to stroke, brain injury, encephalitis, neurological diseases (Alzheimer’s, Parkinson’s), cervical spine damage, or complications from surgery.
Prominent Causes & Types of Central Sleep Apnea:
Cheyne-Stokes breathing.
In Cheyne-Stokes breathing, your breathing speeds up and slows down before stopping for short periods, starting again; this can happen in cycles lasting 30 seconds to 2 minutes each time. It's common among people with heart failure or stroke because it occurs in about half the cases with central sleep apnea.
Narcotic-induced central sleep apnea.
The use of narcotic-induced central sleep apnea has been on the rise in recent years due to prescription opioid medications such as morphine and Oxycontin that are designed for pain relief and symptoms of nervousness or anxiety. However, one of the main side effects is that they produce drowsiness during their effects phase, which can cause a person’s breathing pattern to change.
The constant use of narcotics eventually diminishes the brain's ability to initiate and regulate breathing properly. This can harm your health by suppressing the respiratory system leading to central sleep apnea.
High-altitude Induced Periodic Breathing
A person may experience altitude-induced periodic breathing if they are at a high elevation. This type of sleep apnea occurs because of the lower concentration of oxygen in higher altitudes. As the individual ascends, the condition causes the breathing to become faster and deeper to compensate for the lower oxygen levels in the air. The aberrant pacing and control of respiration can cause pauses during breathing while sleeping.
Treatment-Emergent Central Sleep Apnea
Formerly known as complex sleep apnea, treatment-emergent sleep disorder is a type of Central Sleep Apnea that starts to occur after someone begins continuous positive airway pressure (CPAP) treatment for Obstructive Sleep Apnea. In most cases, this version of sleep apnea eventually resolves on its own.
Idiopathic Central Sleep Apnea:
Idiopathic sleep apnea is a rare disorder with an unclear etiology. In most cases, this diagnosis of exclusion sleep apnea occurs among older males, who are the only ones to display symptoms and have difficulty breathing while they're asleep. It's often cited as one of three forms that occur without readily identifiable explanations; it has been observed in many people but not studied rigorously enough for scientists to establish its cause definitively yet (though some doctors suspect genetics).
Central Sleep Apnea Symptoms
Snoring is an indication of some degree of obstruction in the airways. However, people with obstructive sleep apnea will experience more prominent sounds than those with CSA because their lower airways are more blocked. In contrast, someone experiencing CSA would only have one side obstructed, which might result in less audible sound or none at all.
Other CSA Symptoms:
- Experiencing frequent episodes of stopped or short breaths that might cause you to wake up.
- Insomnia – Difficulty falling asleep.
- Excessive daytime sleepiness (hypersomnia).
- Chest pain at night & Morning headaches.
- Shortness of breath that's usually relieved by sitting up.
- Difficulty concentrating & mood changes.
- Lower exercise for tolerance.
- Snoring.
Central Sleep Apnea Risk Factors
Anyone can suffer from CSA, but it is most prevalent in seniors over the age of 65 and often live with other illnesses like diabetes or heart disease. The chances for developing CSA are much higher in the elderly than in others. Also, men are usually at a higher risk of both central and obstructive sleep apnea.
Significant conditions that may be linked to this sleep disorder include:
- Hypothyroid disease.
- Congestive heart failure.
- Kidney failure.
- Neurological diseases, such as Alzheimer's disease, Parkinson's disease, and amyotrophic lateral sclerosis (ALS or Lou Gehrig's disease).
- Brainstem damage from swelling (encephalitis), stroke, or injury.
Treatment for Central Sleep Apnea.
The treatment might be different for each person depending on the underlying cause of their sleep apnea condition. Some general home treatments include:
- Keeping a healthy weight.
- Continuous positive airway pressure
- Anti snoring mouthguards and mouthpieces
- Use nasal sprays or breathing strips to keep air flowing.
- Get plenty of sleep.
You can read more about the best Central Sleep Apnea treatment suitable for your condition here.
How Do I Know I Have Sleep Apnea?
You might be living with obstructive sleep apnea and not even know it. The condition manifests while you're sleeping, so unless you are conscious of the effects when waking up, there's no way to tell if you experience this ailment too.
If you or your partner suspects you have some of the symptoms associated with sleep apnea, then a medical diagnosis from a qualified doctor is the best way to be sure. There are different tests and diagnoses that doctors use to check if you have sleep apnea. You can read more about them in our recent article covering all the basics you need to know about OSA & CSA.
