Normally, the airway remains open and intact to allow easy and normal breathing during sleep.

Obstructive Sleep Apnea is a condition, wherein the airway at the back of throat becomes narrow during sleep because the muscles supporting the throat relax and collapse. This makes the airway narrow causing difficulty in breathing.

Symptoms

The narrow airway causes labored breathing and decreases airflow, in turn decreasing the oxygen levels in the blood and increases the carbon dioxide levels in blood. The brain reacts to this and makes the person wake up for a brief moment from sleep or brings the sleep cycle to wakefulness or light sleep to adjust the breathing back to normal.

Most common symptoms are

  • Loud snoring.
  • Cessation of breathing in episodes, lasting for a couple of seconds.
  • Sudden awakening from sleep many times associated with choking, gasping.
  • Dry and sore throat after waking up in the morning.
  • Morning headache.
  • Drowsiness, sleepiness with short naps while watching TV, working, etc. many times in the day.
  • Difficulty in focus and concentration in the day time, mood swings and irritability due to improper sleep at night.
  • Night sweats and decreased libido.

Most commonly, the person with whom one may sleep may notice these changes in breathing pattern and snoring first because one may not be aware of this during sleep and may say that they slept very well at night.

Causes

  • Overweight/obesity- The fat tissue around neck, throat may narrow the airway. But all individuals with obstructive sleep apnea may not be overweight/obese.
  • Enlarged tonsils, adenoids.
  • Asthma.
  • Family history of obstructive sleep apnea.
  • Hypertension.
  • Diabetes.
  • Smoking.
  • Alcohol consumption, especially within a few hours before going to sleep can make snoring and sleep apnea worse.
  • Sleeping pills.
  • Men experience obstructive sleep apnea more commonly than women.
  • Individuals more than 40 years of age may be at high risk comparatively, though it may occur at any age.
  • Hereditary factors with natural narrow airway.
  • Conditions such as deviated nasal septum, large tongue since birth, development of nasal polyps.

Diagnosis and tests

Consulting the doctor may be important if the symptoms are severe or if they disturb the daily routine life.

The doctor may take a history of symptoms, previous or current medical conditions to know if there is an underlying cause such as nasal polyps, overweight, smoking, asthma, etc., that may be responsible for the episodes to decide on treatment options.

A physical examination to check weight, blood pressure, examination of nose and throat, tests such as blood sugar levels, X-ray, etc. may be done and you may be referred to a sleep specialist, if needed.

A Test called Polysomnography may be recommended by a specialist- This is a sleep study, wherein equipment is hooked to the body overnight to study the reactions and function of heart, brain, lung, breathing movements, blood oxygen levels, blood pressure, arm and leg movements, eye movements, snoring intensity during sleep. This can be done at home or at the sleep centre.

Treatment

Treatment is primarily focused on the correction of underlying cause.

A few lifestyle changes may generally help, such as

  • Weight loss with healthy diet and regular exercises, if one is overweight/obese.
  • Not sleeping on back but preferring to sleep to the side may help in avoiding airway block.
  • Cessation of smoking or avoiding alcohol intake at least a few hours before going to sleep.
  • Taking prescribed medications for hypertension (high blood pressure) and Diabetes to make sure blood pressure and blood glucose levels are maintained normal, respectively.
  • Taking medications to relieve congestion causing cold, cough, phlegm/mucus in throat, etc.

If none of the above help or improve sleep, the following may be considered depending on the underlying cause

  • Surgery to remove adenoids, enlarged tonsils, nasal polyps, correction of deviated nasal septum, etc.
  • Positive airway pressure (continuous or auto titrating or bivalved). This machine may keep the airway open and intact without collapse by exerting pressure into the respiratory tract through a mask, fitted to the nose.
  • Oral device (mandibular advancement device) helps in preventing the tongue from falling back and blocking the airway or advances the lower jaw a little forward for an intact airway.

       – Dr. Divya Teja Pasupuleti

References:

https://www.mayoclinic.org/diseases-conditions/obstructive-sleep-apnea/symptoms-causes/syc-20352090

https://www.webmd.com/sleep-disorders/guide/understanding-obstructive-sleep-apnea-syndrome#1

https://www.healthline.com/health/sleep/obstructive-sleep-apnea#types

https://www.aafp.org/afp/2016/0901/p355.html

https://www.nhs.uk/conditions/obstructive-sleep-apnoea/

https://www.sleepapnea.com/diagnosis/about-sleep-apnea/

 

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