Everything you wanted to know about sleep apnea

I think you’ll agree with me when I say that most people have heard of sleep apnea but don’t fully understand what it is or its implications. With terrifying rumours that sleep apnea means you are approaching death and a whole host of dubious alternative treatment options, we thought it was time to take a good look at sleep apnea and debunk the rumours. Using scientific studies and proven resources, this article will tell you everything you’ll ever need to know about sleep apnea.

What is sleep apnea?
What is sleep apnea?

What is sleep apnea?

Sleep disorders are on the rise and scientists are learning more and more about our unusual sleeping patterns. Sleep apnea is a surprisingly common disorder which causes people to stop breathing for a very short time, or to experience moments where their breathing is much more shallow during their sleep. These pauses in breath can range from lasting for a couple of seconds to minutes at a time. The frequency of these pauses or changes in breath may vary, with some sufferers experiencing it 30 times or more every hour.



The idea that you can stop breathing in your sleep can be a scary one, which is why the idea of sleep apnea has sparked a number of rumours. However, people with sleep apnea are largely unaware of these pauses in breath. Their body will make them breathe again without them knowing. This means that many sleep apnea patients are unaware that they have the condition for some time before getting diagnosed. However, doctors know which warning signs to look out for and if someone is classified in the at-risk group and displays some of the symptoms, then it is likely that the doctor will investigate the possibility of sleep apnea.

Effects of sleep apnea

As sleep apnea affects breathing, this means that someone with the condition may suffer from a lack of oxygen which could have an impact on how their body and brain function.

Untreated sleep apnea can affect how someone performs in everyday activities. It has been linked to poor performance in the workplace, car crashes and academic underachievement in school children and college students.

Heart failure or heart attacks

Heart failure or heart attacks

Without treatment sleep apnea can cause the following:

  • Stroke
  • Heart failure or heart attacks
  • Irregular heartbeat
  • High blood pressure
  • Depression
  • Diabetes
  • Worsening of ADHD or ADD symptoms
  • Headaches

These are the most frightening and extreme effects of sleep apnea and are often linked to other health conditions. There are several common symptoms of sleep apnea.

Common symptoms of sleep apnea
  • Loud snoring

    Loud snoring

    A sore or dry throat upon waking

  • Loud snoring
  • Occasionally being awoken by a sudden choking or gasping sensation
  • Lack of energy or lethargy during the day
  • Feeling sleepy during the day
  • Headaches (that are more common in the morning)
  • Feeling sleepy while driving (people with sleep apnea have 5 times as many road accidents as people without it)
  • Restless sleep
  • Unrefreshing sleep
  • A decreased interest in sex
  • Forgetfulness

    Forgetfulness

    Forgetfulness

  • Memory loss
  • Concentration difficulties
  • Changes in mood
  • Lack of interest in things that used to bring you pleasure
  • Insomnia
  • Irritability
  • Waking frequently throughout the night
  • Nocturia (waking in the night to go to the toilet)
  • Frequent pauses in breathing during the night that last for more than 10 seconds (this can be difficult to monitor unless you have a partner with a sleep cycle different from yours)
Risk factors

Although anyone can develop sleep apnea, there are certain risk factors that are worth being aware of.

certain risk factors that are worth being aware of

certain risk factors that are worth being aware of

Sleep apnea is more common in the following people:

  • Males
  • People who are overweight
  • Anyone over the age of 40
  • Those with a large neck measurement (over 17” in men and 16” in women)
  • Anyone with large tonsils, a large tongue or a small jawbone
  • People who have a history of sleep apnea in their family
  • Anyone with Gastroesophageal reflux (GERD) – this is a digestive complaint that affects the muscles between the esophagus and the stomach
  • Anyone with any nasal obstructions, including sinus problems, allergies, nasal polyps or a deviated septum
Sleep apnea causes

There are two types of sleep apnea and the type you have depends on the cause.

Obstructive sleep apnea (OSA) is more common. It is caused by some sort of blockage to the airway which can be caused by a collapse in the soft tissue of the throat during sleep.

Central sleep apnea has a completely different cause. Rather than being the result of a blockage, this form of sleep apnea is the result of the brain failing to send signals to the muscles and instructing them to breathe. This happens when there is some sort of instability in the respiratory control centre of the brain.

