What Is Sleep Apnea? Everything You Need To Know.

Sleep apnea is a condition that causes abnormal breathing during sleep.

Typically, air flows through your lungs without any obstructions at all. With sleep apnea, your airway collapses or becomes wholly or partially blocked during sleep. The temporary breathing lapses can last anywhere from a couple of seconds to a few minutes and can happen dozens of times per hour while trying to sleep.

This results in lower quality sleep and an inadequate supply of oxygen to your body that could potentially cause serious health problems.

When diagnosed, sleep apnea syndrome is treatable. However, because of its prevalence and potentially lifelong health impact, it is important to be aware of what causes it, its types, symptoms, and treatments.

How Common is Sleep Apnea?

It’s estimated that 4-9% of middle-aged men and 2-4% of women in the United States suffer from sleep apnea, and at least 24-31% of men and 9-21% of women (general population) have obstructive sleep apnea with over 80% of these cases undiagnosed. Although the studies show that OSA affects men more than women, it can occur in both sexes and is more common in older adults.

Children can also suffer from sleep apnea, although it's at a much lower rate of prevalence. Approximately about 2% of children suffer from sleep apnea. The leading causes for sleep apnea in kids is usually enlarged tonsils and/or adenoids.

What Causes Sleep Apnea?

Several factors increase the risk for sleep apnea. Some of the most common include large necks or a small airway. Obesity is also a common factor that leads to the blockage of the upper airway.

When you sleep, your whole body relaxes. If the throat muscles collapse upon relaxation and restrict airflow, there's a higher chance of experiencing sleep apnea.

Smoking is also thought to cause sleep deprivation as it inflames the throat. On the other hand, alcohol consumption causes intense muscle relaxation which may choke off the air supply to the body.

Checkout our article on how diet can impact sleep apnea.

Types of Sleep Apnea

There are three different types of this disorder.

Obstructive Sleep Apnea

Commonly known as OSA in medical circles, this is the most prevalent type of apnea. It affects approximately 85% of sufferers and is associated with an obstruction in the throat or airways. Sleep apnea is serious as a person can stop breathing repeatedly sometimes hundreds of times.

Some of the factors that cause blockages leading to obstructive sleep apnea include allergies that clog airways, nasal congestion, enlarged tonsils, excessive soft palate, or excess throat tissue.

Central Sleep Apnea

The rarest form of apnea, central sleep apnea (CSA), only affects approximately 1% of people who suffer from sleep apnea. Central sleep apnea occurs when the brain cannot send the right signals to the respiratory system, leading to decreased respiratory effort.

Mixed or Complex Sleep Apnea

Mixed sleep apnea occurs when a patient suffers symptoms seen in both OSA and CSA. It's more common than CSA and affects about 14% of sufferers.

Of the three types of sleep apnea, OSA is the most prevalent, which is why it will be our main focus here.

What Are The Signs and Symptoms of Sleep Apnea?

An episode of sleep apnea means oxygen supply to the brain and cut off or decreased significantly throughout the body.

The result is poor sleeping patterns and a lack of relaxation. Consequently, sleep deprivation causes drowsiness during the day and confusion in the morning. The signs and symptoms experienced by people with obstructive sleep apnea include:

Persistent headaches that don't respond to standard medication.
Grumpiness.
Periodic memory loss.
Drowsiness or excessive daytime sleepiness.
Dry mouth

Other than the symptoms above, untreated sleep disorder also causes:

Low sexual interest.
Ade (swelling of the leg in severe apnea cases).
Poor overall performance at work or school.
Heightened depression.
Hyperactivity in children.

The longer an individual suffers untreated sleep apnea, the higher the chances of increased industrial and road accidents due to drowsiness.

Who is Most Likely to Suffer from Obstructive Sleep Apnea

While anyone can get obstructive sleep disorder, specific characteristics increase the chances of experiencing the sleeping disorder. High-risk people include:

Children with enlarged tonsils and adenoids.
Men and women with a collar size of 17 and 16 inches, respectively.
People with a larger tongue than average, which increases chances of blocking the airway.
People whose lower jaw is short than their upper jaw (condition know as retrognathia).
People with an airway or narrow palate that's susceptible to collapse easily.

