Sleep Apnea Symptoms

What Is Sleep Apnea?

Sleep apnea is a condition with irregular breathing patterns during sleep. Your breathing may stop and restart many times while you’re sleeping [¹]. This can cause your body to receive inadequate oxygen. Poor quality sleep can affect various aspects of your life. It may be wise to consult a doctor if you’ve been snoring or gasping excessively during sleep.

Types of Sleep Apnea

There are two types of sleep apnea: obstructive and central. Obstructive sleep apnea or OSA is when there is an obstruction in the mouth. This means that your tongue could fall against the soft palate while you’re asleep.

The soft palate may fall against the throat and make breathing very difficult [²]. In most cases of OSA, people wake up suddenly when they’re unable to breathe. Even though the lungs work perfectly fine, there isn’t enough air in through the upper airway.

Central sleep apnea, or CSA, is a condition that inhibits your breathing at night. But it isn't due to airway obstruction. Instead, it is due to a neurological cause.

In OSA, your body attempts to breathe but isn't able to. In CSA, the body does not even try to breathe. There is no snoring. Since the nervous system and brain don't send a signal to breathe, you may stop breathing [³]. There are many potential causes of CSA. Some of them include the following:

Sleeping at high altitudes
Congestive heart failure
Using sedatives such as opiates

In some cases, the doctors are unable to identify an underlying cause.

How Is Sleep Apnea Diagnosed?

Your healthcare provider will first evaluate your symptoms and sleep history. Then they might refer you to a sleep disorder center. This is where a sleep specialist may recommend further evaluation. In this evaluation, they monitor your breathing overnight and suggest undergoing tests like:

Nocturnal polysomnography. In this test, experts hook you up to equipment that monitors your:

Heart
Brain activity
Lungs
Breathing patterns
Blood oxygen levels
Leg and arm movements

Home sleep tests: These simple tests help you confirm your diagnosis at home. They measure the following:

Blood oxygen levels
Heart rate
Breathing patterns
Airflow, etc.

Sleep Apnea Staging

Sleep apnea can be mild, moderate, or severe. In mild apnea, there are 5 to 14 episodes of apnea or less airflow to the lungs every hour. Symptoms of mild apnea cause minor problems with daily work and functioning [⁴].

In moderate apnea, there are 15 to 29 apnea episodes or less airflow to the lungs every hour. Symptoms of moderate apnea cause moderate problems with daily work and functioning.

Severe apnea consists of 30 or more apnea episodes along with less airflow to the lungs every hour. Its symptoms can cause severe problems with daily work and functioning.

In children, the classification is different. This is because they’re still developing. They also breathe at a much faster rate than adults.

Is Sleep Apnea Hereditary?

Unfortunately, genetic factors play a role in the onset of obstructive sleep apnea. Central sleep apnea is a result of non-genetic factors. Studies show that people with family members with the disorder have a greater risk of developing OSA [⁵]. There are many ways genetics predispose you to OSA. Some of them are:

Face Anatomy: Genes play a role in defining a person's face. They also affect the width and length of the nose, etc. As a result, they affect the flow of the airway.

Body weight: Genes also affect your body weight. They determine where most of the fat is. They also influence whether you will or won’t develop OSA. Those with obesity are more likely to have OSA.

Circadian rhythm: Your genes influence your innate sleep schedule. They also influence how well you sleep and whether you have any other sleep disorders.

All in all, genetic factors may not be directly responsible for sleep apnea. But they affect aspects of your body, face shape, and sleep schedule.

Sleep Apnea Symptoms

Identifying sleep apnea can be challenging at first. But, if you experience the following persistently, consult a doctor immediately.

What Are the Symptoms of Sleep Apnea?

Common Sleep Apnea symptoms include [⁶]:

Exhaustion and tiredness, even after a full night's sleep
Sleepiness during daytime
Frequently waking up in the middle of the night
Snoring (but sleep apnea can also occur without snoring)
Restlessness at night
Unusual breathing patterns

What Are Some Signs of Sleep Apnea?

As mentioned before, signs of Sleep Apnea include:

Insomnia
Excessive restlessness at night
Night sweats
Mood changes due to lack of sleep
Disruptions in brain function
Pauses in breathing that others witness
Headaches after waking up
Waking up feeling like you’re choking
Sexual dysfunction

Symptoms of Sleep Apnea in Women vs. Symptoms of Sleep Apnea in Men*

The experience of sleep apnea is different for men and women. There are also differences in symptomatic presentation [⁷].

Men report symptoms like:

Gasping
Snorting
Snoring, etc.

Women report more indirect symptoms like:

Fatigue
Headache
Anxiety
Depression
Sleep onset insomnia, etc.

