What is Sleep Apnea

Obstructive Sleep Apnea / Hypopnea Syndrome (OSAHS) is a disorder caused by the repetitive and intermittent closure of the upper airways during sleep. Mainly due to the collapse of the pharyngeal walls.

Hypopnea is a transient and incomplete reduction of 50% of airflow to the lungs, while apnea is the absence of breathing which lasts for more than 10 seconds.

In obstructive sleep apnea, an airway obstruction is accompanied by reduced oxyhemoglobin saturation. The obstruction causes symptoms such as loud snoring, periods of apnea, fragmented sleep, and frequent awakening, leading to daytime sleepiness.

Clinical symptoms are classified as either diurnal or nocturnal. Diurnal sleep apnea symptoms include excessive sleepiness, gastroesophageal reflux, irritability, poor concentration, and headaches. Nocturnal sleep apnea symptoms include respiratory pauses during sleep and restless sleep.

Doctors use an apnea-hypopnea index (AHI) to determine whether a person has mild, moderate, or severe OSAHS.

Sleep Apnea History

In 1918, Sir William Osler, a Canadian physician, first used the term "Pickwickian" to describe patients who were obese and hyper somnolent. The term is based on the overweight messenger boy Joe in Charles Dickens’s novel, The Pickwick Papers, who was always sleepy.

Around 1956, Dr. C. S. Burwell followed the treatment of patients with congestive heart failure, drowsiness, extreme fatigue, as well as airflow deficiency to the lungs and respiratory failure. He diagnosed these patients with Pickwick's Syndrome.

In 1965, a group of French and German doctors led by Dr.  Henri Gastaut recorded the breathing and sleep patterns of a patient with Pickwick's Syndrome and began researching what they called "Obstructive Sleep Apnea."

They discovered three distinct patterns in patients and classified them into three types: obstructive, central, and mixed sleep apnea.

In 1981, an Australian researcher, Dr. Colin Sullivan and his colleagues Berthon-Jones, Issa and Eves, developed a machine called Continuous Positive Airway Pressure (CPAP) to treat OHSAS. It treated sleep apnea because an inverted vacuum cleaner motor blew air into the patient's nasal passage, using a tube to keep the airways open.

Initially, CPAP machines were large, bulky, and noisy. But by the late 1980s, the machines improved and soon people suffering from sleep apnea began to use them more frequently.

Sleep Apnea Causes

Obstructive sleep apnea occurs due to the obstruction of the respiratory tract that makes it difficult for someone to breathe properly.

The causes of sleep apnea include:

- Having a very large tongue and small or dorsal chin: a large tongue can prevent air from flowing from the throat to the lungs. Having a smaller chin or jaw reduces the amount of space for the tongue in the mouth, so the tongue moves back towards the throat, blocking the airway.

- Genetic predisposition: some individuals may have inherited sleep apnea if their parents or other family members also suffer from it. They may also have inherited features such as a narrow airway, a large tongue, small chin, or large tonsils, which might obstruct the passage of air to the lungs.

- Maxillomandibular hypoplasia: mandibular hypoplasia occurs when the bones in the jaw don’t develop properly in infants. If the lower jaw (mandible) is set further back than the upper jaw (maxilla), the tongue may cause an airway obstruction blocks the airflow to the lungs.

Sleep Apnea Risk Factors

Several factors can increase the risk of developing sleep apnea. These include:

- Obesity: people who are obese might have more fat accumulated around the upper airway may narrow the airway, interfering with breathing.

- Being male: men are two to three more times likely to develop sleep apnea compared to women.

- Being a woman post menopause: Post-menopausal women have a higher risk of developing sleep apnea because the upper airway may change after menopause. Women may also gain weight after menopause increase their risk of sleep apnea.

- Nasal congestion: nasal congestion makes breathing through the nose difficult and may increase the risk of sleep apnea if the nose is constantly blocked.

- Other medical conditions:  Having diseases such as diabetes, high blood pressure, heart disease, stroke, allergies, asthma, and Parkinson’s disease increases a person’s risk of developing sleep apnea.

- Hypothyroidism: hypothyroidism occurs when the thyroid gland isn’t producing enough thyroid hormones and can affect a person’s sleep and breathing patterns. It can disrupt the function of the throat muscles or enlarge the tongue, making it more difficult to breathe. Hypothyroidism increases the risk of weight gain and obesity, which can increase the risk of sleep apnea.

- Excessive alcohol consumption: excessive alcohol consumption relaxes the throat muscles which makes it harder for people to breathe normally.

Sleep Apnea Symptoms

Symptoms of sleep apnea can be very annoying to partners to an extent that it can prevent them from sleep. However, it can be quite hard for the person to tell if he or she has sleep apnea. Someone can stay with the patient while he or she is sleeping to check for symptoms.

Some common signs and symptoms of sleep apnea are:

• Snoring: people with sleep apnea snore or breathe noisily during sleep.

