Sleep Apnoea - Symptoms, Causes, Prevention, Treatment

Sleep Apnea is a typical sleep condition where an individual's breathing repeatedly stops and begins during sleep. The body may not receive enough oxygen as a result.

People suffering from Sleep Apnea experience unexplained exhaustion and mood fluctuations due to frequent breathing disruptions. Their breathing interruptions keep them from falling into a deep sleep. There are two types of Sleep Apnea

1. Obstructive Sleep Apnea: It occurs when the airways become entirely or partially closed while sleeping, typically due to collapsing of soft tissue in the throat. During these episodes, the diaphragm and chest muscles must work harder than usual to keep the airways open. An individual might jerk their body or start to breathe loudly. It may disrupt their sleep and reduce the amount of oxygen reaching the essential organs, and cause irregular heartbeats.
2. Central Sleep Apnea: The airway is not closed in Central Sleep Apnea, but the brain cannot signal the muscles to breathe because the respiratory control centre is unstable. It is the most common form of Sleep Apnea.

Disease Progression of Sleep Apnea

1. Sleep Apnea is a progressive condition, and diagnosing and treating it early is necessary. It may result in premature death.
2. Obstructive sleep apnea may be a severe and life-threatening condition if left untreated. Sleep apnea increases the person's blood pressure. It may cause stress, heart attack, heart failure, and even stroke. 

Obstructive and Central Sleep Apnea have almost the same signs and symptoms, making it difficult to distinguish between them. The most common symptoms include:

1. Obesity Hypoventilation Syndrome (a breathing disorder in an obese person).
2. Heart or Kidney Failure
3. Pregnancy
4. Neuromuscular Conditions (stroke)
5. Endocrine Conditions (hypothyroidism, acromegaly, and Poly Cystic Ovary Syndrome (PCOS))
6. Genetic Factors
7. Cold and Allergies
8. Enlarged or Swollen Tonsils
9. Nasal Congestion

Obesity and excess weight in adults are the most frequent causes of Sleep Apnea, which is connected to the soft tissues of the throat and the mouth. This soft tissue can cause the airway to become clogged in sleep since the throat and tongue muscles are more relaxed. A few causes of Sleep Apnea are:

1. Obesity Hypoventilation Syndrome (a breathing disorder in an obese person).
2. Heart or Kidney Failure
3. Pregnancy
4. Neuromuscular Conditions (stroke)
5. Endocrine Conditions (hypothyroidism, acromegaly, and Poly Cystic Ovary Syndrome (PCOS))
6. Genetic Factors
7. Cold and Allergies
8. Enlarged or Swollen Tonsils
9. Nasal Congestion

Sleep Apnea can affect anyone, including children. However, a few factors can make an individual more vulnerable to Sleep Apnea. Some factors that can increase the risk of Sleep Apnea are:

1. Old age
2. Underlying diseases include obesity, diabetes, high blood pressure, Parkinson’s disease, congestive heart failure, PCOS, history of stroke, hormonal disorders, and chronic lung diseases. 
3. Smoking and alcohol consumption
4. Pregnancy
5. Menopause
6. Large tonsils
7. Having a family history of sleep apnea
8. Blockage of passage due to the large size of the tongue
9. Recessed chin or a large overbite
10. Congestion in the nose

While there isn't a specific way to stop Sleep Apnea, there are several lifestyle choices that can prevent it. The following steps may help in lowering the risk of Sleep Apnea:

1. Loss of weight: Maintaining a healthy weight will help quality sleep hours. Obesity, especially in the upper body, can obstruct the air passage by narrowing the nasal passage, causing Sleep Apnea.
2. Try yoga: Practicing yoga will help strengthen the patient's heart and respiratory system. As a result, it will also help in reducing Sleep Apnea.
3. Sleep position: The patients should try to sleep on their side instead of on their back. It will help in a better flow of air.
4. Quit smoking and avoid alcohol intake: Lifestyle changes like quitting smoking and decreasing the intake of alcohol will help in improving sleep. It will also reduce the symptoms of Sleep Apnea.

