What Is Sleep Apnea?
Sleep apnea is a common disorder in which you have
one or more pauses in breathing or shallow breaths while you sleep.
Breathing pauses can last from a few seconds to
minutes. They often occur 5 to 30 times or more an hour.
Typically, normal breathing then starts again, sometimes with a loud snort or
choking sound.
Sleep apnea usually is a chronic (ongoing) condition
that disrupts your sleep 3 or more nights each week. You often move out of deep
sleep and into light sleep when your breathing pauses or becomes shallow.
This results in poor sleep quality that makes you
tired during the day. Sleep apnea is one of the leading causes of excessive
daytime sleepiness.
Overview
Sleep apnea often goes undiagnosed. Doctors usually
can't detect the condition during routine office visits. Also, there are no
blood tests for the condition.
Most people who have sleep apnea don't know they
have it because it only occurs during sleep. A family member and/or bed partner
may first notice the signs of sleep apnea.
The most common type of sleep apnea is obstructive
sleep apnea. This most often means that the airway has collapsed or is blocked
during sleep. The blockage may cause shallow breathing or breathing pauses.
When you try to breathe, any air that squeezes past
the blockage can cause loud snoring. Obstructive sleep apnea happens more often
in people who are
overweight,
but it can affect anyone.
Central sleep apnea is a less common type of sleep
apnea. It happens when the area of your brain that controls your breathing
doesn't send the correct signals to your breathing muscles. You make no effort
to breathe for brief periods.
Central sleep apnea often occurs with obstructive
sleep apnea, but it can occur alone. Snoring doesn't typically happen with
central sleep apnea.
This article mainly focuses on obstructive sleep
apnea.
Outlook
Untreated sleep apnea can:
Lifestyle changes, mouthpieces, surgery, and/or
breathing devices can successfully treat sleep apnea in many people.
Other Names for Sleep Apnea
- Sleep-disordered breathing
- Cheyne-Stokes breathing
What Causes Sleep Apnea?
When you're awake, throat muscles
help keep your airway stiff and open so air can flow into your lungs. When you
sleep, these muscles are more relaxed. Normally, the relaxed throat muscles
don't stop your airway from staying open to allow air into your lungs.
But if you have obstructive sleep
apnea, your airways can be blocked or narrowed during sleep because:
- Your throat muscles and tongue relax more than
normal.
- Your tongue and tonsils (tissue masses in the
back of your mouth) are large compared to the opening into your windpipe.
- You're
overweight.
The extra soft fat tissue can thicken the wall of the windpipe. This causes the
inside opening to narrow and makes it harder to keep open.
- The shape of your head and neck (bony structure)
may cause a smaller airway size in the mouth and throat area.
- The aging process limits the ability of brain
signals to keep your throat muscles stiff during sleep. This makes it more
likely that the airway will narrow or collapse.
Not enough air flows into your lungs
when your airways are fully or partly blocked during sleep. This can cause loud
snoring and a drop in your blood oxygen levels.
When the oxygen drops to dangerous
levels, it triggers your brain to disturb your sleep. This helps tighten the
upper airway muscles and open your windpipe. Normal breaths then start again,
often with a loud snort or choking sound.
The frequent drops in oxygen levels
and reduced sleep quality trigger the release of stress hormones. These
compounds raise your heart rate and increase your risk for
high
blood pressure,
heart
attack, stroke, and
irregular
heartbeats. The hormones also raise the risk for or worsen
heart
failure.
Untreated sleep apnea also can lead
to changes in how your body uses energy. These changes increase your risk for
obesity
and diabetes.
Who Is At Risk for Sleep Apnea?
It's estimated that more than 12 million American
adults have obstructive sleep apnea. More than half of the people who have this
condition are
overweight.
Sleep apnea is more common in men. One out of 25
middle-aged men and 1 out of 50 middle-aged women have sleep apnea.
Sleep apnea becomes more common as you get older. At
least 1 out of 10 people over the age of 65 has sleep apnea. Women are much
more likely to develop sleep apnea after menopause.
African Americans, Hispanics, and Pacific Islanders
are more likely to develop sleep apnea than Caucasians.
If someone in your family has sleep apnea, you're
more likely to develop it.
