Warning signs of sleep apnea include snoring, nighttime gasping, pauses in breathing during sleep, and daytime sleepiness.
Warning signs of sleep apnea include snoring, nighttime gasping or choking, pauses in breathing during sleep, and daytime sleepiness.

The four warning signs of sleep apnea in adults include:

  1. Snoring that is loud enough to disturb others
  2. Waking up gasping or choking
  3. Noticeable intermittent pauses of breathing during sleep
  4. Excessive daytime drowsiness, causing one to fall asleep while working, watching television, or even driving a vehicle

Snoring can disrupt the sleep of another person sharing the room, often causing marital discord.

Warning signs of sleep apnea in children include:

  • Snoring 
  • Mouth breathing while sleeping
  • Daytime sleepiness
  • Bedwetting
  • Behavioral problems

What is sleep apnea?

Sleep apnea is a sleep disorder that can potentially lead to serious systemic health complications. It is a condition that causes a person to intermittently stop breathing during sleep. This is often indicated by the presence of snoring. Sleep apnea can affect anyone, including children, but it more commonly affects older men who are overweight.

What are the causes and risk factors of sleep apnea?

Anyone can develop obstructive sleep apnea; however, certain factors put people at an increased risk, which include:

  • Weight: Most patients with obstructive sleep apnea are overweight.
  • Medical conditions: Medical conditions that are associated with obesity, such as diabetes, hypothyroidism (underactive thyroid), and polycystic ovary syndrome, can also cause obstructive sleep apnea. 
  • Narrow airwayThe tonsils or adenoids (lymphoid tissue similar to the tonsils behind the nose) may become enlarged. This is common in children and sometimes in adults. This can obstruct airways. Tumors in the throat and nasal congestion or blockage can also obstruct the airway.
  • Hypertension (high blood pressure): Obstructive sleep apnea is more common in people with hypertension.
  • SmokingPeople who smoke are more likely to have obstructive sleep apnea.
  • Gender: Sleep apnea is more common in men. The risk of obstructive sleep apnea increases in women after menopause.
  • A family history of sleep apnea: Having a family history of sleep apnea increases a person’s risk.
  • Decreased muscle tone: Muscle tone decreases with age and lack of adequate physical activity causes the muscles around the upper airway to become floppy and narrow the airway.

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What are the signs and symptoms of sleep apnea?

Sleep Apnea
Sleep apnea is a disorder that causes a person to stop breathing many times while they are sleeping.

Signs and symptoms of obstructive sleep apnea include:

It is important to note that the bed partner of individuals with sleep apnea may also suffer from poor nighttime sleep and can have some of the same symptoms.

Can sleep apnea be cured?

This depends on a case-to-case basis. Sleep apnea can be managed by using nonsurgical and surgical treatments depending on the cause and lifestyle modifications.

Non-invasive treatments of sleep apnea

Various noninvasive sleep apnea treatment techniques are available, some of which are more effective than others. Positive airway pressure (PAP) devices and oral appliances are the two nonsurgical solutions. 

  • Continuous positive airway pressure (CPAP): CPAP is considered the standard treatment of obstructive sleep apnea (OSA), and it is typically the initial treatment administered to people diagnosed with moderate or severe OSA. A CPAP machine connects to a sleeper's face through a tube leading to a mask that covers either their mouth and nose or just their nostrils and plugs into an outlet adjacent to their bed. The CPAP machine then blasts air into the sleeper's airway, preventing it from closing while they sleep. 
  • Bilevel positive airway pressure (BiPAP or BPAP): When a person with sleep apnea cannot tolerate CPAP, doctors may prescribe a BiPAP or BPAP machine. The BiPAP machine works similarly to a CPAP machine in that it connects to the sleeper's face through a tube and mask and then pushes air out to keep the airway open. However, a BiPAP machine varies from a CPAP machine in that it releases air at higher pressure during inhalation and lower pressure during exhalation
  • Automatic positive airway pressure (APAP) devices: APAP devices, also known as auto-CPAP machines, are similar to CPAP machines in that they use a tube and mask to attach to a sleeper's face and then pump air out to keep the airway open. The capacity of APAP machines to automatically change the pressure of air they emit sets them apart from CPAP machines. Because sleepers require varying degrees of pressure during different times of the night, based on their sleeping position, sleep stage, or amount of congestion, this feature may make the machine more comfortable than a CPAP machine. 
  • Adaptive servo-ventilation (ASV): ASV is generally used to treat people who have central sleep apnea. ASV works similarly to PAP therapy in that it pushes air through a tube and mask worn by the sleeper. However, ASV is programmed to release customized air pressure that adjusts in real-time, anticipating and responding to central apneic events rather than releasing a fixed amount of air on inhalation and exhalation. 
  • Expiratory positive airway pressure (EPAP): An EPAP device is not a motorized machine, unlike CPAP and BiPAP machines. EPAP therapy is made up of two tiny valves that fit inside the nostrils. EPAP treatment maintains airway pressure by producing resistance that keeps the airway open during exhalation.

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Dental implants

By physically opening the airway, oral appliances help alleviate OSA symptoms. Oral appliances are frequently administered only after a person has discovered that they are unable to tolerate one of the PAP machine treatments.

The most common oral appliances include:

  • Mandibular advanced splints (MAS): These are custom-made dental device that fits over the top and bottom teeth and pulls the lower jaw forward. Because MAS keeps the jaw and tongue forward, the airway is more likely to stay open. When a person cannot tolerate a PAP machine, MAS therapy is one of the most widely prescribed therapies, but its efficiency varies from person to person. In cases of disruptive snoring and mild to moderate OSA, MAS may be the best option. 
  • Tongue-retaining devices: These devices use suction to keep the tongue positioned forward, keeping the airway clear. Tongue-retention devices help lower the intensity of OSA symptoms although they are not as effective as CPAP machines. They may be superior for short-term use, according to researchers. Another benefit of these devices is that they are inexpensive and may be purchased without a prescription.

