Sleep apnea is a condition in which your breathing stops periodically during sleep, as many as 20-30 times per hour. Each time you stop breathing in your sleep, the resulting lack of oxygen alerts your brain, which temporarily wakes you up to restart proper breathing. Since the time spent awake is so brief, most people with sleep apnea don't remember it, and many believe they are getting a good night's sleep when, in fact, they are not. The constant wake-sleep, wake-sleep cycle prevents those with sleep apnea from achieving deep sleep, resulting in a constant drowsy feeling during the day.
Types of Sleep Apnea
There are three main types of sleep apnea:
- Obstructive Sleep Apnea (OSA): This is the most common type of sleep apnea. It occurs when the muscles in the throat relax excessively during sleep, causing the airway to collapse or become blocked. This obstruction leads to pauses in breathing (apneas) or shallow breathing (hypopneas). When the brain detects the lack of oxygen, it briefly wakes the person up to reopen the airway, often resulting in a gasping or choking sensation. These awakenings can fragment sleep and lead to daytime sleepiness and other symptoms.
- Central Sleep Apnea (CSA): CSA is less common and occurs when the brain fails to send proper signals to the muscles that control breathing. Unlike OSA, there is no physical obstruction in the airway. Instead, the respiratory control centers in the brain do not function properly, leading to pauses in breathing during sleep. CSA can be associated with certain medical conditions such as heart failure, stroke, or brainstem lesions. Cheyne-Stokes breathing, a specific pattern of breathing characterized by cyclic fluctuations in breathing effort and depth, is often seen in CSA.
- Mixed Sleep Apnea: Also known as complex sleep apnea, this type involves a combination of both obstructive and central sleep apnea. It typically starts as obstructive sleep apnea but can develop central features with the use of continuous positive airway pressure (CPAP) therapy, which is the standard treatment for OSA. Mixed sleep apnea is relatively rare compared to OSA and CSA.
Each type of sleep apnea requires different approaches to diagnosis and treatment. It's important for individuals experiencing symptoms of sleep apnea to undergo a thorough evaluation by a healthcare professional, often involving a sleep study (polysomnography), to determine the type and severity of the condition. Treatment options may include lifestyle changes, CPAP therapy, oral appliances, surgery, or other interventions depending on the specific diagnosis and individual circumstances.
Symptoms
Sleep apnea can present with various symptoms, which can vary depending on the type and severity of the condition.
Obstructive Sleep Apnea (OSA)
- Loud and chronic snoring: Often accompanied by snorting, gasping, or choking sounds as breathing resumes.
- Pauses in breathing during sleep: Witnessed by a bed partner.
- Episodes of waking up abruptly: Sometimes accompanied by a sensation of choking or gasping for air.
- Daytime sleepiness: Feeling excessively tired during the day, even after a full night's sleep.
- Morning headaches: Waking up with a headache, which may be due to the decrease in oxygen levels during apnea episodes.
- Dry mouth or sore throat: As a result of breathing through the mouth during sleep.
- Difficulty concentrating: Impaired cognitive function and difficulty focusing due to fragmented sleep.
- Irritability or mood changes: Irritability, mood swings, or feelings of depression may occur due to poor sleep quality.
- Frequent urination at night: Nocturia or waking up multiple times during the night to urinate, can be a symptom of sleep apnea.
Central Sleep Apnea (CSA)
- Pauses in breathing during sleep: Similar to OSA, but in CSA, these pauses occur because the brain fails to send proper signals to the muscles that control breathing.
- Difficulty staying asleep: Frequent awakenings during the night.
- Difficulty initiating sleep: Difficulty falling asleep at the beginning of the night.
- Cheyne-Stokes breathing: A pattern of breathing characterized by gradually increasing and then decreasing breathing rates, followed by a period of apnea.
It's important to note that not everyone with sleep apnea will experience all of these symptoms. Additionally, some individuals may not be aware of their symptoms, especially if they occur during sleep and are not witnessed by a bed partner. If you suspect you or someone you know may have sleep apnea, it's essential to consult a healthcare professional for proper evaluation and diagnosis.
Causes and Risks
Sleep apnea can have various causes, and it poses several risks to one's health. Here are some of the causes and risks associated with sleep apnea:
Causes
- Obesity: Excess weight, particularly around the neck, can obstruct the airway, leading to sleep apnea.
