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Obstructive sleep apnea
What is obstructive sleep apnea?
Obstructive sleep apnea occurs when, during sleeping, your throat walls relax and/or your tongue flops back to block the upper section of the airway. This can lead to a temporary stopping of breathing, known as apnea. This can cause an interruption in sleep, as your breathing can stop from between a few seconds to about a minute. When your brain registers that you have stopped breathing, a wake-up signal is sent and you begin to breathe again. Apneas can occur many times through the night, often without you noticing, but causing you to feel tired the next day.
Obstructive sleep apnea happens when your throat muscles relax during sleep. These muscles support your soft palate, uvula, tonsils, tongue and the throat walls. As the throat muscles relax, your airway can become narrow and even close completely, causing reduced breathing. When you are not breathing properly, not as much oxygen is carried around your body. Your brain senses this and wakes you briefly to allow you to reopen your airway. These interruptions may be happening all night long, between 5-30 times or more an hour, without you knowing. This disrupts your sleep patterns and can cause you to feel tired and irritable during the day.
Some risk factors of obstructive sleep apnea can include:
Obesity or excessive weight
Being obese or carrying too much weight can lead to the formation of fat around your upper airway that can contribute to obstruction of your breathing.
Some people have an increased risk of obstructive sleep apnea due to their anatomy. If your family members have obstructive sleep apnea, or you are born with a narrow throat or large tonsils, you have an increased risk. Other risk factors include the shape of your facial bone, the size of your throat muscles and having a thicker neck. If you are a male, you are twice as likely to have obstructive sleep apnea. The risk for females increases if you are overweight or have gone through menopause. The risk of sleep apnea also increases with age in both sexes.
Alcohol, sedatives and tranquilizers
Using these substances can cause the throat muscles to relax, particularly if they are taken before you sleep.
Smoking can increase inflammation and fluid retention in your upper airway. If you smoke, you are three times more likely to have obstructive sleep apnea than people who do not.
The severity of obstructive sleep apnea is categorized by how often your breathing stops while you sleep. These types include:
- Normal - fewer than five interruptions per hour;
- Mild sleep apnea - anywhere between 5-15 interruptions per hour;
- Moderate sleep apnea - anywhere between 15-30 interruptions per hour, and;
- Severe sleep apnea - greater than 30 interruptions per hour.
Signs and symptoms
As obstructive sleep apnea occurs while you are sleeping, you may not know that you have the condition. Some associated signs that you or others may notice can include:
- Sleepiness during the day, fatigue or tiredness;
- Irritability or mood changes;
- Poor concentration;
- Reduced sex drive or impotence;
- Frequent toilet breaks during the night;
- Loud snoring and silence cycles;
- Episodes of stopped breathing during sleep (apneas) witnessed by others, and;
- Morning headache.
Methods for diagnosis
A diagnosis of obstructive sleep apnea requires the identification of repetitive apneas (stopping of breathing) and the presence of symptoms indicating broken sleep; this commonly includes excessive daytime sleepiness. Your doctor may use a questionnaire such as the 'Epworth sleepiness scale' to assess your level of tiredness and advise whether you are safe to drive a car or work with heavy machinery. You may also be referred to a sleep specialist, who can perform overnight monitoring tests to evaluate your signs and symptoms. Some tests to detect obstructive sleep apnea can include:
This test involves you being connected to equipment to monitor your heart rate, blood oxygen levels, lung and brain activity and breathing patterns. This test is done while you sleep and can identify any problems. This test is normally performed in a special sleep laboratory.
Home sleep test
This test is similar to nocturnal polysomnography, but is slightly simpler and can be done at home. This test often involves measuring the rate of your heart, blood oxygen level, breathing patterns and airflow. During obstructive sleep apnea, the results will show a drop in oxygen levels and then later, a rise in oxygen levels when you awaken. If abnormal results are found, you may not need to undergo any further testing and your doctor can prescribe a treatment method. Sometimes you may also be required to take a nocturnal polysomnography test to confirm the diagnosis. To rule out that you do not have a throat or nose blockage, your doctor may refer you to an ear, nose and throat specialist (otolaryngologist).
Types of treatment
In milder cases of obstructive sleep apnea, lifestyles changes including losing weight, cutting down on alcohol or quitting smoking may help improve your condition. In more severe cases, there are many different types of treatment available. These can include:
Continuous positive airway pressure
The continuous positive airway pressure (CPAP) device helps to keep your airways open while you sleep by providing slightly more air pressure than your normal surroundings. It does this by feeding air through a mask into your mouth and nose. A different type of device, called a bi-level positive airway pressure (BPAP), can provide slightly more pressure when you breathe in and slightly less pressure when you breathe out.
These appliances are inserted in your mouth before you sleep and can reduce snoring and mild cases of obstructive sleep apnea. They work by bringing your jaw forward and opening your throat to help you breathe easier.
