What is Sleep Apnea?

By Vidya Pai, MD

National Sleep Medicine Director at Low T Center

Sleep apnea is a condition that causes you to stop breathing for short periods of time while you sleep. This disrupts your rest and deprives your organs of oxygen for seconds or even minutes during the night. An estimated 22 million Americans have sleep apnea, and between 80-90% of sleep apnea sufferers don’t realize they have the condition or that they could benefit from sleep apnea treatment. Untreated sleep apnea can cause many undesirable symptoms and negatively affect your overall health.

Many people with sleep apnea wake up startled or gasping for breath in the middle of the night or hear complaints from their families that they snore. Additionally, sleep apnea patients may feel tired during the day or experience morning headaches. If you are dealing with these symptoms, a sleep clinic can help you with diagnosis and treatment.

Sleep apnea risk factors

There are several factors that increase your risk for sleep apnea. Family history of snoring or sleep apnea, a small lower jaw, large neck circumference, large tonsils, gender, age, and weight can all be risk factors of sleep apnea. Other conditions can also influence sleep apnea, like hypothyroidism (low levels of thyroid hormone), acromegaly (high levels of growth hormone), heart disease, kidney disease and lung disease. Lifestyle choices like heavy alcohol consumption, smoking, and opioid use can also increase your risk for developing sleep apnea.

Though this condition can affect both men and women, men are two to three times more likely to have sleep apnea. Additionally, sleep apnea is about 18% more prevalent in men once they reach 61 years of age or older. A neck circumference over 16 inches in men can also increase the likelihood of obstructive sleep apnea, as excess adipose, or fat, tissue can exacerbate narrowing in the airway during sleep.

The 3 types of sleep apnea:

Obstructive Sleep Apnea – The most common type of sleep apnea is obstructive sleep apnea. Obstructive sleep apnea occurs when your upper airway narrows or closes during sleep. This causes you to momentarily stop breathing. Some common causes of obstructive sleep apnea are obesity, large neck circumference, and narrow upper airways.

Central Sleep Apnea – Central sleep apnea occurs when your brain doesn’t send proper signals to the muscles that control respiration, which temporarily pauses your breathing. Some common causes for central sleep apnea are opioid use and disorders that affect the brain stem’s ability to function.

Complex Sleep Apnea or Mixed sleep apnea – Complex or mixed sleep apnea is when you experience both obstructive and central sleep apnea.

Determining sleep apnea severity

Sleep apnea is rated in severity from mild to severe. At the time of diagnosis, your physician will also likely tell you how severe your condition is. The way sleep doctors measure sleep apnea severity is called the apnea-hypopnea index (AHI), which measures the average number of apnea and hypopnea events per hour. Apnea refers to a complete cessation in breathing, while hypopnea refers to periods of shallow breathing or periods where you are partially stopping to breathe. For an event to count in your AHI, it must last for a minimum of 10 seconds.

The sleep apnea severity ratings are:

• No Apnea: Less than 5 events per hour
• Mild Sleep Apnea: 5-15 events per hour
• Moderate Sleep Apnea: 15-30 events per hour
• Severe Sleep Apnea: More than 30 events per hour.

Is sleep apnea hereditary?

A family history of snoring or sleep apnea can increase your risk for sleep apnea. Many of the influencing factors can also be hereditary. For example, you can be born with naturally narrow airways or excessive tissue in the neck area. Patients may also have a genetic predisposition to obesity, which increases their risk of developing sleep apnea at some point in their lives.

Is sleep apnea dangerous?

It can be. Patients with sleep apnea experience sleep fragmentation, as apnea disrupts rest to help you start breathing again. Sleep apnea sufferers often experience daytime fatigue and difficulty concentrating. This can cause negative effects for their mental, physical, and emotional health and can also impact their ability to perform daily tasks. For example, patients with sleep apnea are more prone to poor work performance due to poor sleep quality. Sleep apnea sufferers are also more likely to be involved in work accidents and car crashes.

In addition, sleep apnea is linked to other serious complications. Due to sudden drops in oxygen levels during the night, sleep apnea sufferers have an increased chance of developing hypertension, also known as high blood pressure. Intermittent hypoxia, or oxygen deprivation, can increase your risk of recurrent heart attacks, strokes, and irregular heartbeats. Sleep apnea sufferers may be more likely to develop insulin resistance and type 2 diabetes.

Sleep apnea can also increase the risk for depression and erectile dysfunction. Sleep deprivation and poor sleep quality can often lead to depressive episodes and aggravate erectile dysfunction, as it diminishes the oxygen to the brain and disrupts healthy sleep patterns. Therefore, sleep apnea can affect your life in both the short-term and the long-term and lead to other serious health concerns. However, CPAP therapy can help alleviate symptoms and reduce the risks associated with sleep apnea.

Symptoms of sleep apnea

The main symptoms of sleep apnea are loud snoring, daytime fatigue, and difficulty concentrating. Some other symptoms include restless sleep, morning headaches, dry mouth, sore throat, nocturia (waking up at night to urinate frequently), sexual dysfunction, impotency, and daytime exhaustion. However, some people with sleep apnea don’t experience any symptoms, or aren’t aware they have them. Oftentimes, sleep apnea sufferers may not realize it’s abnormal to be tired during the day or experience the above symptoms. Additionally, those who seek help are often misdiagnosed with depression, as both conditions can cause similar symptoms.

Sleep Apnea Testing

If you suspect you have sleep apnea, your physician will conduct a comprehensive health assessment and may recommend a sleep test for diagnosis. In the past, patients would have to visit a sleep lab for sleep apnea testing. Unfortunately, many people have to wait months for an appointment at a sleep lab, and these sleep studies are often very expensive. Additionally, many patients have difficulty re-creating a normal night for them in an unfamiliar environment and with technicians monitoring their sleep.

