Understanding Sleep Apnea
Sleep apnea – involuntary pauses in breathing during sleep – is a sleep disorder that affects millions of people worldwide. Untreated sleep apnea increases one's risk of stroke, high blood pressure, heart attacks, diabetes, and obesity. It also leads to poor quality of sleep and daytime fatigue and drowsiness. Anyone can be affected by sleep apnea and it is usually diagnosed by a sleep specialist through a sleep study. Treatment options include lifestyle changes, breathing devices, surgery, and alternative remedies.
Have people ever told you that you snore loudly at night? Or do you feel fatigued throughout the day even after getting enough sleep at night? Chances are, you may be suffering from sleep apnea. The word “apnea” literally means “without breath” in Greek and this sleep disorder can have significant short- and long-term consequences for your overall health.
What Is Sleep Apnea?
Sleep apnea is a fairly common sleeping disorder where people experience shallow breathing and/or an intermittent blockage of airflow during sleep. These blockages can last for a few seconds to a few minutes and can take place approximately 30 times per hour, which makes sleep apnea a potentially dangerous disorder.1
Sleep apnea has become a significant health concern in recent times, and the American Sleep Apnea Association estimates that 22 million people suffer from sleep apnea in the United States alone!2 And, since it is a disorder that occurs during sleep and does not usually rouse a person fully from sleep, an overwhelming percentage of sleep apnea cases go undiagnosed.
Why Is Sleep Apnea So Dangerous?
Sleep apnea is a chronic condition can take a serious toll on your health if not properly diagnosed and treated.
Disrupted Sleep And Tiredness
Imagine the consequences of frequent breaks in breathing during sleep. With each involuntary pause in breathing, your brain tries to wake you up briefly, in order for normal breathing to resume. While you may not wake up fully, this switch in sleep pattern can happen dozens (or even hundreds) of times throughout the night. The result is significantly disrupted sleep. Sleep-disordered breathing can happen in the midst of deep (REM) sleep as well. This compromises the quality of your sleep and so you wake up feeling tired and may be excessively sleepy throughout the day.3
Lower Oxygen Level And Spike In Stress
If that’s not bad enough, frequent interruptions in breathing caused by sleep apnea can lower your blood oxygen level, which subsequently triggers stress hormones.
Higher Risk Of Hypertension, Cardiac Problems, Diabetes, And Obesity
In turn, these stress hormones spike your heart rate and heighten your risk of stroke, high blood pressure, heart attacks, diabetes, and obesity. Sleep apnea can also make you likely to develop arrhythmia (irregular heartbeats) and prone to having accidents at work or while driving.4
Types Of Sleep Apnea
There are three primary types of sleep apnea5:
Obstructive Sleep Apnea (OSA)
This is the most common form of sleep apnea. It occurs when the tongue starts to rest against the soft palate, which then collapses against the back of the throat, causing an airway blockage. And when you attempt to breathe through the blockage, it causes loud snoring noises.
Central Sleep Apnea
In the case of central sleep apnea, your airway is not constricted, but your brain fails to properly signal the muscles that are responsible for regulating breathing. As a result, you may not make an effort to breathe for brief periods of time during your sleep.
Complex Sleep Apnea
This is a combination of obstructive and central sleep apnea.
Causes Of Sleep Apnea
The most common type of sleep apnea – obstructive sleep apnea – is characterized by your airway becoming fully or partially blocked during sleep. This can occur due to several factors:6
- Your tongue and throat muscles relax abnormally when you sleep.
- Your tonsils and tongue are excessively large, relative to the size of the opening of your windpipe.
- The shape of your neck and head may have caused a narrower than usual airway in your throat.
- You are overweight or obese and extra fatty tissue has thickened and narrowed your windpipe.
Central sleep apnea stems from the brain’s inability to send signals correctly to muscles that control your breathing. It is often associated with medical problems such as:
- Brain infections or problems with the brainstem
- Cardiac problems such as stroke
- Degeneration of the cervical spine
- Extreme obesity
Narcotic painkillers can also trigger central sleep apnea.
