Obstructive Sleep Apnea

Obstructive Sleep Apnea – Answering 7 of The Most Burning Questions About It

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Obstructive Sleep Apnea (OSA) is a disorder that till now only those suffering from it knew about. With the recent passing away of Bappi Lahari, however, everyone seems to be eager to know more about it. 

We are sure that you have a lot of questions regarding it as well. 

So, without any further ado, let us dive right in and answer all of your queries in detail.

What is Obstructive Sleep Apnea?

Simply put, Obstructive Sleep Apnea is a sleep-related breathing disorder that causes you to repeatedly stop and start breathing while you sleep. While there are many types of sleep apneas, of them OSA is the most common. 

Obstructive Sleep Apnea

OSA occurs when the muscles of your throat relax intermittently while asleep. When that happens, your diaphragm and chest muscles have to work harder to pull air into your lungs and keep the airway open. 

This can lead to a lack of quality sleep, but you will never know it is happening. Further, this condition can also cause a lower flow of blood to your organs and cause uneven heart rhythms. 

What causes Obstructive Sleep Apnea?

Now that you know what causes Obstructive Sleep Apnea, in a nutshell, you must be wondering about the causes behind it. So, let us first understand the muscles around our throat. 

OSA occurs when the muscles at the back of our throat – the roof of the mouth (soft palate), uvula, tonsils, and the tongue – relax too much and hamper normal breathing. This causes the airway to become constricted for around 10 seconds or more and lowers the level of oxygen in the blood.  

This happens repeatedly, and almost every time your brain wakes you up from sleep so that the airway can open. However, such awakenings are so brief that we do not remember them. This can happen nearly 30 times or more during the length of your sleep. 

These repeated disruptions hamper your ability to reach the deep restful phases of sleep and thus, you feel sleepy while awake. 

Some of the other causes of Obstructive Sleep Apnea are as follows – 

  • Pregnancy
  • Obesity Hypoventilation Syndrome – a breathing disorder in people with obesity
  • Any kidney or heart failure that can cause fluid to build up in the neck and obstruct the upper airway
  • Neuromuscular conditions such as stroke can interfere with brain signals to control the chest muscles and airway
  • Chronic lung diseases such as Asthma, Pulmonary Fibrosis, and Chronic Obstructive Pulmonary Disease (COPD), and
  • Endocrine conditions such as Acromegaly, Hypothyroidism, and Polycystic Ovary Syndrome can affect your breathing when asleep

What are the signs and symptoms of OSA?

Signs and symptoms of Obstructive Sleep Apnea are as follows – 

  • Snorting
  • Drowsiness
  • Loud snoring
  • Night sweats
  • Forgetfulness
  • Decreased libido
  • Morning headache
  • High blood pressure
  • Worsening depression
  • Hyperactivity in children
  • Restlessness during sleep
  • Feeling disgruntled or grumpy
  • Excessive daytime sleepiness
  • Trouble getting up in the mornings
  • Difficulty concentrating during the day 
  • Gastroesophageal reflux disease (GERD)
  • Awakening with a dry mouth or sore throat
  • Waking up in the middle of the night to pee
  • Abrupt awakenings followed by gasping or choking

What increases the risk factors for OSA?

Physical features that constrict the upper airway significantly increase the risk of Obstructive Sleep Apnea. Some of these risk factors include – 

  • Obesity
  • Old age
  • Diabetes
  • Smoking
  • Retrognathia
  • Large tonsils
  • High blood pressure
  • Family history of OSA
  • A large tongue, which can block the airway
  • Men with a collar size of 17 inches or more
  • Women with a collar size of 16 inches or more
  • A narrow palate or airway that collapses easily
  • Have too much tissue at the back of your throat that hangs down to block your airway

What are the complications of Obstructive Sleep Apnea?

Obstructive Sleep Apnea is a serious medical condition that can cause a wide range of complications such as –

Daytime Fatigue

Because of a lack of sound sleep at night, patients with Obstructive Sleep Apnea experience daytime drowsiness, irritability, and fatigue. Such people also experience difficulty in concentrating and frequently find themselves falling asleep, be it at work, and even while driving, or watching TV. 

Cardiovascular Problems

Cardiovascular Problems - Obstructive Sleep Apnea

As oxygen level drops during OSA, it leads to increased blood pressure levels which in turn puts a strain on the cardiovascular system. This in turn significantly increases the risk of heart diseases. The more severe the OSA, the greater the risk of heart attacks, strokes, heart failures, and coronary artery disease. Further, OSA also ups the risk of abnormal heart rhythms (arrhythmias) which can lower blood pressure, and if left untreated could even cause sudden death.

Surgical and Medicinal Complications

Certain medications such as sedatives, narcotic analgesics, and general anesthetics, relax the upper airway and can eventually worsen Obstructive Sleep Apnea. People with OSA are more prone to complications after surgery. This is because, post-surgery, patients are sedated and lying on their backs which can worsen breathing issues. As such, doctors need to be informed of Obstructive Sleep Apnea or any related symptoms. 

