The sleep apnea syndrome is a fairly common disorder in which the patient’s breathing is interrupted one or more times or excessively slows down during sleep.
The pauses can last from a few seconds to a few minutes. They can even be more than 30 in an hour. Usually breathing resumes normally, in some cases with a snoring sound.
Sleep apnea is usually a chronic (continuous) disease that disturbs sleep and when breathing stops or slows down often the patient switches from deep sleep to a lighter sleep.
The quality of sleep, therefore, is very poor, which is why you feel tir ed during the day. Sleep apnea is one of the most frequent causes of excessive daytime sleepiness.
It is a disorder that in many cases is not diagnosed because often it is not possible to frame it through a single medical examination and there are no blood tests useful to diagnose it.
Most patients who suffer from sleep apnea do not know they are sick, because the disorder only occurs during sleep. Generally, the family members or partner are the first to notice the symptoms.
The most common type is obstructive apnea , in which the airways collapse or become obstructed during sleep, slowing down or interrupting breathing: when trying to breathe the air that goes through the obstruction can cause a loud snoring. Obstructive sleep apnea is more prevalent among overweight patients, but it can affect anyone; for example, children with enlarged tonsils may suffer from obstructive apnea.
The central apnea in sleep is instead a type of sleep apnea less common: the area of the brain that controls breathing does not send the correct signals to the muscles involved in breathing, therefore, for a very short time, the organism “forgets” of to breathe.
Central sleep apnea can affect anyone, but it is more common among patients who suffer from certain conditions or who use certain medications.
Central sleep apnea can affect the patient together with obstructive apnea, or it can occur on its own. Normally central sleep apnea does not cause snoring.
During the vigil the muscles of the neck support the airways keeping them open, so the air can get into the lungs without problems. During sleep these muscles relax and the airways shrink.
In normal conditions, the narrowing does not prevent the air from entering and leaving the lungs, however, if you suffer from sleep apnea, the airways can remain obstructed, in whole or in part, for these reasons:
- the neck and tongue muscles relax more than normal;
- the tongue and tonsils (the masses of tissue in the back of the mouth) are too large compared to the width of the airways;
- the patient is overweight, so excess fat can make the walls of the trachea thicken (channel where air passes);
- the shape of the head and neck (bone structure) can cause a narrowing of the airways in the mouth and neck;
- the aging process limits the ability of nerve impulses to keep the neck muscles rigid during sleep; the respiratory tract therefore runs a greater risk of shrinking or collapsing.
If the airways are blocked in whole or in part during sleep, the lungs will not receive a sufficient amount of air, so there may be a strong snoring and a sudden drop in the level of oxygen in the blood .
If the oxygen levels get too low, the brain starts to disturb sleep, because it sends nerve impulses to try to tighten the muscles of the upper airway and keep the trachea open. So breathing returns to normal, often causing the patient to snore significantly.
Frequent lowering of blood oxygen levels and poor sleep quality may result in the release of stress hormones that increase heart rate and the risk of hypertension, heart attack, stroke and arrhythmias (abnormal heartbeat). Furthermore, these hormones increase the risk of heart failure, or they can aggravate it if it is pre-existing. If sleep apnea is not treated, it can cause changes in the metabolism and increase the risk of obesity and diabetes.
- Obstructive sleep apnea is a common condition and about half of the patients who suffer from it are overweight.
- Men are more at risk than women.
- Obstructive sleep apnea can affect any age, but the risk increases proportionally over the years.
- Furthermore, the risk increases if there are precedents in the family.
- If the airways of the nose, throat or mouth are small, the risk of suffering from sleep apnea is higher. The airways may be small due to anatomic causes, due to allergies or other conditions that cause congestion.
- Young children can have enlarged tonsils and therefore run a greater risk of suffering from sleep apnea. Even overweight children are at risk.
- About half of patients with sleep apnea also suffer from hypertension.
- Sleep apnea is also related to smoking, metabolic syndromeand diabetes, and is a risk factor for stroke and heart failure.
