Sleep apnea oftentimes goes unnoticed for a simple reason: the patient is asleep and unaware of what is happening to him. Despite this, the diagnosis can have a subsequent impact on health and therefore it deserves to be evaluated and treated responsibly.
What is sleep apnea?
The medical definition states that apnea means the cessation of airflow for at least 10 seconds.
Sleep apnea is defined as a severe sleep disorder in which breathing repeatedly stops and starts. If left untreated for long periods of time, it can negatively impact the heart’s health.
Another complication of sleep apnea is that it makes the patient predisposed to a series of accidents because, due to fatigue, the ability to concentrate decreases significantly.
Types of sleep apnea
Obstructive sleep apnea
Obstructive apnea occurs when the muscles in the back of the neck relax too much, causing the airways to narrow or even close. The body is not oxygenated well enough and in turn, the brain sends a signal causing you to briefly wake up in order to resume proper breathing.
Sometimes the awakening period is so brief that the patient is not even aware of it. At other times, it may be accompanied by a feeling of shortness of breath. This cycle can repeat itself up to 30 times an hour, which prevents the body from reaching the phases of a deep sleep state (and getting the rest it needs).
Central sleep apnea
Central sleep apnea is a less common form of the disease, in which the brain “forgets” to send the proper nerve signals to the respiratory muscles. This means that your body briefly forgets to breathe.
Complex sleep apnea syndrome (mixed apnea)
Complex sleep apnea syndrome is a mixed apnea with obstructive and central causes. Most often, it is found in patients with obstructive sleep apnea who have been on treatment with CPAP and who, over time, have also developed central sleep apnea.
Sleep apnea causes and risk factors
Causes may vary depending on the type of apnea diagnosed.
Obstructive sleep apnea causes and risk factors:
- Obesity: fat deposits in the upper respiratory tract exert additional pressure
- Neck circumference: people with thick necks generally have narrower airways;
- Narrowing of the upper respiratory tract: it may be a genetic inheritance, polyps or tonsils greatly enlarged in children, septal deviation;
- Family history: the risk of suffering from sleep apnea is higher in people who have family members with this diagnosis;
- Gender: men are 2-3 times more likely to develop sleep apnea than women;
- Age: sleep apnea occurs more frequently in adults;
- Consumption of alcohol, sedatives or tranquillizers: these substances contribute to the relaxation of the neck muscles, which in turn aggravates sleep apnea;
- Smoking: the risk of sleep apnea in smokers is 3 times higher than that of non-smokers; in addition, smoking increases inflammation and fluid retention in the upper respiratory tract;
- Nasal congestion: permanently clogged nose increases the risk;
- Some conditions: congestive heart failure, high blood pressure, type 2 diabetes and Parkinson’s disease are some of the diagnoses that increase the risk of sleep apnea. Polycystic ovary syndrome, hormonal disorders, history of stroke or chronic lung disease also contribute to the onset of the disease.
Central sleep apnea causes and risk factors:
- Age: occurs more frequently in people of second and third age;
- Gender: is more commonly diagnosed in men than in women;
- Heart disease: congestive heart failure increases the risk of developing it;
- Use of narcotics painkillers: long-acting opioids such as methadone increase the risk of central apnea;
- History of stroke: in patients who have suffered a stroke central sleep apnea is a pathology with high frequency.
Sleep apnea symptoms – what are the signs and how does this manifest?
Many of the symptoms of sleep apnea are not identified by the patient but are observed by his sleep partner. These include:
- Snoring loudly;
- Episodes of stopped breathing during sleep
- Sudden moments when the patient seems to drown or suffocate;
- Insomnia
- Very dry mouth in the morning on waking;
- Drowsiness and fatigue during the day;
- Difficulty concentrating;
- Morning headaches;
- Irritability;
- Hyperactivity in case of sleep apnea in children;
- Depression;
- Low performance at work/school;
- Decreased libido
Complications
According to studies, sleep apnea increases the risk of developing various conditions:
- Stroke;
- Metabolic syndrome, including type 2 diabetes and hypertension;
- Cardiovascular problems due to insufficient oxygen supply;
- Problems with concentration, memory, and other cognitive functions;
- Atrial Fibrillation;
- Asthma-like symptoms;
- Chronic kidney disease;
- Dementia
Diagnosis
Suspicions of sleep apnea require a careful assessment of symptoms and follow-up of sleep patterns, plus a detailed history from the person sleeping in the same bed with the patient.The medical speciality that deals with the diagnosis and treatment of sleep apnea is called somnology.
A definite diagnosis involves monitoring overnight, at home or at a dedicated centre, while performing different tests:
- Polysomnography: a test in which the patient is connected to the equipment that monitors his heart, lungs and brain activity, breathing patterns, arm and leg movements and oxygen levels during sleep.
- Simplified somnography: a test that can be performed at home, which monitors heart rate, oxygen levels, airflow and respiratory patterns. Unfortunately, these portable devices do not have the same reliability as the polysomnograph, therefore it is possible that the final recommendation is to perform complete polysomnography.
Treatment for sleep apnea
Depending on the determining causes and how serious the form of sleep apnea is, there are several treatment options:
Conservative treatment in mild forms of sleep apnea:
- Weight loss is very effective in overweight or obese people. A weight loss of only 10% is likely to reduce the number of apnea events for most patients.
- Eliminating alcohol and sleeping pills from the patient’s lifestyle is likely to reduce the risk of apnea events;
- Side sleeping can eliminate the episodes of apnea that, in the mild version of the disease, occur only when the patient sleeps on his back.
- Treating sinusitis or chronic rhinitis improves airflow and reduces snoring, which is likely to decrease the number of apnea episodes.
- Mechanical therapy
- Positive Airway Pressure (PAP) is the therapy of choice for moderate forms of obstructive sleep apnea – the patient wears a mask that covers his mouth and nose, while a light current of air forces the air to enter the airways, with the pressure being adjusted in such a way as to prevent their closing. There are several types of medical equipment in this category: most of the devices have constant pressure, but there are also models that allow the adjustment of the pressure to the respiratory times. The best-known device for apnea is known as CPAP.
- Mandibular advancement devices. These medical devices are recommended for people with mild or moderate forms of obstructive sleep apnea. These can be splints or devices that modify the position of the jaw, tongue and other supporting structures of the upper airways.
- Hypoglossal nerve stimulation. This medical device is implanted under the skin, on the right side of the chest, with electrodes in the neck and intercostal area. Before going to bed, the device is turned on by remote control and will periodically stimulate the hypoglossal nerve, which will correct the position of the tongue and soft palate to prevent airway obstruction.
Surgical treatment of sleep apnea
The surgical treatment is adapted to specific problems and is generally applied to patients with a large amount of tissue that obstructs the nose or neck: deviation of the nasal septum, greatly enlarged tonsils, undersized mandible and so on.
In general, surgical treatment is reserved for cases that have not responded to conservative treatment methods.
Sleep apnea – natural remedies
In addition to the diagnosis and allopathic treatment, there are a number of natural remedies that are worth trying to get rid of the unpleasant symptoms of sleep apnea:
Acupuncture
Acupuncture is a promising alternative treatment, although studies to date have involved a relatively small number of patients.
It is preferable to seek the advice of a doctor before looking for an acupuncture specialist and not to give up the recommended treatment.
Herbal remedies
When we talk about sleep apnea, natural herbal treatments that have been studied according to the rigours of scientific research do not exist.
On the other hand, there are patients who claim that natural remedies such as valerian have produced an improvement in general condition and a reduction in symptoms.