Sleep apnea is a serious sleeping disorder in which there are pauses in your breathing in your sleep. In other words, it is a common sleep disorder in which your breathing is interrupted. You might even stop breathing about a 100 times during your sleep due to sleep apnea. Although this condition is usually transient (lasts only for a short while), leaving it untreated can result in other serious health conditions.

There are mainly 2 types of sleep apnea:

  • Obstructive sleep apnea (OSA): occurs when the muscles supporting the soft tissues in your throat and nose, temporarily relax while you're sleeping.

  • Central sleep apnea (CSA): a condition in which your brain fails to signal the muscles to breathe, leading to interrupted breathing.

  • Mixed sleep apnea: When a person has both OSA and CSA at the same time, it is known as mixed sleep apnea or complex sleep apnea.

Causes and Risk Factors 

  • Obesity: Being overweight leads to fat deposition in your neck area, blocking the upper airways during your sleep

  • Enlarged tonsils: Having enlarged tonsils results in frequent infections that can block your airways and interrupt your breathing during sleep

  • Family history

  • Allergies: Allergies such as hay fever or the common cold cause nasal congestion, resulting in blocking of the airways 

  • Age over 40 years 

  • Sinusitis: Infection in the sinus/sinuses can block your airways due to nasal inflammation and cause sleep apnea 

  • Small jaw bone: This may interfere with your breathing and cause sleep apnea 

  • Fat around your neck area 

  • Gender: Being a male increase the risk of sleep apnea

Symptoms of Sleep Apnea

  • Snoring

  • Uneasiness during your sleep 

  • Frequent and sudden awakenings in your sleep due to gasping or choking

  • Daytime sleepiness or fatigue

  • Dry mouth or sore throat upon awakening

  • Trouble focusing or concentrating, forgetfulness or irritability

  • Depression or anxiety

  • Frequent urination at night

  • Sexual problems or loss of interest in sexual activities

  • Headaches

Smoking, alcohol, sleeping pills, sedatives — promote sleep apnea as they relax your throat muscles which may lead to a collapse of the airway at night.

Diagnosis of Sleep Apnea  

Home sleep tests are simplified tests used to diagnose sleep apnea. These tests usually measure your heart rate, blood oxygen level, airflow, and breathing patterns.

If the results of home sleep tests look abnormal, your doctor might recommend a therapy without further testing. Portable monitoring devices don't detect all cases of sleep apnea, however, your doctor might still suggest polysomnography and a few other tests, depending on your symptoms, like: 

1. Nocturnal polysomnography (or sleep study) is a test in which equipment is attached to you that monitors your heart, lung, and brain activity, breathing patterns, movements in the arm and legs, and blood oxygen levels while you sleep.

2. EEG (electroencephalogram) to measure and record brain wave activity.

3. EMG (electromyogram) to record your muscle activity during sleep, such as face twitches, teeth grinding, and leg movements.

4. EOG (electrooculogram) to record eye movements during the different stages of your sleep. 

5. ECG (electrocardiogram) to record heart rate and rhythm.

6. Snore microphone to record snoring activity.

Treatment of Sleep Apnea

1. Oropharyngeal exercises have been proven to be very hopeful for people with sleep apnea. These are muscle exercises derived from speech–language pathology (a branch of medical science that studies the causes and effects of diseases or injuries) and include your soft palate, tongue, and facial muscles. Some common and easy oropharyngeal exercises to perform are:

a) Open your mouth as wide as possible, move your tongue down past your teeth as far as you can (as if you’re trying to lick your chin) which will lift the uvula (the flesh that hangs in the back of your throat that helps you swallow and speak). Do for about 3-5 seconds at a time and repeat for about 5 times.

b) Singing is a great way to strengthen the muscles in your soft palate and upper throat, so sing a song every day. 

c) Push the tip of the tongue against the roof of your mouth and slide the tongue backward. Repeat around 10 times.

d) Stretch for your soft palate. Open your mouth as wide as you can while saying “ah” in the back of the throat. Continue for about 10 seconds. Close your mouth, wait 2-3 seconds, then repeat about 10 times.

e) Soft palate blowing is another effective exercise. Close your mouth and inhale gently through your nose, then press your lips together and exhale by blowing the air out from your mouth. Try to blow out air for 5 seconds and repeat 10 times, about 5 times daily.

f) With your tongue in the resting position and your mouth closed, arch your tongue against your mouth's roof and slide the tip of your tongue back as far as it will go along the mouth's roof. Keeping your tongue in this position, slowly open your mouth until your tongue can no longer rest on the mouth's roof. Repeat for around 3 minutes, three times daily.

2. Pranayama (breathing exercises) for controlling sleep apnea. Common breathing practices include bhastrika (bellows breath), kapalbhati (skull shining breath), ujjayi (victorious breath or ocean breathing), and anulom vilom (alternate nostril breathing). Talk to your doctor to know more about each of these techniques and how to perform them.

3. Weight loss can have a huge effect on sleep apnea symptoms. Losing weight can help reduce fat deposition in your neck area which is one of the leading causes of sleep apnea. 

4. CPAP (continuous positive airway pressure) therapy or BiPAP (bi-level positive airway pressure).  A CPAP/BiPAP machine uses a mask or nosepiece to deliver constant and steady positive air pressure to your throat, to ensure that your airway stays open during sleep. This therapy is very effective for treating the spontaneous pauses in breath associated with sleep apnea. 

Consult your ENT specialist to understand more about CPAP/BiPAP therapy.

5. Lifestyle modifications can reduce the chances of sleep apnea. A few points to remember are: 

  • Sleep on your side or abdomen instead of your back. When your body is positioned on its side during sleep, your airways are more stable and less likely to block or restrict air.

  • Avoid fatty diet, excess alcohol, sleeping pills, and sedatives. Fatty foods are hard to digest and can make it difficult for you to fall asleep. Similarly, alcohol can keep you up during the night and cause disturbed sleep. Sleeping pills tend to relax your airway tissue, so they're even more likely to block the airway and cause sleep apnea.

  • Regular exercise like 30 minutes of brisk walking at least 6 days/week is recommended if you have sleep apnea. Exercising aids weight loss, helps you sleep better, and allows for maximum utilization of oxygen even while you are at rest. 

6. Surgery is done to either stimulate a hypoglossal nerve, reposition your jaw, remove enlarged tonsils, or tissue removal (uvulopalatopharyngoplasty).

Complications of Sleep Apnea

  • Type 2 diabetes. When you do not get enough sleep, your body can become insulin resistant. Insulin is a hormone that controls your blood sugar levels. When you are insulin resistant, your body’s cells don’t respond to insulin, thus increasing blood sugar (glucose) levels in your body, which can lead to type 2 diabetes.

  • Liver diseases

  • Stroke. Sleep apnea can result in low oxygen levels in your body. Low oxygen makes it hard for your brain to control how blood flows in your brain and throughout the body, resulting in a stroke., 

  • Hypertension or high blood pressure. Sleep apnea can worsen the symptoms of hypertension if you already have it. When you wake up often during the night, your body gets stressed. As a result, your hormones are overactivated, which increases your blood pressure levels. 

Sleep apnea can lead to serious health problems in the long-run. Consult your ENT specialist for a diagnosis and timely treatment.

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