Sleep Apnea

Sleep apnea is characterized by the following signs:

• Loud snoring (particularly in obstructive sleep apnea), especially if surrounded by periods of silence
• Episodes when you stop breathing while sleeping
• Abrupt awakenings at night when you are gasping or short of breath (particularly in central sleep apnea)
• Waking frequently at night to urinate (what wakes you is the fact that you stopped breathing)
• Waking in the morning with a dry mouth or sore throat 

As a result of the difficulty you have in breathing during the night — even if you don’t remember it — you’ll often have a headache in the morning, become very sleepy during the day, have attention problems and act irritably.

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Obstructive Sleep Apnea

Obstructive sleep apnea is caused by exactly that: an internal obstruction that stops you from breathing. Especially prevalent when you sleep on your back, the muscles in the back of your throat can relax. These muscles support your tonsils, your tongue, your uvula and the side walls of your throat.

Your airways are therefore narrowed, and you can’t breathe adequately. This lowers the oxygen level in your blood. Your brain, aware of this, wakes you up so you can reopen the airway. It happens so quickly that you don’t remember it. In fact, it can repeat up to five to 30 times an hour!

What causes the obstruction? Obesity is a major factor. People who are obese have four times the risk of obstructive sleep apnea than the general population. This may be due to excessive fat deposits around the airway. Similarly, people with thicker necks often have narrower airways; and a narrow airway might be inherited, or might be caused by enlarged tonsils or adenoids, particularly in children. Nasal congestion, whether caused by a deviated septum or allergies, can also be a factor.

Smokers have three times the risk of sleep apnea than non-smokers. And because alcohol, sedatives and tranquilizers relax the throat muscles, you are at higher risk for apnea if you use these substances or medicines.

Central Sleep Apnea

Central sleep apnea is caused by the failure of the brain to send signals to your breathing muscles. This itself can stem from various other medical conditions, such as congestive heart failure, or if you’ve had a stroke. Age is a factor, as well; the aging process may impair your brain’s signaling ability. Narcotic pain medications can also have this effect.

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The most important thing you can do to combat your sleep apnea is to use the tools you and your physician at St. Luke’s have agreed on. Often, a breathing “machine” is given to you. It may take time to get adjusted to wearing a mask at night and being hooked up to a machine; it may also take time for the fit to be correct. Persevere. Once you’ve gotten used to it, the machine can improve your sleep and therefore your life.

Aside from following doctor’s orders, you can try sleeping on your side to prevent your tongue and soft palate from blocking the back of your throat and hence your airway. Avoid sedatives and alcohol, especially four to six hours before bedtime, as these can also cause your throat muscles to relax.

Losing weight, if you are obese, will also greatly improve your sleep apnea. Exercising at least 30 minutes every day will help with both weight loss and sleep. Stop smoking if you do; smokers are at much higher risk for sleep apnea. If you suffer from allergies, try using a saline spray or nasal rinse to keep your nasal passages open at night.

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After performing a physical examination and taking a family history, your health care practitioner at St. Luke’s may want you to see an ear, nose and throat (ENT) specialist to rule out blockage in your nose or throat, such as large tonsils or adenoids or a deviated septum.

If central sleep apnea is suspected, you may be referred to a cardiologist or neurologist for testing.

Your physician may also think it best for you to undergo a sleep study at one of st. luke’s sleep centers. with sleep apnea, one of the benefits of a sleep study, particularly the nocturnal sleep test, is that the test measures your muscle action and your breathing. your rate of breathing as recorded during the test can be used to set up any necessary breathing apparatus that is deemed necessary as a result.

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It is important that your sleep apnea is treated, because an untreated condition can lead to other illnesses. You may be at higher risk for heart problems or high blood pressure, because your lack of breathing will trigger stress hormones. People with sleep apnea are also at higher risk for both insulin resistance and Type 2 diabetes, since the condition changes the way your body uses energy.

Things that you can start on your own include sleeping on your side instead of your back, losing weight, and stopping smoking. You may need to seek treatment for nasal allergies.

The latest treatment for moderate to severe obstructive sleep apnea is hypoglossus nerve stimulation, a big name for a small device that is implanted in your chest to monitor your breathing and stimulate a nerve that keeps your airway passage open. The unit comes with a remote control — you can adjust it, and also turn it on and off so that functions only when you are sleeping.

For most, though, the tried-and-true treatment is a continuous positive airway pressure (CPAP) machine. This apparatus delivers air pressure through a mask you wear when you sleep; the continuous air pressure keeps your throat passage open. It may take time for you to find the most comfortable way to wear the mask.

Other treatments include valved devices you place over each nostril, and oral appliances that realign your jaw, opening the space in the back of your throat.

Depending on the root cause of your sleep apnea, different kinds of surgery may be an option for you and your physician. For example, you may need nasal surgery to move a deviated septum or remove polyps; you may need a tonsillectomy or to have your adenoids removed; weight loss surgery may be your best path forward. The tissue at the back of your throat may be removed; you may need to have your jaw realigned surgically; or you may require rods put into the soft palate. As a last resort, you may require a tracheostomy, where the surgeon will create an opening in your neck with a tube. Covered during the day, the tube is used for breathing at night.

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