People who have small airways in their noses,
throats, or mouths also are more likely to have sleep apnea. Smaller airways
may be due to the shape of these structures or allergies or other medical
conditions that cause congestion in these areas.
Small children often have enlarged tonsil tissues in
the throat. This can make them prone to developing sleep apnea.
Other risk factors for sleep apnea include smoking,
high
blood pressure, and risk factors for stroke or
heart
failure.
What Are the Signs and Symptoms of Sleep
Apnea?
Major Signs and Symptoms
One of the most common signs of obstructive sleep
apnea is loud and chronic (ongoing) snoring. Pauses may occur in the snoring.
Choking or gasping may follow the pauses.
The snoring usually is loudest when you sleep on
your back; it may be less noisy when you turn on your side. Snoring may not
happen every night. Over time, the snoring may happen more often and get
louder.
You're asleep when the snoring or gasping occurs.
You will likely not know that you're having problems breathing or be able to
judge how severe the problem is. Your family members or bed partner will often
notice these problems before you do.
Not everyone who snores has sleep apnea.
Another common sign of sleep apnea is fighting
sleepiness during the day, at work, or while driving. You may find yourself
rapidly falling asleep during the quiet moments of the day when you're not
active.
Other Signs and Symptoms
Others signs and symptoms of sleep apnea may
include:
- Morning headaches
- Memory or learning problems and not being able to
concentrate
- Feeling irritable, depressed, or having mood
swings or personality changes
- Urination at night
- A dry throat when you wake up
In children, sleep apnea can cause hyperactivity,
poor school performance, and aggressiveness. Children who have sleep apnea also
may have unusual sleeping positions, bedwetting, and may breathe through their
mouths instead of their noses during the day.
How Is Sleep Apnea Diagnosed?
Doctors diagnose sleep apnea based on your medical
and family histories, a physical exam, and results from
sleep
studies. Usually, your primary care doctor evaluates your symptoms first.
He or she then decides whether you need to see a sleep specialist.
These specialists are doctors who diagnose and treat
people with sleep problems. Such doctors include lung, nerve, or ear, nose, and
throat specialists. Other types of doctors also can be sleep specialists.
Medical and Family Histories
Your doctor will ask you and your family questions
about how you sleep and how you function during the day. To help your doctor,
consider keeping a sleep diary for 1 to 2 weeks. Write down how much you sleep
each night, as well as how sleepy you feel at various times during the day.
You can find a sample sleep diary in the National
Heart, Lung, and Blood Institute's
"Your
Guide to Healthy Sleep."
Your doctor also will want to know how loudly and
often you snore or make gasping or choking sounds during sleep. Often you're
not aware of such symptoms and must ask a family member or bed partner to
report them.
If you're a parent of a child who may have sleep
apnea, tell your child's doctor about your child's signs and symptoms.
Let your doctor know if anyone in your family has
been diagnosed with sleep apnea or has had symptoms of the disorder.
Many people aren't aware of their symptoms and
aren't diagnosed.
Physical Exam
Your doctor will check your mouth, nose, and throat
for extra or large tissues. The tonsils often are enlarged in children with
sleep apnea. A physical exam and medical history may be all that's needed to
diagnose sleep apnea in children.
Adults with the condition may have an enlarged uvula
or soft palate. The uvula is the tissue that hangs from the middle of the back
of your mouth. The soft palate is the roof of your mouth in the back of your
throat.
Sleep Studies
A sleep study is the most accurate test for
diagnosing sleep apnea. It captures what happens with your breathing while you
sleep.
A sleep study is often done in a sleep center or
sleep lab, which may be part of a hospital. You may stay overnight in the sleep
center.
Polysomnogram
A polysomnogram (poly-SOM-no-gram), or PSG, is the
most common study for diagnosing sleep apnea. This test records:
- Brain activity
- Eye movement and other muscle activity
- Breathing and heart rate
- How much air moves in and out of your lungs while
you're sleeping
- The amount of oxygen in your blood
A PSG is painless. You will go to sleep as usual,
except you will have sensors on your scalp, face, chest, limbs, and finger. The
staff at the sleep center will use the sensors to check on you throughout the
night.
A sleep specialist reviews the results of your PSG
to see whether you have sleep apnea and how severe it is. He or she will use
the results to plan your treatment.
