Sleep apnea is one of the most common types of sleep disorders, and yet it remains one of the most under-diagnosed disorders we see. This is troubling because undiagnosed, untreated sleep apnea can cause major medical issues that can have a lasting impact on your day-to-day life.
Luckily, there are proven treatment plans that can help your body regulate nighttime breathing and even combat some of the resulting medical problems you might be having. The most important step in many people’s sleep apnea treatment journey is recognizing the symptoms and being diagnosed by a sleep disorder specialist.
What is Sleep Apnea
Perhaps the most important question we have to answer is simply, what is sleep apnea? In short, sleep apnea is a type of sleep disorder in which you experience “gaps” in your breathing. This means that, for whatever reason, you stop breathing for short periods of time while you are sleeping.
While sleep apnea can cause many issues and lead to more extreme conditions, it also happens to be easily identifiable in most cases. Breathing pauses, or apneic episodes, usually result in disruptive sleep behaviors such as loud snoring, gasping, choking sounds, or startling awake suddenly. The person exhibiting these behaviors often does not realize they are doing them, but they are easy enough symptoms for bed partners to notice and report back to the patient. Unfortunately, many people do not share a bed with anyone or their partner is a heavy sleeper, so this condition often goes undiagnosed for a long time and goes on to cause other issues.
There are three types of sleep apnea: obstructive, central, and complex. These different types of sleep apnea all come with their own causes, symptoms, and treatment plans, so it is important to look for signs of these sleep disorders individually.
Obstructive
Obstructive sleep apnea syndrome, or OSA, is the most common type of sleep apnea. This occurs when a patient’s throat muscles relax and block your airway for prolonged periods of time while they sleep. This is typically caused by a physical blockage that obstructs airways and impedes breathing.
The most noticeable symptom of OSA is loud, consistent snoring. While occasional snoring is normal and could be caused by things like congestion or a poor sleeping position, snoring every night for more than a few days could be a sign that you are experiencing obstructive sleep apnea. OSA is minor, and not severe, but treatment options like oral airway patency devices are appropriate for mild to moderate OSA.
Central
Central sleep apnea is less common and can be harder to treat. Patients with central sleep apnea experience apneic episodes because their brain is not sending the proper signals to the muscles in a patient’s body that control respiratory function. In other words, their brain is not telling their muscles to breathe often or consistently enough.
In this case, the gaps in breathing are not caused by external factors, but by irregular brain activity. Central sleep apnea is often caused by other medical conditions such as heart failure or stroke or even by repeatedly sleeping at high altitudes. Treatment plans should be discussed with a sleep disorder specialist to determine the most effective course of action for a patient’s individual needs.
Complex
Complex sleep apnea is a combination of obstructive and central apnea and more challenging to treat.
Central Sleep Apnea can also be seen in congestive heart failure and a rare brain abnormality called Arnold Chiari Malformation.
On rare occasions when sleep apnea is resistant to continuous positive airway pressure, or CPAP, a patient is determined to have complex sleep apnea and other treatments must be implemented. Other treatment plans could include lifestyle changes, treatment of other medical conditions that could be exasperbating the existing sleep apnea, or even surgery. It is important that a patient works closely with their sleep disorder specialist in this case, to determine the proper treatment plan.
Who Can Be Affected By Sleep Apnea?
Sleep apnea can affect anyone, even children. However, it is most common in men, obese people, and elderly people. This is because certain risk factors can increase your risk such as obesity, neck circumference, a narrowed airway, drinking, smoking, nasal congestion, hormonal irregularities, and family history of sleep apnea or respiratory issues. Even having certain facial features, such as a small lower jaw or narrow nose bridge can increase a person’s chances of developing sleep apnea.
Sleep apnea is not as common in children, but it does happen. Juveniles are most likely to experience apneic episodes in infancy, if there were any kinds of complications during their birth, or later in childhood if they develop childhood obesity. Even children who tend to have fuller faces and necks but are not overweight could be at a higher risk for sleep apnea because of the potential airway blockage. Pediatric sleep apnea can lead to many other medical conditions later in life, so it is important that we monitor children for signs of sleep disorders early on. For example, it is not uncommon for a sleeping child to occasionally snore, cough, or snort. As in adults, occasional disruptive sleep behaviors can be due to sickness, congestion, or position. However, excessive or frequent snoring, snorting, coughing, or choking during sleep can be a warning sign of pediatric sleep apnea.
