What Is Obstructive Sleep Apnea?
Sleep apnea is a common condition in the United States, but can lead to serious health problems if untreated. Sleep apnea occurs when breathing is interrupted during sleep. Obstructive sleep apnea causes the upper airway to become blocked repeatedly during sleep, causing airflow to reduce or stop.
People with untreated sleep apnea stop breathing many times during their sleep, sometimes hundreds of times during the night. If untreated, sleep apnea can cause a number of health problems, including hypertension, stroke, cardiomyopathy, heart failure, diabetes, and heart attacks.
Obstructive sleep apnea is the most common sleep-related breathing disorder, but there are multiple courses of treatment that can greatly improve quality of life. Read on to learn more about obstructive sleep apnea treatment options, causes, and symptoms.
Types of Sleep Apnea
There are two types of sleep apnea, obstructive, and central:
Obstructive sleep apnea: This form of sleep apnea is more common. It occurs when the throat muscles sporadically relax causing an airway blockage. When apneic episodes cause breathing to stop, the diaphragm and chest muscles attempt to overcompensate by increasing pressure to open the airway. The body will wake itself up, typically with a loud gasp. Apneic episodes disrupt sleep, causing reduced flow of oxygen through the body, and can lead to heart conditions.
Central sleep apnea: This form of sleep apnea occurs when the brain does not send signals to muscles to breathe. It is caused by instability in the respiratory control center, and is usually caused by central nervous system dysfunction. This can be caused by a stroke or neuromuscular diseases like amyotrophic lateral sclerosis (ALS, Lou Gehrig’s disease). It can also develop in patients with heart, kidney, or lung disease.
Obstructive Sleep Apnea Causes
Obstructive sleep apnea is caused by an airway blockage due to the soft tissue of the back of the throat collapsing during sleep. As muscles relax, the airway narrows, and can shut completely for 10 seconds or longer. This lowers oxygen levels causing blood to accumulate carbon dioxide, and will cause patients to briefly wake up. People typically wake up snorting, choking, or gasping, but it is so short that people don’t remember it.
Apneic episodes can happen 5 to 30 times or more per hour, and can occur all night long. Frequently waking up so often leads to an inability to have a restful night’s sleep, or reach a deep REM state that the brain needs to properly function.
Anyone can develop obstructive sleep apnea, but it is usually caused by a person's physical structure or medical conditions. These could consist of obesity, large tonsils, endocrine disorders, neuromuscular disorders, heart or kidney failure, certain genetic syndromes, and premature birth.
There are many risk factors that increase the likelihood of someone developing sleep apnea. Some risk factors include:
Excess weight
Older age
Narrowed airway
High blood pressure
Chronic nasal congestion
Smoking
Diabetes
Being male
A family history of sleep apnea
Asthma
Obstructive Sleep Apnea Symptoms
Symptoms of sleep apnea can be observed by the affected person, but can also be observed by a partner. Some symptoms of obstructive sleep apnea include:
Excessive daytime sleepiness
Loud snoring
Observed episodes of stopped breathing during sleep
Abrupt awakenings accompanied by gasping or choking
Awakening with a dry mouth or sore throat
Morning headache
Difficulty concentrating during the day
Mood changes, such as depression or irritability
Decreased libido
What Does Obstructive Sleep Apnea Feel Like?
Obstructive sleep apnea is described as feeling like breathing through a straw. When waking up from an apneic episode, it is common to feel short of breath, and usually causes gasping or choking. When people wake up from a night suffering from obstructive sleep apnea, they may feel fatigued, have a headache, or have a dry or sore throat.
Obstructive Sleep Apnea Diagnosis
Diagnosing obstructive sleep apnea will start with telling your doctor about the symptoms that you are experiencing. Once other possible medical conditions are ruled out, your doctor will begin the diagnosis process.
Your doctor will evaluate you based on your medical history, a physical exam, and results from a sleep study. Typically, an obstructive sleep apnea diagnosis is confirmed with a sleep evaluation from a sleep specialist, and could involve an overnight sleep study to objectively evaluate for sleep apnea.
The two kinds of tests used to detect obstructive sleep apnea include:
Polysomnography: This sleep study involves visiting a sleep specialist facility where you will be supervised by a trained technologist. Your heart, lung, and brain activity, breathing patterns, arm and leg movements, and blood oxygen levels will be monitored. Once completed, the severity of the sleep apnea will be graded based on how many times breathing was impaired during sleep.
Home sleep apnea testing: There is another version of a polysomnography that can be done at home to diagnose obstructive sleep apnea. It records less measurements than a polysomnography, but will still monitor including airflow, breathing effort, blood oxygen levels, snoring intensity, and limb movements, which can confirm a diagnosis of moderate to severe obstructive sleep apnea.