How Is Sleep Apnea Treated?
Goals of Treatment
The goals of treating obstructive sleep apnea are
to:
- Restore regular breathing during sleep
- Relieve symptoms such as loud snoring and daytime
sleepiness
Treatment may help other medical problems linked to
sleep apnea, such as
high
blood pressure. Treatment also can reduce your risk for heart disease,
stroke, and diabetes.
Specific Types of Treatment
Lifestyle changes, mouthpieces, breathing devices,
and/or surgery are used to treat sleep apnea. Currently, there are no medicines
to treat sleep apnea.
Lifestyle changes and/or mouthpieces may be enough
to relieve mild sleep apnea. People who have moderate or severe sleep apnea
also will need breathing devices or surgery.
Lifestyle Changes
If you have mild sleep apnea, some changes in daily
activities or habits may be all that you need.
- Avoid alcohol and medicines that make you sleepy.
They make it harder for your throat to stay open while you sleep.
- Lose weight if you're
overweight
or obese. Even a little weight loss can improve your symptoms.
- Sleep on your side instead of your back to help
keep your throat open. You can sleep with special pillows or shirts that
prevent you from sleeping on your back.
- Keep your nasal passages open at night with nose
sprays or allergy medicines, if needed. Talk to your doctor about whether these
treatments might help you.
- Stop smoking.
Mouthpiece
A mouthpiece, sometimes called an oral appliance,
may help some people who have mild sleep apnea. Your doctor also may recommend
a mouthpiece if you snore loudly but don't have sleep apnea.
A dentist or orthodontist can make a custom-fit
plastic mouthpiece for treating sleep apnea. (An orthodontist specializes in
correcting teeth or jaw problems.) The mouthpiece will adjust your lower jaw
and your tongue to help keep your airways open while you sleep.
If you use a mouthpiece, it's important that you
check with your doctor about discomfort or pain while using the device. You may
need periodic office visits so your doctor can adjust your mouthpiece to fit
better.
Breathing Devices
Continuous positive airway pressure (CPAP) is the
most common treatment for moderate to severe sleep apnea in adults. A CPAP
machine uses a mask that fits over your mouth and nose, or just over your nose.
The machine gently blows air into your throat.
The air presses on the wall of your airway. The air
pressure is adjusted so that it's just enough to stop the airways from becoming
narrowed or blocked during sleep.
Treating sleep apnea may help you stop snoring. But
stopping snoring doesn't mean that you no longer have sleep apnea or can stop
using CPAP. Sleep apnea will return if CPAP is stopped or not used correctly.
Usually, a technician will come to your home to
bring the CPAP equipment. The technician will set up the CPAP machine and
adjust it based on your doctor's orders. After the initial setup, you may need
to have the CPAP adjusted on occasion for the best results.
CPAP treatment may cause side effects in some
people. These side effects include a dry or stuffy nose, irritated skin on your
face, sore eyes, and headaches. If your CPAP isn't properly adjusted, you may
get stomach bloating and discomfort while wearing the mask.
If you're having trouble with CPAP side effects,
work with your sleep specialist, his or her nursing staff, and the CPAP
technician. Together, you can take steps to reduce these side effects. These
steps include adjusting the CPAP settings or the size/fit of the mask, or
adding moisture to the air as it flows through the mask. A nasal spray may
relieve a dry, stuffy, or runny nose.
There are many different kinds of CPAP machines and
masks. Be sure to tell your doctor if you're not happy with the type you're
using. He or she may suggest switching to a different kind that may work better
for you.
People who have severe sleep apnea symptoms
generally feel much better once they begin treatment with CPAP.
Surgery
Some people who have sleep apnea may benefit from
surgery. The type of surgery and how well it works depend on the cause of the
sleep apnea.
Surgery is done to widen breathing passages. It
usually involves removing, shrinking, or stiffening excess tissue in the mouth
and throat or resetting the lower jaw.
Surgery to shrink or stiffen excess tissue in the
mouth or throat is done in a doctor's office or a hospital. Shrinking tissue
may involve small shots or other treatments to the tissue. A series of such
treatments may be needed to shrink the excess tissue. To stiffen excess tissue,
the doctor makes a small cut in the tissue and inserts a small piece of stiff
plastic.