Hidden dangers of sleep apnea
depression

depression

One of the main dangers of sleep apnea is that it often goes untreated because the symptoms can be easy to miss. So many people feel tired, experience restless nights and are plagued by a lack of energy or motivation. These sorts of symptoms could just as easily be attributed to depression. It is common for people to experience a lack of energy as they grow older too. Even hitting your thirties can give you substantially less energy than you enjoyed in your twenties. Due to the vague nature of symptoms and the fact that it happens while you are sleeping, it can be very difficult for people to realise that they have sleep apnea. This can mean that the disorder is left untreated for many years, which may lead to more serious problems.

High blood pressure

High blood pressure

High blood pressure – If your blood pressure is already a little elevated, then the sleeplessness and lack of oxygen in your blood can cause it to increase even more. Lack of quality sleep can put your body under immense stress, interfering with your hormone systems and interrupting the sense of balance in your body. Sleep deprivation has been linked to an increase in stress which can cause hormones such as cortisol and adrenaline to rise. In short bursts, an increase in these hormones can be helpful (to aid us in fleeing potential danger for example). However, living with elevated levels of these stress hormones can be detrimental to our health. High blood pressure is often associated with these hormones. Many people who have high blood pressure before treatment for sleep apnea notice that their blood pressure improves a great deal once they start sleep apnea treatment.

Heart attacks and strokes – The combination of the stress of waking often and a lack of oxygen in the body can cause an increase in heart failure and strokes in sleep apnea sufferers. The disruption in oxygen flow that sleep apnea causes can affect the blood flow in your arteries which is directly linked to the causes of both heart attack and stroke.

Type 2 diabetes – There is a definite correlation between type 2 diabetes and sleep apnea. This could be due to the fact that obesity is a risk factor for both conditions. With over 80% of people with type 2 diabetes also suffering from sleep apnea and 90% of those with type 2 diabetes being classed as overweight or obese, then weight may be the main issue. It is also known that not sleeping enough can inhibit insulin production which could potentially lead to diabetes.

The link between weight and sleep apnea
yearnings for sweet foods

yearnings for sweet foods

One of the main reasons that links weight gain to sleep apnea is that fatty deposits can form in the neck of people who are overweight or obese. These deposits can actually obstruct breathing. Unfortunately, sleep apnea has also been linked to the release of a specific hormone, ghrelin. This hormone has been linked to food cravings and is thought to especially bring on yearnings for sweet foods and carbohydrates. Many people with sleep apnea also reach for sugary snacks due to feeling exhausted all the time. When you are tired, the systems of your body do not work as efficiently. This is also true for your digestive system. Your body may struggle to metabolise food and convert it into energy. If your food isn’t being processed properly, you will experience even more lethargy and this can also lead to more weight gain. In many cases, trying to lose weight in order to treat sleep apnea is not always the best move. It can be helpful to start a different treatment for your sleep apnea. As soon as the treatment has started, a sleep apnea patient often sees immediate results. You may feel much less tired. Having more energy means it is much easier to lose weight. Your body will find it easier to convert food into energy and you will have more energy to exercise or engage in a more active and healthier lifestyle.

The link between adult asthma and sleep apnea
link b/w treatment for sleep apnea & adult asthma

link b/w treatment for sleep apnea & adult asthma

Some reports claim that there is a link between treatment for sleep apnea and an improvement in adult asthma. This isn’t scientifically proven and it could be a dangerous claim if people start to neglect to take their asthma medication. Some people believe that they have experienced fewer asthma attacks after starting treatment for sleep apnea. However, without confirmed and carefully regulated medical studies, you would be wise to continue following the treatment for both conditions.

How to self-test for sleep apnea

Like many conditions and diseases, there are a plethora of online surveys that you can take to evaluate the risk of having sleep apnea. Of course, these resources should all be taken with a pinch of salt. Although they can help you to pinpoint any specific symptoms of sleep apnea, the only true way to diagnose and treat this condition is to seek medical attention. Like any medical survey, it can be easy for us to start exaggerating the severity of symptoms or assuming that tiredness is caused by sleep apnea when it could be linked to a number of different conditions.

