A Guide to Sleep Apnea Facts

Believed to affect as many as 24 percent of middle-aged American males and 9 percent of females, sleep apnea was first identified as a sleep disorder as recently as 1965. The combination of symptoms–daytime sleepiness, snoring, excess weight–were recognized much earlier. Over the past three decades, doctors have come to better understand the causes of this syndrome and devise effective treatment options.

Most persons with sleep apnea are unaware of these breathing pauses, but their bed partners are likely to be disturbed by the major sleep apnea symptom–snoring, usually loud and punctuated by sudden snorting or choking sounds.

The breathing interruptions actually occur during the snorting, choking phase, and they cause the person to awaken for a brief period, during which time normal breathing resumes.

In addition to the daytime sleepiness, the consequences of poor sleep quality and frequent drops in blood oxygen level can be substantial–an increased level of stress hormones which can result in a higher heart rate, hypertension and irregular heart beats. Persons with untreated sleep apnea are at risk of heart attacks, heart failure and rhythm abnormalities such as atrial fibrillation.

Being overweight is a major risk factor for obstructive sleep apnea, the most common type. More than half of patients are overweight or obese, but even thin people can develop sleep apnea, usually because of the shape or size of their throat passage. The problem is really one of breathing.

Central sleep apnea occurs when the brain fails to send the proper signals to the muscles that control breathing. This often is an effect of heart disease or a stroke or heart attack. Obstructive sleep apnea, usually a cause rather than an effect of heart disease, occurs when throat muscles, relaxed because of sleep, fail to keep the airway open to allow air to get into the lungs. A third type, complex sleep apnea, combines features of both central and obstructive.

Besides narrowing of the passage, the other major factor is relaxation of throat muscles. Smoking and use of alcohol, sedatives or tranquilizers can cause these muscles to weaken and relax too much during sleep. So can age; sleep apnea becomes increasingly common after age 45.

Long periods of sitting during the day can lead to pooling of body fluids which then shift from the legs to the upper body at night, narrowing airway passages.

Heart problems such as atrial fibrillation (an abnormal heart rhythm) and heart failure can lead to sleep apnea, and men are more vulnerable than women.

Because of chronically poor sleep, persons with sleep apnea are prone to nodding off at inappropriate moments–even in the middle of an important business meeting.

Sleep apnea patients are frequently unproductive at work, have difficulty concentrating and are prone to memory problems, headaches, mood swings, feelings of depression, frequent urination during the night and erectile dysfunction. Over the long term, they are vulnerable to hypertension, heart attack, stroke and heart failure.

Even with all these negative consequences, sleep apnea often goes undiagnosed and is most commonly detected either because of the snoring or the effects of sleep deprivation, including accidents on the road or on the job.

Not all snorers have sleep apnea, and not all persons with sleep apnea are snorers, but the connection is strong. A doctor can often make a diagnosis on the basis of signs and symptoms, but sleep studies may be needed to confirm the diagnosis and determine the most appropriate treatment.

An evaluation, such as those available in the Baptist Sleep Center, usually includes an overnight stay (either in a special hospital room or a hotel room equipped with polysomnographic equipment). Electrodes are attached to the patient’s body and head to monitor heart, lung and brain activity; breathing patterns; arm and leg movements, and blood oxygen levels during sleep.

The preferred method for treating moderate to severe sleep apnea is continuous positive airway pressure (CPAP). During sleep, the patient wears a mask that delivers enough air pressure to keep the airway passages open, preventing snoring and apnea. A humidifier may be used to supplement the action of the CPAP machine.

There are variations on CPAP that automatically adjust airway pressure. The BPAP (bi-level positive airway pressure) machine, for example, increases the pressure during inhalation and decreases it during exhalation.

Less effective but preferred by many patients are oral appliances designed to keep the throat open. These are usually obtained from a dentist or orthodontist. The newest treatment is PROVENT, a small device that attaches over the nostrils and re-directs air flow. It’s a single use disposable device, available by prescription only.

When all else fails, surgery can be used to remove excess tissue from the nose and throat. In some cases, removal of tonsils, adenoids or nasal polyps or straightening of a crooked nasal partition (deviated septum) may be what’s needed to enlarge air passages and reduce snoring and apnea.

For mild cases, overweight patients are advised to lose some weight. Smokers should quit, and drinkers should reduce their alcohol consumption, particularly in the late evening. Certain medications such as tranquilizers should also be avoided. Most snorers breathe better when they sleep on their side rather than their back.