Obstructive sleep apnea: This is the most common type. Obstructive sleep apnea happens when person's upper airways become blocked partially or fully many times during sleep and it usually happens when muscles in person's head and neck relax and block the flow of air into the lungs during sleep. Airway can be narrowed by many factors such as obesity, large tonsils or changes in hormone levels. During these episodes, person may start to breathe with loud gasps or body jerk.
Central sleep apnea: Under ordinary circumstances, person's brain manages breathing all the time. Central sleepa apnea happens when person's brain fails to tell muscles to breathe. This condition is related to the function of central nervous system. Central sleep apnea happens most often in people with neuromuscular disease such as amyotrophic lateral sclerosis (Lou Gehrig’s disease), people who’ve had a stroke or heart failure or people who’ve heart, kidney or lung related issues.
Complex sleep apnea: Complex sleep apnea happens when person has both obstructive sleep apnea and central sleep apnea. This condition is also known as treatment-emergent central sleep apnea.
Person's bed partner may alert to some of the symptoms of sleep apnea. While person may notice some of the symptoms by self. The most common symptoms of obstructive and central sleep apneas include:
• Frequent loud snoring
• Breathing that starts and stops during sleep
• Gasping for air during sleep
• Awakening with a dry mouth
• Headaches
• Fatigue or sleepiness during the day
• Sexual dysfunction
• Frequent need to go pee at night
• Depression or anxiety
• Night sweats
• Insomnia
Both obustrutive and central sleep apnea have specific causes. The most common causes and factors regarding this condition are listed below:
Causes for obstructive sleep apnea: Obstructive sleep apnea is more common form of sleep apnea and happens when the muscles in the back of the throat relax during sleep and reducing space for air to pass through. When the airway narrows, a person starts to snor. When the airway is obstructed, a person fails to get enough oxygen. The lack of oxygen causes partial or complete awakenings in order to restore airflow. These breathing disruptions happen repeatedly during sleep. This makes it hard to get the deep and restful sleep.
• Family history: People are more likely to experience this condition when they have family members with obstructive sleep apnea.
• Age: Obstructive sleep apnea can occur at any age but aging people are more likely to experience this condition mostly after the age of 60 as fatty tissue can be build up in the neck and the tongue and raise the risk of sleep apnea.
• Sex: Men are 2 to 3 times more likely to have obstructive sleep apnea than are women.
• Obesity: People with excessive weight or obesity are more likely to experience this condition as fat deposits around the upper airway can obstruct the breathing.
• Head and neck anatomy: People who have specific anatomical features such as a thicker neck or a large tonsils or a larger tongue or a shorter lower jaw or a rounded head are more likely to experience this condition as upper airway is narrowed because of above mentioned anatomical features.
• Family history: People are more likely to experience this condition when they have family members with obstructive sleep apnea.
• Medical condition: People with congestive heart failure or kidney failure or high blood pressure or type 2 diabetes or asthma are more likely to experience this condition.
• Lifestyle habits: People who drink alcohol or smoke regularlry are more likely to experience this condition as alcohol can relax the muscles of the mouth and throat where smoking can cause inflammation in the upper airway which affects breathing.
Causes for central sleep apnea: Central sleep apnea is less common form of sleep apnea and happens when a person's brain fails to send signals to breathing muscles. This means that breathing-related muscles stopped working. The shortness of breath causes awakening in order to restore breathing function. This makes it hard to get the deep and restful sleep.
Some of the possible risk factors for central sleep apnea are:
• Family history: People are more likely to experience this condition when they have family members with central sleep apnea.
• Age: Central sleep apnea can occur at any age but aging people are more likely to experience this condition mostly after the age of 60-65 as fatty tissue can be build up in the neck and the tongue and raise the risk of sleep apnea.
• Sex: Men are 2 to 3 times more likely to have central sleep apnea than are women.
• Opioid use: People with opioid use disorder or long-term use of prescribed opioid-based medications are more likely to experience this condition.
• Medical condition: People with congestive heart failure or brain stroke or amyotrophic lateral sclerosis (ALS) or myasthenia gravis or hormone imbalance are more likely to experience this condition.
• Lifestyle habits: People who drink alcohol or smoke regularlry are more likely to experience this condition as alcohol can relax the muscles of the mouth and throat where smoking can cause inflammation in the upper airway which affects breathing.