Reasons for fatigue or tiredness that are not related to sleep apnea:

  • anaemia or iron deficiency
  • coeliac disease
  • diabetes
  • underactive thyroid
  • depression
  • anxiety
  • chronic fatigue syndrome
  • restless legs
  • glandular fever
  • food intolerance
  • UTIs
  • heart disease
Using an app for sleep apnea

Nowadays, there seems to be an app for absolutely everything. This is even true for diagnosing sleep apnea. For those in America or other parts of the world where you have to pay for your medical care, a diagnosis of sleep apnea can cost you a fair amount. As it is usual for those with suspected sleep apnea to spend at least one night in hospital and the process involves some pretty vigorous testing, it can result in a pretty hefty hospital bill. As the symptoms of sleep apnea can be easily mistaken for other conditions, many people are reluctant to get tested. In fact, it is believed that only 5% of people with sleep apnea are aware that they have the condition.

app for sleep apnea

app for sleep apnea

In an effort to cut medical costs, the University of Washington has developed an app that can keep track of your breathing by recording audio activity. This app removes the need for sensors and is completely wireless. Users can try it from their own bedrooms and the experience is completely wireless. ApneaApp emits inaudible sound waves using the speakers on your smartphone. It uses these to track changes in breathing patterns, picking them up using the microphone in the mobile phone. There is no denying that this sonar system is a highly innovative use of technology inspired by bats and the way that they catch insects and navigate through the air.

Although the idea of using an app to gauge whether you have a condition like sleep apnea sounds like a bad idea, in reality, the results have been surprising. According to the clinical study involving the app, it was able to offer results that were as accurate as a hospital polysomnography test in 98% of cases.

ApneaApp is currently unavailable outside of clinical trials. However, researchers and developers believe that it could be out in the next year. They are currently seeking FDA approval before releasing the app.

Unfortunately, a number of companies have already jumped on the idea of tracking sleeping patterns using your smartphone. Although the idea is similar and many claim to use sonar technology, without stringent testing and scientific grounding, it would be dangerous to rely on these apps instead of seeking medical advice. The only true way to determine whether you have sleep apnea is to undergo testing at a sleep clinic or sleep disorder centre. Although an overnight hospital stay may prove costly, when you consider the potential health complications linked to sleep apnea, it is worth paying.

Diagnosing sleep apnea
Diagnosing sleep apnea

Diagnosing sleep apnea

If you exhibit any of the symptoms or risk factors of sleep apnea, your doctor may suggest testing you while you are sleeping. This is often done at home but can also be done in a sleep disorder centre or sleep study centre. The sleep apnea test is also known as a polysomnogram and comprises of several components. The test is carried out while you are sleeping and records different activities that occur in your body. It is usual for sleep disorder specialists to analyse the results. They will be able to tell by looking at the records whether you have sleep apnea, a different type of sleep disorder or are perhaps exhibiting none of the expected symptoms while you sleep.

Once sleep apnea has been diagnosed, you may need to undergo further tests to establish the best course of treatment. Once treatment has been arranged, you will also need to be regularly monitored.

Although the idea of being tested in your sleep can feel quite intrusive or overwhelming, in reality, subjects have little trouble falling asleep. The equipment is specially designed to be used while you are sleeping and will not interfere with your natural sleeping patterns.

It is likely that the medical team will use the following equipment during your sleep study:

  • surface electrodes – attached to the scalp and face, any electrical signals that are generated by your muscles and brain will be sent to the measuring equipment where they will be digitally recorded.
  • abdominal belts – fastened around the abdomen and chest and will record breathing
  • an oximeter probe – wrapped around the finger like a bandage, this is used to measure how much oxygen is in the blood

In some cases, the following equipment will be used:

  • EEG (electroencephalogram) – measures and records activity in the brain
  • EMG (electromyogram) – records muscle activity (this might include leg twitching, teeth grinding, facial spasms and can indicate the presence of REM sleep) http://www.gnet.org/REM-sleep
  • EOG (electrooculogram) – this is used to record eye movement which can then be analysed to determine various sleep stages
  • ECG (electrocardiogram) – this records the rhythm and rate of the heartbeat
  • Nasal airflow sensor – this records the flow of air through the nose
  • Snore microphone – this creates an audio record of any snoring
Classifying sleep apnea
Classifying sleep apnea

Classifying sleep apnea

Sleep apnea is classified based on how many apneas or hypopneas are experienced during each hour of sleep. An apnea is a complete absence of breathing, a hypopnea is when the breathing is very shallow. These figures are charted using an index known as AHI (apnea-hypopnea index).

