Sleep apnea - a commonly undiagnosed condition with potentially serious complications

11/27/2022

Do you snore loudly at night? Do you have a hard time staying asleep? Do you wake up with a dry mouth and a headache? Then you might be suffering from a potentially serious condition called sleep apnea.

What is sleep apnea?

Sleep apnea means that your breathing stops intermittently during the night. These breath stops are often accompanied by gasping, snorting, or choking noises. There are multiple different types of sleep apnea. The most common one is obstructive sleep apnea (OSA).

Obstructive sleep apnea

Obstructive sleep apnea means that the muscles that support the soft tissues in your throat, such as your tongue, temporarily relax. When this occurs, your airway is narrowed or closed entirely, which cuts off the circulation of air and therefore also your breathing. This will often lead to you snoring and gasping for air. This shortness of breath will be sensed by the brain, which in turn wakes you up so that you can start breathing again. This awakening is usually so brief that you won’t remember it. The fact that the awakening is brief is a double-edged sword since, on the one hand, it’s positive because the loss of sleep quantity is minimized, but on the other hand, it might be harder to detect these apneas.

Symptoms of obstructive sleep apnea

I listed some common symptoms of obstructive sleep apnea at the beginning of this post, but here is a more exhaustive list of some of the most prevalent symptoms of obstructive sleep apnea:

Dry mouth when waking up
Headaches when waking up that can last for hours
Frequent daytime sleepiness
Irritability or frustration
Snoring accompanied by gasping sounds
Periods of wakefulness during the night
Increased need to get up from bed to pee
Reduced focus

Risk factors for obstructive sleep apnea

There is a multitude of factors that can contribute to an increased risk of developing sleep apnea. These include:

Nasal congestion. If you have difficulty breathing through your nose, you’re more likely to develop obstructive sleep apnea.
Being older. Sleep apnea occurs significantly more often in older adults.
Use of alcohol or other sedatives. These substances relax the muscles in your throat, which can lead to congestion in the airways. I talk a little bit about this in my post on how sleep works.
Smoking. Smoking can induce an increased amount of inflammation and fluid retention in the upper airway.
Being male. Men have a significantly larger risk of developing sleep apnea than women.
Being overweight. Fat deposits can impact the airways negatively.
Family history. Immediate relatives of people who have obstructive sleep apnea are twice as likely to develop OSA as someone who doesn’t have OSA in their immediate family.
Certain physical features of your head and face. Having a lower jaw that is small or positioned farther back increases the risk of developing OSA.

Health implications of obstructive sleep apnea

The health implications of obstructive sleep apnea go far beyond the aforementioned symptoms. If left untreated, sleep apnea is associated with an increased risk of a myriad of health concerns, such as:

Metabolic disorders like type 2 diabetes
Cardiovascular diseases like hypertension, heart disease, and abnormal heartbeat
Impaired concentration and focus
Depression and mood disturbances
Nonalcoholic fatty liver disease, meaning an increase in fat deposits in the liver

Central sleep apnea

There’s another form of sleep apnea called central sleep apnea (CSA). While obstructive sleep apnea is more of a mechanical failure, central sleep apnea is caused by a signaling failure. It occurs when the brain doesn’t send proper signals to the muscles that control respiration, meaning that you will intermittently stop breathing.

Risk factors for central sleep apnea

As for obstructive sleep apnea, some factors increase the risk of developing central sleep apnea. These include:

Age. Central sleep apnea occurs more frequently in people over the age of 65.
Being male. Central sleep apnea is, like obstructive sleep apnea, more prevalent in men.
Medical conditions. Conditions like heart failure, kidney failure, stroke, metabolic disorders, etc increase the risk of developing central sleep apnea.
Medications. Categories of medication like opioids, benzodiazepines, muscle relaxants, etc all increase the risk of developing central sleep apnea.

Health implications of central sleep apnea

It’s harder to generalize the health implications of central sleep apnea, as they are very dependent on the underlying condition that is causing the disturbed breathing.