- Anatomical factors: Certain physical characteristics such as a narrow airway, enlarged tonsils or adenoids, a large tongue, or a small jaw can contribute to obstructive sleep apnea (OSA).
- Age: Sleep apnea is more common in older adults.
- Gender: Men are more likely to have sleep apnea than women, although the risk for women increases if they are overweight, and it also tends to rise after menopause.
- Family history: If you have family members with sleep apnea, you may be at increased risk.
- Alcohol and sedatives: These substances relax the muscles in the throat, which can worsen obstructive sleep apnea.
- Smoking: Smoking can increase inflammation and fluid retention in the airway, exacerbating sleep apnea symptoms.
- Nasal congestion: If you have difficulty breathing through your nose due to allergies, sinus problems, or a deviated septum, you are more likely to develop sleep apnea.
Risks
- Daytime fatigue: Fragmented sleep due to sleep apnea can lead to excessive daytime sleepiness, which can impair your ability to concentrate, make decisions, and perform daily tasks.
- Cardiovascular problems: Sleep apnea is associated with an increased risk of high blood pressure, heart disease, heart attack, stroke, and irregular heart rhythms.
- Type 2 diabetes: Sleep apnea is more common in people with type 2 diabetes, and it can worsen insulin resistance.
- Liver problems: Nonalcoholic fatty liver disease is more common in people with sleep apnea.
- Complications with medications and surgery: Sleep apnea can increase the risk of complications during and after surgery, as well as with certain medications that depress the respiratory system.
- Mental health issues: Sleep apnea has been linked to depression, anxiety, and cognitive impairment.
- Decreased quality of life: Sleep apnea can affect your relationships, work performance, and overall quality of life due to chronic fatigue and daytime sleepiness.
It's important to recognize the signs and symptoms of sleep apnea and seek medical evaluation and treatment if necessary, as untreated sleep apnea can have serious consequences for your health and well-being.
Treatment for Sleep Apnea at East Texas Oral & Maxillofacial Surgery
Treatments for sleep apnea depend on the severity of each individual case, and the type of apnea. Basic treatment can be behavioral — for instance, patients are instructed to lose weight, stop smoking, or sleep on their sides instead of on their backs. Beyond that, oral devices can be used to position the mouth in such a way that prevents throat blockage. In more severe cases, surgery may be the best option.
East Texas Oral & Maxillofacial Surgery can play a significant role in the treatment of sleep apnea, particularly in cases where anatomical factors contribute to airway obstruction.
- Oral Appliance Therapy (OAT): Oral appliances are custom-made devices that are worn during sleep to reposition the jaw and tongue, thereby preventing airway obstruction in patients with mild to moderate obstructive sleep apnea (OSA). Drs. Luke Mack, Andy Mack, and Nathan Yang can assess patients for suitability for OAT, fabricate custom appliances, and provide follow-up care to monitor treatment efficacy and adjust the device as needed.
- Maxillomandibular Advancement (MMA) Surgery: MMA surgery is a surgical procedure performed to advance the upper and lower jaws forward, thereby enlarging the airway and reducing the likelihood of airway collapse during sleep. As board-certified oral surgeons, Drs. Andy Mack, Luke Mack, and Nathan Yang are trained to perform MMA surgery and can assess patients for candidacy and perform the procedure.
- Combination Therapy: In some cases, a combination of treatment modalities may be necessary to effectively manage sleep apnea. This may include a combination of oral appliance therapy, surgical intervention, and/or other treatments such as continuous positive airway pressure (CPAP) therapy or weight loss interventions. Our oral surgeons can work collaboratively with sleep medicine specialists and other healthcare providers to develop personalized treatment plans for patients with sleep apnea.
- Follow-up Care: Drs. Andy Mack, Luke Mack, and Nathan Yang can provide ongoing follow-up care to monitor treatment efficacy, address any complications or side effects, and make adjustments to treatment as needed. Regular follow-up appointments at our Longview or Mt. Pleasant oral surgery office are essential to ensure optimal outcomes and long-term management of sleep apnea.
Contact East Texas Oral & Maxillofacial Surgery, and we can refer you to a sleep apnea specialist. The specialist may recommend a sleep study to diagnose the precise extent of the problem and can prescribe appropriate treatment.