Sleep Apnea

(Snore, snore, snore, snore) . . . you wake up multiple times throughout the night, cover your head with a pillow, insert ear plugs, pull out ear plugs because they are uncomfy, toss and turn . . . (snore, snore, snore) . . . angrily, you move to the couch.
Does this sound like you, trying to sleep with a loved one? Many Americans suffer from Sleep Apnea without even being aware they have the condition. We who sleep with them must be the ones to suggest they get help.

(Thanks to the National Heart, Blood, and Lung Institute for the following information)

Who Is At Risk for Sleep Apnea?

Millions of American adults have obstructive sleep apnea. More than half of the people who have this condition are overweight.

Sleep apnea appears to be more common in men than in women. The condition also becomes more common as you get older. At least 1 in 10 people older than 65 has sleep apnea. Women are more likely to develop sleep apnea during pregnancy and after menopause.

Sleep apnea also is more common in African Americans, Hispanics, and Pacific Islanders than in Caucasians.

If someone in your family has sleep apnea, you’re more likely to develop it.

People who have small airways in their noses, throats, or mouths also are more likely to have sleep apnea. Smaller airways may be due to the shape of these structures or allergies or other medical conditions that cause congestion in these areas.

Small children may have enlarged tonsil tissues in their throats. This can increase their risk of sleep apnea. Overweight children also may be at increased risk for the condition.

About half of the people who have sleep apnea also have high blood pressure. Sleep apnea also is linked to smoking, metabolic syndrome, diabetes, and risk factors for stroke, and heart failure.

Major Signs and Symptoms

One of the most common signs of obstructive sleep apnea is loud and chronic (ongoing) snoring. Pauses may occur in the snoring. Choking or gasping may follow the pauses.

The snoring usually is loudest when you sleep on your back; it may be less noisy when you turn on your side. Snoring may not happen every night. Over time, the snoring may happen more often and get louder.

You’re asleep when the snoring or gasping happens. You likely won’t know that you’re having problems breathing or be able to judge how severe the problem is. Your family members or bed partner often will notice these problems before you do.

Not everyone who snores has sleep apnea.

Another common sign of sleep apnea is fighting sleepiness during the day, at work, or while driving. You may find yourself rapidly falling asleep during the quiet moments of the day when you’re not active. Even if you don’t have daytime sleepiness, talk with your doctor if you have problems breathing during sleep.

Other Signs and Symptoms

Others signs and symptoms of sleep apnea may include:

  • Morning headaches
  • Memory or learning problems and not being able to concentrate
  • Feeling irritable, depressed, or having mood swings or personality changes
  • Urination at night
  • A dry throat when you wake up

In children, sleep apnea can cause hyperactivity, poor school performance, and angry or hostile behavior. Children who have sleep apnea also may have unusual sleeping positions, bedwetting, and may breathe through their mouths instead of their noses during the day.

How Is Sleep Apnea Diagnosed?

Doctors diagnose sleep apnea based on medical and family histories, a physical exam, and results from sleep studies. Usually, your primary care doctor evaluates your symptoms first. He or she then decides whether you need to see a sleep specialist.

Sleep specialists are doctors who diagnose and treat people who have sleep problems. Examples of such doctors include lung and nerve specialists and ear, nose, and throat specialists. Other types of doctors also can be sleep specialists.

Medical and Family Histories

Your doctor will ask you and your family questions about how you sleep and how you function during the day. To help your doctor, consider keeping a sleep diary for 1 to 2 weeks. Write down how much you sleep each night, as well as how sleepy you feel throughout the day.

You can find a sample sleep diary in the National Heart, Lung, and Blood Institute’s “Your Guide to Healthy Sleep.”

Your doctor also will want to know how loudly and often you snore or make gasping or choking sounds during sleep. Often you’re not aware of such symptoms and must ask a family member or bed partner to report them.

If you’re a parent of a child who may have sleep apnea, tell your child’s doctor about your child’s signs and symptoms.

Let your doctor know if anyone in your family has been diagnosed with sleep apnea or has had symptoms of the disorder.

Many people aren’t aware of their symptoms and aren’t diagnosed.

Physical Exam

Your doctor will check your mouth, nose, and throat for extra or large tissues. The tonsils may be enlarged in children who have sleep apnea. A physical exam and medical history may be all that’s needed to diagnose sleep apnea in children.

Adults who have sleep apnea may have an enlarged uvula (U-vu-luh) or soft palate. The uvula is the tissue that hangs from the middle of the back of your mouth. The soft palate is the roof of your mouth in the back of your throat.

Sleep Studies

A sleep study is the most accurate test for diagnosing sleep apnea. It records what happens with your breathing while you sleep.

There are different kinds of sleep studies. If your doctor suspects you have sleep apnea, he or she may recommend a polysomnogram (poly-SOM-no-gram; also called a PSG) or a home-based portable monitor.

PSGs often are done at sleep centers or sleep labs. In some cases, doctors suggest using portable sleep monitors at home.

Polysomnogram

A PSG is the most common sleep study for diagnosing sleep apnea. This test records:

  • Brain activity
  • Eye movement and other muscle activity
  • Breathing, heart rate, and blood pressure
  • How much air moves in and out of your lungs while you’re sleeping
  • The amount of oxygen in your blood

A PSG is painless. You’ll go to sleep as usual, except you’ll have sensors on your scalp, face, chest, limbs, and finger. The staff at the sleep center will use the sensors to check on you throughout the night.

A sleep specialist reviews the results of your PSG to see whether you have sleep apnea and how severe it is. He or she will use the results to plan your treatment.

Your doctor also may use a PSG to find the right setting for you on a CPAP (continuous positive airway pressure) machine. CPAP is the most common treatment for sleep apnea. A CPAP machine uses mild air pressure to keep your airway open while you sleep.