Causes
Sleep apnea can be caused by several different factors. Obstructive sleep apnea, the most common type of sleep apnea, can be caused by any number of external factors including fat pockets around the neck or nose, deviated septum, large or elongated tonsils, or any number of other bodily blockages.
Most cases of sleep apnea occur when the muscles at the back of the throat relax too much to allow regular breathing or when a patient’s airway is otherwise blocked. When the muscles in the back of the throat relax too much, it narrows or closes the airway entirely. This can stop breathing for 10 seconds or more. If this happens repeatedly, the loss of oxygen for those few seconds can become a very real medical problem. Some patients experience these kinds of apneic episodes anywhere between five and forty times every hour, all night. This kind of disruptive sleep behavior can cause excess strain on the heart, allow too much carbon dioxide into the bloodstream, cause hormonal imbalances, negatively impact metabolism, and trigger mental health problems like depression and ADHD.
Diagnosis
Only a qualified physician or sleep disorder specialist can diagnose a patient with sleep apnea, so if you recognize some of these warning signs in yourself or a loved one, please make an appointment with a medical professional to determine your diagnosis.
If you are experiencing symptoms, your doctor may proceed with any number of tests and evaluations to determine your diagnosis. Blood tests, psychological evaluations, and sleep journals are all ways to help determine what the issue might be, but the most common and conclusive way to determine if a patient is suffering from sleep apnea is through a polysomnogram, also known as a sleep study. Sleep studies may be performed at home, using technology linked to a computer, which records movement and patterns while you sleep or it may be done in a medical facility where the same results can be monitored more directly.
This kind of test can also detect signs of other sleep disorders, so they will help a sleep specialist determine how best to proceed. If the test shows sleep apnea, you may need more sleep testing to figure out the best treatment option.
Treatment
For milder cases of sleep apnea, your doctor may recommend only lifestyle changes, such as weight loss, limiting smoking and vaping, treating allergies or hormonal imbalances and any other medical issues that might exacerbate disruptive sleep behaviors.
If these measures don’t improve your signs and symptoms or if your apnea is moderate to severe, a number of more aggressive treatments are available. The most popular and effective treatment plan is by using a continuous positive airway pressure (CPAP) machine at night. This machine delivers pressurized air through a mask while a patient sleeps. If this machine works the way it is intended, the air being pumped through the machine will be greater than the air around you and it will keep your airway open and combat apneic episodes.
One alternative to the CPAP machine is wearing an oral appliance at night. These are designed to keep your throat open and blockage-free. CPAP may be the more effective treatment plan, compared to oral appliances, but oral appliances are often easier to use. Some popular appliances are as simple as a small bit to keep a patient’s back teeth apart and open up the throat and others may be designed to open the throat by bringing the jaw forward or correcting any number of facial obstructions.
Another option available is surgery. This is usually only an option after other treatments have failed, but there are cases where bone structure and facial configuration might make other treatment plans difficult and where sleep apnea is more likely to be a life-long, chronic condition. Generally, at least a three-month trial of other treatment options is suggested before considering surgery. However, for a small number of people with certain jaw structure problems prefer this option.
Gingras Sleep Medicine
If you or a loved one is experiencing sleep apnea symptoms, it is crucial that you see a qualified sleep disorder physician as soon as possible. Gingras Sleep Medicine is a North Carolina based sleep medicine facility with a reputation for stellar results! Dr. Jeanine Gingras is a nationally recognized double board-certified sleep medicine doctor and pediatrician. Along with her team, Dr. Gingras provides thorough evaluations and innovative treatment plans for a wide variety of sleep disorders, including all types of sleep apnea.
Call (704) 944-0562 or request an appointment online with Dr. Gingras at Gingras Sleep Medicine in Charlotte and Concord, North Carolina to start your journey to better, more restful sleep!