Obstructive Sleep Apnea (OSA) is a condition in which a patient's muscles and tissues in the throat and air passage relax while sleeping, and this impedes the flow of air into the lungs due to a blockage of the airway. This can occur many times per night in the sleep cycle and especially during the REM sleep stages. Apnea is Greek for "without breath."
The scientific standard of an apneic event is the patient must stop breathing for at least 10 seconds per event and have an overall blood oxygen desaturation level of 3 % to 4 percent along with certain potential changes in EEG frequencies and data. If a person has 5 or more of any type of events per hour of sleep then they can be clinically diagnosed with Sleep Apnea.
The body responds to this lack of oxygen by arousing, or waking from sleep. This cycle leads to the patient being unable to get the needed quantity of restful sleep and results in:
Untreated Sleep Apnea is potentially fatal and frequently results in the following serious health problems:
Apnea is Greek for "without breath." Obstructive Sleep Apnea (OSA) is a condition in which a person's muscles and tissues in the throat and air passage relax while sleeping. The tissues impede the flow of air into the lungs due to the blockage of the airway. This can occur many times per night in the sleep cycle, especially during the REM sleep stages.
The scientific standard for an apneic event is when you stop breathing for at least 10 seconds. There must be an overall blood oxygen desaturation level of 3 to 4 percent along with certain potential changes in EEG frequencies and data. If a person has 5 or more of any type of events per hour of sleep then they are clinically diagnosed with sleep apnea.
The body responds to the lack of oxygen by arousing, or waking, from sleep. This cycle leads to the person being unable to get the needed quantity of restful sleep and may result in:
In Central Sleep Apnea (CSA), a person stops breathing throughout the night, not due to a blocked air passage, but because the brain temporarily stops sending signals to the muscles that control breathing.
BiPAP therapy can be used to assist persons with central sleep apnea. The BiPAP machine provides air pressure in an inhale/exhale pattern helping a person to breathe.
In Mixed Sleep Apnea, the patient has a combination of both Central Sleep Apnea and Obstructive Sleep Apnea. Treatment is usually a combination of medication and CPAP use. There are now some advances in technology with some recent BiPap or BiLevel machines on the market made specifically to treat the special needs of those afflicted with MSA.
The following symptoms go hand and hand with Sleep Apnea:
An overnight sleep study is usual indicated when seeking to diagnose if a patient is suffering from Obstructive Sleep Apnea. This sleep test, usually conducted in a specialized sleep lab by a sleep doctor and a respiratory therapist, is called a polysomnogram or polysomnography test; also known as a PSG. Signs or Symptoms of Sleep Apnea
Often people are unaware that they may have Sleep Apnea or they do not realize they have difficulty breathing in their sleep at all. It is usually someone else who witnesses the person sleeping and having these events or obstructions, usually gasping for air or sudden stoppage of breathing while asleep, whereby they first become aware they may have Sleep Apnea.
Snoring is another big symptom but there are many people who snore who do not have sleep apnea. If snoring stops briefly and then resumes, that is a significant indicator of sleep apnea. Daytime tiredness or drowsiness, difficulty or lack of concentration, headaches, impotence or decreased sex drive, moodiness or irritability, lack of energy, acid reflux (gastro-esophageal reflux), restless sleep, tossing and turning, night sweats, memory problems, nighttime choking or chest pain, swelling of the legs in the obese, waking up foggy, groggy, or unrefreshed, anxiety, depression, increased urination at night; these could all be symptoms of Sleep Apnea. Some people first learn of the problem when they fall asleep at the wheel of a car, or are even involved in a car wreck or crash caused by the side effects of having untreated sleep apnea.
Sleep apnea is a serious and potentially fatal medical condition. If you or a loved one suspect you have it, you should be tested as soon as possible.
Yes, the link below will take you to a questionnaire designed to evaluate the most common symptoms of sleep apnea. This quiz may be a useful tool for discussing your symptoms with your doctor and can be taken to your appointment.
Sleep Apnea Screening Questionnaire
We provide a CPAPtalk.com tool to help you find sleep labs in your area. Simply click the link and enter your address or zipcode to find one near you.
Locate Sleep Apnea Services
Understanding OSA may help friends and family offer support or lead them to an awareness of their own symptoms. This newsletter can help them learn about sleep apnea:
CPAP.com Newsletter: Educate your Family and Friends About Sleep Apnea
Sir William Olser in 1918 first used a term he invented, "Pickwickian", to describe patients who were both obese and hyper-somnolent. Olser was obviously a reader of Charles Dickens as the Dickens novel Pickwick Papers had a character in it that was similar to the patients he had identified with these common symptoms. Around 1956, Dr. Burwell was treating patients who often had congestive heart failure, extreme sleepiness or fatigue, as well as improper airflow to the lungs; or respiratory failure. He termed these types of patients as having Pickwickian Syndrome.
