Obstructive Sleep Apnea
What is Obstructive Sleep Apnea (OSA)?
Normally when we sleep, air moves in and out at a regular rhythm through our nose, throat, and lungs. In a person with sleep apnea, air movement is episodically reduced or stopped. There are two types of sleep apnea, obstructive sleep apnea and central sleep apnea. In obstructive sleep apnea, breathing becomes abnormal because of narrowing or blockage of the throat. In central sleep apnea, breathing is abnormal because of a change in the breathing control, but the upper airway remains open. Sleep apnea is a serious medical condition that can affect sleep quality, alertness while awake, the ability to safely drive a motor vehicle, and also impact long-term health.
What Causes OSA?
During sleep, the muscles around your throat and upper airway are less active, which can cause the throat to narrow. In most people, this upper airway narrowing does not affect breathing; however, in others it can lead to snoring. For individuals with OSA, it causes a reduction or complete blockage of airflow, resulting in low oxygen levels. Normally when a person sleeps, the airway remains open, and air can pass from the nose and mouth to the lungs. In a person with OSA, parts of the throat and mouth drop into the airway and block off airflow. This can cause loud snoring and interrupt breathing for short periods.
What are the Signs/Symptoms and Risk Factors?
Common signs/symptoms of OSA include snoring, fatigue during the day, restless sleep, awakening with choking or gasping, morning headaches, dry mouth or sore throat, frequent nighttime urination, low energy, difficulty concentrating, memory impairment, depressive or irritable mood swings, and high blood pressure. Risk factors of OSA include the following:
Increased Age as OSA more commonly occurs in middle and older age adults
Gender as OSA is twice as common in males as females
Obesity as weight increases the risk of developing OSA
Neck Circumference as OSA is more commonly found in males whose neck circumference exceeds 17 inches and in females whose neck circumference exceeds 16 inches
During Sedation from certain medications or alcohol as these reduce breathing, prevent awakening during sleep, and can lengthen periods of no breathing
How do we Diagnose and Treat OSA?
The diagnosis of OSA is best made by a knowledgeable sleep medicine physician who has an understanding of an individual’s health issues. This diagnosis will usually be based upon a person’s medical history, physical examination, and testing. Testing includes:
An overnight (in-lab) sleep study called a polysomnogram (PSG) that measures breathing effort and airflow, blood oxygen level, heart rate and rhythm, duration of the various stages of sleep, body position, and movement of the arms/legs.
- Home Sleep Apnea Tests (HSAT) are also available and monitor breathing, oxygen saturation, position, and heart rate. This type of testing is an alternative if the patient does not have any other illnesses or sleep disorders that may interfere with the interpretation of the results.
The goal of treatment is to maintain an open airway during sleep and includes the following:
- Positive Airway Pressure (PAP) therapy — The most effective, predictable, and commonly used treatment for sleep apnea uses positive air pressure from a mechanical device to keep the upper airway open during sleep.
- Behavior and Lifestyle Changes — Most people with OSA can benefit from certain behavioral changes, such as avoiding sleeping in the supine position (on one’s back) if possible, undertaking healthy weight loss, and avoiding alcohol and other sedatives that slow down the drive to breathe.
While behavioral changes and PAP therapy are typically recommended as initial therapy for people with OSA, other treatments may be used in some situations and can be discussed with our providers after your initial evaluations.
What happens if I don't get treated for Sleep Apnea?
Obstructive Sleep Apnea and Central Sleep Apnea are serious concerns that typically require treatment for patients to achieve restful sleep, which is paramount to overall wellbeing and daily functions. If left untreated, the following effects can persist: reduced alertness; reduced concentration; increased risk or decreased control of cardiovascular conditions, such as high blood pressure, heart attack, abnormal heart rhythms, or stroke; excessive daytime sleepiness; and approximately double the risk for motor vehicle crashes, accidents, and errors.