The Severity of Sleep Apnea

What to Know About Sleep Apnea

We spend about one-third of our lives sleeping – don’t let it be a waste of time! For more than 18 million Americans, sleep apnea prevents restful sleep no matter how many hours are clocked in bed. Read on to learn more about the condition, the complications, and
the corrections you can make if you are at risk.

By Amanda Parks

What is Sleep Apnea?

Sleep apnea is a common yet potentially serious sleep disorder in which breathing is interrupted during sleep. The Greek word “apnea” means “without breath.”

There are two types of sleep apnea: obstructive and central. Obstructive sleep apnea, sometimes referred to as OSA, is the most common form of the disorder. Dr. Sumit Patel, a pulmonologist with the Buz Standefer Lung Center at CHI Memorial, explains, “This is where the upper airway is partially or completely obstructed. These obstructions make your chest and abdominal muscles work harder to overcome the obstruction in order to breathe.”

With central sleep apnea, on the other hand, the airway is open, but the brain fails to send signals to the muscles to breathe.

Regardless of the root cause, people who have sleep apnea stop breathing repeatedly while sleeping. The most telltale signs of sleep apnea are frequent loud snoring and sudden gasps for air, but others include difficulty staying asleep, frequent nighttime urination, morning headache, awaking with dry mouth, and excessive daytime sleepiness.

Am I at Risk?

According to the National Sleep Foundation, sleep apnea affects more than 18 million Americans. Unfortunately, not everyone who has it will recognize it. These factors increase your risk:

OBESITY: This is the most significant risk factor in obstructive sleep apnea. Fat and excess soft tissue of the mouth and throat can obstruct the airway. Those with excess weight are significantly more likely to develop OSA.

AGE: Both obstructive and central sleep apnea occur more often in middle-aged and older adults. Normal changes that occur with age sometimes affect how the brain controls breathing during sleep.

SEX: Both obstructive sleep apnea and central sleep apnea are more common in men than in women.

ANATOMICAL FEATURES: A narrow throat, thick neck, or enlarged tonsils or adenoids can cause blockage.

FAMILY HISTORY: Many of these risk factors are genetic, such as obesity and anatomical features, so the condition often runs in families.

LIFESTYLE: Smoking can cause inflammation in the upper airway, which restricts breathing. Alcohol can relax the mouth and throat muscles, closing the airway. Both smoking and drinking can affect how the brain controls these muscles.

Sleep specialists are trained to diagnose sleep apnea as mild, moderate, or severe based on the results of your evaluation:

MILD: 5 to 14 apnea events in one hour

MODERATE: 15 to 29 apnea events in one hour

SEVERE: More than 30 apnea events in one hour

“An apnea occurs when breathing is stopped for 10 seconds or more,” explains Dr. Tareck Kadrie, medical director at the Erlanger North Sleep Disorders Center.

The Long-Term Effects

Left untreated, sleep apnea can lead to other serious conditions. Sudden drops in blood oxygen levels put a strain on the cardiovascular system, increasing risk of high blood pressure, heart attack, stroke, heart disease, and abnormal heartbeat. “We have found that 70% of congestive heart failure patients have untreated sleep apnea,” says Dr. Erick Kimmerling, medical director at the Hamilton Regional Sleep Center. “More and more, cardiologists are requesting sleep studies to make sure sleep apnea is not a contributing factor to heart-related issues.”

Beyond that, everyday fatigue caused by poor sleep can take a toll on your body, your quality of life, and even your relationships. It can potentially lead to difficulty at work, accidents caused by falling asleep, irritability or depression, or sleep-deprived partners who may find themselves forced to sleep in another room to get good rest.

I Snore. Do I Have Sleep Apnea?

More often than not, snoring and sleep apnea are interrelated. But that’s not always the case. Dr. Patel explains, “It’s a common misconception that everyone who snores has sleep apnea. Snoring could just be due to nasal congestion or nasal deviation. Vice versa, not everyone who has sleep apnea snores.”

That being said, it is a frequent indicator, so it shouldn’t be ignored.

Diagnosing Sleep Apnea

If you (and/or your partner) think you might have sleep apnea, take a trip to visit your physician. He or she will consider your symptoms, family history, and risk factors before conducting a physical exam. Bringing along a partner who shares your bed or a roommate would be helpful to provide a more complete account of your symptoms.

“Sleep apnea is diagnosed by both subjective and objective measures,” says Dr. Kadrie. “Subjective measures include history, a physical exam, and use of such measures as the Epworth Sleepiness Scale (a self-report test that establishes the degree of sleepiness in an individual). The exam may reveal physical sources of possible airway collapse including palate, uvula, tonsils, pharynx, and nasal passages. Neck circumference is measured in all individuals.”

For objective measures, you will likely need to undergo a sleep study. Sleep studies involve overnight monitoring at a sleep center, though they may be possible at home. During an at-home evaluation, a simple test will measure your heart rate, blood oxygen level, airflow, and breathing patterns.

At a sleep center, a more in-depth study monitors heart and lung activity and body movements, as well as apnea events (when your breathing slows or stops) and mouth and throat muscle activity. It also monitors blood oxygen levels and brain activity during sleep. “During these tests, there is a tech present to ensure everything is properly captured for a precise reading,” says Dr. Kimmerling.

Men vs. Women

While sleep apnea affects men more, it is also found in women and may be under-diagnosed in women. Dr. Patel explains, “This is due to the fact that women who have sleep apnea may present with symptoms other than snoring such as insomnia, morning headaches, mood disturbances, and lack of energy.”

Treating Sleep Apnea

The route of treatment recommended by your doctor will depend on which form of sleep apnea you’re diagnosed with and the severity. For mild cases, you may be advised to lose weight, stop smoking, begin an allergy medication regimen to control nasal inflammation, or see an ear, nose, and throat doctor to treat blockage in your nose or throat. For moderate to severe cases, or if the above treatments don’t improve your symptoms, your doctor may want to discuss other options. These may include:

Continuous positive airway machines (CPAP) that deliver air pressure through a mask fitted over your nose and mouth during sleep. These are the most common, painless, and effective course of treatment.

Oral appliances to keep your airway open by repositioning the lower jaw and tongue.

Tissue shrinkage surgery to reduce the amount of tissue at the rear of the mouth. This is an effective treatment for mild to moderate sleep apnea with few surgical risks.

Jaw repositioning surgery to move your jaw forward to enlarge the space behind the tongue and soft palate and reduce obstruction.

“It is estimated that only 10% of patients with sleep apnea are being treated,” says Dr. Kadrie. If you think you or a loved one may have sleep apnea, it’s important to take it seriously. Effective and restful sleep is vital to our health, happiness, and quality of life. HS