Sleep Apnoea Clinic

Sleep apnea is a condition that makes breathing while asleep difficult. Sleep apnea occurs when a person stop breathing while asleep. This occurs either because of blockage of airway or when the brain can’t control your breathing adequately.

A survival reflex is activated by the resulting lack of oxygen to wake you just enough so that you resume breathing. Even though this reflex ensures that you keep breathing, it also interrupts a healthy sleep cycle. As a result, restful sleep is prevented and some other effects are also seen that can put additional stress on the heart and have serious consequences.

Sleep apnea can affect anyone - whether its infants, children, or older adults. Obstructive sleep apnea is, however, more commonly seen in some groups of people and in certain circumstances.

Age: Obstructive sleep apnea is more common in males before the age of 50. After the age of 50, it affects males and females at the same rate. People are more susceptible to develop obstructive sleep apnea as they age.

Obesity: Having excess weight greatly increases your risk of developing obstructive sleep apnea.

Race: Obstructive sleep apnea is more common in Hispanic, black, or Asian people. Following are the groups of people in whom sleep apnea is more common:

• Adults over the age of 60 years.
• Those taking opioid pain medications.
• People with cardiac conditions like congestive heart failure and atrial fibrillation.
• Some people with obstructive sleep apnea using CPAP can develop treatment-emergent central sleep apnea.
• Central apneas can occur in people who live at high altitudes.

Although sleep apnea is rare, it is a widespread condition. Worldwide it affects about 5-10% of people.

There are many symptoms of sleep apnea. Some are easier to detect than others. Following are some of the symptoms:

• Feeling exhausted when waking up. People with sleep apnea feel extremely tired even after having a full night’s sleep.
• Daytime sleepiness: Sleep apnea can cause drowsiness during working, driving, or other activities.
• Snoring: Snoring is a common problem that people with sleep apnea face. Some people have sleep apnea even without snoring.
• Mood changes: Anxiety and depression are the common symptoms of sleep apnea.
• Disturbance in brain function: These include trouble concentrating, memory loss, and other brain-related issues.
• Waking up again and again in the middle of the night: People usually don’t remember waking up, so this symptom is hard to notice. People doing this often remember waking up for other reasons such as the need to go to the bathroom or heartburn.
• Pauses in breathing when asleep as noticed by others: A partner, spouse, or other loved one may witness this while the person is asleep.
• Abnormal breathing patterns: A certain breathing pattern called Cheyne-Stokes breathing occurs in people with central sleep apnea. It is characterised by fast breathing that tends to get shallower and deeper until the breathing stops altogether. They will start breathing again after stopping for several seconds and the pattern goes on again and again.
• Feeling restless during night and night sweats.
• Insomnia.
• Headaches, especially when waking up.
• Sexual dysfunction.

There are certain causes responsible for sleep apnea and it is suspected that it runs in families. There are three main types of sleep apnea overall which differ in why and how they happen. Those include:

• Central sleep apnea (CSA)
• Obstructive sleep apnea (OSA)
• Complex/ mixed sleep apnea.

Central sleep apnea (CSA)

This form of sleep apnea occurs due to some problem in the brain. Normally, your brain controls your breathing at all times, even when you are asleep. Central sleep apnea is characterised by inability of the brain to send signals to keep the breathing-related muscles functioning. There are many different reasons that can be responsible for central sleep apnea such as:

• Hypoxia secondary to high altitude.
• Heart failure.
• Treatment of obstructive sleep apnea with CPAP initially.
• Damage to the nervous system, especially in parts of your spinal cord or in your brainstem.
• Conditions of the nervous system such as amyotrophic lateral sclerosis or Lou Gehrig’s disease.

Obstructive sleep apnea (OSA)

This is the commonest form of sleep apnea which occurs when the neck and head muscles relax while sleeping, causing the surrounding tissues to press on the windpipe. This decreases the ability of the air to pass via it.

Complex/ mixed sleep apnea

This type of sleep apnea is characterised by a combination of central and obstructive events.

For diagnosing sleep apnea, your doctor will ask you a few questions regarding your medical history and symptoms. If they suspect that you have sleep apnea on the basis of your answers and symptoms, they will suggest that you undergo testing for sleep apnea.

Following are some of the commonest tests performed to diagnose sleep apnea:

• Polysomnography
  This overnight test is conducted in a medical facility that ensures that you are as comfortable as possible during the whole procedure. Sensors that monitor your breathing, heart rate, brain waves, and blood oxygen levels are used.
• Home sleep apnea testing
  During this test, the person is allowed to undergo sleep apnea test at home. It is quite similar to an overnight sleep test but there is no monitoring of brain waves here. This test is not an option for diagnosing severe sleep apnea or when you have other medical conditions or sleep disorders. If sleep apnea is not diagnosed with a home study, experts recommend an overnight sleep study for confirming it.

