Sleep apnea is a condition involving pauses or decreases in breathing during sleep. Most commonly, it is due to airway collapse; this is called obstructive sleep apnea. This collapse occurs in the nose and/or the throat — anywhere from where air enters the nostrils to the back of the tongue. Frequently, this airway collapsibility problem is inherited and starts in childhood. It is not a problem during the day because there is good muscle tone in the airway, and the brain monitors breathing. At night however, the throat muscles become relaxed, and the brain is not as attentive to the airway. Upon inhalation, the airway walls can either completely collapse or significantly narrow. This is a problem because the body must struggle to breathe, and the brain has to “wake up” to reopen the airway.
These frequent awakenings lead to fragmentation of nighttime sleep. You may not remember the awakenings because they are so brief. Patients with sleep apnea could actually wake up more than 30 times an hour and think that they slept uninterrupted through the night. Since sleep must be continuous and consolidated in order to be restorative, a number of cognitive problems can occur with sleep fragmentation. These can include daytime sleepiness, memory problems, concentration difficulties, emotional instability, irritability, slowed reaction time, and most importantly, an increased risk of motor vehicle accidents.
There are also cardiovascular consequences of this constant struggle to breathe. This puts strain on the heart and blood vessels, leading to increased risk of high blood pressure, heart disease, and stroke.
Finally, there are social implications of sleep apnea. The snoring that is frequently associated with sleep apnea can disrupt the sleep of others. In fact, one study showed that when a person treats his or her sleep apnea, the sleep partner gets the equivalent of one hour more sleep per night.
Sleep apnea is a progressive disease. It often gets worse with age, weight gain, and alcohol consumption.
Who Gets Sleep Apnea?
A common misconception is that only overweight men that snore have sleep apnea, but the facts are:
- Sleep apnea can occur without snoring
- Thin people can have sleep apnea
- Women can have sleep apnea
- Children can have sleep apnea
How Is Obstructive Sleep Apnea Treated?
There are four main categories of treatment for sleep apnea: Continuous Positive Airway Pressure (CPAP), surgery, oral appliances, and behavioral modification.
The most effective way to treat sleep apnea is with CPAP. CPAP is a treatment in which a mask is worn over the nose, attached by a hose to an air compressor. The air compressor gently and quietly blows room air into the nose, which “stents” the airway open, preventing airway collapse. This is the most reliably effective way to treat sleep apnea, and all patients diagnosed with sleep apnea should at least try it before considering other options.
Surgery can sometimes be an effective way to treat sleep apnea. A variety of different procedures can be performed on the airway. These range from nasal septum repair to jaw reconstruction. Talk to your doctor about whether surgery is the right option for you.
An oral appliance is a device made by a dentist or an orthodontist designed to pull your lower jaw forward. By pulling your lower jaw forward, the tongue is pulled away from the back of the throat. If your airway obstruction is occurring behind the tongue, then this can be an effective way to treat milder obstructive sleep apnea. The treatment of sleep apnea with oral appliance should be a coordinated effort between the sleep physician, the dentist/orthodontist, and the patient.
Behavioral modifications can help in the treatment of sleep apnea but are usually the least effective. These include such techniques as weight loss, sleeping on your side, and avoiding alcohol before bedtime.