Additionally, OSA is more severe in men than women. The difference in severity is a result of body mass index. But with age, this sex difference decreases.

Risk Factors for Sleep Apnea

Factors that increase your risk of sleep apnea include:

Being older
Having a family history (only for obstructive sleep apnea)
Being overweight or obese
Thicker necks
Narrowed airways due to genetic factors
Use of tranquilizers, sedatives, alcohol, etc. (these substances relax your throat muscles)
Nasal congestion
Smoking (it increases fluid retention and inflammation in the upper airway)
Other medical conditions (diabetes, blood pressure, heart failure, etc.)

Sleep Apnea Prevention

The good news is that sleep apnea prevention is possible. Here are some ways to do it:

Avoid sleeping on your back
Quit smoking
Avoid taking sedatives
Exercise daily
Focus on losing weight if you’re overweight

Sleep Apnea Prognosis and Treatment

Sleep apnea prognosis is good with treatment. If you leave the symptoms to improve on their own, you might make them worse. Without treatment, you may also be at risk for the following:

Atrial fibrillation
Hypertension
Heart failure
Injuries due to accidents (because of hypersomnia) [⁸]

Sleep Apnea Survival Rate

A study by the American Academy of Sleep Medicine showed that people with sleep apnea have a high risk of death [⁹]. Those with severe sleep apnea are at greater mortality risk. Without treatment, the risk of death increases further.

People with severe sleep apnea have a three times higher risk of dying. The same isn’t the case with those who do not have severe sleep apnea. The hazard ratio in the study was initially 3.2. Researchers controlled factors such as:

Sex
Age
Body mass index

126 participants used CPAP or continuous positive airway pressure. After discontinuing it, their hazard ratio rose to 4.3. The research concluded that those with untreated or undiagnosed sleep apnea had poorer survival. They drew this conclusion after ensuring that the sex, age, and BMI were equal.

Another study concluded that 19% of patients with severe sleep apnea died compared to 4% with no sleep apnea. But, determining the survival or death rate still requires more research.

Sleep Apnea Treatment Options

OSA Treatments

People with moderate or severe OSA can benefit from using CPAP machines. These machines deliver air pressure through a mask while you’re asleep. The machine ensures that the air pressure is greater than that of the air in the surroundings. It helps keep your airway passages open. It also prevents snoring and apnea.

While it is a common treatment approach, many find it uncomfortable. People may require practice to adjust themselves to the mask. There are also other masks if the one you have is uncomfortable. Regardless, do not stop using the machine for this reason.

There are also certain oral appliances to keep your throat open. They might not be as effective as CPAP, but they are easier to use. Some of these appliances help open your throat by bringing your jaw forward. You might need to try some devices before choosing one for yourself.

Surgery is the last option for treating OSA. Surgical options include but are not limited to:

Shrinking the Tissues

Doctors use radiofrequency ablation to shrink the tissue at the back of the throat. They may recommend this procedure for mild to moderate sleep apnea.

Removing the tissues

Surgeons remove tissue from the top of the throat or the rear of the mouth. They may also remove your adenoids and tonsils. The procedure may help stop the throat structures from causing snoring.

Repositioning the Jaw

This procedure involves moving the jaw forward. As a result, the space behind the soft palate and tongue enlarges. Obstruction becomes less likely.

Tracheostomy

The procedure involves making a new air passageway. This treatment becomes necessary only if all else has failed [¹⁰]. The surgeon begins by making an opening in your neck. Then, they insert a plastic or metal tube to help you breathe.

Throughout the day, you’ll have to cover the opening. At night you can uncover it and allow air to pass through. There are also other surgeries to reduce snoring and improve sleep apnea. Some focus on removing enlarged tonsils. Others focus on reducing weight. The latter is ‘bariatric surgery.’

CSA Therapies

Supplemental Oxygen

Supplemental oxygen helps deliver oxygen to your lungs while you sleep. It can significantly help if you have central sleep apnea.

Changes in Medicines

Some medications can help you manage your breathing. One of them is acetazolamide. Other medications, such as opioids, may make your CSA worse.

ASV, or adaptive servo-ventilation, is also a useful airflow device. It first learns your breathing pattern. Once you fall asleep, the machine regulates your breathing pattern. It also prevents pauses in your breathing. While it is a good option for some, it may not be for others. Those with advanced heart failure should avoid using it.

Conclusion

Takeaway

Sleep apnea can cause you significant discomfort. It can hinder your ability to sleep well. It may also pose a threat to your life if you don’t attend to the symptoms on time. Fortunately, there are many therapies and treatment options available. But, your healthcare provider might need to run a few checks before prescribing or recommending them.