Obstructive Sleep Apnea Treatment Options
If you have obstructive sleep apnea, your doctor will create a treatment plan with you that works for you. If you have a mild case, lifestyle changes could be enough to treat the condition. However, if you have severe obstructive sleep apnea, then a breathing machine, mouthpiece, or even surgery may be the best course of treatment.
For more mild cases of obstructive sleep apnea, your doctor may recommend some conservative options including:
Make heart-healthy eating choices
Limit alcohol intake
Get regular physical activity
Develop healthy sleeping habits
Quit smoking
Take sleeping pills
Use a wedge pillow or other devices that help sleep in a different position
Use nasal sprays or breathing strips
If these options do not improve sleep, or if you have moderate to severe sleep apnea, then your doctor may recommend one of the following obstructive sleep apnea treatment measures:
Mechanical Therapy
Positive airway pressure (PAP) therapy is typically the initial treatment and is the most common treatment for sleep apnea. This treatment requires patients to wear a machine that has a mask over the mouth and nose. An air blower delivers gentle air pressure that can be adjusted specifically for each patient. It prevents the airway from closing, and reduces the number of respiratory events that occur as you sleep.
There are multiple different styles and types of positive airway pressure devices that include:
Continuous positive airway pressure
Bi-Level positive airway pressure
Auto CPAP or Auto Bi-Level PAP
Adaptive Servo-Ventilation (ASV)
Jaw Advancement Devices
These are devices for patients with mild to moderate obstructive sleep apnea. Dental appliances or jaw advancement devices that help to prevent the tongue from blocking the throat and/or advance the lower jaw forward can be made. These devices help keep the airway open during sleep. A sleep specialist and dentist (with expertise in oral appliances for this purpose) should jointly determine if this treatment is best for you.
Hypoglossal Nerve Stimulator
A stimulator is implanted under the skin on the right side of the chest with electrodes tunneled under the skin to the hypoglossal nerve in the neck and to intercostal muscles (between two ribs) in the chest. The device is turned on at bedtime with a remote control. With each breath, the hypoglossal nerve is stimulated, the tongue moves forward out of the airway and the airway is opened.
Surgery
Surgical procedures may help people with obstructive sleep apnea and others who snore but don’t have sleep apnea. Among the many types of surgeries done are outpatient procedures. Surgery is for people who have excessive or malformed tissue obstructing airflow through the nose or throat, such as a deviated nasal septum, markedly enlarged tonsils, or small lower jaw with an overbite that causes the throat to be abnormally narrow.
These procedures are typically performed after sleep apnea has failed to respond to conservative measures and a trial of CPAP. Types of surgery include:
Somnoplasty
Tonsillectomy
Uvulopalatopharyngoplasty (UPPP)
Mandibular/maxillary advancement
Nasal surgeries including correction of nasal obstructions, such as a deviated septum
What Is the Most Effective Obstructive Sleep Apnea Treatment?
The most effective treatment for obstructive sleep apnea is using positive airway pressure (PAP) therapy. Using a PAP machine is typically the first treatment option that a doctor will recommend newly diagnosed patients with sleep apnea to try.
According to a study titled “Treatment Options for Obstructive Sleep Apnea,” Doctor Patrick Pavwoski concludes, “PAP therapy remains the gold standard treatment for OSA. Other treatment modalities may be considered for OSA patients who decline or cannot tolerate PAP therapy. Some OSA patients may benefit from multimodal treatment.”
Online Doctor for Obstructive Sleep Apnea Treatment
If you think that you may have obstructive sleep apnea, it is important to begin treatment as soon as possible, as untreated sleep apnea may lead to significant health issues.
Contact your doctor if you experience any of the following:
Snoring loud enough to disturb your sleep or that of others
Waking up gasping or choking
Pausing in your breathing during sleep
Having excessive daytime drowsiness, which may cause you to fall asleep while working, watching television, or even driving a vehicle
PlushCare makes finding an online doctor simple and easy, with same-day appointments often available. The licensed, board-certified doctors at PlushCare have an average of 15 years of experience, have trained at the top 50 U.S. medical schools, and have practice in treating obstructive sleep apnea. If necessary, your doctor can also refer you to a sleep specialist in your area to conduct a sleep study in order to confirm an obstructive sleep apnea diagnosis.
Book an appointment with an online PlushCare doctor to talk about obstructive sleep apnea treatment today.
Read More About Obstructive Sleep Apnea Treatment
Sources
Mayo Clinic. Obstructive sleep apnea - Diagnosis and treatment. Accessed on January 15, 2022 at https://www.mayoclinic.org/diseases-conditions/obstructive-sleep-apnea/diagnosis-treatment/drc-20352095
National Institutes of Health. National Heart, Lung, and Blood Institute. Sleep Apnea. Accessed on January 15, 2022 at https://www.nhlbi.nih.gov/health/sleep-apnea
Pavwoski P, Shelgikar AV. Treatment options for obstructive sleep apnea. Neurol Clin Pract. 2017;7(1):77-85. Accessed on January 15, 2022 at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5964869/
