Obstructive Sleep Apnea

• Obstructive sleep apnea (OSA) occurs when your breathing is interrupted during sleep. If this interruption lasts for longer than 10 seconds at least 5 times an hour on average throughout your sleep period this is known as OSA. When your breathing is reduced and you're not taking in enough oxygen, it's called hypopnea. If your breathing completely stops, it's called apnea. OSA can be a multi-level problem throughout the upper airway. Airway obstruction often occurs due to soft tissue collapse of the palate, throat, base of tongue, or parts of the larynx. In some cases, a person's facial skeleton can contribute to airway obstruction during sleep. Obstructive sleep apnea can range from mild to severe. This is based on a measurement and rating system called the apnea-hypopnea index (AHI). The AHI measures an average number of apnea and hypopnea episodes you have per hour that you sleep.

Obstructive sleep apnea is classified by severity:

• Severe obstructive sleep apnea means that your AHI is greater than 30. You have more than 30 episodes per hour.

• Moderate obstructive sleep apnea means that your AHI is between 15 and 30.

• Mild obstructive sleep apnea means that your AHI is between 5 and 15.

When you sleep, your body is completely relaxed. This even includes the muscles that help you breathe. In people with sleep apnea, these relaxed muscles combined with a narrowed airway to interrupt breathing.

Anyone at any age can have obstructive sleep apnea. But it's most common in middle-aged and older adults. Only about 1 in 50 children have obstructive sleep apnea. It's also more common in men than in women.

But what's frightening is that as many as 9 in 10 people who have obstructive sleep apnea don't know that they have it. Untreated, sleep apnea can lead to serious health problems.

Knowing the risk factors for obstructive sleep apnea can help you get a diagnosis. Risk factors include:

• Family member with obstructive sleep apnea.

• Large or thick neck. This means greater than 16 inches for women and 17 inches for men.

• Long-term (chronic) nasal congestion.

• Thyroid disorder or other endocrine condition.

• Postmenopause.

• Being overweight.

• Defect of the tissues that support the head and neck.

• Down syndrome.

• Smoking.

• Swollen or large adenoids and tonsils (in children).

Some people have obstructive sleep apnea with no symptoms. Others find that they just don't feel rested after a night of sleep. They feel sleepy during the day.

Snoring is one of the biggest symptoms of obstructive sleep apnea. Other symptoms include:

• Snoring that's interrupted with periods of quiet. This is called an apnea episode.

• Snoring that resumes with a loud sound as breathing starts again.

• Morning headache.

• Frequently falling asleep during the day.

• Being easily irritated.

• Depression.

• Trouble remembering things.

Diagnosis of obstructive sleep apnea usually involves being in a sleep study. During a sleep study, you're watched as you sleep. You may have a test called a polysomnogram at a hospital or sleep center. But you may also use a take-home version of the test. Your doctor may give you a monitor to wear when you sleep. The monitor measures your oxygen levels and heart rate. This can help diagnose sleep apnea.

Your doctor will also do a physical exam. This includes an exam of the throat, neck, and mouth. The provider will also ask about your health history. You'll probably also have to answer questions about your sleep and bedtime routine, as well as your symptoms.

These are common treatments to keep your breathing consistent and stop or reduce apnea episodes:

• Sleeping with a CPAP (continuous positive airway pressure) machine and mask. This treatment gives a constant flow of air to help keep your airway open.

• Wearing an oral appliance. This is a custom-fit mouthpiece your dentist or orthodontist can make for you to keep airways open while you sleep.

Several types of surgery can be done to treat obstructive sleep apnea in adults who fail CPAP or medical therapies:

• Surgery to repair problems in facial structures.

• Surgery to get rid of extra tissues that can block airways.

• Surgery to repair problems that cause obstructions when you breathe or to create a wider airway.

• Removal of adenoids and tonsils. This works best in children.

• Implanting nerve stimulators to help prevent airway collapse.

Making a few changes to your sleep and other behaviors can also help manage obstructive sleep apnea:

• Work with your healthcare provider to lose weight if needed.

• Sleep on your side instead of on your back.

• Don't drink alcohol.

• Limit your use of sedatives.

Letting obstructive sleep apnea continue untreated is risky. You can get in a serious accident if you fall asleep while operating machinery or driving a car.

Health problems may develop as a result of obstructive sleep apnea. These include:

• Increased blood pressure.

• Unstable oxygen levels.

• Changes in your body's response to insulin and glucose.

• Changes in mental function and mood.

• Cardiovascular problems such as heart failure, stroke, or heartbeat problems (arrhythmia).

Don't do things that relax your muscles. For example, don't drink alcohol or take sedatives to help you sleep. And stay at a healthy weight.

Talk with your healthcare provider if your bed partner hears symptoms of apnea episodes or your snoring is causing problems. Ask your provider about a sleep study. Feeling drowsy or falling asleep often during the day are also signs that you should call your provider.