Surgical sleep apnea treatments

When non-invasive methods fail to effectively cure sleep apnea, a sleep specialist may consider surgery to help prevent sleep apnea. The sort of surgery a person may need is determined by their anatomy and the cause of their breathing problems.

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Shrinkage or tissue removal

Several tissue removal or shrinkage procedures may aid in the treatment of OSA caused by identified blockages: 

  • Radiofrequency tissue reduction: Surgeons use a high-frequency current to remove tissue blocking the airway using a recent surgical technique termed radiofrequency surgery. 
  • Uvulopalatopharyngoplasty: Sections of the uvula, the bell-shaped tissue dangling at the rear of the mouth, and parts of the soft palate are removed in uvulopalatopharyngoplasty. Uvulopalatopharyngoplasty is successful in about 60 percent of people when done with radiofrequency and paired with tonsil excision. 
  • Tonsillectomy: Tonsillectomy is a popular OSA surgical treatment that may be combined with other tissue-removal procedures. 
  • Tracheotomy: A tracheotomy is a procedure that includes making a hole in the neck so that air can enter the windpipe directly through a tube. This procedure is the most effective, but it is the most invasive. Experts advise that tracheotomy be used only when a person's life is in danger and all other options have been exhausted. 
  • Repositioning the jaw 
  • Maxillomandibular advancement: It is when the jaw is permanently moved forward to help maintain the airway free. 
  • Tongue-related operations: The genioglossus muscle, which makes up the majority of the visible tongue, is the target of this surgery. The tongue can be surgically advanced forward in the mouth, making it less prone to fall back and restrict the airway.

Nasal procedures

The structure of a person's nose and nasal passage can contribute to OSA symptoms in some situations. OSA can be caused or exacerbated by a crooked middle nasal wall (called a deviated septum), nasal growths, and overly big bones within the nose (called turbinate hypertrophy). 

Following procedures are sometimes used to treat OSA: 

  • Rhinoplasty is a procedure that alters the structure of the nose. 
  • Septoplasty is a procedure that corrects a deviated septum
  • Endoscopic sinus surgery is a type of surgery that helps clear the sinuses. 
  • Nasal valve surgery involves the opening of the nostrils or internal nasal valves. 
  • Turbinectomy is a procedure that involves removing or shrinking part of the small bones in the nose.

Stimulation of nerves

People with sleep apnea might choose between two nerve stimulation operations. OSA is treated with hypoglossal nerve stimulation, whereas central sleep apnea is treated with transvenous phrenic nerve stimulation.

Changes in lifestyle to treat sleep apnea

  • Weight loss: Decreasing weight can help many people improve their OSA symptoms. As a result, doctors may advise people with OSA who are obese to follow a diet and exercise program or possibly undergo bariatric surgery. 
  • Throat exercises: These repeated movements of the tongue, soft palate, and throat, also known as oropharyngeal exercises, reduce the severity of OSA symptoms. 
  • Changing your sleeping position: Positional therapy can help some people with their OSA symptoms. 
  • Avoiding alcohol and certain medications: If at all possible, people with OSA should avoid alcohol and sedatives in the hours leading up to bedtime. Alcohol is known to exacerbate OSA symptoms by relaxing airway-related muscles, resulting in obstructions. 
  • Quitting smoking: Because smoking cigarettes increases a person's risk of OSA, doctors frequently advise smokers with OSA to quit.

Is sleep apnea serious?

Sleep apnea is a serious health problem because it can result in the following complications: 

  • Sleep apnea causes frequent awakenings, making normal, restorative sleep difficult, resulting in significant daytime sleepiness, weariness, and irritability. 
  • You may find it difficult to concentrate and fall asleep at work, while watching TV, or even while driving. Motor vehicle and job accidents are more likely in people with sleep apnea. 
  • You may be irritable, moody, or depressed. Sleep apnea in children and teenagers can lead to poor academic performance and behavioral issues. During sleep apnea, sudden reductions in blood oxygen levels increase blood pressure and put a burden on the cardiovascular system. High blood pressure is more likely if you have obstructive sleep apnea (OSA) (hypertension). 
  • OSA can put you at risk of heart attacks, strokes, and irregular heartbeats such as atrial fibrillation. Multiple episodes of low blood oxygen (hypoxia or hypoxemia) in people with heart disease might result in sudden death due to an erratic heartbeat. 
  • If you have sleep apnea, you're more likely to develop insulin resistance and type II diabetes
  • Excessive blood pressure, abnormal cholesterol levels, high blood sugar, and an enlarged waist circumference are all associated with an increase.
  • Because people with sleep apnea are prone to respiratory problems, they may be more likely to suffer complications after major surgery, especially when sedated and laying on their backs. 
  • People with sleep apnea are more likely to have abnormal liver function tests, and their livers are more likely to show scarring (nonalcoholic fatty liver disease). 
  • Snoring can prevent anyone sleeping nearby from enjoying a good night's sleep. It's fairly uncommon for a partner to have to sleep in a different room or even on a different floor of the house.

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Medically Reviewed on 5/26/2022
References
Medscape Medical Reference

Sleep Foundation
https://www.sleepfoundation.org/sleep-apnea

National Heart, Lung, and Blood Institute
https://www.nhlbi.nih.gov/health-topics/sleep-apnea

SleepApnea.org https://www.sleepapnea.org