Sleep apnea is a relatively common disorder affecting up to 19 million people in the U.S., most cases going undiagnosed. It is most common in adults 45 to 65 years old, more common in men and increased in women after menopause. It is also found in about 2-3 percent of children. Although not recognized as a disorder until the 1900s, a character in Charles Dickens’ "The Pickwick Papers” had the clinical picture of sleep apnea, and thus Pickwickian syndrome was an early name for the malady.
There are three types of sleep apnea — obstructive, central and mixed. Although they have different causes, people with all these types of sleep apnea repeatedly stop breathing during sleep. There are no specific blood tests for this condition. Central sleep apnea is the less common form. It occurs when the area of your brain that controls breathing doesn’t send the correct signals to your breathing muscles. As a result, you will make no effort to breathe for brief periods. Snoring doesn’t usually occur with this form.
Obstructive sleep apnea is the most common type. It occurs when the tissue in the back of the throat relaxes, collapses and blocks the upper airway during sleep. Some people have a narrower throat area, making this more likely. This deprives the body of oxygen until the sleeping person gasps and briefly wakes up, thus opening the airway. This causes you to move out of deep sleep and into light sleep, resulting in poor sleep quality that makes you tired during the day. Sleep apnea is one of the leading causes of excessive daytime sleepiness. Chronic snoring is a strong indicator of sleep apnea, as are choking or snorting during sleep.
Other symptoms include morning headache, difficulty concentrating, depression, irritability, impotence, learning and memory difficulties, and falling asleep at work or while driving. Mixed sleep apnea is a combination of the above; it often begins as central and becomes obstructive. It is treated as obstructive. Doctors usually can’t detect sleep apnea during routine office visits. Most people who have it don’t know they have it because it only occurs during sleep. A family member and/or bed partner may first notice the signs of sleep apnea.
The causes of obstructive sleep apnea are many, though the cause of central sleep apnea is unknown. Obstructive sleep apnea can be a result of excessive body weight, combined with loss of muscle tone at the base of the throat. Other factors include having a narrowed throat and/or enlarged tonsils or adenoids, a family history of obstructive sleep apnea, smoking, chronic nasal congestion, using substances that cause throat muscle relaxation (such as alcohol, sedatives or tranquilizers) and being a male over 40 years old.
Over-the-counter and prescription sleep aids can add to the problem. Obstructive sleep apnea is a serious problem, due to sudden drops in blood oxygen levels that put a strain on your cardiovascular system. If left untreated, it could increase the risk of high blood pressure, heart attacks, irregular heartbeats, strokes and heart failure. It can also increase the risk of obesity and diabetes and increase the chance of work-related or driving accidents.
Managing this problem begins with your physician considering the diagnosis, ordering the appropriate tests and/or referring you to a sleep specialist. Treatment will depend on the nature and degree of the sleep apnea. Supplemental oxygen during sleep may help. Lifestyle changes such as weight loss, not sleeping on your back, quitting smoking, and avoiding alcohol and certain drugs can help. Pressurized masks, oral appliances and surgery (tonsillectomy/adenoidectomy is the most common treatment for pediatric patients) are also options. Bottom line, Sleep apnea is a chronic condition that requires long-term management.