Sleep Apnea

Sleep Apnea

Sleep apnea means that your breathing often is blocked or partly blocked during sleep. The problem can be mild to severe, based on how often your lungs don't get enough air. This may happen from 5 to more than 50 times an hour.


This topic focuses on obstructive sleep apnea, which is the most common type.


A less common type of apnea, called central sleep apnea, can occur in people who have had a stroke, have heart failure, or have a brain tumor or infection. Even though this topic isn't about central sleep apnea, some of the treatments discussed here may also help treat it. Talk with your doctor to find out more about central sleep apnea.


The most common symptoms of obstructivesleep apnea (OSA) that you may notice include:


  • Excessive daytime sleepiness.
  • Waking with an unrefreshed feeling after sleep, having problems with memory and concentration, feeling tired, and experiencing personality changes.
  • Morning or night headaches. About half of all people with sleep apnea report headaches.
  • Heartburn or a sour taste in the mouth at night.
  • Swelling of the legs.
  • Getting up during the night to urinate (nocturia).
  • Sweating and chest pain while you are sleeping.


Symptoms of sleep apnea that others may notice include:


  • Episodes of not breathing (apnea), which may occur as few as 5 times an hour (mild apnea) to more than 50 times an hour (severe apnea). How many episodes you have determines how severe your sleep apnea is.
  • Loud snoring. Almost all people who have sleep apnea snore, but not all people who snore have sleep apnea.
  • Restless tossing and turning during sleep.
  • Nighttime choking or gasping spells.


Symptoms in children


In children, symptoms of sleep apnea depend on how old the child is:


  • In children younger than 5, symptoms include snoring, mouth breathing, sweating, restlessness, and waking up a lot.
  • In children 5 years and older, symptoms include snoring, bed wetting, doing poorly in school, and not growing as quickly as they should for their age. These children may also have behavior problems and a short attention span.


Children who have sleep apnea nearly always snore. But they may not appear to be excessively sleepy during the day (a key symptom in adults). The only symptom of sleep apnea in some children may be that they do not grow as quickly as they should for their age.


Although rare, in children sleep apnea can cause developmental delays and can cause failure of the right side of the heart (cor pulmonale).


Other conditions with symptoms similar to sleep apnea include an underactivethyroid (hypothyroidism) and other sleep disorders, such as suddenly falling asleep (narcolepsy) or an intense urge to move the legs (restless legs syndrome).


A blockage or narrowing of the airways in your nose, mouth, or throat generally causes obstructive sleep apnea (OSA). This usually occurs when the throat muscles and tongue relax during sleep and partially or completely block the airway. When you stop breathing or have reduced flow of air into your lungs during sleep, the amount of oxygen in your blood decreases briefly.


Obstructive sleep apnea can also occur if you have bone deformities or enlarged tissues in your nose, mouth, or throat. For example, you may have enlarged tonsils. During the day when you are awake and standing up, this may not cause problems. But when you lie down at night, the tonsils can press down on your airway, narrowing it and causing sleep apnea.


Other factors that may contribute to sleep apnea include:


  • Drinking alcohol, which affects the part of the brain that controls breathing. This may relax the breathing muscles and cause a narrowing of the airway and sleep apnea.
  • Obesity. Fat in the neck area can press down on the tissues around the airways. This narrows the airways and can cause sleep apnea. About 70% of people who have sleep apnea are obese.
  • Some medicines that are taken for conditions such as allergies, depression, insomnia, or anxiety. These medicines, especially sedatives, can also relax the muscles and tissues in the throat, causing it to narrow.


In children, the main cause of sleep apnea is large tonsils or adenoids.


Treatment for obstructive sleep apnea (OSA) includes lifestyle changes, continuous positive airway pressure (CPAP) (to prevent the airway from closing during sleep), the use of dental devices (oral breathing devices) to help keep your airway open, medicine to help you stay awake during the day, and surgery.


The goals of treatment are to relieve symptoms such as snoring and excessive daytime sleepiness and prevent other problems, such as high blood pressure. Your doctor will base your treatment on how severe your sleep apnea is.


In general, your doctor will have you try lifestyle changes and CPAP first. Surgery might be a first choice only if the sleep apnea is caused by a blockage that is easily fixed.