Mostly a healthcare provider or a sleep specialist can diagnose the condition of sleep apnea using various clinical processes. They are as below:
Medical condition: A healthcare provider or a sleep specialist can diagnose this condition based on symptoms, time duration of symptoms, possible triggers, a sleep history which can be got from person's bed partner or other family members, medical history, family history etc.
• Lab tests: Blood test and urine test may be performed to rule out other medical conditions and help a doctor to diagnose properly. These tests do not confirm condition of sleep apnea.
• Polysomnography: This is an overnight sleep test where person sleeps in a medical facility known as a “sleep lab” to monitor person's heart rate, breathing, awakenings, blood oxygen levels, brain waves, lung activities while sleeping. This test is considered as the gold standard for diagnosing obstructive or central sleep apnea.
• Home sleep tests: Person needs to complete a sleep study from home which is given by a health care provider to diagnose central sleep apnea. It’s similar to an overnight sleep study, but doesn't involve brain wave monitoring. Usually polysomnography is recommended rather than a home sleep test if central sleep apnea is suspected.
There are multiple ways to manage symptoms and to treat sleep apnea. Treatments may include medications, lifestyle management, devices, therapies, surgeries etc depending on the type and severity of sleepa apnea. These treatments can include:
Continuous positive airway pressure (CPAP) for obstructive sleep apena and central sleep apnea: Positive airway pressure (PAP) therapy is a treatment offered to almost all people with obstructive sleep apnea. This treatment can also be used for central and mixed sleep apneas. PAP therapy keeps the airway open with pressurized air that is pumped from a machine through a hose and a mask worn on the face.
The most common and reliable PAP device is the Continuous Positive Airway Pressure (CPAP) machine. However, there are other types of PAP machines too. These devices increase the air pressure inside of person's airway and lungs when person inhales to keep surrounding tissue from pressing the airway shut. Some people feel uncomfortable while using this devide during sleep, so person might need to try more than one type of mask to find one that's comfortable. But with practice, most people learn to adjust the tension of the straps on the mask to make it comfortable during sleep. There are other types of PAP devices available such as auto-CPAP which automatically adjusts the pressure while sleeping, bilevel positive airway pressure (BPAP) which provides more pressure during inhale and less during exhale.
Oral devices for obstructive sleep apena: Oral devices are another treatment option for people with certain anatomical features and less severe obstructive sleepa apnea (OSA). Various types of mouthpieces are available to wear while sleeping. These devices can help hold the jaw and tongue in a specific position that keeps pressure off the windpipe. CPAP is more reliably effective than oral devices but oral devices might be easier and comfortable to use. These oral devices often do not improve breathing as much as PAP therapy but they can reduce snoring issue.
Surgical treatments for obstructive sleep apena: Healthcare providers recommend surgical treatment based on the severity of symptoms, medical condition and failure of other treatment options. Surgical treatment options are as below:
Tissue removal (Uvulopalatopharyngoplasty): In this procedure, a surgeon removes uvula (the teardrop-shaped soft tissue that hangs at the back of the mouth) and soft tissue from the soft palate and pharynx at the rear of the mouth and top of the throat. These widen the area where the mouth and throat meet and thus making it easier for air to pass through.
Jaw repositioning (maxillomandibular advancement): In this procedure, the jaw is moved forward from the remainder of the face bones. This enlarges the space behind the tongue and soft palate. This procedure is helpful for people who have sleep apnea for structural reasons like micrognathia.
Supplemental oxygen for central sleep apena: Oxygen is supplied to lungs using devices while sleeping to get undistubed sleep. Various forms of oxygen are available with devices to deliver oxygen to the lungs.
Lifestyle management: Follow these lifestyle related changes to make everyday life better and to improve symptoms at some levels.
• Take prescribed medications: Take prescribed medications regularly without any miss. This will be very helpful to manage symptoms. Talk to healthcare providers in case of any side effects due to medicines or prescribed medications that are not as effective as they should be.
• Follow-up appointments: It is recommended to visit healthcare providers for regular follow-up appointments to evaluate the symptoms and medical conditions.
• Maintain weight: It's highly recommended to reduce obesity or body mass index (BMI) to reduce sympoms and especially snoring.
• Sleeping position: Avoid back sleeping by altering sleeping positions or habits.
• Drinking and smoking: Reduce alcohol consumption and smoking gradually to reduce symptoms at some level.