Surgery to remove excess tissue is only done in a
hospital. You're given medicine that makes you sleep during the surgery. After
surgery, you may have throat pain that lasts for 1 to 2 weeks.
Surgery to remove the tonsils, if they're blocking
the airway, may be very helpful for some children. Your child's doctor may
suggest waiting some time to see whether these tissues shrink on their own.
This is common as small children grow.
Living With Sleep Apnea
Obstructive sleep apnea can be very serious.
However, following an effective treatment plan can often improve your quality
of life quite a bit.
Treatment can improve your sleep and relieve daytime
tiredness. It also may make you less likely to develop
high
blood pressure, heart disease, and other health problems linked to sleep
apnea.
Treatment may improve your overall health and
happiness as well as your quality of sleep (and possibly your family's quality
of sleep).
Ongoing Health Care Needs
Follow up with your doctor regularly to make sure
your treatment is working. Tell him or her if the treatment is causing side
effects that you can't handle.
This ongoing care is especially important if you're
getting continuous positive airway pressure (CPAP) treatment. It may take a
while before you adjust to using CPAP.
If you aren't comfortable with your CPAP device or
it doesn't seem to be working, let your doctor know. You may need to switch to
a different device or mask. Or, you may need treatment to relieve CPAP side
effects.
Try not to gain weight. Weight gain can worsen sleep
apnea and require adjustments to your CPAP device. In contrast, weight loss may
relieve your sleep apnea.
Until your sleep apnea is properly treated, know the
dangers of driving or operating heavy machinery while sleepy.
If you're having any type of surgery that requires
medicine to put you to sleep, let your surgeon and doctors know you have sleep
apnea. They might have to take extra steps to make sure your airway stays open
during the surgery.
How Can Family Members Help?
Often, people with sleep apnea don't know they have
it. They're not aware that their breathing stops and starts many times while
they're sleeping. Family members or bed partners usually are the first to
notice signs of sleep apnea.
Family members can do many things to help a loved
one who has sleep apnea.
- Let the person know if he or she snores loudly
during sleep or has breathing stops and starts.
- Encourage the person to get medical help.
- Help the person follow the doctor's treatment
plan, including CPAP.
- Provide emotional support.
Key Points
- Sleep apnea is a common breathing disorder in
which you have one or more pauses in breathing or shallow breaths while you
sleep.
- Sleep apnea usually is a chronic (ongoing)
condition that disrupts your sleep 3 or more nights each week.
- Sleep apnea often goes undiagnosed. Doctors
usually can't detect the condition during routine office visits. Also, there
are no blood tests for the condition. Most people who have sleep apnea don't
know they have it because it only occurs during sleep.
- The most common type of sleep apnea is
obstructive sleep apnea. This most often means that the airway has collapsed or
is blocked during sleep. This may cause shallow breathing or breathing
pauses.
- Sleep apnea can cause daytime sleepiness,
increase the risk for or worsen some medical conditions, and increase the
chance of having a work- or driving-related accident.
- It's estimated that more than 12 million American
adults have sleep apnea. More than half of the people who have this condition
are overweight.
- The most common signs of sleep apnea are loud
snoring and choking or gasping during sleep and being very sleepy during the
day.
- Doctors diagnose sleep apnea based on your
medical and family histories, a physical exam, and results from sleep
studies.
- Treatment is aimed at restoring regular breathing
during sleep and relieving symptoms. Treatment also may help other medical
problems linked to sleep apnea.
- Lifestyle changes, mouthpieces, breathing
devices, and/or surgery are used to treat sleep apnea. Continuous positive
airway pressure (CPAP) is the most common treatment for moderate to severe
sleep apnea.
- Sleep apnea can be very serious. However,
following an effective treatment plan can often improve your quality of life
quite a bit. Follow up with your doctor regularly to make sure your treatment
is working. Tell him or her if the treatment causes side effects that you can't
handle.
- Family members can help a person who snores
loudly or stops breathing during sleep by encouraging him or her to get medical
help.
- Treatment may improve your overall health and
happiness as well as your quality of sleep (and possibly your family's quality
of sleep).
Links to Other Information About Sleep Apnea
NHLBI Resources
Non-NHLBI Resources
Clinical Trials
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