Effects of Untreated Sleep Apnea

Obstructive sleep apnea is a serious condition if left untreated. People with this sleep disorder often end up suffering from other diseases if the condition goes on for too long without treatment. However, with the correct health information and proper medical treatment, it's possible to live a life free of OSA.

Other conditions that might be caused by this disorder include:

Diabetes
Heart failure
Stroke
High blood pressure

Untreated sleep apnea can also cause poor performance in your everyday activities such as work, school, driving, and much more.

How Snoring And Sleep Apnea Affects Our Mental Health

When you don't get enough sleep, it's more than just feeling tired the next day. Lack of sleep can lead to depression. Studies revealed that people who don't get enough sleep are more likely to experience symptoms of depression, such as feelings of loneliness, sadness, and irritability, compared to those who get a good night's sleep. Lack of sleep can also worsen existing depression, making it more challenging to treat.

According to the National Institute of Mental Health, anxiety is the most common mental illness in the United States, affecting 40 million adults. While there are many different types of anxiety disorders, one of the most common is generalized anxiety disorder (GAD), which is characterized by persistent and excessive worry about everyday events. People with GAD often have difficulty sleeping, and research has shown that lack of sleep can develop anxiety disorders.

One study found that people who slept less than six hours a night were twice as likely to develop GAD as those who slept more than seven hours. Sleep deprivation can cause an increase in stress hormones, which can lead to feelings of anxiety. It can also cause problems with focus and concentration, making it difficult to cope with everyday stressors. In addition, lack of sleep can adversely affect physical health and contribute to anxiety. If you're experiencing anxiety symptoms, you must talk to a doctor or mental health professional.

Studies have shown that people who do not get enough sleep are more likely to develop cancer than those who get a whole night's rest. One theory is that lack of sleep alters hormone levels in the body, leading to cell damage and cancer growth. Another approach is that lack of sleep weakens the immune system, making it more difficult for the body to fight off cancer cells. Regardless of the exact mechanism, there is no doubt that lack of sleep can increase your risk for cancer. So if you're having trouble sleeping, don't wait to see if it gets better on its own.

A new study has found that lack of sleep may be a factor in the development of Alzheimer's disease. The study found that sleep deprivation may cause the build-up of a protein called beta-amyloid in the brain. Beta-amyloid is a hallmark of Alzheimer's disease and is thought to play a role in the deterioration of cognitive function. While the study did not find a direct causal link between sleep deprivation and Alzheimer's disease, it did suggest that there may be a connection between the two. Further research is needed to confirm this connection, but the findings suggest that getting enough sleep may help lessen the risk of Alzheimer's disease.

Snoring can have a significant impact on relationships and marriage. The National Sleep Foundation reports that snoring affects 37 million adults in the United States; of those, about 90% are regular snorers. Snoring can cause sleep deprivation for the snorer and their partner, leading to irritability and fatigue. In addition, research has shown that snoring can increase levels of stress hormones, which can further contribute to relationship problems. Snoring can be the final straw for couples with strained relationships. Some studies suggest that snoring is one of the leading causes of divorce. If you or your partner is struggling with snoring, it's essential to seek help from a doctor or sleep specialist. With treatment, it's possible to reduce or eliminate snoring and improve your relationship.

How Do I Know If I Have Obstructive Sleep Apnea?

The best way of knowing whether you have obstructive sleep apnea is getting a medical diagnosis from a qualified doctor.

Most people with obstructive sleep apnea often live with the condition without their knowledge. Because apnea manifests while sleeping, you can't tell if you experience it unless you are conscious of the effects when you wake up. The goal would be for the patient to have their airway open to reduce symptoms.

A majority of obstructive sleep apnea patients only find out they have OSA after someone else tells them of their behavior while sleeping. Often, the most common sign of apnea is loud snoring.

How Sleep Apnea Is Diagnosed

Doctors use a combination of your sleeping history and physical examinations to diagnose this sleep disorder. During the first stage of diagnosis, a doctor will examine the patient for any anatomical factors that increase the risk of apnea.