Getting Help For Sleep Apnea
While sleep apnea can be treated, knowing whether the problem is physical (obstructive) or neurological (central), or a combination (mixed) can help a physician diagnose and treat the root causes as well as the actual apnea. If you or someone you care about suspects that you have sleep apnea symptoms, you should see your physician for an accurate diagnosis and treatment.
Dangers Of Sleep Apnea: FAQ's Answered.
What Causes Sleep Apnea?
In central sleep apnea, the brain fails to send the signal to the muscles to breathe, whereas, in obstructive sleep apnea, the tissue at the rear of the throat falls closed, preventing breathing from occurring. There are also cases where a person might suffer from a mix of the two types of sleep apnea.
Can sleep apnea cause high blood pressure?
The lack of sleep caused by sleep apnea strains the heart. But it's OSA, in particular, that has a significant effect on blood pressure. OSA over-activates the sympathetic nervous system, increasing the chances of developing high blood pressure among people with obstructive sleep due to OSA.
The sympathetic nervous system controls the human fight or flight response. Once it's activated, the sympathetic nervous system sets off a series of short-term physical reactions, including:
- Elevated heart rate.
- Increased metabolism.
- Higher blood pressure.
- Dilated pupils.
It's these reactions that help us respond to stressful incidents. However, when the activation of the sympathetic nervous system is excessive, severe obstructive sleep apnea may cause chronic elevation of blood pressure.
Sleep apnea: Is it hereditary?
According to research, there is a 40% chance that a case of obstructive sleep apnea is genetic, which means it might be hereditary. However, 60% of obstructive sleep apnea cases are lifestyle and environmental-related.
If your family has a history of sleep apnea, there is a higher chance that you may develop obstructive sleep apnea too. Although research on sleep apnea shows a clear genetic link, researchers are yet to discover the exact gene responsible for the condition. An indirect genetic obstructive sleep apnea can be inherited through obesity, which is a high-risk factor for OSA and a well known hereditary condition.
Other than obesity, another hereditary condition that may cause obstructive sleep apnea is a recessed jaw (Retrognathia).
Does sleep apnea affect your heart?
Over the last 20 years, research into obstructive sleep apnea shows that the condition has an undeniable effect on cardiovascular health. However, scientists are yet to pinpoint how OSA may increase cardiac arrest risk, cause hypertension, or weaken the heart.
That said, some studies show a connection between obstructive sleep apnea and decreased heart health. According to one study, over 50% of patients with cardiovascular disease have sleep apnea. To put that into perspective, only about 5% of the general population suffer from OSA.
A second study showed that the death rate among those with heart disease and sleep apnea was twice as high as it was among people with heart failure only.
There is also evidence that:
- Central sleep apnea is most common among people with heart failure.
- Sleep apnea sufferers are more likely to suffer sudden cardiac death as they sleep when usually, sudden cardiac death occurs during the day.
Does sleep apnea affect the brain?
When you sleep, your brain regenerates. Sleep deprivation hinders restorative sleep as it causes you to wake up multiple times throughout the night. It also starves the brain of oxygen. Pair that with physical strain, stress, and chronic fatigue from lack of sleep may cause brain damage over the long term.
A study by UCLA found that adults suffering from sleep apnea had about 20% smaller mammillary bodies (brain structures essential for storing memory) than those without the condition.
A separate study published in Sleep journal found less brain gray matter concentration in people with obstructive sleep apnea. The conclusion from the study was that continuous brain damage and poor sleep quality experienced by OSA patients could cause:
- Increased cardiovascular problems
- Emotional instability
- Poor memory
- Decreased cognitive functioning
References
Cowie, M. R., & Gallagher, A. M. (2017). Sleep disordered breathing and heart failure: what does the future hold?. JACC: Heart Failure, 5(10), 715-723.
Park, B., Palomares, J. A., Woo, M. A., Kang, D. W., Macey, P. M., Yan‐Go, F. L., ... & Kumar, R. (2016). Disrupted functional brain network organization in patients with obstructive sleep apnea. Brain and behavior, 6(3), e00441.
Kuwabara, M., Tomitani, N., Shiga, T., & Kario, K. (2018). Polysomnography‐derived sleep parameters as a determinant of nocturnal blood pressure profile in patients with obstructive sleep apnea. The Journal of Clinical Hypertension, 20(6), 1039-1048.
Huebra, L., Coelho, F. M., Rezende Filho, F. M., Barsottini, O. G., & Pedroso, J. L. (2019). Sleep disorders in hereditary ataxias. Current neurology and neuroscience reports, 19(8), 1-10.
Burgess, K. R., & Ainslie, P. N. (2016). Central sleep apnea at high altitude. Hypoxia, 275-283.
