What is Sleep Apnea and The Comprehensive Treatments for Sleep Apnea

Sleep apnea is a common sleep disorder with 100 million people affected by it, according to WHO. But HOW and WHY does it happen?

WHAT IS SLEEP APNEA?

Apnea Sleep (SA) is a condition that automatically pauses breathing when sleeping for short periods. Pauses in which the breathing stops are called apneic episodes. SA is typical for snoring. Airflow squeezing through the restricted airway causes snoring.

Dynamic changes throughout the body define sleep. It’s made up of distinct phases, and as you navigate through them, your breathing, blood pressure, and body temperature will all fluctuate. When you sleep, the tension in your muscles largely remains the same as when you are awake. Most key muscle groups relax significantly during periods. However, if you relax your throat muscles too much, your airway collapses and becomes obstructed. The result is obstructive sleep apnea – from the Greek ápnoia, or ‘breathless. Your airway may collapse or get blocked at night, which is when sleep apnea begins. When you resume breathing, you can sometimes make a loud snoring sound that both wakes you and your sleeping companion.

What is Obstructive Sleep Apnea?

There are three types of sleep apnea, they are:

• Obstructive Sleep Apnea (OSA): This is the most common type of sleep apnea, in which the airway has become narrowed, blocked, or floppy. Usually, the blockage is tongue muscles, soft palate, or parts of the throat that relax too much during sleep and block the airway.
• Central Sleep Apnea (CSA): There is no airway blockage, but the brain doesn’t signal the respiratory muscles to breathe.
• Mixed Apnea Or Complex Apnea Syndrome: This is a combination of obstructive and central sleep apnea.

The most prevalent type of sleep apnea is obstructive sleep apnea (OSA).

DOES SNORING MEAN APNEA?

Obstructive Sleep Apnea OSA and snoring are often associated with each other. Although snoring by itself doesn’t mean that someone has OSA, it can be a sign to get a doctor’s opinion if snoring is along with any of the following symptoms: Sleep breathing interruptions. More research needs to be done on this topic. A single colossal study was conducted on habitual snorers and the link between the degree of sleep apnea and snoring volume. 87% of the frequent snorer population had apnea.

RISK FACTORS OF SLEEP APNEA

1. Obesity: Obesity is regarded as the most significant risk factor by the American Lung Association (ALA). According to Johns Hopkins Medicine, sleep apnea affects more than 20% of people with obesity compared to 3% of people with moderate weight.
2. Family History: You may be at higher risk if other family members have been diagnosed.
3. The Male Gender: According to the American Lung Association, males are 2 to 3 times more likely than premenopausal women to suffer from obstructive sleep apnea. Men and postmenopausal women are at roughly the same risk. Check out what you need to know about menopause here.
4. Medical Conditions: If you have high blood pressure, diabetes, or asthma, your chances of developing OSA increase.
5. Nasal Congestion: People with chronic nasal congestion at night are twice as likely to develop this sleep disorder.
6. Smoking: It is more common in people who smoke, according to research in 2021.
7. Tonsils: Children with large tonsils and adenoids
8. Use of Alcohol, Sedatives, or Tranquilizers: These compounds relax your throat’s muscles, which can worsen obstructive sleep apnea.

OSA is more common in older people and those who are overweight.

How Many People, Men or Women, are Affected by Sleep Apnea?

• Breathing sleep disorders affect 23.4% of women and 49.7% of males.
• Male to female sleep apnea ratio 2 to 3:1.
• According to research done in 2014, 26% of adults between 30 and 70 years of age have OSA.
• The sleep apnea rate significantly increases as we age. However, 10% of men between 30 and 49 years of age are likely to experience it, while 3% of women have apnea within the same period.  Between the age bracket of 50-70, 17% of men and 9% of women are affected.
• This increase halts in older adults. Only 8% (65 and up) of the elderly population were evaluated with this sleep disorder.

How to Define Mild, Moderate, and Severe Sleep Apnea?