If the simple anatomical examination and a sleeping history questionnaire are inconclusive, the doctor may recommend more sophisticated tests, including:

Polysomnogram

This is one of the most comprehensive sleep apnea tests and monitors your breathing during sleep. In this test, you stay in a hospital sleep study center overnight where the test monitors how active different body systems are while you are sleeping.

This test involves a combination of diagnosis procedures, including:

Electroencephalogram (EEG) to monitor brain waves
Electro-oculogram (EOM), which tracks eye movement and is often used together with EEG
Arterial blood gas analysis (ABG)
Electromyogram (EMG) to measure muscle activity
Electrocardiogram (EKG or ECG) to measure the heart rate and its rhythm
Pulse Oximetry Test to measure oxygen levels in your blood

Electroencephalogram and Extraocularmovement (EEG & EOM)

When a doctor performs an EEG to diagnose your sleep apnea, they attach electrodes to the patient's scalp. These electrodes monitor the patient's brain waves before, during, and after sleeping.

On the other hand, the extraocular movement (EOM) test tracks eye movement. In OEM, the doctor placed a small electrode just under the left eye's outer corner when it monitors and records each time there's eye movement from the centre of the eye.

A combination of the brain waves and eye movement records provides the doctor with insight into your sleeping pattern. During the evaluation, the specialist looks at when and for how long you were in either of the two phases of sleep:

Non-Rapid Eye Movement Sleep (non-REM)
Rapid Eye Movement sleep (REM)

EMG (Electromyography)

This test features the use of electrodes, two on the chin (above and below the jawline) and one on each shin. These electrodes monitor the electrical activity that muscles generate when they move during sleep.

EKG (Electrocardiogram)

An EKG test is meant to determine whether there is an underlying heart condition. If you have a history of high blood pressure, the results of an EKG change. Tracking your heart rate and rhythm tells doctors whether there is atrial fibrillation (disturbance of the heart) when you experience sleep apnea.

Pulse Oximetry

During this test, a pulse oximeter device is clipped to a thin body area with good airflows such as the fingertip or earlobe. The machine produces red and infrared LEDs through a tiny emitter to measure blood oxygen levels.

Your blood's oxygen saturation decreases to levels lower than the standard percentage point of 95 to 100%.

Arterial Blood Gas

This test involves drawing blood from an artery and measuring several factors in arterial blood, including:

Oxygen content and saturation
The partial pressure of oxygen and carbon dioxide
Bicarbonate levels in the blood

Typically, if you have a history of sleep apnea, this test will show low blood oxygen and saturation, among other factors. The reason is that sleep apnea makes you stop repeatedly breathing when you experience this sleep disorder, denying your blood enough oxygen.

How to Treat Sleep Apnea

When treating obstructive sleep apnea, the goal is simple - to ensure there is no obstruction of airflow so you don't stop breathing while you sleep. There's a wide range of treatments, including sleep apnea devices for obstructive sleep disorder, including:

Start A Weight Loss Program

Obstructive sleep apnea is common among the obese. But that's not the only problem that comes with being obese.

Obesity also increases the risk of heart attack, type 2 diabetes, breathing problems, and other health problems. It may also increase the risk of developing neurological disorders such as dementia and Alzheimer's disease.

A weight-loss journey needs total lifestyle changes that include eating healthier and exercising to keep health problems at bay. If you have obstructive sleep apnea, weight loss will provide the relief you lead to sleep better.

Continuous Positive Airway Pressure Therapy

Obstructive sleep apnea occurs when air doesn't flow through the airway properly. CPAP is a type of therapy where you wear a facemask that delivers positive airflow gently. In turn, the positive airflow keeps the airways open at night.

CPAP is one of the most effective OSA therapies.

Bilevel Positive Airway Pressure (BiPAP or BPAP)

In cases where CPAP is not effective, BiPAP or BPAP takes centre stage. These also use machines but with high and low settings that mimic your breathing to deliver the right pressure during inhaling and exhaling.

Sleeping Position Therapy

People with sleep apnea may experience it worst when they sleep on their back (supine position). In positional therapy, doctors teach you how to adopt better sleeping positions for relief and counter loud snoring.