Sleep Apnea Risk Factors
Sleep apnea can affect anyone at any age, although it has been proven to be more common in some specific populations, including people who:
- Are male
- Are overweight or obese
- Are over 40 years of age
- Have a large neck
- Have a smaller jaw bone, large tonsils, and a large tongue
- Have a nasal obstruction due to a deviated septum, sinus issues, or allergies
- Have high blood pressure and diabetes
- Have a family history of sleep apnea7
Sleep Apnea Symptoms
Sleep apnea has very noticeable symptoms but since patients are asleep as they experience these symptoms, they may remain unaware for a long period of time. Usually, a family member is the first one to notice symptoms of sleep apnea. The National Institutes of Health identify the following symptoms of sleep apnea in men and women alike:
- Loud and chronic snoring, especially when sleeping on your back. People with central sleep apnea don’t, however, usually snore. Note: not everyone who snores has sleep apnea
- Gasping, choking, snorting noises during sleep
- Pauses in breathing during sleep
- Excessive daytime drowsiness even after getting plenty of sleep at night
- Waking up with a headache or dry mouth
- Inability to concentrate or focus
- Mouth breathing, hostile behavior, hyperactivity, poor academic performance in children8
Sleep Apnea Diagnosis
Sleep apnea cannot be diagnosed during your routine doctor’s visit or annual physical or through blood tests. The only definitive diagnostic test for sleep apnea is through a sleep study aka a polysomnogram.9
During a sleep study, you’ll sleep through the night in a sleep lab and technicians will monitor your sleeping pattern, brain-wave activity, eye movements, respiration rate, and blood oxygen levels with the help of sensors attached to your body. These sensors will also help track your apnea-hypopnea index, which is the number of apnea incidents you experience per hour. Sleep data collected throughout the night will then be reviewed by a sleep specialist who will diagnose if you have sleep apnea and its severity.10
Sleep Apnea Treatment And Management
Once a diagnosis of sleep apnea has been made by a sleep specialist, proper treatment is essential. Your sleep specialist will develop a treatment plan for you based on the results of your sleep study.
Managing Obstructive Sleep Apnea
The goal of treatment is to ensure that your airway is not constricted during sleep, thereby restoring normal nighttime breathing. Sleep apnea treatment can include lifestyle changes, breathing devices, surgery, and alternative/natural therapies. Treatment does not typically entail the use of medication. With the right treatment, you’ll be able to manage your condition better and even minimize occurrences. Options like weight loss and surgery have also helped completely cure the condition in some cases.
Making Changes To Your Lifestyle
Based on the results of your sleep study, your sleep specialist may recommend that you:
- Lose weight
- Quit smoking
- Cut down on or eliminate alcohol consumption
- Sleep on your side using specially designed pillows
- Stop using sleep medication/sedatives, which can make it more difficult for your throat to stay open when you’re asleep
- Use nasal sprays to keep nasal passages open
- Use a nighttime dental correction device
These changes to your daily habits can give you a restful night, especially if you have mild obstructive sleep apnea. Some people even find that sleeping on their side instead of their back can give them a restful night.
If you’re overweight and have obstructive sleep apnea, the American College of Physicians strongly recommends losing weight.11 The link between losing weight and improvement in the symptoms of obstructive sleep apnea is well established, with studies showing that losing weight reduces the collapsibility of the upper airway.12 Even losing around 10% of your weight can reduce the acuteness of your sleep apnea by over 50%.13 In some cases, losing a significant amount of weight can even cure sleep apnea completely.14
Exercising Your Throat
Research has also shown that exercises that strengthen the throat muscles may significantly reduce the symptoms of obstructive sleep apnea (by about 39%) and can even reduce the girth of your neck.15 Disciplines like yoga have specific practices that may be helpful. For instance, in the Ujjayi breathing technique, the passageway of the throat is narrowed to control the flow of air. In addition to cleaning the lungs and throat, this also strengthens the muscles of the throat.16
In fact, you may even be able to reduce the symptoms of sleep apnea by playing the didgeridoo, a wind instrument from Australia that can exercise the throat muscles.17 So if you’ve always wanted to learn to play an instrument, try the didgeridoo and also sleep better in the bargain!