Early Diagnosis and Treatment
In 1965 a group of French and German doctors lead by Dr. Gastaut started doing research on what is now called Obstructive Sleep Apnea, and recorded breathing and sleeping patterns of a patient with Pickwickian Syndrome and discovered distinctively unique patterns of the 3 types of apneas.
Beginning in 1969 OSA (Obstructive Sleep Apnea) was often treated with a tracheostomy; bypassing the upper air passage altogether by creating an incision or opening in the trachea (windpipe) and inserting a breathing tube.
Invention of the CPAP machine
In 1981, an Australian researcher by the name of Dr. Colin Sullivan and his colleagues Berthon-Jones, Issa and Eves, introduced their findings on the treatment of OSA with something called a Continuous Positive Airway Pressure machine, or CPAP. The treatment plan started off with a reversed vacuum cleaner motor that blew air into the afflicted person's nasal passage using a Silastic tubing to keep the airway open. The initial CPAP machines were large, bulky and noisy but by the late 1980s many improvements had been made to the machine and masks and soon this became the preferred method of treatment for those who suffer from Sleep Apnea. The publishing of their research papers was a landmark development in the treatment of Sleep Apnea.
The answer to this question depends on the person. Some people report experiencing less severe or cured sleep apnea after losing weight. Others report no change in their sleep apnea with weight lose. Most experience other benefits by losing weight healthily. Losing weight is good for your overall health when done properly.
You will need a CPAP machine, hose (tubing), power cord, filters, and a CPAP mask for effective CPAP therapy. Every CPAP machine comes with a power cord, filter, and a hose (tubing). CPAP masks are sold separately.
During your CPAP therapy you may find that your needs require additional elements. More advanced and comfortable setups also include humidifiers, machine software, CPAP mask strap pads, chinstraps, insulated hose coverings, and extra filters.
CPAP stands for Continuous Positive Airway Pressure. CPAP therapy is the most commonly recommended, and the most effective, treatment for obstructive sleep apnea.
A CPAP machine provides air at a constant prescribed pressure. The air is delivered to the person through a tube and a CPAP mask. CPAP therapy provides a constant airflow which keeps the airway open so uninterrupted breathing is maintained during sleep. The air stream eliminates Sleep Apnea events and allows the person to get a restful sleep.
The level of air pressure required to maintain your airway is determined during your sleep study. Your doctor will write a prescription for a CPAP machine set at that pressure.
CPAP therapy is delivered through a nasal mask that seals around the nose or nasal pillows which seal at the nasal opening. Full face masks are available for a person who breathes through both the nose and mouth. Many innovative and comfortable options are available and advances in the delivery of CPAP therapy are continually occurring.
For instance: Some machines offer a comfort feature such as FLEX or EPR technology. It provides exhalation relief, a slight drop in pressure at the time of exhalation to help make therapy more natural. APAP, BiPAP and BiLevel machines offer various levels of pressure throughout the night.
Successful CPAP users report improvements in:
Untreated Sleep Apnea can lead to:
Yes. Using CPAP therapy every night and during naps will increase the effectiveness of therapy, which will lead to an improvement in your mood and energy levels. Remember that even during a short rest your air passage is obstructed and being without oxygen is harmful to your health both short and long term. To avoid the side effects of untreated Sleep Apnea use your CPAP each time you sleep.
It will get easier, and become second nature to you if you stick with CPAP and surround yourself with support. CPAPtalk.com is a free sleep apnea patient forum we maintain. It is a great source of advice and support at any hour of the night or day.
To get used to CPAP, wear it every night without exception even if you end up taking it off after a few hours. Get into the habit of wearing it. CPAP therapy is necessary for your life. You need to make a commitment to a longer, healthier life.
Wear your Mask around the house when you are first starting out. Watch TV with it on, read while wearing your mask. Getting used to the feel of the mask when you are awake will help it to feel familiar at bedtime.
Using a CPAP machine treats OSA, it is not a cure. It is very important to remember that this is therapy and therapy is continuous. CPAP therapy is still today, the most recommended and the most effective treatment for obstructive sleep apnea.
There are several different types of surgeries available for Sleep Apnea, depending on the patient, but any surgery comes with inherent risks or possible complications, and can be painful. CPAP machines are still the most effective treatment for Sleep Apnea with very minimal risk to the end-user. Often the surgery success rate is relatively low and many people report being back on a CPAP machine, or the like, within a year, albeit often at a lower pressure.