- Race and ethnic group could influence risk factors for sleep apnea, but further research is needed.
One of the most frequent symptoms of obstructive sleep apnea is snoring, strong and chronic (continuous). It can be interrupted by pauses: after the breaks, the patient can gasp or gasp.
Snoring is usually stronger when you sleep supine and can be less noisy when you turn to one side. The patient can snore only a few nights every now and then; with the passage of time, however, it begins to snore louder and more frequently.
When you snore or gasp, you do not wake up. In all probability you do not realize that you have breathing problems and you are not able to estimate the severity of the disturbance. Often the family or partner is the first to notice that something is wrong.
Snoring does not necessarily mean suffering from sleep apnea.
Another frequent symptom of sleep apnea is daytime sleepiness, at work or when driving. In many cases you find yourself falling asleep quickly in the quiet moments of the day when you are not active. Even if you do not suffer from daytime sleepiness, it is advisable to talk to your doctor if you suspect you have breathing problems during sleep.
Other signs and symptoms
Other signs and symptoms of sleep apnea include:
- headache in the morning,
- memory and learning problems, inability to concentrate.,
- irritability, depression , mood swings or personality changes,
- wake up often and get up to urinate,
- dry mouth or sore throat when you wake up.
In children, sleep apnea can cause hyperactivity, school problems, anger or hostile behavior. Babies suffering from sleep apnea can breathe through their mouths instead of their noses during daylight hours.
Sleep apnea, if not treated, can increase the risk of:
- hypertension , heart attack, stroke , obesity and diabetes ,
- heart failure ,
- arrhythmias or abnormalities of the heartbeat,
- accidents at work or driving vehicles.
Sleep apnea is a chronic disease that must be managed and treated over the long term. In most patients it can be cured by changing the lifestyle, using surgery and breathing aids.
Doctors diagnose sleep apnea based on the patient’s medical history and family history of family apnea, the results of the visit and sleep study. In some cases, the first to notice the symptoms is the family doctor, who can then decide if it is advisable to consult a specialist for a diagnosis.
Sleep medicine specialists are doctors who diagnose and treat people with sleep disorders: among them are pneumologists, neurologists and otolaryngologists but also other categories of doctors.
Personal and family history
If you think you suffer from a respiratory sleep disorder, you can keep a sleep diary for one, two weeks and take it with you on your first visit.
Take note of the times you go to sleep, where you wake up and take naps. Write down how much you can sleep at night, how much you feel alert and rested in the morning and how much you feel the drowsiness at different times of the day. This information will help the doctor to understand if you suffer from a sleep disorder.
During the visit, the doctor will ask you several questions about the quality of sleep and how you feel during the vigil.
Your doctor will also want to know if you are snoring, how often you snore and at what volume you snore or if, during sleep, you produce sobs or choking noises. Often the patient is not aware of these symptoms and should ask a family member or partner if they really are present.
Remember to tell your doctor if any of your family has been diagnosed with sleep apnea, or have suffered symptoms of this disorder.
If you believe your child is suffering from sleep apnea, inform the pediatrician of the signs and symptoms you have observed.
The doctor will check the mouth, nose and throat to rule out any swelling or swelling of the tissues. In fact, children suffering from sleep apnea may have enlarged tonsils. Only a medical examination and a history to diagnose sleep apnea in children may be sufficient.
Adults who suffer from sleep apnea may have enlarged uvula or soft palate. The uvula is the tissue that protrudes in the posterior central part of the mouth. The soft palate is the upper part of the mouth, which goes back towards the throat.
Sleep studies are tests that measure the quality of sleep and the body’s response to sleep problems. These tests can help the doctor find out if you suffer from a sleep disorder and the severity of this disorder. Sleep exams are the most reliable tests for the diagnosis of sleep apnea.
There are different types of sleep exams. If your doctor thinks you suffer from sleep apnea, he may recommend polysomnography or a portable home study monitor.