Using A Mouthpiece
This is a custom-made device that fits around your teeth and adjusts your jaw and tongue so there is more space at the throat and your airway can be kept open at night when you sleep.Your doctor will help you arrive at a comfortable fit.
Using A Breathing Device
The most common treatment for sleep apnea is continuous positive airway pressure (CPAP). A CPAP machine consists of a mask worn over your nose and mouth to gently push air through your airways to keep it open, thereby also preventing you from snoring. The amount of air pressure can be adjusted by your doctor based on the severity of your apnea.18
A dry nose/mouth or irritation of the skin where the mask fits are common when you use a CPAP machine. But adjustments made to the mask or machine can help reduce these side effects.19 This treatment has been found to be quite effective, but if you stop using the machine regularly when you get better, the sleep apnea will return.20
Opting For Surgery
Surgical intervention is an option suggested to people with obstructive sleep apnea, especially if it has been caused by an unusual physical characteristic like large tonsils. A surgeon can perform a procedure that can widen your airways by removing or shrinking extra tissue from the throat or mouth or by resetting your lower jaw.21 22
Managing Central Sleep Apnea
CPAP has also been found to be helpful for people with central sleep apnea.23 Since central sleep apnea can sometimes occur when you take opioids or strong prescription drugs, stopping these drugs may also help alleviate the condition. Your doctor might also recommend oxygen supplements or other medications.24
Natural Remedies And Alternative Care For Sleep Apnea
Some alternative therapies are also known to help in the treatment of sleep apnea.
Research has shown that acupuncture can be effective in treating sleep apnea by manipulating meridian points in the body.25 Acupuncture has been shown to change sleep patterns, especially of REM sleep, and bring about a noteworthy reduction in obstructive sleep apnea symptoms. It is thought to act by increasing serotonin levels and by influencing the sympathetic nervous system.26
The ancient Indian medicinal practice of Ayurveda considers sleep apnea to be a result of imbalance in the kapha energy in your body. Foods that taste bitter, spicy foods, honey, and lentils are said to help regulate excess kapha. Avoid sweet and salty foods, soda, red meat, deep fried foods, and alcohol to regulate your kapha energy. Herbal formulations such as pippali, trikatu churna or sitopaladi can help regulate kapha when taken with honey and ghee on an empty stomach.27
If your sleep apnea is driven by obesity, yoga may be particularly helpful, along with a healthy diet. It has been found that even a brief but intense yoga program (five hours a day for six days) can bring about changes in your body mass index (BMI), reduce the level of your serum leptin, and lower hip and waist circumferences.28
There is also evidence that meditation can help deal with the effects of obstructive sleep apnea. In one study, meditation improved performance on a psychomotor vigilance task which measured attention and reaction. Those with sleep deprivation showed an improvement in performance after meditating. Interestingly, people who meditated long term seemed to able to get by with less sleep without showing any decrease in performance.29
Ayurvedic massages can help combat sleep apnea by normalizing the flow of energy throughout your body, improving blood circulation, and promoting deep relaxation and sleep.30 Abhyanga or oil massage is part of the panchakarma purification therapy recommended for sleep apnea treatment. An expert Ayurvedic practitioner can help set up a regimen and guide you through it.31
References [ + ]
|1, 3, 4.||↑||What Is Sleep Apnea? National Institutes of Health.|
|2, 5, 9.||↑||Sleep Apnea Information for Clinicians. American Sleep Apnea Association.|