The index apnea-hypopnea (AHI) assesses apnea in sleep to identify how many pauses you have every hour in your sleep, from mild to severe. According to the American Academy of Sleep Medicine,

THE EFFECTS OF SLEEP APNEA ON THE BODY

Sleep Apnea does more than make you sleepy. It can contribute to heart disease, diabetes, and other long-term health hazards if left untreated. Following effects occur to the body:

• Respiratory System: Troubled breathing while sleeping and difficulty in exercising. Sleep apnea can worsen symptoms of asthma and chronic obstructive pulmonary disease (COPD).
• Nervous System: The CSA, due to interrupted brain signals to breathing muscles, can cause numbness and tingling. 
• Cardiovascular System: High Blood pressure and obesity are related to apnea while sleeping by many researchers. It can also cause irregular heart rhythm and increasing the chances of stroke by the Canadian General of Cardiology. Heart failure is also one of the things related to SA.
• Endocrine System: According to research done in 2017, people are more prone to developing insulin resistance, thus being a risk factor for Type 2 Diabetes.  Its also linked with Metabolic Syndrome with several diseases and risks.
• Digestive System: Fatty Liver disease has been associated with this disorder. It can also increase the risks of heartburn and GERD.
• Reproductive System: It reduces the desire to have sexual interaction. In men, it contributes to erectile dysfunction and infertility.
• Other Symptoms: Some other common symptoms include

1. Irritability for the partner.
2. Trouble in concentration.
3. Headache.
4. Waking up often during the night
5. Dry mouth/ Sore throat.
6. More than typical sleeping during the day

Find out what other changes sleep causes in our bodies. By clicking HERE

SLEEP APNEA SYMPTOMS

Talk to your doctor if you have any of the symptoms of obstructive sleep apnea, in particular:

• Loud and disruptive snoring.
• Abrupt awakening in the middle of the night with gasps and chokes.
• Episodes of paused breathing in sleep.
• Awakening with a dry mouth.

Diagnosis is made when a  doctor may conduct an examination based on indications and symptoms and a sleep history. You may also be referred to a sleep disorder center where a specialist will evaluate and see if you need any other examinations for diagnosis. An evaluation may include nightly monitoring of your breathing and other physiological systems at a sleep facility. Tests to detect sleep apnea include:

1. Home Sleep Tests: The doctor may recommend performing simple tests at home to identify sleep apnea. These tests usually measure your heart rate, blood oxygen level, airflow, and breathing patterns.
2. Nocturnal Polysomnography: You’ll be linked up to equipment that will monitor your heart, lung, and brain activity, breathing patterns, arm and leg movements, and blood oxygen levels as you sleep during this test.

SLEEP APNEA TREATMENTS

Depending on the severity of sleep apnea, the health risks, and the annoyance to your sleeping partner, the below comprehensive list of sleep apnea treatments can be considered, from natural remedies for sleep apnea to invasive surgeries to treat severe sleep apnea.

Natural Remedies and Treatments for Sleep Apnea

1. Weight reduction

Maintaining a healthy weight can help keep your airways open and lessen sleep apnea symptoms. According to research, moderate weight loss in obese persons can reduce the need for upper airway surgery or long-term CPAP therapy.

2. The Position Therapy

Sleep apnea is more prevalent in people who sleep on their backs. A 2006 study found that more than half of obstructive sleep apnea symptoms rely on posture. Sleeping on sides and the tummy is advised; however, at the back, it’s not. Another research has suggested that lying on your side appears ideal for people who snore and suffer from sleep apnea. Positional Therapy is advised in this research. 

3. Exercise and yoga

Regular exercise boosts your heart rate and enhances your energy levels during the day. To increase the quality of your sleep, do at least 30 minutes of cardiovascular exercise every day, such as walking, running, swimming, or biking. (Make sure you don’t do it within two hours of going to bed!) Yoga can help to strengthen your respiratory system and increase oxygen flow.

Click here to see which exercise works best for you! 

4. Avoid alcohol and smoking

To avoid sleep apnea issues, consider stopping smoking and minimizing your alcohol intake. Throat muscles relax due to alcohol intake and can result in snoring. It can also cause inflammation in your airways, which can obstruct your breathing.  It was recommended in the study of 2021 to avoid alcohol and smoking for better treatment of sleep apnea. Smoking was recognized as a risk factor in a 2012 study that suggested avoiding it.

What other damages happen when you drink alcohol READ HERE!

5. Nasal decongestants

If you experience congestion, you can keep your nasal passages open by using a saline nasal spray.  A study in 2018 concluded that nasal sprays could improve nasal patency by decongestants could improve sleep quality, AHI, and oxygen saturation level during sleep.