The polysomnography is the kind of examination of the most widely used to diagnose sleep apnea in sleep records brain activity, eye movements, heart rate and blood pressure.
Polysomnography also records the amount of oxygen present in the blood, the movement of the air in the nose while breathing, the snoring and the movements of the chest. Chest movements indicate if the patient is making an effort to breathe.
The test is usually performed in a hospital or in a specialized clinic, is completely painless and the patient can fall asleep normally, but several sensors are attached to the scalp, face, chest, limbs and a finger. Nurses and doctors use sensors to monitor the patient throughout the night.
At the end of the examination, the specialist checks the results to see if the patient suffers from sleep apnea and the severity of the disorder. The results of the exam are used to program the therapy.
The doctor can also use polysomnography to adapt the therapy to the continuous positive pressure ventilator (CPAP). Continuous positive pressure ventilation is the most common sleep apnea therapy, which creates a slight air pressure to keep the airway open while the patient is asleep.
If the polysomnography indicates that the patient suffers from sleep apnea, he will be exposed to the continuous positive pressure ventilator during the second half of the night. Nurses will modify the airflow of the equipment to find the most suitable settings for the patient.
Your doctor can recommend a home sleep test with a portable monitor. The portable monitor will record some of the information that can also be obtained from the polysomnography, for example:
- the amount of oxygen in the blood,
- the movement of the air in the nose during breathing,
- the heartbeat,
- chest movements indicating that an effort is being made to breathe.
The specialist can use the results of the home sleep test to diagnose sleep apnea and also to decide if it is necessary to perform the polysomnography in a specialized center.
Care and therapy
Sleep apnea can be cured by changing the lifestyle, using orthodontic appliances, breathing devices and surgery. Medicines are usually not used.
Those who suffer from moderate or severe apnea may need a ventilator or surgery.
Sleep apnea therapy aims to:
- restore normal breathing during sleep,
- relieve symptoms such as loud snoring and daytime sleepiness.
Therapy can improve other health problems related to sleep apnea, such as hypertension. It can also decrease the risk of heart disease, stroke and diabetes.
If despite the therapy the patient continues to feel daytime sleepiness, the doctor can ask if he sleeps sufficiently. Adults should sleep at least 7-8 hours per night, while children and adolescents need more hours (in- depth study ).
If the therapy and the optimal duration of sleep do not relieve the daytime sleepiness, the doctor will consider other possible therapies.
If you suffer from mild sleep apnea, probably all you need to do to treat yourself will be to slightly change your daily habits or activities.
- Avoid alcohol and drugs that cause drowsiness, because they cause difficulty in keeping the throat open during sleep.
- If you are overweight or obese, try to lose weight. Lose weight even just a little can alleviate the symptoms a lot.
- Sleep lying on one side instead of lying on it to have less difficulty keeping the airways open. You can use special pillows or pajamas that prevent you from sleeping on your back.
- At night, if necessary, keep your nose open using nasal sprays or anti-allergy medications (but not vasoconstrictors!). Ask your doctor if these therapies can help you.
- Stop smoking . Ask your doctor to show you programs and products useful for quitting.
Wearing the dental appliance can be useful for some of the patients suffering from mild sleep apnea. The doctor can also advise you to put the appliance if you snore a lot but do not suffer from sleep apnea.
The dentist or orthodontist can make a customized plastic device to treat sleep apnea. The orthodontist is specialized in correcting the problems of the teeth and jaws. The appliance will hold the jaw and tongue in place and will help keep the airway open during sleep.
If you use the appliance and find it is uncomfortable or it hurts you, tell your doctor. In all likelihood you will have to make periodic visits to adjust it so that you are well.
Continuous positive pressure fan
Continuous positive pressure ventilation is the most frequent therapy for moderate to severe sleep apnea in adult patients. The continuous positive pressure ventilator (CPAP) uses a mask that covers the nose and mouth, or just the nose.
The ventilator gently blows the air into the patient’s throat. Air pressure helps keep the airways open while you sleep.