Diagnosing sleep apnea

Diagnosing sleep apnea is a little bit tricky. Since most of the symptoms occur during sleep, it’s hard for the afflicted person to self-diagnose. And the symptoms that don’t occur during sleep are quite fuzzy and can be caused by a myriad of other factors. Therefore, it’s best to contact your doctor to start an investigation. This investigation typically comprises a review of your overall physical health and your symptoms, as well as a physical exam. This is done to identify your risk factors for sleep apnea. If your doctor concludes that it’s plausible that you might suffer from sleep apnea, you will undergo a sleep study as the next step.

The sleep study

The most common form of sleep study is polysomnography. This is conducted during an overnight stay at a specialized sleep laboratory. During this study, a multitude of sensors is used to track factors like breathing, awakenings, oxygen levels, and so on during your sleep. This form of study is very sophisticated and can determine if you have sleep apnea, and can also tell the difference between obstructive sleep apnea and central sleep apnea. In some cases, you can take an at-home sleep study instead of the laboratory one. This might be more convenient for the patient, but the results still need to be processed by a professional. A home test can not be used to determine central sleep apnea.

Treating sleep apnea

Treating sleep apnea is about minimizing breathing disruptions during the night and improving sleep in general. The approach is a bit different depending on if you have obstructive sleep apnea or central sleep apnea.

Treating obstructive sleep apnea

One of the most common treatments for OSA is through the use of a so-called CPAP machine. CPAP stands for Continuous Positive Airway Pressure. This device sends a stream of pressurized air through your airways at night to remedy the breathing stops. A CPAP machine is a prescription-only device as it needs to be calibrated to work correctly. This type of treatment can be quite intrusive to you and your partner, since it’s a machine that will make noise, and you will have hoses attached to you at all times during the night. So the CPAP machine can take some time to get used to, but it’s a very effective treatment.

Another treatment for OSA is the use of a mouthpiece that keeps the tongue and the jaw in certain, fixed positions. This is often used for less severe levels of OSA and does not improve breathing significantly, but it can reduce snoring and it is an alternative for people that are not comfortable with the CPAP machine.

Surgery to remove tissue in the throat that is blocking your airways is also an alternative treatment.

In addition to all this, it’s also possible to change certain lifestyle factors as part of treating OSA. For example, losing weight, exercising, reducing alcohol consumption, and switching sleep positions to avoid sleeping on your back can all help treat obstructive sleep apnea.

Treating central sleep apnea

Treatment of CSA is mainly focused on treating the underlying cause of the person’s suboptimal breathing rather than the symptoms. If the breathing disruptions are not severe, this treatment is often all it takes to get rid of CSA. In more severe cases or if the CSA persists after trying to treat the underlying condition, the use of a CPAP machine might be required as well. Certain medications that speed up a person’s breathing or oxygen therapy can be used as alternative treatments.

My thoughts on sleep apnea

As I mentioned in my post on how sleep works and my experience with it, I have had problems with my sleep for a long time. Since I learned about sleep apnea a couple of years back, I’ve always had the thought in the back of my mind that I might suffer from it. As I’ve been doing research for this article, I’ve further realized that I suffer from most of the symptoms of obstructive sleep apnea. I have never felt well-rested upon awakening. My mouth is always dry and I often have a headache when waking up. I wake up frequently during the night and I’m often sleepy during the day. My focus is lacking and I’m quite easily irritated or frustrated. I also realized that I do carry some of the risk factors for obstructive sleep apnea as well. I’m male, I have narrow airways and a congested nose. I also believe that the structure of my face in general and my mouth and jaw in particular is suboptimal. I’ve had a lot of dental problems throughout the years and I’ve had to remove a lot of teeth due to lack of space in my mouth. In the near future, I will contact my doctor to try and undergo an investigation for obstructive sleep apnea. Updates on how this goes will of course be posted here on the blog. So stay tuned for that! Thank you all for reading. Until next time!