Causes, Diagnosis, and Treatment of Sleep Apnea

Although there are several types of sleep apnea, obstructive sleep apnea is the most common. Obstructive sleep apnea (OSA) causes the affected person to stop and start breathing repeatedly while they sleep. With some people, this can happen hundreds of times during the night. Although the disorder can affect anyone, older and overweight men are the most affected. Untreated, sleep apnea can lead to health problems such as heart trouble and high blood pressure.

Obstructive sleep apnea causes loud snoring and may lead to daytime tiredness, even though the person had a full night’s sleep. Snoring, however, doesn’t necessarily indicate that someone has a potentially serious problem. Also, not everyone who snores heavily has OSA.

In people with obstructive sleep apnea, certain clinical features and physical traits are common. These include a large neck and excessive weight. Others are structural abnormalities that reduce the diameter of the upper airway such as enlarged tonsils, nasal obstruction, low-hanging soft palate, or small jaw with an overbite.

If someone has obstructive sleep apnea, the doctor might refer them to an ear, nose, and throat (ENT) specialist to rule out blockage in the throat or nose. It might also be necessary to have a cardiologist (heart doctor) or neurologist (nervous system specialist) carry out an evaluation and rule out central sleep apnea or its causes.

In central sleep apnea, it’s not the airway that is blocked but the brain that fails to signal the muscles to breathe. It happens because of instability in the patient’s respiratory control center and is basically a central nervous system problem.

Obstructive sleep apnea (OSA), on the other hand, is due to the repetitive collapse of the upper airway as the person sleeps. Untreated, it has many potential adverse clinical consequences including metabolic dysfunction, excessive daytime sleepiness, impaired daytime function, and a higher risk of cardiovascular disease and death.

When breathing, the heart rate tends to drop if it’s deprived of oxygen for a long period. Then, involuntary reflexes startle the person awake, causing the oxygen to start flowing again. When that happens, the heart rate may accelerate quickly and cause the blood pressure to rise. The body may start to experience severe adverse effects if the OSA episodes are frequent.

Based on the symptoms and signs, the doctor may make a physical evaluation and evaluate the sleep history. If possible, someone who shares the bed or the same household may help with information about the patient’s sleeping habits.

Depending on the evaluation outcome, the patient may be referred to a sleep disorder specialist or clinic to determine whether further evaluation is required. At a sleep disorder clinic, the evaluation often entails overnight monitoring of the breathing and other body functions as one sleeps.

Although surgery may be necessary in severe cases, OSA can usually be managed through nonsurgical measures. Behavioral changes like avoiding alcohol four to six hours before bedtime, losing weight, and sleeping on one’s side rather than the back or stomach (positional therapy) are recommended for OSA management.

For moderate to severe sleep OSA cases, treatment with continuous positive airway pressure (CPAP) can be beneficial. CPAP uses a machine that delivers air pressure through the nasal system through a mask as one sleeps. CPAP keeps upper airway passages open and also prevents snoring.