Lewis Gale Physicians October 09, 2017

Sleep apnea is a serious health condition in which a person stops breathing for brief periods of time while sleeping. It can last for 10-30 seconds, and may occur up to 20-30 times per hour. During one night of sleep, this can cause up to 400 episodes of interrupted breathing. Every time you stop breathing, you interfere with the normal patterns of deep sleep. The quality of sleep that you get is greatly impaired. Your level of alertness and your ability to pay attention may be seriously affected.

If you have sleep apnea, you are also more likely to have:

  • Accidents, especially car accidents
  • Coronary artery disease
  • Stroke
  • Lung disease
  • High blood pressure
  • Diabetes
  • Kidney disease

Types of Sleep Apnea

There are several kinds of sleep apnea. These include:

Obstructive Sleep Apnea

This type of sleep apnea is the most common, and is caused by a temporary airway obstruction. This blockage may be partial or complete. Obstructive sleep apnea can occur when the tissues of your throat relax too much and cave in on each other. If you are overweight, then your excess tissue might be putting too much pressure on your airway, causing it to collapse. You may have a deviated septum, nasal polyps, large tonsils, or an elongated soft palate and uvula that obstruct your airway while you are sleeping.

For children, enlarged tonsils and adenoids are the most common reason for obstructive sleep apnea.

Central Sleep Apnea

This occurs when the lower brain stem fails to send signals to the muscles that control breathing. Conditions that cause problems with the lower brain stem include certain types of polio, encephalitis, stroke, brain tumors, and other diseases that affect the brain and central nervous system. For children, the most common reason for central sleep apnea is prematurity.

Mixed Sleep Apnea

Mixed sleep apnea includes aspects of both obstructive and central sleep apnea.

Symptoms of Sleep Apnea

The symptoms of sleep apnea when it’s occurring may include:

  • Frequent, very loud snoring.
  • Episodes of long pauses of interrupted breathing during sleep.
  • Possibly struggling, snorting, gasping, choking, and partially or completely awakening in an attempt to restart breathing.

Symptoms that occur as a result of these episodes of sleep apnea may include:

  • Daytime sleepiness
  • Problems staying alert or paying attention
  • Irritability
  • Poor memory, confusion, or difficulty learning
  • Decreased energy
  • Headache
  • Sexual problems
  • Depression and/or anxiety
  • Weight gain
  • Hyperactivity and behavioral issues in children

Diagnosis of Sleep Apnea

If your doctor suspects that you have sleep apnea, you will need an exam of your mouth, nose, throat, and neck to make sure that there are no problems with those tissues or structures. An ear, nose, and throat specialist, also called an otolaryngologist, specializes in this type of diagnosis. 

You will be asked about your sleep habits, such as whether you snore and if your bed partner witnesses that you stop breathing. You also will be asked about daytime sleepiness, fatigue, and if you easily fall asleep. A screening form may be completed, such as the Epworth Sleepiness Scale (ESS). There are 2 tests that can help in the diagnosis of sleep apnea: the polysomnogram and the multiple sleep latency test. A sleep specialist usually conducts both of these tests in an overnight sleep laboratory, though it is possible to perform a modified test at home. 

  • Polysomnogram Test (Sleep Study)
    For this test, you spend the night in a sleep center. Tiny electrodes are attached to various areas of your body in order to closely monitor your heart rate, eye movements, brain waves, and muscle activity throughout the night. Monitors also record your pulse rate, information about your breathing, changes in the concentration of oxygen in your blood, and your body position. An electrocardiogram (EKG) keeps track of whether you have any changes in your heart’s rhythm during sleep, and the number of apnea events is recorded. A modified version of this test can sometimes be performed at home.

    If you have obstructive sleep apnea, the most common type of sleep apnea, you may have the same test again, while wearing a facemask that provides positive pressure. This is called continuous positive airway pressure (CPAP). This mask is supposed to prevent the collapse of your airway and maintain your breathing during the night. At times, evaluation with CPAP can occur during the second half of the night after evaluation without CPAP. This is called a split-night study.
  • Multiple Sleep Latency Test
    This test is usually done the day after the polysomnogram. With the same set of electrodes still attached, you are asked to take a series of 20-minute naps, every 2 hours throughout the day. The electrodes provide information about how quickly you fall asleep and how quickly you reach various levels of sleep, particularly the level called rapid eye movement (REM) sleep. This test can help determine your level of daytime sleepiness due to sleep apnea. If you fall asleep in 5 or fewer minutes, it may be a sign of extreme sleepiness due to sleep apnea. This test is most often performed to evaluate for other sleep disorders such as narcolepsy. It is often not necessary when evaluating for sleep apnea.

  • Other Tests
    If you are suspected of having central sleep apnea (less common than obstructive sleep apnea), you may need a variety of other tests to diagnose an underlying medical condition. Your doctor will have to determine what other symptoms you have and use these symptoms to determine which further studies may be needed. Possible other tests include:
    • Blood tests
    • Echocardiogram
    • MRI or CT scans of your brain
    • Electroencephalogram (EEG) studies—brain wave studies
    • Electromyogram (EMG) studies—studies of electrical conduction along nerves
    • Nocturnal pulse oximetry

Traditional Treatment Options

The goal of treating sleep apnea is to decrease the frequency of, or to completely eliminate, episodes of breathing interruption. As a first recourse, traditional treatment options may include:

  • Medication
  • Lifestyle changes, such as weight loss
  • Continuous Positive Airway Pressure (CPAP) machines
  • Oral appliances

If these options fail to resolve sleep apnea, surgery may be the best option.

Surgical Treatment Options

If problems are identified that may be contributing to sleep apnea, and if the continuous positive airway pressure (CPAP) treatment fails, it may be beneficial to have surgery. The types of surgeries include:

  • Tonsillectomy and/or adenoidectomy—this is a common and effective treatment, especially for children.
  • Removal of nasal polyps.
  • Surgery to straighten a deviated septum.
  • Correction of facial or jaw deformities.
  • Removal of tissue in the throat.

Remember, a good night’s sleep is essential to good health. Talk to your physician if you think you or someone you know may be suffering from sleep apnea.

If you suspect you are experiencing sleep apnea, please consult your healthcare provider. Dr. Paul Lenkowski of LewisGale Physicians is available to answer all of your questions and offer treatment options. To schedule an appointment, call the practice at (540) 444-8100 or book an appointment online below.

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