Your doctor may check for any signs and symptoms and a sleep history, which you can offer with assistance from a bed partner or household member, if possible. While you sleep, your breathing and other physiological activities are frequently monitored nightly in a sleep centre as part of an exam. The doctor diagnoses sleep apnea through the following methods:

1. Physical evaluation: The doctor may comprehensively evaluate the patient and analyse the signs and symptoms. The doctor may also ask the person who shares the bed with the patient about night time symptoms. In addition, the patient should inform the doctor about their medications, as some medications, such as opioids, may affect sleep. The doctor may also inquire about travel history as some people may have sleep apnea symptoms a few days after travelling to an altitude higher than 6000 ft. 
2. Nocturnal polysomnography (PSG): In nocturnal polysomnography, the patients are asked to sleep overnight, either in a hospital or at a sleep centre. While sleeping, the patient is connected to various monitoring systems. These machines record variables such as breathing patterns, lung and brain activity, blood oxygen levels, cardiac function, and leg and arm movements. 
3. Home sleep test: This test for diagnosing sleep apnea can be done at home. It may include monitoring blood oxygen level, breathing patterns, and heart rate. 
4. Electromyography (EMG): In an EMG test, two electrodes are placed on the chin, one above the jawline and the other below the jawline. These electrodes record the electrical signal in the muscles of the chick. Therefore, there should be relaxation of the muscles during the sleeping hours.
5. Pulse Oximeter: This device is attached to the portion of the body, having a very rich blood supply like a fingertip. It measures the blood oxygen level during sleep hours, which doctors further analyze.

Your doctor might merely advise making lifestyle changes, such as quitting to smoke or decreasing weight, for milder forms of Sleep Apnea. He will recommend allergy treatment if you have nasal allergies.

Numerous alternative therapies are available if these steps don't help your signs and symptoms or if your apnea is moderate to severe.

Sleep Apnea Treatment with Surgery

Typically, surgery is an option only when all other forms of treatment have failed. Before choosing surgery, it is advised to try alternative treatment options for at least three months.

1. Removal of tissue: This treatment is also known as Uvulopalatopharyngoplasty. In this treatment, the doctor removes some of the tissues from the back of the mouth and the top of the throat. If there is any tonsil and adenoid, they are also removed during the surgery.
2. Shrinking of tissue: This process uses the principle of radiofrequency ablation. It also includes the removal of the tissues from the back of the throat. This procedure is used to treat mild to moderate cases of Sleep Apnea. It provides results similar to the surgical removal of the tissues but has fewer complications.
3. Jaw repositioning: This procedure is also known as maxillomandibular advancement. In this surgery, the lower jaw is moved forward from the face bone. As a result, it increases the space at the back of the throat and reduces the obstruction caused by Sleep Apnea. 
4. Tracheostomy: This surgery is performed when all the other treatment approaches have failed or in cases when the patients have a severe case of life-threatening apnea. In this surgery, an artificial opening is created in the trachea. The doctor may insert a metal or a plastic tube in the trachea for breathing. 
5. Nerve stimulation: In this surgery, a stimulator has been implanted to stimulate the nerve that controls the movement of the tongue. Increasing the nerve stimulation helps keep the tongue at its position, preventing the air passage's blockage.

Sleep Apnea Treatment without Surgery

1. Adaptive servo-ventilation: This type of non-invasive ventilation is used to treat Sleep Apnea. It helps in keeping the airway open and provides adequate breathing when required. 
2. PAP (Positive Airway Pressure) therapy: It is the most preferred initial therapy used in case of Sleep Apnea. The patient wears a mask on the mouth, and then an air blower gently forces the air through the mouth or the nose. 
3. Bi-level PAP: In this approach, two different pressures are used. Comparatively, higher pressure is used for breathing in, and lower pressure is used for breathing out. 
4. Continuous PAP: This is also a widely used method in the case of Sleep Apnea. It uses a single pressure for the whole procedure. The technique used to conduct is the same as in PAP.

High blood pressure (hypertension) is a common complication of obstructive sleep apnea and raises the risk of heart disease. The risk of heart disease, heart attacks, heart failure, and strokes increases with the severity of obstructive sleep apnea. Complications of sleep apnea include:

1. Respiratory diseases such as asthma
2. Daytime fatigue results in an increased risk of vehicular accidents
3. Cardiovascular Diseases include increased blood pressure, nighttime angina, heart attack, and heart failure
4. Metabolic disorders like Diabetes Mellitus Type 2
5. Gastrointestinal diseases like Gastroesophageal Reflux Disease (GERD) and liver problems
6. Pregnancy complications

When to consult a doctor for Sleep Apnea?

There are some links between Sleep Apnea and other medical problems. Health issues like depression, heart attack, and stroke are also associated with sleep apnea. The patients should seek medical attention if they have any symptoms of Sleep Apnea that have started affecting their day-to-day life.

1. Fatigue
2. Snoring causes problems for another person as well
3. Choking during sleep
4. If patients get interrupted in between the periods of sleep
5. Neurological conditions like dementia, poor concentration and depression
6. Chronic kidney disease