Here are some of the more common surgeries available, although doctors are always innovating and coming up with new procedures. Not all are covered here. Talk to a sleep doctor to find out more about what the newest and best options are in your own case.
Tonsillectomy or Adenoidectomy
This is performed to increase the size or opening of the air passage in the case of Sleep Apnea treatment.
UPPP is performed to reduce or remove or reshape parts of the soft palate and the uvula. It may also involve removal of part of the soft tissue from the pharyngeal areas.
LAUP is similar to the above description of Uvulopalatopharyngoplasty however it uses lasers or radiofrequency waves to remove and shape the tissue.
MMA, also known as (MMO) Maxillomandibular Osteotomy or (Bi-Max) Bimaxillary Advancement, is usually reserved for severe cases which have not responded to other surgeries or an CPAP machine well or where craniofacial syndromes or structures are suspected as the cause of the problem. It is more invasive and involves removing the top and bottom jaw and moving them forward or restructuring the chin, maxilla or mandible. Often it is performed in conjunction with Genioglossus Advancement.
This procedure, commonly known as tongue advancement, is designed to move or pull the tongue forward to increase the size of the airway. It is sometimes performed along with Maxillomandibular Advancement (see description above).
This procedure involves pulling forward the hyoid bone in the neck to place it in front of the larynx. The hyoid bone is one of the attachment points for the tongue.
TAP Implant (Pillar Procedure)
The Pillar system is different from other treatments. It is specifically designed to produce a lasting reduction in snoring after a single office procedure. Unlike other procedures, the Pillar procedure does not require heating or removing tissue, or the use of any sclerosing agents, which means the procedure causes minimal discomfort and recovery time is short. In fact, most patients resume a normal diet and activities the same day.
During the Pillar procedure, no tissue is removed. Instead, three tiny inserts are placed in your soft palate during a brief office visit using local anesthetic. The inserts support and stiffen the palate, which has been shown to reduce snoring in individuals with very moderate sleep apnea. In addition, the inserts are made of a polyester material that causes a stiffening response in the palate tissue itself. This supporting and stiffening of the soft palate will last as long as the inserts are in place.
Unfortunately, this is not a solution for those with more than mild sleep apnea. If the obstruction occurs in a place other than the site of the implants, this procedure will be ineffective.
Currently there are no drugs on the market that are effective for the treatment of Obstructive Sleep Apnea.
Methylxanthine Theophylline is often used to treat those afflicted with Central Sleep Apnea and sometimes children or infants with Sleep Apnea but is not indicated for adults with OSA.
If normal treatments are not effective, sometimes a doctor may prescribe drugs that usually are reserved for narcolepsy or to help combat somnolence, such a stimulants or amphetamines. Modafinil, an anti-narcoleptic medication or wakefulness promoting drug, is sometimes used in this capacity.
Protriptiline, a tricyclic antidepressant, is helpful for a small number of Sleep Apnea patients. Sometimes acetazolamide and Medroxyprogesterone are prescribed to stimulate normal breathing. Prescription steroids or nasal decongestants can be useful in some cases to assist in widening the upper air passage.
Dental Devices or Oral Devices are sometimes used to treat Obstructive Sleep Apnea. There are several dental devices or procedures available and approved for use in treating Sleep Apnea. Usually one must go to a dentist to discuss which one would be the best choice based on the individual and to have the device custom made or fitted. They are often relatively expensive and have a moderate success rate, but could be a good option for some individuals. In general it seems the dental devices have an overall higher success rate than surgery but still lower than CPAP therapy. There are often some side effects that could be uncomfortable or cause other problems. Talk to a qualified dentist about these potential issues. Here are just a few of the dental devices available:
Usually these are things to be tried in conjunction with traditional treatments. Always consult with your doctor about any alternative treatment methods before trying them.
Some people have reported that playing a didgeridoo has helped strengthen the muscles in the pharynx and upper air passage and improved the number of apnea events or allowed them to lower their pressure.
In obese or overweight individuals, losing weight can have an effect on their Sleep Apnea and pressure needs for the CPAP machine. Eating a healthy diet combined with exercise, can promote loss of weight and with weight loss can lead to the need for a lower pressure on the CPAP machine.
It is recommended to avoid alcohol or other depressants or drugs that can adversely affect those with Sleep Apnea. Avoiding cigarette smoke or quitting smoking and avoiding other pollutants can help with irritation of the mucous membranes in the nose and air passage that may cause swelling.
Trying different sleeping positions can help in some cases, especially sleeping in a somewhat upright position if one is not using a CPAP machine.
Breathe Right strips might reduce snoring which is a symptom of Sleep Apnea. However, no medical research shows that these strips are affective in treating Sleep Apnea.