AHI = 0-5 Normal

AHI = 5-15 Mild sleep apnea

AHI = 15 – 30 Moderate sleep apnea

AHI >30 Severe sleep apnea

Sleep apnea studies

In recent years, more studies have been done in the field of sleep disorders and there is a greater understanding of the dangers of conditions such as sleep apnea.

In 2009, a landmark study proved what people had feared, that sleep apnea was linked to an increased risk of death. It is important to note that these results are related to severe sleep apnea and early diagnosis can be very helpful.

Sleep apnea can be successfully treated and Continuous positive airway pressure (CPAP) is one of the safest and most effective ways to relieve the symptoms of sleep apnea. One of the main issues linked to lack of successful treatment using CPAP is compliance. Many people who are diagnosed with sleep apnea and put on CPAP will start the treatment only to abandon it later on. Research shows that around half of those who are told to use CPAP abandon it within the first three weeks. Many people find it hard to sleep with the CPAP machine over their face as it can be uncomfortable or can give people nightmares. In some cases, people even remove the machine without realising it as they sleep.

Treatments for sleep apnea
Mandibular maxillar advancement surgery

Mandibular maxillar advancement surgery

In some cases, you can have a specialist dental device fitted that will ensure your airways remain open while you sleep. In other instances, the treatment option may be more severe. Surgery is one of these options. There are several types of surgery that can be used to treat sleep apnea depending  on the cause of sleep apnea.

These are the most common types of surgery for treating sleep apnea:

Nasal surgery – when nasal problems have led to sleep apnea, then nasal surgery is the obvious solution. Nasal surgery can correct conditions such as a deviated septum or remove nasal polyps.

Uvulopalatopharyngoplasty (UPPP)

Uvulopalatopharyngoplasty (UPPP)

Uvulopalatopharyngoplasty (UPPP) – this surgery increases the size of the airway by removing excess soft tissue at the back of the throat or in the palate region.

Mandibular maxillar advancement surgery – If the problem is related to the size or shape of the jawbone, then this surgery can reduce any obstructions that may be causing sleep apnea

Treating sleep apnea at home

As the causes of sleep apnea vary so wildly, it makes sense that the treatment options reflect this diversity. In cases of mild sleep apnea, the doctor may suggest some simple lifestyle changes that could help your sleep apnea symptoms to improve.

Your doctor may suggest the following lifestyle changes:

  • Losing weight
  • Avoiding sleeping pills
  • Avoiding alcohol
  • Stopping smoking (tobacco can cause the upper airway to swell which has been known to aggravate snoring and sleep apnea)
  • Changing your sleeping position (sleeping on your back may cause sleep apnea to worsen)
CPAP treatment for sleep apnea from home (CPAP)

Continuous positive airway pressure or CPAP is a common way to treat sleep apnea. It involves wearing a mask over your mouth and/or nose while you sleep. The mask ensures that a steady supply of oxygen is provided while you sleep. This oxygen is provided by a special machine. As well as ensuring that you get enough oxygen, the CPAP machine also helps to maintain regular breathing by keeping the airways open. In some instances, a BPAP (bi-level continuous positive airway pressure) machine is used. This is similar to the CPAP except that the airflow changes for inhalation and exhalation.

Inspire treatment for sleep apnea

In some cases patients are unable to use CPAP treatment and an implantation device is used instead. This device is known as Inspire and is a type of upper airway stimulator. As surgery is needed to fit the device, it is only used when all other options have been exhausted. Inspire consists of a pulse generator that is implanted into the chest which is wired up to the lungs to record breathing activity. Another wire is linked up to the neck where it stimulates the nerves in the muscles that form the airways. This stimulation can help to keep the airways open while someone is sleeping. Patients who use Inspire are given a remote control so that they can easily turn the device on before they fall asleep and switch it off again when they wake up. Doctors can even program an Inspire device externally.