Eye Problems

Eye Problems - Obstructive Sleep Apnea

Research conducted has found connections between Obstructive Sleep Apnea and certain eye conditions such as Glaucoma. However, on the bright side, such eye complications can be treated. 

Sleep-Deprived Partners

Patients with OSA tend to snore a lot and this affects the quality of sleep of those who sleep with them. This not only disrupts good rest but also relationships in the long run. Some partners even opt to sleep in another room. 

How is Obstructive Sleep Apnea diagnosed?

Diagnosis of Obstructive Sleep Apnea begins with a physical examination which will include examing your head and neck to identify any physical factors that are associated with sleep apnea. Doctors may even ask those who live with you about your sleeping patterns and check whether you have a history of snoring and daytime sleepiness or not. Accordingly, you may have to spend a night in a sleep lab or have a sleep study done at your house. You will have to wear devices that will monitor the following aspects:

  • Airflow
  • Eye movement
  • Muscle activity
  • Breathing patterns
  • Blood oxygen levels
  • Heart rate or rhythm
  • Electrical activity in your brain 
  • Movement of your arms and legs

Depending on your condition, one or more of the following tests may also be performed to diagnose Obstructive Sleep Apnea – 

Polysomnography (PSG)

During PSG, you have to sleep overnight in a hospital while connected to various monitoring devices that record the various organ activities such as:

Polysomnography - Obstructive Sleep Apnea
  • Electrooculogram (EOM) – for measuring eye movement
  • Electromyography (EMG) – for measuring muscle activity
  • Electroencephalogram (EEG) – for measuring brain waves
  • Electrocardiogram (ECG) – for measuring heart rate and rhythm
  • Pulse Oximetry Test – for measuring changes in blood oxygen levels

These tests and their purpose have been explained in detail below –

ECG

This is done to record electrical signals from your heart while you sleep to help doctors monitor your heart’s rate and rhythm.

EMG

Electromyography - Obstructive Sleep Apnea

During EMG, electrodes are placed above and below the jawline, and on each shin to pick up electrical activity generated during muscle movements. Muscles relax when we are asleep and EMG helps record when they are relaxing and moving while we sleep.

EEG and EOM

During an EEG, electrodes are attached to your scalp that record brain waves before, during, and after sleep. EOM, on the other hand, records eye movement. Using brain waves and eye movements, doctors can understand the timing of different phases of sleep. 

Pulse Oximetry

Pulse Oximetry - Obstructive Sleep Apnea

In this test, a pulse oximeter is clipped mostly to your fingertip, or in certain cases – your earlobe. The oximeter uses tiny LEDs (Light Emitting Diodes) to measure the oxygen saturation level of your blood. This is done because blood oxygen saturation levels tend to decrease during episodes of Obstructive Sleep Apnea.

What are the treatment options for OSA?

The primary objective when treating a patient for Obstructive Sleep Apnea is to ensure that the airflow is not obstructed during sleep. As such, possible treatment options for OSA include – 

Reducing Weight

Weight Reduce - Obstructive Sleep Apnea

Weight reduction will not lead to a complete remission of OSA, but it can surely improve your quality of life. Weight loss not only reduces the severity of OSA but also lowers blood pressure and decreases daytime sleepiness. 

Nasal Sprays

These are supposed to help if you have sinus issues or nasal congestion that makes it harder for you to breathe while you are asleep.

No Alcohol or Sleeping Pills

No Alcohol - Obstructive Sleep Apnea

Both of these may close your airway making it difficult for you to breathe for long periods like you should be.

Oral Devices

Patients with mild OSA are advised to get dental appliances such as an oral “mandibular advancement” device that keeps the tongue from blocking your throat and aids in bringing your lower jaw forward. This helps in keeping the airway while you are asleep. 

Continuous Positive Airway Pressure (CPAP)

Continuous Positive Airway Pressure - Obstructive Sleep Apnea

CPAP is highly beneficial for those patients who have mild or moderate OSA. It is administered through a face mask worn at night. This mask delivers a positive airflow at regular intervals and ensures that the airway remains open at night. 

Bilevel Positive Airway Pressure (BPAP)

BPAP is used for treating those patients with OSA, where CPAP is not effective. BPAP machines are also known as BiPAP machines and come with two pressure settings – inhaled and exhaled pressure. This means that the pressure changes during inhaling and exhaling.

Sleeping on Your Side

Sleeping on Your Side - Obstructive Sleep Apnea

Sleeping on your back, or in a supine position can further worsen your OSA. Doctors thus suggest sleeping on your side for relief.

Surgery

This is considered to be the last resort in cases where CPAP or BiPAP machines are not effective. This is most effective for those patients who have severe Obstructive Sleep Apnea and surgery helps correct the lesion obstructing the upper airway. 

Surgery provides long-term benefits to patients with severe OSA, however, complete elimination may not be possible depending on the surgical procedure involved. 

Thus, to sum up, if you are consistently experiencing daytime drowsiness or have trouble getting deep sleep, then you must talk to a doctor. 

As mentioned above, Obstructive Sleep Apnea has many treatment options which can not only help you manage your symptoms but also help you lead a better quality of life.

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