If you find yourself chronically fighting fatigue and drowsiness during the day despite getting at least seven or more hours of shut-eye — which is the amount of sleep recommended for adults by the American Academy of Sleep Medicine (AASM) — you may want to consider seeing your doctor to be evaluated for sleep apnea. e60dc2a1-f33c-4a05-9b50-8e3e8e5976294b390852-6e3f-45f3-abfa-7664d77e767c Sleep apnea is a sleep disorder that is thought to affect nearly 30 million people in the United States, or 12 percent of the population, according to research funded by the AASM . e60dc2a1-f33c-4a05-9b50-8e3e8e5976296d70cc97-1c6a-41ba-a217-028d44a37db7 Though it’s common, the condition often goes undiagnosed. Since most common and telltale symptoms of sleep apnea — such as snoring, pauses in breathing, and gasping for air — occur during sleep, many people may not even be aware that they are experiencing symptoms, so they go undiagnosed and untreated. Each type of sleep apnea is characterized by many of the same hallmark symptoms, but the mechanism (or cause) of sleep apnea is somewhat different among each type.
First, What All Types of Sleep Apnea Have in Common People who have sleep apnea experience intermittent episodes of pauses in breathing; the term “apnea” comes from the Greek word for “breathless,” according to the Cleveland Clinic . Such moments of apnea occur repeatedly during sleep in people with the condition, causing individuals to partially wake up multiple times during the night as they struggle to breathe. Someone with severe sleep apnea may have these partial arousals from sleep several hundred times a night. Because these awakenings are typically very brief, the person with sleep apnea may not even be aware that they are experiencing interrupted sleep, according to the Sleep Foundation . But the episodes can wreak havoc on the sleep cycle and prevent the person with sleep apnea from reaching the deep, restful phases of sleep . And that’s why people who have sleep apnea can experience significant exhaustion and drowsiness the next day, despite getting what they thought was a full night of sleep.
Obstructive Sleep Apnea (OSA) Is the Most Common Subtype of the Condition Obstructive The most common type of sleep apnea is obstructive sleep apnea, sometimes referred to as OSA. With OSA, the throat muscles in the back of your throat, which naturally become more relaxed during sleep, collapse too much to allow for normal breathing, according to the AASM.e60dc2a1-f33c-4a05-9b50-8e3e8e5976298c4a6d42-4d94-46c2-8509-5193f49f87a3 The throat muscles support the soft tissues in the back of the throat — such as the soft palate, the uvula, the tonsils, and tongue — so when those muscles collapse too much, those tissues can fall back into the throat, partially or completely blocking the normal flow of air in your airway. When the airway is blocked partially the person may start to snore, which is why this symptom is common in OSA. (It’s worth noting not everyone who snores has sleep apnea.) When your brain senses that you aren’t getting enough oxygen, it signals your body to wake up enough so that you can reopen your airway, and you may gasp for air during the night. Simply put, having obstructive sleep apnea means that not enough air can get into the lungs at night, and your brain wakes you up to breathe, says Robson Capasso, MD , chief of sleep surgery and a professor of otolaryngology and head and neck surgery at Stanford University School of Medicine in California. Research indicates that cases of obstructive sleep apnea have risen significantly in the last two decades. This is likely due to two main factors: Obesity (one of the most common risk factors for OSA) has increased dramatically; and there is more awareness about sleep apnea among doctors and the public at large, so more people are being screened and diagnosed, says James Rowley, MD , a pulmonologist and sleep medicine specialist at Detroit Medical Center and a member of the AASM’s board of directors. Doctors diagnose OSA using a sleep test that measures your cardiorespiratory and brain activity during sleep, which is conducted either at home or at a sleep lab, according to Stanford Medicine.e60dc2a1-f33c-4a05-9b50-8e3e8e5976293e56d52f-3c65-45a8-951d-b750e55f57e5 Obstructive sleep apnea can be treated with a device to keep your airway open, such as a machine that pushes air pressure into your lungs through a mask that fits over your nose and mouth while you sleep, called continuous positive airway pressure (CPAP ). Other OSA treatment options include other breathing machines, mouthpieces designed to keep your jaw forward and keep your airway open, or surgery (in more severe cases) to remove tonsils or other tissue that could cause airway obstruction or move your jaw to open up your airway. Your doctor may also advise you to lose weight and to avoid sleeping on your back, to prevent gravity from further pushing your tongue, tonsils, and other soft tissues in your throat into your airway.