If your doctor thinks that you have sleep apnea, he or she may schedule a split-night sleep study. During the first half of the night, your sleep is checked without a CPAP machine. This will show whether you have sleep apnea and how severe it is.

If the PSG shows that you have sleep apnea, you may use a CPAP machine during the second half of the split-night study. During this time, the flow of air from the CPAP machine will be adjusted to find the setting that works best for you.

Home-Based Portable Monitor

Your doctor may recommend a home-based sleep test with a portable monitor. The portable monitor will record some of the same information as a PSG. For example, it may record:

  • The amount of oxygen in your blood
  • How much air is moving through your nose while you breathe
  • Your heart rate
  • Chest movements that show whether you’re making an effort to breath

A sleep specialist may use the results from a home-based sleep test to help diagnose sleep apnea. He or she also may use the results to determine whether you need a full PSG study in a sleep center.

How Is Sleep Apnea Treated?

Lifestyle changes, mouthpieces, breathing devices, and surgery are used to treat sleep apnea. Medicines typically aren’t used to treat the condition.

The goals of treating sleep apnea are to:

  • Restore regular breathing during sleep
  • Relieve symptoms such as loud snoring and daytime sleepiness

Treatment may improve other medical problems linked to sleep apnea, such as high blood pressure. Treatment also can reduce your risk of heart disease, stroke, and diabetes.

If you have sleep apnea, talk with your doctor or sleep specialist about the treatment options that will work best for you.

Lifestyle changes and/or mouthpieces may be enough to relieve mild sleep apnea. People who have moderate or severe sleep apnea may need breathing devices or surgery.

If you continue to have daytime sleepiness despite treatment, your doctor may ask whether you’re getting enough sleep. (Adults should get at least 7 to 8 hours of sleep; children and adolescents need more.)

If treatment and enough sleep don’t relieve your daytime sleepiness, your doctor will consider other treatment options.

Lifestyle Changes

If you have mild sleep apnea, some changes in daily activities or habits may be all the treatment you need.

  • Avoid alcohol and medicines that make you sleepy. They make it harder for your throat to stay open while you sleep.
  • Lose weight if you’re overweight or obese. Even a little weight loss can improve your symptoms.
  • Sleep on your side instead of your back to help keep your throat open. You can sleep with special pillows or shirts that prevent you from sleeping on your back.
  • Keep your nasal passages open at night with nasal sprays or allergy medicines, if needed. Talk with your doctor about whether these treatments might help you.
  • If you smoke, quit. Talk with your doctor about programs and products that can help you quit smoking.

Mouthpieces

A mouthpiece, sometimes called an oral appliance, may help some people who have mild sleep apnea. Your doctor also may recommend a mouthpiece if you snore loudly but don’t have sleep apnea.

A dentist or orthodontist can make a custom-fit plastic mouthpiece for treating sleep apnea. (An orthodontist specializes in correcting teeth or jaw problems.) The mouthpiece will adjust your lower jaw and your tongue to help keep your airways open while you sleep.

If you use a mouthpiece, tell your doctor if you have discomfort or pain while using the device. You may need periodic office visits so your doctor can adjust your mouthpiece to fit better.

Breathing Devices

CPAP (continuous positive airway pressure) is the most common treatment for moderate to severe sleep apnea in adults. A CPAP machine uses a mask that fits over your mouth and nose, or just over your nose. The machine gently blows air into your throat.

The air presses on the wall of your airway. The air pressure is adjusted so that it’s just enough to stop the airways from becoming narrowed or blocked during sleep.

Treating sleep apnea may help you stop snoring. But not snoring doesn’t mean that you no longer have sleep apnea or can stop using CPAP. Sleep apnea will return if CPAP is stopped or not used correctly.

Usually, a technician will come to your home to bring the CPAP equipment. The technician will set up the CPAP machine and adjust it based on your doctor’s prescription. After the initial setup, you may need to have the CPAP adjusted on occasion for the best results.

CPAP treatment may cause side effects in some people. These side effects include a dry or stuffy nose, irritated skin on your face, dry mouth, and headaches. If your CPAP isn’t adjusted properly, you may get stomach bloating and discomfort while wearing the mask.

If you’re having trouble with CPAP side effects, work with your sleep specialist, his or her nursing staff, and the CPAP technician. Together, you can take steps to reduce these side effects. These steps include adjusting the CPAP settings or the size/fit of the mask, or adding moisture to the air as it flows through the mask. A nasal spray may relieve a dry, stuffy, or runny nose.

There are many types of CPAP machines and masks. Tell your doctor if you’re not happy with the type you’re using. He or she may suggest switching to a different type that may work better for you.

People who have severe sleep apnea symptoms generally feel much better once they begin treatment with CPAP.

Surgery

Some people who have sleep apnea may benefit from surgery. The type of surgery and how well it works depend on the cause of the sleep apnea.

Surgery is done to widen breathing passages. It usually involves shrinking, stiffening, or removing excess tissue in the mouth and throat or resetting the lower jaw.

Surgery to shrink or stiffen excess tissue in the mouth or throat is done in a doctor’s office or a hospital. Shrinking tissue may involve small shots or other treatments to the tissue. A series of such treatments may be needed to shrink the excess tissue. To stiffen excess tissue, the doctor makes a small cut in the tissue and inserts a small piece of stiff plastic.

Surgery to remove excess tissue is done in a hospital. You’re given medicine that makes you sleep during the surgery. After surgery, you may have throat pain that lasts for 1 to 2 weeks.

Surgery to remove the tonsils, if they’re blocking the airway, may be very helpful for some children. Your child’s doctor may suggest waiting some time to see whether these tissues shrink on their own. This is common as small children grow.

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