Sleep apnea is a condition in which breathing stops and starts during sleep. It is a condition that affects as many as 100 million people world wide. Sleep apnea causes a variety of potentially serious health issues and side effects. But the most startling thing about sleep apnea is most sufferers don’t actually know they have it. At least not until it has begun to take a serious toll on their health. You might wonder how that is possible. How could someone stop and start breathing several times a night and not even know? What are the signs of sleep apnea? How do we so often miss these signs?
What is Sleep Apnea?
Before we get into the signs of sleep apnea, let’s talk a little bit about what it is. An apnea is a period in which breathing stops unexpectedly, especially during sleep. These apneas can last anywhere from 5 seconds to several minutes at a time. With mild to moderate sleep apnea a person may stop breathing anywhere from 5 to 30 times an hour during sleep. In the most extreme cases these pauses may occur several hundred times a night.
The most common type is Obstructive Sleep Apnea. With this type, the brain continues sending messages to the muscles of the chest and diaphragm to keep breathing. However, the airway becomes partially or completely blocked. The heart, lungs, and muscles of the chest work harder to try to keep blood and oxygen moving through the body. When these efforts to clear the blockage fail, blood oxygen levels begin to drop. If normal breathing does not resume, the patient will begin to suffocate. This triggers a gasp reflex, causing you to wake suddenly and begin breathing again.
The other main type of sleep apnea is Central Sleep Apnea. With Central Sleep Apnea the brain fails to properly signal the body to continue breathing. Unlike Obstructive Sleep Apnea, with CSA all breath functions stop. The muscles of the chest and diaphragm do not continue trying to move air through the lungs. Normal breathing resumes only after blood oxygen levels drop low enough, triggering you to wake up.
Signs and Symptoms
We’ve talked a little about what sleep apnea is, but what does it look like? What do sufferers experience?
If you have ever lived with someone who snored, you are probably already familiar with the most common signs of sleep apnea. While not all snorers have sleep apnea – and not all people with sleep apnea snore – it is a classic symptom of the condition. With Obstructive Sleep Apnea the airway becomes partially or completely blocked.
As you struggle to clear the obstruction, the movement of air past the blockage causes these soft tissues to vibrate. The result is a loud, chain-saw like snore interrupted by observable periods where breathing stops. These apneas are usually accompanied by a fit of gasping or choking before normal breathing resumes. The sufferers themselves are usually completely unaware of these particular symptoms. Depending on how violent their fits of choking or gasping are, they may not even realize how often they wake up.
Because they occur during sleep, someone with sleep apnea is usually only aware of the lingering side effects. These might include waking up with a dry mouth or sore throat, chest pain, or morning headache. These symptoms are easily misinterpreted as other issues and often go misdiagnosed. Chest pain might result from your sleeping posture, lifestyle, or other health issues. A morning headache might get ignored as just needing your morning cup of coffee. Dry mouth could be the result of dehydration, sleeping with your mouth open, or a side effect from medication.
Other symptoms include excessive daytime sleepiness, difficulty concentrating, mood changes, and decreased libido. Most of those symptoms, especially in the absence of loud snoring, are very often misdiagnosed as depression. The nighttime sweating is easily ignored as preferring a cooler sleep environment. Sleep apnea also causes high blood pressure. However, high blood pressure is common among people who do not suffer from sleep apnea. So high blood pressure on its own is not a major red flag.
Diagnosing Sleep Apnea
So how do so many people with sleep apnea go un- or misdiagnosed? As discussed, many of the symptoms are easily explained away by other complaints. Imagine a patient comes in to see their doctor. They complain of poor sleep, low moods, and difficulty focusing. Because they live alone, they are not aware of their loud snoring. To the doctor, this presents as a fairly typical case of depression. It’s not until they develop or complain of other common symptoms that the cause becomes clear, if ever.
In fact, most people who do finally seek medical advice don’t actually think there is anything wrong. They only speak to their doctor because their loved one is losing sleep too, due to their loud snoring. Individuals who live alone or who do not snore may go months or even years before they see a doctor.
Sleep apnea affects as many as 70 million US adults. The condition is most common among men and people over the age of 60. But, women and children are also affected. Being overweight, diabetic, or a smoker also increases your risk of developing sleep apnea. Other risk factors include asthma, narrow airway, family history, illness, and hypertension.
Treating Sleep Apnea
Thankfully, sleep apnea is easy to treat. Reducing your risks and contributing factors are a great long term goal. Ways to reduce your risks and improve your symptoms include:
- Weight Control
- Making sure underlying conditions are well controlled
- Change sleeping positions
- Use a humidifier
- Quit smoking
But in the meantime, you need to get some restful sleep. The frequent waking has left you exhausted and falling asleep at work. You need relief now. So what can you do? A CPAP machine is usually the go-to answer for most sleep apnea patients. CPAP stands for Continuous Positive Airway Pressure. It’s a mask that fits over the nose and mouth to pressurize your airway, preventing it from collapsing during sleep. These masks are large and usually fairly heavy. Many patients have difficulty falling or staying asleep while wearing it.
As a result, many patients do not wear their CPAP as often as they should to see relief. Thankfully, there are other options. An alternative, and equally effective option is to use an oral appliance. An oral appliance is a device worn in the mouth to maintain an open airway during sleep. It does this by shifting the lower jaw forward to prevent soft palate collapse. Oral appliances come in generic versions or can be custom designed to fit your mouth. With a custom fit appliance, patients report much higher compliance with their prescribed sleep apnea therapy. And better compliance means better sleep.
At Sleep Better Columbus we pride ourselves on providing high quality custom fitted oral appliances. With Dr. Mark Levy’s extensive experience and education, you can rest assured you’re getting the best possible care.