You may need to be treated for other health problems before you are treated for sleep apnea. For example, people who also have inflammation of the nasal passages (rhinitis) may need to use nose spray to reduce the inflammation. People who have an underactive thyroid gland (hypothyroidism) need to take thyroid medicine.


Children have the same treatment options as adults. But surgery (tonsillectomy and adenoidectomy) typically is the first choice because enlarged tonsils or adenoids cause most cases of sleep apnea in children. If surgery is not possible or does not work, children are treated using CPAP.


Initial treatment


The first treatment for obstructive sleep apnea (OSA) consists of making lifestyle changes.


Your sleep apnea may be helped if you:

  • Lose weight (if needed). Small studies have shown that losing weight decreases the number of times an hour that you stop breathing (apnea) or that a reduced amount of air enters your lungs (hypopnea). Experts agree thatweight loss should be part of managing sleep apnea.
  • Wake up at the same time every morning.
  • Sleep on your side. Try this: Sew a pocket in the middle of the back of your pajama top, put a tennis ball into the pocket, and stitch it shut. This will help keep you from sleeping on your back. Sleeping on your side may eliminate mild sleep apnea.
  • Avoid the use of alcohol and some medicines, especially sleeping pills andsedatives, before bed.
  • Quit smoking. The nicotine in tobacco relaxes the muscles that keep the airways open. If you don't smoke, those muscles are less likely to collapse at night and narrow the airways.
  • Raise the head of your bed 4 in. (10 cm) to 6 in. (15 cm) by putting bricks under the legs of the bed. You can also use a special pillow (called a cervical pillow) when you sleep. A cervical pillow can help your head stay in a position that reduces sleep apnea. Using regular pillows to raise your head and upper body will not work.
  • Promptly treat breathing problems, such as a stuffy nose caused by a cold or allergies.


All people who have sleep apnea should make these lifestyle changes. They may be all that is needed to relieve mild sleep apnea.


Some people use nasal strips, which widen the nostrils and improve airflow. Although these strips may decrease snoring, they cannot treat sleep apnea.


First medical treatment


Continuous positive airway pressure (CPAP) is nearly always the first medical treatment for sleep apnea.

  • With CPAP, you use a breathing device that prevents your airways from closing during sleep.
  • CPAP is the preferred treatment for moderate or severe sleep apnea.
  • It may take time for you to be at ease when you use CPAP. You may find that you want to take the mask off, or you may find it difficult to sleep while using it. If you can't get used to it, talk to your doctor. You might be able to try another type of mask or make other adjustments.
  • CPAP does not always get rid of daytime sleepiness. If you still feel sleepy during the day while using CPAP at night, tell your doctor.
  • Some CPAP devices automatically adjust air pressure or use different air pressures when you breathe in or out. They are easier and more comfortable for some people to use.


Other medical treatment includes oral breathing devices. These devices reposition your tongue and jaw during sleep, which opens up your airways.


Surgery might be the first treatment only when a blockage can be fixed easily, such as when you have overly large tonsils.


Ongoing treatment


Ongoing treatment for obstructive sleep apnea (OSA) includes using continuous positive airway pressure (CPAP) or an oral breathing device and making changes in your lifestyle.


Lifestyle changes include losing weight (if needed), improving sleep habits (such as sleeping on your side and waking up at the same time every morning), avoiding the use of alcohol and certain medicines (especially sleeping pills and sedatives) before bed, and stopping smoking. Sometimes medicine to help you stay awake during the day is used along with CPAP.


If CPAP is not working, you may need another sleep study to find out whether your CPAP machine needs to be adjusted. You may also need to think about surgery.


Surgical choices include:

  • Uvulopalatopharyngoplasty, which removes excess tissue in the throat to make the airway wider. It is the most common surgery to treat sleep apnea in adults.
  • Tonsillectomy and/or adenoidectomy, which removes the tonsils and/or the adenoids. It may be used if you have enlarged tonsils and adenoids that are blocking your airway during sleep. This is often the first treatment option for children because enlarged tonsils and adenoids are usually the cause of their sleep apnea.
  • Other surgical procedures, which are used to repair bone and tissue problems in the mouth and throat.
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