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Sleep Apnea

Causes, Symptoms and Treatments

Sleeping disorder
Sleeping disorder
"Apnea or apnoea" is a sleeping disorder which literally means "no breath" or "the stopping or ceasing of breathing". Sleep apnea is a sleep disorder that involves cessation or significant decrease in airflow in the presence of breathing effort. It is a chronic breathing disorder in which one repeatedly stops breathing during the night, this may be due to a partial or complete obstruction (or collapse) of the upper airway, typically affecting the base of the tongue and the soft palate. The involuntary pause in breathing can result either from a blocked airway or a signaling problem in the brain.

Types of Sleep Apnea
Sleep apnea is a generic term that includes any sleeping disorder that causes pauses  or temporary stoppage in breathing during sleep. It may affect someone at any age, but the prevalence of sleep apnea increases beyond middle age. There are a few major sub-types, including:

Obstructive Sleep Apnea: Obstructive sleep apnea (OSA)  is a common and serious sleep disorder that causes you to stop breathing during sleep.

Central Sleep Apnea: In central sleep apnea (CSA), the neurological controls for breathing are faulty, causing the control and rhythm of breathing to malfunction. In other words, there is a disconnect in communication between the brain and the body. This failure of the brain to signal the muscles controlling breathing causes breathing to stop repeatedly or shallow.

Complex Sleep Apnea:  this is a combination of obstructive sleep apnea and central sleep apnea.

Sleep apnea is not the only problem that can lead to difficulties breathing during sleep. There are a few other problems that do not cause a complete pause in the breathing but may still be problematic, such as:
  • Snoring,
  • Catathrenia or sleep groaning,
  • Upper Airway Resistance Syndrome (UARS), etc.


Symptoms of Sleep Apnea
Aside from the pauses in breathing which are typical of the disorder, the first and most common symptom of sleep apnea is snoring. This is basically first observed by partners and/ or family members. In addition to snoring, they might also tell you that, you make gasping or choking sounds while sleeping. Other common  symptoms include;
  • Loud, chronic snoring,
  • Choking or gasping during sleep,
  • depressed mood,
  • night sweats,
  • weight gain,
  • Lack of energy,
  • frequent urination at night,
  • Witnessed pauses in breathing during sleep,
  • Waking frequently to urinate (nocturia),
  • Teeth grinding or clenching (bruxism),
  • Dry throat or mouth upon awakening,
  • Nocturnal palpitations or a racing heart rate,
  • Hypertension,
  • Nocturnal heartburn,
  • Morning confusion,
  • Insomnia (inability to sleep well),
  • Excessive daytime sleepiness,
  • Sexual dysfunction, including impotence and reduced libido,
  • Morning headache,
  • Short-term memory or learning problems,
  • Decreased vigilance,
  • Poor concentration or attention,
  • Feeling irritable,
  • Daytime fatigue/ constant tiredness, etc.

Note that these symptoms may not and are not always limited to sleep Apnoea, so consult your doctor.

Causes of Sleep Apnoea
There are a few common causes of obstructive sleep apnea (OSA) and some situations that can make it worse. These include:
  • Being overweight or obese (include having  a large neck size),
  • Abnormal upper airway anatomy (including a deviated septum),
  • Using medications,
  • Drug abuse,
  • Excessive alcohol consumption,
  • Aging,
  • Sleeping on the back,
  • REM or dreaming sleep,
  • Smoking, etc.


Risk factors
The following are some common risk factors of sleep apnea.
  • Obesity,
  • Central fat distribution,
  • Male sex,
  • Age,
  • Postmenopausal state,
  • Alcohol use,
  • Sedative use,
  • Smoking,
  • Habitual snoring with daytime somnolence,
  • Supine (flat on back) sleep position,
  • Rapid eye movement (REM) sleep,
  • Chronic sinusitis,
  • Large neck circumference,
  • Recent weight gain,
  • Menopause,
  • Large tonsils or adenoids,
  • Down syndrome,
  • Smoking,
  • Family history of sleep apnea, etc.



Complications of Sleep Apnea
There can be serious consequences or complications associated to untreated sleep apnea, such complications are:
  • Stroke or transient ischemic attacks,
  • Coronary heart disease,
  • Heart failure,
  • Irregular heartbeat,
  • Heart attack,
  • High blood pressure,
  • Heartburn and reflux,
  • Diabetes,
  • Erectile dysfunction,
  • Concentration and memory problems (dementia),
  • Depression,
  • Sudden death,
  • Accidents while driving,
  • Metabolic syndrome,
  • Hypertension,
  • Stroke,
  • Glaucoma,
  • Chronic fatigue,
  • Decreased quality of life,
  • Increased risk of mortality,
  • Headaches,
  • Dry mouth or sore throat after sleeping with the mouth open, etc. 

Treatment
Lifestyle changes: Changes in Lifestyle are essential to normalizing breathing, and they are critical first steps in  the treatment of sleep apnoea. They include:
  • Withdrawing from alcohol,
  • Stop smoking,
  • Weight loss,
  • Side sleeping,
  • Avoid sedatives (particularly 4-6 hours before bedtime),
  • Avoiding sleep deprivation, etc.


Mechanical measures: Mechanical measures used in the treatment of Obstructive sleep already (OSA) include the following:
  • Nasal CPAP: Standard treatment option,
  • Bilevel positive airway pressure,
  • Oral appliance therapy,
  • Pharmacotherapy, etc.


Medications: Medications are generally not a part of the primary treatment recommendations for Obstructive Sleep Apnea (OSA), however, central nervous system stimulants such as modafinil and armodafinil have been used adjunctively in the management of this condition.

Surgery: Surgical intervention for obstructive sleep apnea (OSA) includes, but is not limited to, the following:
  • Uvulopalatopharyngoplasty,
  • Craniofacial reconstruction with advancement of tongue or maxillomandibular bones,
  • Tracheostomy, etc.

Always consult your doctor and avoid self medications.

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