Depending on the type and severity of sleep apnea, many different treatment options are available. Even though none of these offer a complete cure, they can reduce the incidence, severity, and frequency of apneic events. If you have sleep apnea, many treatments must be a part of your everyday routine. That can decrease or eliminate the effects of sleep apnea on your life. Following are the possible treatments:

• Adaptive ventilation and positive airway pressure devices
• Conservative treatments.
• Nerve stimulators.
• Oral appliances.
• Medications
• Surgery

Conservative treatments

Conservative treatment approaches are nonmedical treatment modalities that can improve or resolve obstructive sleep apnea. Although they don’t provide a complete cure, they control the symptoms to a point where those are not severe enough to cause serious discomfort. Those include:

• Weight loss
  The symptoms of sleep apnea can be significantly improved by decreasing body weight by 10% in those who have obesity.
• Sleeping aid items and posture changes while sleeping
  Sleep apnea worsens if you sleep on your back. Support items like special support pillows can help maintain a favourable posture while you sleep and prevent soft tissue from pressing on your windpipe and blocking breathing.
• Adhesive strips and nasal sprays
  These products can be found over-the-counter and they improve breathing by allowing the air to easily travel through the nose. While they can’t help with advanced sleep apnea, they can keep mild sleep apnea and its symptoms under control.
• Treatment of underlying condition
  Treating underlying conditions like heart failure can result in an improvement in central sleep apnea.
• Changes of medication
  Sleep apnea can be improved or resolved if you work with your healthcare provider to reduce or stop the intake of opioid pain medications.
• Adaptive ventilation and positive airway pressure (PAP)
  During positive airway pressure technique, a specialised device is used to enhance air pressure inside the windpipe while you inhale. This method can be used to treat central, obstructive, and mixed sleep apnea. When pressurised air is pushed down your windpipe, it stays open so that you can breathe. Air is pushed by these devices down your windpipe so that you can breathe. The air is pushed through a hose that is attached to a mask that you wear while you sleep. These masks come in many different types and styles and they can cover your mouth, nose, or both.
  
  The Continuous Positive Airway Pressure (CPAP) machine is the best-known PAP device but there are many other machines available for this purpose. Due to these devices, the pressure of the air inside your lungs and airways is increased while inhaling which prevents the surrounding tissues from pressing on your airways.

Oral devices

When the soft tissues in the neck or the head pressure down on the windpipe, obstructive sleep apnea occurs. Special oral devices are available that can help your tongue and jaw in a position that decreases the pressure on your windpipe. Sleep medicine specialists and dentists often collaborate together to design these for those who need them.

Nerve stimulators

All the tongue movements are controlled by the hypoglossal nerve. If a stimulator is attached to this nerve, it will get stimulated and help push the tongue slightly forward while the person is asleep. This prevents the pressing of the tongue on the windpipe while you are asleep, which is one of the ways in which sleep apnea occurs.

The nerve under the jaw is attached to an electrode which then connects to a device placed under the skin in your chest. Before you sleep, the stimulator has to be turned on and it has to be turned off after you wake up. The strong electrical current prevents your tongue from relaxing too much.

Central sleep apnea can also be controlled with this type of nerve stimulation. It affects the phrenic nerves, the nerves that connect the diaphragm to the spinal cord. Stimulation of the phrenic nerve causes flexing of those muscles, facilitating breathing.

Surgery

Surgeries of the mouth, nose, and throat can prevent obstructions in your throat, nose, and windpipe. However, their impact on adults is usually limited and differs from one person to another.

Sleep apnea can be prevented, especially when it occurs as a result of obesity or excessive weight. However, some people who are underweight or have a healthy body weight also develop sleep apnea. For such people, the cause of sleep apnea is usually a structural tissue and, therefore, it can’t be prevented. Following are some steps that you can take to decrease your risk of developing sleep apnea:

• Practise good sleep hygiene.
• Achieve and maintain a healthy weight.
• Undergo a health checkup at least once a year.
• Manage any existing health problems like high blood pressure, high cholesterol, or type 2 diabetes.

Sleep apnea is a relatively common condition that interferes with the breathing of a person while he’s asleep. This makes him wake up during the night and disrupts a healthy sleep cycle. It also prevents him from feeling rested. Over time, serious or deadly complications can arise as a result of sleep apnea, therefore, early diagnosis and treatment of the condition is important.

There are many treatment options available to control this condition, of which the most common and effective ones are positive airway pressure devices— meant to be used every night. These treatment approaches will show the best outcome when you stick to them and follow the advice of your doctor. If you are suffering from sleep apnea and reside in Indore, you can visit the Sleep Apnea Clinic at Kokilaben Dhirubhai Ambani Hospital, Indore. Our experts will formulate the most suitable treatment plan for you that will help keep your symptoms under control and allow you to have a normal and fulfilled life.