If lifestyle changes and less invasive devices do not improve your obstructive sleep apnea, surgery may be performed. The main goal of these surgeries is to increase the size of the airway through your throat and nose. Some procedures can include:
When large tonsils may be contributing to obstructive sleep apnea, the tonsils can be removed in a procedure called a tonsillectomy. Another procedure involves removing the tonsils and uvula tissue, and tightening the soft palate. This procedure is known as uvulopalatopharyngoplasty (UPPP).
This procedure involves your jaw being moved slightly forward from your other facial bones. This increases the space behind the soft palate and tongue, lessening the chance of a breathing obstruction. An orthodontist and oral surgeon are generally required to perform this procedure called maxillomandibular advancement.
This procedure is used for patients who cannot tolerate a continuous positive airway pressure (CPAP) device. It involves the surgical insertion of plastic rods into the soft palate to relieve obstructive sleep apnea.
Forming a new air passageway (tracheostomy)
This procedure can be performed if you have not responded to any other treatment and have severe, life-threatening sleep apnea. This procedure involves the insertion of a metal or plastic tube into your neck for you to breathe through while you sleep. This tube is covered during the day and when you are breathing normally.
Obstructive sleep apnea can be considered a serious medical condition. One serious complication it can cause is high blood pressure (hypertension). This is due to the sudden drop in oxygen levels in the blood, which puts increased strain on the cardiovascular system. Low oxygen levels in the blood caused by obstructive sleep apnea can also damage the heart tissue and may cause cardiac rhythm abnormalities such as atrial fibrillation. Other complications associated with obstructive sleep apnea include fatigue during the day and increased risk of airway problems with general anesthesia.
If you are diagnosed with obstructive sleep apnea, there are various treatments to help lower or completely remove the symptoms of the condition. These can include lifestyle changes, the use of devices such as the continuous positive airway pressure (CPAP), or an oral appliance. If these treatments do not ease or stop obstructive sleep apnea, several surgical options are available.
To help prevent obstructive sleep apnea, some lifestyle changes can be made. These may include maintaining a healthy body weight, quitting smoking and reducing your intake of alcohol and sedatives before you sleep.
- Greenstone M. and M. Hack. Obstructive Sleep Apnoea. BMJ 348 no. jun17 11 (June 17 2014): g3745g3745. doi:10.1136/bmj.g3745
- Mansfield Darren R. Nicholas A. Antic and R. Doug McEvoy. How to Assess Diagnose Refer and Treat Adult Obstructive Sleep Apnoea: A Commentary on the Choices. Medical Journal of Australia 199 no. 8 (2013). link here
- RACGP - Obstructive Sleep Apnoea and Snoring. Accessed July 15 2014. link here
- Sleep Apnea Risk Factors - Diseases and Conditions - Mayo Clinic. Accessed July 15 2014. link here
- Sleep Apnoea. Better Health Channel. Accessed July 15 2014. link here
FAQ Frequently asked questions
What is obstructive sleep apnea?
Obstructive sleep apnea occurs when, during sleeping, your throat walls relax and/or your tongue flops back to block the upper section of the airway. This can lead to a temporary stopping of breathing, known as apnea. This can cause an interruption in …
What are the symptoms of obstructive sleep apnea?
Obstructive sleep apnea occurs while you are sleeping, so you may not realize you have the condition. Some associated signs that you may notice can include: sleepiness during the day, fatigue or tiredness; reduced sex drive or impotence; …
What causes obstructive sleep apnea?
Obstructive sleep apnea happens when your throat muscles relax during sleep. These are the muscles that support your soft palate and the uvula. These muscles also support your tonsils, tongue and throat walls. As the throat muscles relax, your airway …
Who gets obstructive sleep apnea?
Anyone can develop obstructive sleep apnea. Some risk factors can include: obesity, which can lead to obstructive fat forming around the upper airway; genetics, which determine the size of your throat and tonsils; some illnesses, such as nasal congestion; …
How is obstructive sleep apnea diagnosed?
A diagnosis of obstructive sleep apnea requires the identification of repetitive apneas (stopping of breathing) and the presence of symptoms indicating broken sleep; this commonly includes excessive daytime sleepiness. To help reach this diagnosis, …
How is obstructive sleep apnea treated?
In milder cases of obstructive sleep apnea, lifestyles changes including losing weight, cutting down on alcohol or quitting smoking may help. In more severe cases, there are other treatment options such as continuous positive airway pressure (CPAP), …
Can obstructive sleep apnea be prevented?
In some cases, obstructive sleep apnea can be prevented by making lifestyle changes. These may include maintaining a healthy body weight, quitting smoking and reducing your intake of alcohol and sedatives before you sleep.
Can obstructive sleep apnea run in the family?
If any of your family members have obstructive sleep apnea or you are born with a narrow throat or large tonsils, you have an increased risk of apnea. Other risk factors include the shape of your facial bone (having a small chin), large throat …
Are there different types of obstructive sleep apnea?
The different types of sleep apnea are categorized by how frequently your breathing is interrupted while you sleep: normal - fewer than five interruptions per hour; mild sleep apnea - anywhere between five and 15 interruptions per …