Central Sleep Apnea Happens When the Brain Is Involved Central Another type of sleep apnea — central sleep apnea — is less common than obstructive sleep apnea. It can also be trickier to diagnose and treat. Unlike obstructive sleep apnea, which is caused by a mechanical problem that blocks the airway, central sleep apnea occurs because the brain is not sending the proper messages to the muscles that control breathing. (“Central” refers to the central nervous system.) While central and obstructive sleep apneas share many symptoms — such as episodes of pauses in breathing, constant awakenings during the night, and extreme sleepiness during the day — central sleep apnea often affects people who have underlying illnesses, too, such as a brain infection or other conditions that affect the brainstem.e60dc2a1-f33c-4a05-9b50-8e3e8e597629fb6ba123-96e8-43e9-a6b8-f9f2d4a17456 Common diseases associated with central sleep apnea include: severe obesity, Parkinson’s disease , stroke, and chronic heart failure . Certain drugs, such as opioids or benzodiazepines , can also play a role in central sleep apnea. “In patients who use opioids on a chronic basis, the breathing mechanisms can get numbed,” Dr. Capasso explains. RELATED: Obesity and Heart Disease: What’s the Connection? Your doctor may refer you to a sleep specialist for a diagnosis if he or she suspects central sleep apnea, which may involve an overnight sleep test to rule out obstructive sleep apnea or other sleep disorders , notes Mayo Clinic.e60dc2a1-f33c-4a05-9b50-8e3e8e597629a9df2e55-3c20-4a4f-b9a1-d3663ed17fdf The sleep specialist may also work with your cardiologist or order scans of your head and heart to rule out other contributing illnesses. Treatment of central sleep apnea typically means addressing the medical problems that are causing the apnea in the first place — for instance, treating heart problems may improve central sleep apnea symptoms. Reducing the dose of medication can sometimes be helpful, and positive pressure ventilation can be helpful, too, using either CPAP or another type of ventilator, called bilevel positive airway pressure (BiPAP), according to Johns Hopkins Medicine.e60dc2a1-f33c-4a05-9b50-8e3e8e597629086dd165-5ff7-41ef-b459-21a2dd91140f Like CPAP, BiPAP delivers pressurized air to your lungs, but a BiPAP delivers a higher amount of air pressure when you breathe in than when you breathe out compared with CPAP, which delivers the same amount of pressure as you breathe in and out. Another ventilator sometimes recommended for central sleep apnea is an adaptive servo-ventilation (ASV) machine, per the American Thoracic Society . It works similarly to CPAP and BiPAP, but ASV is more specialized in that it measures your breathing patterns and customizes the air pressure to keep your breathing stable throughout the night. However, ASV is not suitable for those with heart failure, so it’s important to talk to your doctor about your medical history before using ASV.
Complex Sleep Apnea Syndrome Is a Combination of OSA and Central Sleep Apnea Complex Doctors have more recently identified a third type of sleep apnea called complex sleep apnea, which is a combination of obstructive sleep apnea and central sleep apnea.e60dc2a1-f33c-4a05-9b50-8e3e8e5976295f313eb7-5e52-405c-9630-733c191bcc3f Patients with this type of sleep apnea may at first seem to have obstructive sleep apnea, but unlike typical patients with obstructive sleep apnea, these patients’ symptoms are not fully addressed with the use of CPAP. (Since CPAP is usually quite effective in treating obstructive sleep apnea, its failure to alleviate symptoms would suggest the patient had central sleep apnea.) In patients with complex sleep apnea syndrome, breathing problems persist even after the airway obstruction is addressed and treated, which means something besides the collapsing throat muscles are also contributing to the apnea. The problem is that there is still a lot of debate among sleep medicine specialists about what exactly is going on in complex sleep apnea, or what the key characteristics that define it are.e60dc2a1-f33c-4a05-9b50-8e3e8e59762953541152-9487-4a36-b88b-be182c2ab487 In one study, doctors conducted a review of 223 patients referred to the Mayo Clinic Sleep Disorders Center over one month, as well as 20 patients diagnosed with central sleep apnea.e60dc2a1-f33c-4a05-9b50-8e3e8e597629fc274f59-dfe7-4e19-b824-3b8873473db8 They found that 15 percent of all sleep apnea patients had complex sleep apnea. As many as 84 percent were found to have obstructive sleep apnea, and 0.4 percent had central sleep apnea. But the researchers were not able to identify factors that influence the risk for complex sleep apnea and did not identify treatment options in this study. They concluded that additional research is needed to better define the condition and further study which treatments are most effective for treating complex sleep apnea.
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