Respiratory Home Care Specialists

Sleep apnea is a common disorder characterized by reduction or cessation of breathing during sleep.  Breathing pauses can last from a few seconds to minutes. They often occur 5 to 30 times or more an hour. Typically, normal breathing then starts again, sometimes with a loud snort or choking sound.  Sleep apnea can be a serious sleep disorder. People who have sleep apnea stop breathing for 10 to 30 seconds at a time while they are sleeping. These short stops in breathing can happen up to 400 times every night. If you have sleep apnea, the periods of not breathing may make you wake up from deep sleep. If you are waking up all night long, you aren't getting enough rest from your sleep.

There are 2 kinds of sleep apnea: obstructive apnea and central apnea. Obstructive sleep apnea is the most common type.  If you have obstructive apnea, something is blocking the passage or windpipe (called the trachea) that brings air into your body. When you try to breathe, you can't get enough air because of the blockage. Your windpipe might be blocked by your tongue, tonsils or uvula (the little piece of flesh that hangs down in the back of your throat). It might also be blocked by a large amount of fatty tissue in the throat or even by relaxed throat muscles.

Central sleep apnea is related to the function of the central nervous system. If you have this type of apnea, the muscles you use to breathe don't get the "go-ahead" signal from your brain. Either the brain doesn't send the signal.

Overall, these individuals experience low oxygen levels throughout the night.  This is very damaging to the heart and blood vessels.

Is it common?

About 20 million people have sleep apnea and approximately 90% remain undiagnosed/ untreated.

• Loud, disruptive snoring 
  
• Gasping, choking, snorting during sleep 
  
• Pauses in breathing during sleep
  

• Unrefreshing sleep                                 
  
• Frequent awakening during the night
  
• Abnormal daytime sleepiness or fatigue
  
• Morning headaches
  
• Limited attention
  
• Memory loss
  
• Loss of sexual interest
  

Because some of the symptoms of sleep apnea occur while you're sleeping, the person you sleep with may notice it first. You, or that person, may notice heavy snoring or long pauses in your breathing during sleep. Even if you don't remember waking up during the night, you may notice daytime sleepiness (such as falling asleep at work, while driving or when talking), irritability or fatigue. You may also experience morning headaches, forgetfulness, mood changes and a decreased interest in sex.

Your doctor can diagnose sleep apnea. He or she may ask you if you feel tired or sleepy during the day. Your doctor may also want to know about your bedtime habits and how well you sleep. Your doctor may ask you to go to a sleep center for a sleep study.  Doctors diagnose sleep apnea based on your medical and family histories, a physical exam, and results from a sleep study. Usually, your primary care doctor evaluates your symptoms first. He or she then decides whether you need to see a sleep specialist.

Your doctor will ask you and your family questions about how you sleep and how you function during the day. To help your doctor, consider keeping a sleep diary for 1 to 2 weeks. Write down how much you sleep each night, as well as how sleepy you feel at various times during the day.

Your doctor also will want to know how loudly and often you snore or make gasping or choking sounds during sleep. Often you're not aware of such symptoms and must ask a family member or bed partner to report them.

Let your doctor know if anyone in your family has been diagnosed with sleep apnea or has had symptoms of the disorder.

Your doctor will check your mouth, nose, and throat for extra or large tissues.  Adults with the condition may have an enlarged uvula or soft palate. The uvula is the tissue that hangs from the middle of the back of your mouth. The soft palate is the roof of your mouth in the back of your throat.

A sleep study is the most accurate test for diagnosing sleep apnea. It captures what happens with your breathing while you sleep.  A sleep study is often done in a sleep center or sleep lab, which may be part of a hospital. You may stay overnight in the sleep center.

A polysomnogram  is the most common study for diagnosing sleep apnea. This test records:

• Brain activity
• Eye movement and other muscle activity
• Breathing and heart rate
• How much air moves in and out of your lungs while you're sleeping
• The amount of oxygen in your blood

A PSG is painless. You will go to sleep as usual, except you will have sensors on your scalp, face, chest, limbs, and finger. The staff at the sleep center will use the sensors to check on you throughout the night.

A sleep specialist reviews the results of your PSG to see whether you have sleep apnea and how severe it is. He or she will use the results to plan your treatment.

Continuous positive airway pressure (CPAP) is the most common treatment for moderate to severe sleep apnea in adults. A CPAP machine uses a mask that fits over your mouth and nose, or just over your nose. The machine gently blows air into your throat. The air presses on the wall of your airway. The air pressure is adjusted so that it's just enough to stop the airways from becoming narrowed or blocked during sleep.

A respiratory therapist will come to your home to bring the CPAP equipment. They will set up the CPAP machine and adjust it based on your doctor's orders. After the initial setup, you may need to have the CPAP adjusted on occasion for the best results.

CPAP treatment may cause side effects in some people.  If you're having trouble with CPAP side effects, work with your home care company. Together, you can take steps to reduce these side effects. These steps include adjusting the CPAP settings or the size/fit of the mask.  There are many different kinds of CPAP machines and masks.

People who have severe sleep apnea symptoms generally feel much better once they begin treatment with CPAP.

What can you do if you think you might have sleep apnea?