|6.||↑||What Causes Sleep Apnea? National Institutes of Health.|
|7.||↑||Who Is at Risk for Sleep Apnea? National Institutes of Health.|
|8.||↑||Sleep Apnea. National Institute On Aging.|
|10.||↑||How Is Sleep Apnea Diagnosed? National Institutes of Health.|
|11.||↑||Qaseem, Amir, Jon-Erik C. Holty, Douglas K. Owens, Paul Dallas, Melissa Starkey, and Paul Shekelle. “Management of obstructive sleep apnea in adults: a clinical practice guideline from the American College of Physicians.” Annals of internal medicine 159, no. 7 (2013): 471-483.|
|12.||↑||Schwartz, Alan R., Avram R. Gold, Norman Schubert, Alexandra Stryzak, Robert A. Wise, Solbert Permutt, and Philip L. Smith. “Effect of weight loss on upper airway collapsibility in obstructive sleep apnea.” American Review of Respiratory Disease 144, no. 3_pt_1 (1991): 494-498.|
|13.||↑||Pi-Sunyer, F. Xavier, D. M. Becker, C. Bouchard, R. A. Carleton, G. A. Colditz, W. H. Dietz, J. P. Foreyt et al. “Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults.” American Journal of Clinical Nutrition 68, no. 4 (1998): 899-917.|
|14.||↑||Weight loss, breathing devices still best for treating obstructive sleep apnea. Harvard Publications.|
|15.||↑||Guimaraes, Katia C., Luciano F. Drager, Pedro R. Genta, Bianca F. Marcondes, and Geraldo Lorenzi-Filho. “Effects of oropharyngeal exercises on patients with moderate obstructive sleep apnea syndrome.” American journal of respiratory and critical care medicine 179, no. 10 (2009): 962-966.|
|16.||↑||Richard Miller.“The Breath Of Life.” The Yoga Journal, no. 116(1994).|
|17.||↑||Puhan, Milo A., Alex Suarez, Christian Lo Cascio, Alfred Zahn, Markus Heitz, and Otto Braendli. “Didgeridoo playing as alternative treatment for obstructive sleep apnoea syndrome: randomised controlled trial.” bmj 332, no. 7536 (2006): 266-270.|
|18.||↑||Choosing a PAP machine. American Sleep Apnea Association.|
|19.||↑||How Is Sleep Apnea Treated? National Institutes Of Health.2012.|
|20.||↑||McArdle, Nigel, Graham Devereux, Hassan Heidarnejad, Heather M. Engleman, Thomas W. Mackay, and Neil J. Douglas. “Long-term use of CPAP therapy for sleep apnea/hypopnea syndrome.” American Journal of Respiratory and Critical Care Medicine 159, no. 4 (1999): 1108-1114.|
|21.||↑||How Is Sleep Apnea Treated? National Institutes of Health.|
|22.||↑||How Is Sleep Apnea Treated? National Institutes Of Health.2012.|
|23.||↑||Eckert, Danny J., Amy S. Jordan, Pankaj Merchia, and Atul Malhotra. “Central sleep apnea: pathophysiology and treatment.” Chest Journal 131, no. 2 (2007): 595-607.|
|24.||↑||Albert, Richard K. The Merck manual home health handbook. Edited by Robert S. Porter, Justin L. Kaplan, and Barbara P. Homeier. Merck & Company, 2009.|
|25.||↑||Freire, Anaflávia O., Gisele CM Sugai, Fernanda Silveira Chrispin, Soˆnia Maria Togeiro, Ysao Yamamura, Luiz Eugênio Mello, and Sérgio Tufik. “Treatment of moderate obstructive sleep apnea syndrome with acupuncture: a randomised, placebo-controlled pilot trial.” Sleep medicine 8, no. 1 (2007): 43-50.|
|26.||↑||Bencz, Kátia Savelli G., and Paulo AD Nabarro. “Acupuncture in obstructive sleep apnea/hypopnea syndrome: a case report with fifteen months of follow-up.” Sleep Science 5, no. 4 (2012): 145-148.|
|27, 31.||↑||Lad, Vasant. The complete book of Ayurvedic home remedies. Harmony, 1999.|
|28.||↑||Telles, Shirley, Visweswaraiah K. Naveen, Acharya Balkrishna, and Sanjay Kumar. “Short term health impact of a yoga and diet change program on obesity.” Medical Science Monitor 16, no. 1 (2009): CR35-CR40.|
|29.||↑||Kaul, Prashant, Jason Passafiume, R. Craig Sargent, and Bruce F. O’Hara. “Meditation acutely improves psychomotor vigilance, and may decrease sleep need.” Behavioral and brain Functions 6, no. 1 (2010): 1.|
|30.||↑||Chaitow, Leon. Naturopathic physical medicine: theory and practice for manual therapists and naturopaths. Elsevier Health Sciences, 2008.|