What is Obstructive Sleep Apnea (OSA)?

Sleep Apnea: An Overview of the Condition

Sleep apnea is one of the more serious sleeping disorders. Studies indicate that at least one out of every 15 Americans is affected by the condition. 

Scientists believe that as many as 24% of men and 9% of middle-aged women are suffering from the problem, but have not been diagnosed.  One of the main symptoms is snoring.  Most people think that snoring is not serious.  So, they fail to see a doctor. 

In addition to snoring, there are other symptoms including:

• Daytime sleepiness
• Dry or sore throat in the morning
• Headaches
• Insomnia or waking frequently during the night
• Waking suddenly with a sensation of being suffocated or feeling breathless
• Lack of energy

Sleeping irregularly can lead to other things such as forgetfulness, irritability and moodiness.  Depression and decreased interest in sex are among the problems reported by those who suffer from sleep apnea.

Often, it is the person’s bed partner that realizes something is wrong.  The pauses in breathing are noticeable.  Doctors can only make an accurate diagnosis during a sleep study, although the patient’s symptoms or the reports of a spouse may lead them to suspect that apneas are the problem.
There are three types of sleep apnea, although a diagnosis may not include the specific type.  It is sometimes difficult to determine the type.  The three types are obstructive (OSA), central (CSA) and mixed or complex, with obstructive being the most common.

In the obstructive type, changes in the muscles of the throat or looseness in the soft tissues surrounding the upper airways cause blockages that interfere with breathing.  This occurs because the muscles of the body naturally relax while you are sleeping.  The increased relaxation allows the soft tissues to collapse and block the airway.

Risk factors for the obstructive type include being overweight or obese, having a large neck circumference and sitting for long periods during the day.  Excess weight places increased pressure on the muscles of the throat and the soft tissues making it more difficult to breathe even during the day.

A large or “thick” neck may be caused by being overweight or very muscular.  It could simply be a genetic tendency. 

Although the neck is larger, the airways are similar in size to a smaller person.  The excess muscle or fat puts pressure on the airways, especially when the person is lying down. 

Sitting for long periods during the day causes fluids to gather in the lower part of your body.  When you lie down at night, the fluids shift and tend to gather around the neck.  This causes the airways to narrow and interferes with breathing.

The cause of central sleep apnea is a failure within the brain to respond to changes in blood gases and tell the body to breathe.  Breathing is normally an automatic action requiring no thought. 

The drive to breathe is normally great, which is why holding your breath is so difficult.  In people with CSA, the drive to breathe is much lower than normal. 

When doctors observe a person with OSA, he or she will struggle to breathe.  Eventually, the person is able to pull in enough air and the struggling ceases.  The person is unlikely to remember struggling for breath.

When doctors observe a person with CSA, he or she does not struggle to breathe.  After several seconds, the chest rises and the person breathes normally again until the next episode.  The breathing may be faster for a few minutes as the body attempts to balance the blood gases. 

People with CSA are more likely to waken as they gasp for breath.  They are also more likely to remember the episode.  Risk factors for central sleep apnea include stroke, heart disease, brain tumor, being male and being over the age of 65. 

Mixed or complex sleep apnea is a combination of both the obstructive and central types.  The risk factors are the same as those already mentioned.  In addition, people with heart disorders are more likely to have the complex type.

Cigarette smoking, drinking alcohol or taking sedatives increases your risk of having some type of sleep apnea.  People with high blood pressure are more likely to have the problem due to the same kind of fluid retention seen in people who sit for long periods of time during the day.

Either type may be genetic.  If you have family members who have the problem, your risks may be higher than average.

A number of treatments have been developed in recent years.  In mild cases, simply sleeping on one’s back can resolve the problem.  A few companies have created night shirts with balls sewn into the back to encourage the person to roll back onto their side.

Other lifestyle changes that are beneficial include losing weight and addressing health problems like high blood pressure.  It is important to avoid alcohol, sleeping pills and other sedatives, because those things relax the throat muscles even more.

In some cases, it is the tongue that falls back into the throat and causes the blockage.  Sleeping on one’s side helps to prevent that.  Also, dentists have developed oral appliances that target the problem of the tongue by pushing the lower jaw forward.

The treatment is known as oral appliance therapy and is more commonly used in Canada and Europe.  Throughout the world, the most common treatment for sleep apnea is the CPAP machine.

CPAP stands for continuous positive airway pressure.  The device forces air into the patient’s mouth and throat.  The forced air prevents the collapse of the soft tissues and the patient can breathe.  The CPAP assists only with inhaling. 

For more severe cases, the BiPAP assists with both inhalation and exhalation.  Both are bedside devices with face masks that the person puts on before going to sleep.

Several kinds of surgery have been used to treat sleep apnea.  The surgical procedures include tongue reduction, tonsillectomy, adenoid removal and Mandibular advancement.  Any surgery can initially make the problem worse due to swelling.  Talk to your doctor about the right treatment for you.