Instead, your physician may recommend a home sleep test to diagnose sleep apnea. Home sleep tests monitor your heart rate, respiration, oxygen levels, and movements while you sleep. They are performed with equipment in the comfort of your own home, which allows your physician to get data about your normal sleep routines and patterns in your normal sleep environment. Home sleep tests are typically more convenient and cost-effective for patients and provide virtually the same results and information about sleep patterns as a sleep lab without all the inconvenience and cost.

Is sleep apnea curable?

Typically sleep apnea is a chronic condition, meaning you have it for life. Luckily, sleep apnea is easily treatable, and many patients experience positive health changes after starting a sleep apnea treatment plan. The reason that sleep apnea generally requires lifelong treatment is because it is most often caused by the anatomy of your upper airway. After adulthood, your anatomy typically doesn’t change significantly, which means that your sleep apnea likely won’t go away on its own. Therefore, sleep apnea treatment is the best way to manage your sleep for better health.

Some sleep apnea patients undergo a surgery to correct their airway anatomy as a way to “cure” sleep apnea. However, these surgeries are typically less effective at reducing symptoms and apnea events than CPAP therapy. Certain lifestyle changes can also help lessen the severity of sleep apnea, like weight management, allergy treatment, and targeted neck exercises. These changes are typically recommended in addition to CPAP therapy.

What happens after a sleep apnea diagnosis? 

An effective treatment that helps many sleep apnea sufferers is nightly use of a continuous positive airway pressure, or CPAP, device. This treatment increases the pressure in your throat by blowing air through a mask to prevent your airway from narrowing while you sleep.

Sleep apnea treatment often utilizes a CPAP device as part of your personalized treatment plan. For CPAP therapy to work effectively, sleep apnea sufferers should use this device every night, unless otherwise instructed by your doctor. Generally, CPAP users experience symptom relief and increased overall health and well-being. Most people acclimate to CPAP therapy in just a few weeks. Your doctor should also monitor your progress every few weeks to keep you updated on your results and adjustment your treatment plan as needed.

Most people with sleep apnea who use a CPAP device find themselves feeling more energetic and better able to concentrate during the day. In addition, their blood pressure, glucose levels, sexual function, mood, and overall health can dramatically improve after just a few weeks of CPAP therapy.

New CPAP Technology and Sleep Apnea Treatment

The idea of using a CPAP device at night can be frightening for some sleep apnea sufferers. Many people assume that all CPAP devices are the same, that they are large, unsightly, and uncomfortable to wear. Unfortunately, these misconceptions deter many patients from seeking proper sleep apnea diagnosis and treatment.

CPAP technology has progressed considerably over the years. Today, CPAP devices are often quite small and lightweight. This gives them a low profile and makes them easier to travel with, so you don’t have to stop treatment while away from home. Additionally, they have become pretty “smart.”

Today’s CPAP devices can automatically transmit your data to your physician regarding your sleep patterns and even allows them to make remote adjustments to air pressure and timing to optimize your sleep health.  This makes it easy for your physician to monitor and adjust your sleep apnea treatment plan. The information that your doctor receives is vital to fine-tuning your sleep apnea treatment and helping you manage your sleep. It’s critical that your physician can receive this data and adjust your machine and treatment plan to optimize your therapy and health.

CPAP devices collect data about hours used, hours spent sleeping, leak rate, and your AHI for the night. This is similar to the information recorded during your home sleep test and creates an easy way for your sleep team to track your results and adapt your CPAP therapy for better results. Sleep data is sent via WIFI connection, so there are no additional steps you need to take to transmit your information. You don’t even have to push a “send” button. If you are away from home or lose your WIFI signal, your device will store your information and transmit it once it re-establishes a connection.

In addition to these improvements, manufacturers have also worked hard to improve masks and offer a variety of options for sleep apnea sufferers. There are many different masks to choose from so that you get the best, most comfortable fit for you. There are three basic styles of masks: full face, nasal pillow, and nasal. Full face masks cover both the nose and mouth, nasal pillow masks are inserted into the nostrils, and nasal masks cover the nose. Each type can come in a variety of shapes and sizes, so patients can typically find a comfortable option for them that suits their face shape and preferences. It’s important to be able to try on masks before deciding which one feels the best and is appropriate for your sleep habits (side, stomach or back sleeper, restful or fitful sleeper, mouth or nose-breather).  The physicians at Low T Center want to help you find the mask that feels right for you. You can even lie down in a private room at our facility to test each one and select your favorite.

In addition to your CPAP device, your doctor may also recommend lifestyle changes. There are also a few lifestyle changes you can pair with CPAP therapy that may help your symptoms. Sleeping on your side or stomach instead of your back, maintaining a healthy weight, and decreasing your alcohol or sedative consumption can all help with sleep apnea treatment. Combining CPAP use and lifestyle changes can help you optimize your sleep management and improve your sleep apnea symptoms.

How do I know my CPAP treatment is working?

Some signs that you are doing well on your CPAP therapy include feeling more refreshed in the morning, having more energy, and improved blood pressure, sugar levels, and libido. Your physician will also monitor the sleep data sent by your CPAP device and update you on your results to help you assess how effective your treatment plan is.

At Low T Center, we want to make sure that you’re always taken care of and comfortable during your sleep therapy. Therefore, if you believe you have sleep apnea, make an online appointment to talk to one of our physicians about your symptoms and receive help.