6. Gadgets / Aids that help snoring and sleep apnea

• Sleep Wedge Pillow: It’s getting popular among people for maintaining a proper head position while sleep and helping with neck pain. It helps to reduce snoring and symptoms of apnea in sleep.
• The Air Humidifier: Humidifiers are machines that add moisture to the air we breathe. A humidifier can help to open up your airways, reduce congestion, and promote cleaner breathing.
• Tongue Retaining Device: This oral appliance is worn in the mouth while sleeping and has a component that prevents your tongue from slipping back into your airway.
• Neuromuscular Tongue Muscle Stimulator: It’s a portable and prescription-only gadget that you place in your mouth for 20 minutes every day while awake. The device uses modest electrical currents to strengthen your tongue muscle, preventing it from relaxing and blocking your airway as you sleep. A study suggested that such stimulation delivered can modulate airflow during sleep in patients with OSA.

Treatments for Sleep Apnea (moderate to severe sleep apnea)

• (CPAP) Continuous Positive Airway Pressure: It is considered the most helpful treatment for moderate to severe sleep apnea. Also known as a sleep apnea machine, it involves having a mask that delivers air pressure while you sleep. The air is delivered through a mask that fits over your nose and mouth or only your nose. The air pressure in a CPAP machine is slightly higher than the surrounding air, just enough to keep your upper airway passages open and avoid apnea and snoring. CPAPs are the usual treatment for OSA, but it may take a few weeks of consulting with a doctor or technician to discover the best combination of settings and CPAP accessories for you.  Another automatic version of the auto-CPAP machine is available that regulates the pressure while you sleep.CPAP is a gold standard yet complicated treatment to continue with, according to a study done in 2016.

• BiPAP (Bilevel Positive Airway pressure):
• It is available when CPAP doesn’t work for you. Some units provide bilevel positive airway pressure (BPAP). When you inhale, the pressure is higher, and when you exhale, the pressure is lower.

• Pros of BiPAP	Cons of BiPAP
  Comfortable for individuals, enhancing compliance. Two different pressures make it easy to use Effective for users with moderate to severe obstructive sleep apnea. More sophisticated settings can be customized to the user’s specific needs.	More expensive than CPAP. Users cannot start on BiPAP, typically, until they “fail” CPAP

• Nasal Expiratory Positive Airway Pressure (EPAP): This is alternate emergency therapy treatment involves the insertion of disposable or reusable valves into or over the nostrils while sleeping. The valves help maintain pressure to keep your airway open while you sleep by limiting your exhalations or breaths out. EPAP valves, unlike CPAP machines, do not require electricity or batteries to operate.
  

  Pros of EPAP	Cons of EPAP
  Small & portable No maintenance required More comfortable to use than other mandibular and tongue devices Slight risk of side effects Requires no electricity	New technology & fewer studies are present to approve the efficacy It is ineffective for people who have difficulty breathing through their noses It doesn’t work for nose breathers

• Other Oral Appliances: According to a 2015 guideline, oral gadgets are recommended for adults with sleep apnea who cannot tolerate CPAP equipment.  Sleep apnea can be treated using oral appliances or dental devices which adjust your jaw or tongue to keep your airway open while you sleep. A prescription-only oral appliance is worn at night and is similar to a sports mouthguard or an orthodontic retainer, but it covers both the top and bottom teeth. It can be used with CPAP as an adjunct or separately. You’ll need to see a dentist experienced in dental sleep medicine appliances for fitting and follow-up therapy.

Surgeries to Treat Sleep Apnea

Upon the failure of all the treatments mentioned above, corrective surgeries are the invasive treatment measures. Consult with one or more physicians to evaluate the pros and cons of each surgery. Any removal of tissue can have an impact on other parts of your health. Surgery should be considered as a last resort. Surgical options to treat sleep apnea can include:

• Tissue Removal Uvulopalatopharyngoplasty (UPPP):  In this, tissue from the back of your mouth and the top of your throat is removed by your doctor. Tonsils and adenoids are typically removed as well. According to the research, the overall success rate of UPPP was 78%.
• Upper Airway Stimulation: A new method for people intolerant to CPAP & BiPAP. A small, thin impulse generator is implanted under the skin. When necessary, the device recognizes your breathing patterns and activates the nerve that governs tongue movement. A recent study in 2021 has shown its effectiveness over this Therapy.
• Jaw Repositioning: In this surgery, your jaw is shifted forward from the rest of your facial bones, making obstruction less likely.
• Creating a new Air Passageway (Tracheostomy): Best when all the treatments have failed, and the apnea is severe and life-threatening.

Diagnosing sleep disorders can improve one’s quality of life and prevent complications or progression of certain diseases; check out this article on why sleep is essential to one’s health!