If sleep apnea is treated, the patient will probably stop snoring; however, if not snoring, it does not automatically mean that sleep apnea has ceased or that it can stop using the ventilator Sleep apnea, in fact, can recur if you do not use the continuous positive pressure ventilator or if you do not use it correctly.
As a rule, the continuous positive pressure fan is delivered to the home by a technician who installs and calibrates it according to the medical prescription. After installation, it is however necessary to have it calibrated from time to time for optimal results.
Continuous positive pressure ventilation can cause side effects in some patients; among them we remember:
- nasal dryness or runny nose,
- irritation of the skin of the face,
- dry mouth,
If the ventilator is not calibrated correctly, you may suffer from stomach swelling and an upset stomach when wearing the mask.
If you have problems with the ventilator, ask the specialist, nurses and technician for advice: together you can take steps to reduce side effects. For example, it may be necessary to change the fan settings or the mask size. To alleviate the nasal dryness or no longer having a runny nose, it can be helpful to humidify the air that passes through the mask or use a nasal spray.
There are different types of fans and masks. If what you are using does not satisfy you, ask your doctor for advice that may suggest you change the type, by switching to a more comfortable one.
People suffering from severe sleep apnea symptoms usually feel much better once continuous positive pressure ventilation has begun
Some patients suffering from sleep apnea may benefit from surgery. The type of intervention and its effectiveness depend on the cause of the apnea.
Surgery is performed to widen the airways, normally the excess tissues are removed, stiffened or restricted in the mouth or throat, or the jaw is reared.
Surgery to stiffen or atrophy excess tissue is done in the clinic or in the hospital. Small injections or other local therapies may be required to make the tissue contract slightly. To make it more restrictive, however, repeated therapy may be useful. To stiffen the tissue, the doctor practices a small incision inside and inserts a rigid plastic plate.
To remove excess tissue, surgery should be performed in the hospital under anesthesia . After surgery, you may continue to have a sore throat for one, two weeks.
L ‘ surgical removal of the tonsils can be useful in some children, if they are the tonsils to block breathing. The pediatrician may suggest waiting to see if the tissues are spontaneously atrophied during the baby’s growth.
Cohabit with sleep apnea
Sleep apnea can be very serious, but it is possible to improve the quality of life at least a little by following an effective therapy.
Therapy can be useful for improving sleep quality and alleviating daytime sleepiness. It can also decrease the risk of hypertension, heart disease and other health problems related to sleep apnea.
The therapy can improve the general state of health, the well-being of the patient, the quality of the patient’s sleep and also that of the family members.
To be sure that the therapy is effective, you must visit the doctor regularly. If the therapy causes troublesome side effects, you must keep it informed.
Continuous surveillance is important if you are being treated with continuous positive pressure ventilation. It may take some time to adapt to this therapy.
If the ventilator is inconvenient or if it does not seem effective, please inform your doctor. You will probably need to switch to a different fan or mask; alternatively, a therapy may be needed to alleviate the side effects.
Try not to get fat. If you get fat, sleep apnea may get worse and you may need to change the ventilator. If you lose weight, however, you may be able to relieve the symptoms of sleep apnea.
As long as sleep apnea is not treated, you must be aware of the risk from driving or using dangerous machinery.
If you need to undergo an operation under anesthesia, tell the surgeon and the doctors who suffer from sleep apnea. Special measures may be necessary to keep the airway open during the operation.
If you use the device to treat sleep apnea, you will need to go to the dentist regularly
In many cases, those suffering from sleep apnea do not know it. He is not aware that breathing stops and resumes many times during sleep. Usually the family or partner is the first to discover the symptoms of sleep apnea.
Family members can do a lot to help those suffering from sleep apnea.
- Let the patient know that he is intensely snoring or that, during sleep, the breathing stops and then resumes.
- Advise the patient to seek medical advice.
- Help the patient to follow the therapy, including the one with the continuous positive pressure ventilator.
- Offer adequate emotional support.