Surgery

When everything else fails, surgery is the last option to relieve the effects of blocked airways. One of the causes of the obstructed airway and reduced breathing in sleep apnea is extra tissue at the back of the throat.

Often, the only way to treat this sleep disorder if it's persistent is to undergo Uvulopalatopharyngoplasty (UPPP). However, the reason it's the last option is that UPPP can cause complications and has not been proven to offer complete relief.

As a last resort, patients that don't respond to UPPP may undergo Tracheostomy, a procedure that punctures a hole in the windpipe to bypass the throat obstruction.

Positions To Sleep With Sleep Apnea

whether it’s on your stomach, back, or side – everybody has their favorite and comfortable sleeping positions. however, if you suffer from Obstructive Sleep Apnea, you might want to sleep on the following most recommended sleeping positions:

Get Your Free Sleep Guide with 33 Secrets To Better Sleep

Side Sleeping

Left-side sleeping is the number one suggested sleep position by experts.

According to experts, side sleeping on your left side aids in digestion and increases blood flow. It's also the most organ-friendly position, with less stress on your internal organs because of their natural positioning.

However, if you have a cognitive heart condition, you should check in with your doctor first. In general, left-side sleeping might be discouraged because it can cause discomfort or add unnecessary stress to the heart.

Variations of Side Sleeping

The Log

The "Log" position is a side-sleeping position where your arms are kept to your sides. This position - enjoyed by 15 percent of sleepers - aids in sleep apnea and helps prevent neck and back pain by keeping your spine aligned. A pillow between the knees can help reduce pressure on your hips.

Fetal Sleep Position

The most popular among adults, the fetal sleep position is preferred by more than four out of 10 adult sleepers, especially women. It's very common to end in the fetal position at one point or another during the night.

If this is your preferred sleeping position, consider adding a pillow between your knees as well for additional comfort and less stress to your back.

Prone (Stomach) Sleeping

With the prone sleeping position, you should lie on your stomach with the arms either tucked under the pillow or up over their heads. When lying on your stomach, gravity prevents the tongue from falling back towards the throat, eliminating airway obstructions and reducing the likelihood of snoring.

One thing worth noting about this position is it can cause slight neck and back stress, and if you end up burying your face too far in the pillow, it can actually work against good breathing. However, for those with sleep apnea, it can be an excellent position to prevent snoring.

Sleep Apnea FAQ's

Is Sleep Apnea Dangerous?

Sleep apnea is a potentially serious sleep disorder that is closely linked to several life-threatening conditions. Untreated sleep apnea may cause or worsen existing chronic illnesses like diabetes, heart disease, stroke, and high blood pressure, among others.

Can Sleep Apnea Cause Bed Wetting?

Children and sometimes adults with this sleep disorder might experience bed-wetting. The brain prioritizes sustaining proper oxygen levels, shifting away focus from other body functions, including bladder control.

Can Sleep Apnea Cause High Blood Pressure?

The gradual drops of blood oxygen levels in your body when you are asleep strains the cardiovascular system increases hypertension. Therefore, having apnea obstructive sleep disorder increases your risk of high blood pressure.

References

Benjafield, A., Valentine, K., Ayas, N., Eastwood, P. R., Heinzer, R. C., Ip, M. S., ... & Malhotra, A. (2018). Global prevalence of obstructive sleep apnea in adults: estimation using currently available data. In B67. Risk and prevalence of sleep disordered breathing (pp. A3962-A3962). American Thoracic Society.

Karimi, M., Hedner, J., Häbel, H., Nerman, O., & Grote, L. (2015). Sleep apnea related risk of motor vehicle accidents is reduced by continuous positive airway pressure: Swedish traffic accident registry data. Sleep, 38(3), 341-349.

Faria, Anamelia Costa et al. “Sleep Apnea Clinical Score, Berlin Questionnaire, or Epworth Sleepiness Scale: which is the best obstructive sleep apnea predictor in patients with COPD?.” International journal of general medicine vol. 8 275-81. 25 Aug. 2015, doi:10.2147/IJGM.S86479