Side effects of treatments
Side effects of treatments

Side effects of treatments

CPAP treatment can take a while to get used to. It is not only the feeling of having to wear a mask while sleeping that people struggle to adjust to. The additional air can feel strange to begin with. Medical professionals urge sleep apnea patients to stick with CPAP as after a little perseverance, most patients adjust to it well.

There are no real serious side effects of using CPAP but there are a few annoying elements that may prevent people from continuing treatment. These include a feeling of claustrophobia, nasal congestion, runny nose, rhinitis and discomfort from wearing the mask. These side effects can usually be dealt with. It helps to have the mask fitted properly and tell your medical team if you are experiencing any discomfort. If you use the heated humidifier option on your CPAP machine, your nasal symptoms should calm down. Most CPAP machines have the capacity to act as a heated humidifier but many patients neglect the  use of this function.

There have been a number of adverse side effects linked to Inspire treatment. These include nerve damage, damage to blood vessels (at site of implant), rejection of implant, swelling, discomfort, difficulties speaking or swallowing, dry mouth, insomnia, headache, choking, coughing and tongue soreness.

There are also a number of risks linked to surgery. In many cases, people prefer the idea of one-off surgery compared to wearing a CPAP machine every night for the rest of their lives. Although CPAP can feel uncomfortable and restrictive, it always improves the symptoms of sleep apnea. The success rate for surgery is much lower at 25-30%. Unfortunately, even if surgery is successful, the symptoms can still come back in the future.

bleeding

bleeding

Surgery for sleep apnea has been linked to the following risks:

  • bleeding
  • pain
  • scar tissue
  • infection
  • difficulty swallowing
  • change in voice
  • unforeseen surgical complications
  • anaesthesia risks (including stroke, heart attack, allergic reaction and death)
Latest scientific breakthrough

Researchers at the University of Edinburgh recently discovered that an enzyme called AMPK could help mice to maintain a controlled breathing pattern. The scientists realised that in mice which were not producing AMPK, signals were not sent to the brain when more oxygen as needed. If AMPK is present, the body will recognise a lack of oxygen and breathe faster to make up for it. The discovery of this connection could make a big difference to anyone who is suffering from central sleep apnea. Of course, in the case of obstructive sleep apnea, the introduction of this enzyme would not address the problem. However, in central sleep apnea, as the condition is caused by the brain not sending the right signals, introducing this enzyme (or drugs that mimic this enzyme) into the body could make a world of difference.

Alternative and natural cures for sleep apnea

Although CPAP is the most common treatment for sleep apnea and the most effective one as well, many people experience compliance difficulties (not using the machine despite medical advice). There are numerous natural treatment options that can be done at home without using CPAP. How effective are they really?

Positional therapy – this simply means sleeping on your side. Although there is evidence to show that sleeping on your side can help with sleep apnea, it is not the easiest habit to get into if you are used to sleeping on your back. There is even a device that can be worn on the back of the neck and will vibrate if you roll onto your back. The device will vibrate with increasing intensity until you change to a side position. In the cases of severe sleep apnea or central sleep apnea, this seems like an unlikely solution.

Tongue exercises for sleep apnea

Tongue exercises for sleep apnea

Tongue exercises for sleep apnea – A large tongue has been identified as a cause of sleep apnea and some people have tongue reduction surgery for this very reason. However, expecting tongue exercises to cure sleep apnea seems like a shot in the dark. Yes, the tongue is made up of muscle tissue and like any muscle, you can improve its strength and tighten fibres through exercise. When it comes to something as potentially fatal as sleep apnea, tongue exercises seem a little unscientific and difficult to monitor. That isn’t to say that if you are using CPAP or another proven therapy that it wouldn’t hurt to try some tongue exercises too.

Exercising to increase airway muscle tone – Like tongue exercises, the idea of exercising the muscles of your airway sounds a little dubious and without substantial scientific backing. This practice involves singing and jaw exercises. Although these exercises could help to strengthen and tone the airway, if your airway is in danger of collapsing during your sleep then it would be wise to take more drastic action. These exercises could take time to perfect and refine, are very difficult to monitor and may not guarantee results. Again, these exercises could help when used alongside another treatment such as CPAP.