• Frequent nightly awakenings: people with sleep apnea wake up several times in the middle of the night because of obstructed breathing. They may wake up because they feel like they’re choking.

• Periods of not breathing during sleep: people with sleep apnea experience episodes of paused breathing during sleep.

• Cognitive disorders: people with sleep apnea may have cognitive disorders and may be unable to memorize things, concentrate, and pay attention because their brains didn’t get enough sleep and their brains don’t have an adequate supply of oxygen.

• Irritability: people with sleep apnea may experience mood changes, such as depression or irritability due to interrupted sleep.

• Fatigue and drowsiness: people with sleep apnea may be fatigued and drowsy because they wake up frequently at night.

• Morning headaches: people with sleep apnea suffer from morning headaches because of the lack of sleep at night.

Sleep Apnea Diagnosis

A dental surgeon may be the first professional to recognize this syndrome. During sedation, some patients with OSAHS have gastroesophageal reflux, due to the effort caused by obstruction of the upper airways, increasing the risk of lung damage.

To diagnose sleep apnea, the physician should first analyze the clinical symptoms present in the patient, such as fatigue, diurnal hyper-drowsiness, often with reports of traffic or work accidents due to difficulty paying attention, irritability, decreased libido, and morning headache.

The doctor then conducts a physical examination evaluating weight, height, neck circumference, and blood pressure because these factors are associated with OSAHS.

A doctor can also conduct a polysomnography (PSG) to diagnose sleep apnea. A PSG is the gold standard method for the diagnosis of OSAHS. It is a quantitative and specific examination performed in a hospital or clinic specializing in sleep. The patient spends the night connected to a device that records parameters such as heart rate, brain activity, eye movement, respiration, and oxygen level in the blood.

Natural Treatments for Sleep Apnea

There are many natural solutions for sleep apnea. Some can help strengthen the muscles of the soft palate and reduce muscular tension in the neck, while others work on improving respiration.

Click on natural treatments for sleep apnea to find a detailed list of all the natural solutions to treat it, including various natural therapies, diet programs, alternative medicine, vitamins, supplements, herbal medicine, and home remedies. You can also use www.aposbook.com to find all natural treatments for any other condition.

Meanwhile, a person can use a combination of these natural solutions for more effective treatment to help overcome several issues and reduce sleep apnea symptoms. These might include:

- Physical treatments: Physical treatments work on the neck adjustment to support the muscle in the area. This helps reduce tension and improve breathing. Other treatments help manage the flow of energy in the body and relax the person to promote good sleep. For example, breathing exercises help improve breathing and reduce tension around the throat, nose, and neck.

- Herbs and plants: Some herbs such as lobelia act as a respiratory stimulant. Lobelia can maintain deep steady breathing in patients with sleep apnea to avert a dangerous drop in blood oxygen levels that occurs because some of the body’s muscles are relaxed. Other herbs such as thyme improve the ability of the lungs to exchange carbon dioxide for oxygen and help maintain the blood’s oxygen levels.

Medical Treatment for Sleep Apnea

For milder cases of sleep apnea, doctors may only recommend lifestyle changes, such as losing weight or quitting smoking.

However, if sleep apnea is moderate to severe, a number of treatments are available. Some of those treatments include:

- Continuous positive airway pressure (CPAP): Continuous positive airway pressure is a machine that delivers air pressure through a mask while sleeping. The air pressure is greater than that of the surrounding air and keeps a patient’s upper airway passages open, preventing apnea and snoring.

- Oral appliances: Wearing an oral appliance is another option to keep a patient’s throat open.  A CPAP is more effective than oral appliances, but oral appliances are easier to use.

- Supplemental oxygen: This airflow device provides the patient with oxygen that might help if the individual has central sleep apnea.

- Adaptive servo-ventilation (ASV): This airflow device is more advanced and efficient than the supplemental oxygen. It continuously monitors the breathing status of the individual and stores the information in a built-in computer. After the patient falls asleep, the machine uses a special algorithm to normalize the patient’s breathing pattern and prevent pauses in breathing.

In some rare instances of severe sleep apnea, doctors perform surgeries to treat it. Some of the surgeries include:

- Tracheostomy: This surgery entails inserting a plastic tube through the neck into the windpipe to allow more air to flow through the airways.

- Uvulopalatopharyngoplasty (UPPP or UP3): During this surgery, doctors may remove certain tissues that include the uvula, soft palate, and tonsils to allow more airspace.

More recently, less invasive procedures have been developed including maxillomandibular advancement that moves the upper and lower jaw forward to allow for greater airspace.

- Hypoglossal nerve stimulator: During this surgery, a device is implanted in the chest wall, stimulating the hypoglossal nerve. The hypoglossal nerve controls the tongue. In sleep apnea, the tongue is relaxed, so this surgery contracts the tongue causing it to move out of the way, preventing the obstruction of the airway.

Sleep Apnea Prevention

Visit the Sleep Apnea Prevention Center to check all the information on how to prevent sleep apnea or deal with it, including the different recommendations to follow and what you should avoid.