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Sleep Apnea
During sleep,
the muscles that control the tissues in the throat (soft palate and uvula)
and tongue tend to relax, resulting in the narrowing of the airway and
partially blocking the air passage. As one breathes, the soft palate and
the uvula vibrate against the back of the throat producing a snoring noise.
While sleeping on the back, snoring is loud because the weight of the
relaxed tongue tends to choke even further the narrowed air passage. Snoring
not only disrupts the sleep of the family members who have to hear it,
but it may be a symptom of a more serious underlying sleep-related breathing
problem called Sleep Apnea.
What
is Sleep Apnea ?
Sleep
Apnea is a potentially life-threatening sleep disorder. It can affect people
of any age, from newborns to elderly. In sleep apnea, instead of the partial
collapse of the airway in the throat associated with snoring, there is a complete
or nearly complete obstruction to the airflow. Apnea is defined as an absence
of airflow for 10 seconds or more. People who suffer from sleep apnea stop breathing
many times during sleep. This may result in a significant drop in oxygen levels
in the blood and often the person's blood pressure will rise to high levels.
A brief awakening called an "arousal" usually terminates apnea. The arousal
increases the tone in the muscles that control the tongue and throat, which
helps reopen the airway. A loud snore or snort usually accompanies reopening
of the airway. When the airway opens, the person will often breathe more rapidly
for a few seconds. This is then usually followed by the next apnea. People who
suffer from sleep apnea may have several hundred apneas each night. This leads
to fragmentation of sleep and the person may complain of non-restorative sleep.
Severe sleep apnea is associated with an increased risk of heart disease, stroke,
early mortality, etc. It can also lead to excessive daytime sleepiness, unusual
forgetfulness, poor work performance, trouble concentrating, depression, motor
vehicle accidents, irritability, impotency, morning headaches, etc. People with
sleep apnea may notice that they are awakening frequently, gasping for air,
choking sensations, and thrashing about in their sleep.
Types of Sleep Apnea:
Obstructive Sleep
Apnea (OSA):
This is most common and severe type of sleep apnea. When the muscles of the soft palate
at the base of the tongue and uvula (the small flashy tissue that hangs
from the center of the back of the throat) relax and sag, the air passage
gets blocked, making breathing labored and noisy, and even blocking it
entirely. OSA most often occurs in obese people. Ingestion of alcohol
and sleeping pills close to bedtime further reduce muscle tone and may
exacerbate OSA.
Central Sleep Apnea
(CSA):
In
this type of sleep apnea, the airway may remain open, but the brain appears
to forget to send out the necessary signal to the muscles that control breathing
(diaphragm and chest muscles).
Mixed
Sleep Apnea:
This type of sleep
apnea is a combination of both OSA and CSA. These apneic events start with a
central component of apnea, which then becomes OSA.
Diagnosing Sleep Apnea:
To make a definitive
diagnosis of sleep apnea, a specialized overnight sleep test (called polysomnography)
is conducted in a sleep disorders clinic. Polysomnography measures various physiological
bodily functions in sleep; such as brain waves, muscle activity, eye movements,
respiratory effort and airflow, heart rate, leg movements, oxygen levels in
blood, etc. A well-trained, qualified sleep technologist monitors the patient
throughout the sleep study.
Treatments of Sleep Apnea:
Lifestyle:
Changes such as weight loss, sleep on the side, and avoidance of alcohol,
tobacco, and sleeping agents can reduce the severity of snoring and sleep apnea.
Nasal CPAP:
(Continuous Positive Airway Pressure)
Devices can be set up for home use to treat Obstructive Sleep Apnea.
Dental appliances:
Custom-made oral devices, help by keeping the upper airway open in sleep
by moving the lower jaw forward and elevating the tongue upwards and preventing
it from falling back. These devices are usually effective in people who snore
without Obstructive Sleep Apnea or who have mild Obstructive Sleep Apnea.
An experienced dentist fits dental appliances.
Surgery:
Surgery is performed to remove excess tissues in the back of the throat
to widen the airway. As surgical interventions include different procedures,
a full oral and nasal airway evaluation includes an assessment by an experienced
ENT (Ear, Nose & Throat doctor).
In Central Sleep Apnea, sometimes medication may be used to stimulate breathing.
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