Kampo extract to treat sleep apnea symptoms – Anyone who is looking for a natural cure for sleep apnea will have come across the numerous claims that celebrate the use of Kampo extract to cure sleep apnea. There has been some research that suggests there is some truth in this but the main study only involves a single participant.

Although the results seem promising and suggest that Kampo extract may be useful in treating the sensation of choking during sleep, we need to recognise the dangers of this sort of limited research. While one person may reap benefits from a particular treatment, that doesn’t mean it will prove to be beneficial or even safe for others. Anyone considering the use of Kampo should be wary. In fact, although Kampo is a prescribed medicine in Japan, it is often used alongside more conventional medicine and this tends to be where it displays the most positive results.

Didgeridoo playing and sleep apnea

Didgeridoo playing and sleep apnea

Didgeridoo playing and sleep apnea – If you feel exhausted and long for a good night’s sleep, the last thing you’ll feel like doing is learning to play a new instrument. However, many people believe that mastering the didgeridoo can have a positive effect on the symptoms of sleep apnea. This may sound like a great marketing plan by a didgeridoo salesman. However, according to this study published in the British Medical Journal regular didgeridoo playing is actually an effective treatment alternative for patients with moderate obstructive sleep apnea. Again, taking the time to get the right muscles strengthened in order to prevent airways from collapsing can be tricky. The didgeridoo also involves a circular breathing technique which can be tricky to master. Also, this treatment is a non-invasive and potentially enjoyable way of keeping the airways open, it is advisable to carry it out alongside conventional treatment methods to reduce any serious health risks while you are working on strengthening the key muscles.

Snoring devices – There are a number of snoring devices on the market, but relying on them may not be a wise move. Although snoring is linked to sleep apnea, reducing snoring may not necessarily improve the condition. Someone with sleep apnea may snore due to nasal obstruction, however, clearing the nasal passageway does not guarantee that the sleep apnea will be cured. There may be other contributing factors such as an enlarged tongue or soft palate problems which will not be rectified by reducing the snoring. Any products that you buy to treat your sleep apnea should be discussed with your doctor before you even consider using them.

Bottom line…
CPAP is known to be a safe and effective treatment

CPAP is known to be a safe and effective treatment

The idea that you stop breathing in your sleep sounds terrifying. Add the increased risk of heart failure and stroke and you start to recognise the severity of the situation. It is important to remember that many people have mild to moderate sleep apnea and are safe from such dramatic risks. It is also important to recognise that even people with severe sleep apnea can get treatment. CPAP is known to be a safe and effective treatment which can help instantly. CPAP users feel instantly more energised and less exhausted. However, it can be tricky to adjust to a CPAP machine and many people soon give up. If your doctor advises you to use the CPAP machine then it is important that you stick with it.

Although it can be tempting to try alternative therapies, it is vital that you remember that complementary therapies are designed to work alongside conventional medicine and not replace them. Engaging in strengthening exercises (or even playing the didgeridoo) on top of using CPAP could mean that you recover and feel better faster.

If you opt for surgery, it is important to realise that the success rate is not particularly high. However, it does work in around a third of all cases and your doctor will be able to advise you. If you are unable to use CPAP, then surgery may be a sensible option to try.

New discoveries and breakthroughs are being made all the time. You may even be interested in being involved in clinical trials. Your doctor will be able to advise you on this, including any risks or potential complications.

It is worth being wary of new products and devices that claim to cure sleep apnea completely. Do your research and only use things that have a solid medical grounding. Many companies will exploit vulnerable people who are desperate for new solutions. It is never worth putting your health at risk.

Unfortunately, with a condition such as sleep apnea, it can take a bit of trial and error before you find what works for you. Adopting new healthy lifestyle choices and being honest and open with your doctor are a good place to start. Sleep apnea is a potentially life-threatening condition that you may need to monitor for the rest of your life. However, it is also perfectly manageable if you are sensible about it.

 

Sasha de Beausset

About Sasha de Beausset

Sasha de Beausset's life project is to become a leader in building solutions to food insecurity and malnutrition in Guatemala. She believes that recognizing community assets and being conscious of the role all sectors play in ensuring an equitable development is the key to building sustainable solutions. If you'd like to read more about benefiting from healthy eating, sign up for our newsletter and get the latest health research.

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