Sleep apnea, otherwise known as obstructive sleep apnea (OBS), is a condition from which up to more than a million Poles suffer. It is a disease that affects more than just sleep, it also leads to unpleasant daytime discomforts. Untreated obstructive sleep apnea, contributes to many dangerous complications and even death. Seemingly innocent snoring, can turn out to be a symptom of dangerous sleep apnea. Therefore, if this condition is suspected, it is necessary to carry out diagnostics as soon as possible and introduce appropriate therapy. There are many effective ways to control sleep apnea. These include the use of a CPAP machine and even cognitive-behavioral therapy for sleep apnea. Find out what sleep apnea is and learn about effective treatments.
What is sleep apnea?
Sleep apnea is repeated episodes of stopped breathing, or shallow breathing, during sleep. An apnea episode can repeat up to several times during each hour of sleep. Respiratory muscles during sleep apnea, function properly, and often work with increased force. Sleep apnea, results from closure of the upper airway within the throat, which impedes airflow and leads to temporary hypoxia. A shallowing or stoppage of breathing, is a state of hypoxia that lasts more than 10 seconds and is usually accompanied by a drop in saturation (oxygen saturation of the blood). Sleep apnea affects as much as 8% of the general population, and the risk of the disease increases with age.
We can divide sleep apnea into two types:
- Obstructive central sleep apnea – Involves complete cessation of airflow through the airways. It is a less common type of sleep apnea. The substrate of its origin, is the dysfunction of brain structures. It can result from complications after a stroke, or from vascular changes in the brain. To summarize obstructive sleep apnea, the severe form is far less frequently diagnosed.
- Obstructive peripheral sleep ap nea – Is the most common form of this disease. It is characterized by cyclic stoppage of airflow, caused by closure of the lumen of the throat. This is caused by a decrease in throat muscle tone, or an anatomical obstruction.
Where does obstructive sleep apnea come from? Causes of sleep apnea
The causes of obstructive sleep apnea can be many. They are united only by impairment of the throat muscles. It is most often diagnosed in men over 40 and women over 50. The occurrence of sleep apnea in the family, many times increases the risk of developing this condition. Sleep apnea is favored by an increased neck circumference. In women greater than 40cm, and in men greater than 43cm. Increased fatty tissue in the neck, leads to pressure on the throat. Some of the most common causes of OBS include:
- Crooked nasal septum.
- Obesity.
- Hypertrophy of the tonsils or nasal auricles.
- Smoking and alcohol consumption (especially before bedtime).
- Abuse of sleeping and antidepressant medications and opioids.
- Pregnancy – Increased body weight and muscle relaxing hormones can lead to OBS.
- Abnormal facial structure.
- Presence of polyps.
- Hypothyroidism.
- Frequent infections of the upper respiratory tract.
- Allergic rhinitis and mouth breathing.
- A receding mandible of small size.
- Menopause in women.
- Familial burden.
- Elongated soft palate.
What are the symptoms of sleep apnea?
Symptoms of sleep apnea, we can divide into those that occur during sleep, but also those that occur during the day. Those occurring during the day are a direct result of nocturnal apnea. Repeated temporary hypoxia during the night, can lead to many uncomfortable symptoms during the day as well. The first and most common symptom that should worry you is snoring. The causes of apnea can vary, but with obs, the condition virtually always manifests itself as snoring. A person who will look at someone with sleep apnea will certainly observe loud breathing during sleep. Breathing and snoring in a person with sleep apnea, are usually very loud and irregular.
Nocturnal apnea symptoms
- Snoring.
- Increased sweating.
- Shortness of breath.
- Frequent changes of position during the night.
- Restless sleep, awakening from sleep.
- Problems falling asleep again after waking up.
- Sensation of palpitations.
- Heartburn.
- Gnashing of teeth.
Daytime apnea symptoms
- Problems with concentration and memory.
- Decrease in libido, problems with potency.
- Excessive daytimesleepiness , despite many hours of sleep during the night.
- Dry mouth upon awakening.
- Increased nervousness.
- Morning headaches, neuralgia.
- Depression, emotional problems.
Sleep apnea in children
Obstructive sleep apnea can also occur in children, but it is usually not common in them. It is estimated to occur in about 1.2-5.7% of children. It is usually seen between a child’s third and sixth years, but it is also possible for OBS to occur in an infant. Preschool-aged children are most severely affected. Sometimes learning problems, impaired concentration and aggressive behavior in children, can result precisely from apnea. Risk factors in children can include obesity, tonsillar hypertrophy, allergies and asthma, hypotonia, Down Syndrome and Cerebral Palsy. Treatment and diagnosis of obstructive sleep apnea in children, looks similar to that in adults.
Who diagnoses and treats sleep apnea?
Sleep apnea is dealt with by doctors with different specialties. Often, a PCP who suspects a patient of having sleep apnea will refer the patient to several specialists for sleep apnea testing. Most often, specialists such as a pulmonologist, an ENT specialist, and a neurologist will be consulted in the diagnosis and treatment of OBS. Often, sleep apnea requires consultation by all these specialists, especially when looking for its cause. Sometimes in the process of treatment, an orthodontist may also be involved. It is also worth noting that a psychologist and therapist will also prove useful in controlling sleep apnea and introducing good sleep habits.
What is the diagnosis of sleep apnea?
Due to the non-specificity of the symptoms, the diagnosis of sleep apnea is not the easiest one. Often the doctor first recommends that the patient fill out a questionnaire, the Epworth sleepiness scale. The patient should also be thoroughly examined by an ENT specialist. To diagnose OBS definitively, a sleep study called polysomnography will work best. A polysomnography test takes all night, so it usually requires a short hospital stay. During this test, brain activity, cardiovascular system, and airflow through the airways are monitored. In addition to breathing parameters, chest movements, snoring, and even limb work are recorded. The AHI index, very important in the diagnosis of OBS, is also monitored. It indicates the average number of apneas, per hour of sleep. The AHI index helps assess the severity of obstructive sleep apnea. More than 30 apneas per hour on this scale, already means a severe degree of sleep apnea. Therefore, the AHI scale is extremely important, because the treatment of OBS, depends on the severity of the disease that is determined through it. There is also a test called polygraphy, but its disadvantage is that it does not monitor brain function through EEG. Among the advantages is that a specialist can perform such a test at home.
Sleep apnea treatment
When it comes to sleep apnea, drug treatment is not used. Treatment of sleep apnea often comes down to surgery, if the cause is a physical anatomical obstruction blocking airflow. Sometimes, an orthodontist can also help, fitting braces designed to move the mandible forward. Treatment that does not require surgery usually involves the use of a mask with a special CPAP device that creates positive pressure in the airway. With a condition such as sleep apnea, home remedies can only support the entire therapy, but most often there is no way around the apparatus. It should also be noted that cognitive-behavioral therapy for sleep apnea, is a highly effective method. CBT can significantly improve sleep quality. It will help create positive sleep patterns, which will effectively influence better, healthier, restorative sleep.
Sleep apnea – using a CPAP machine
CPAP machines are a modern and highly effective method of treating OBS. They work by creating positive pressure in the airway. It is crucial to choose the right apparatus, but also a mask that is a good size. CPAP apparatus ensures airway patency, and airflow with constant pressure. The cost of such a device, oscillates around up to 7 thousand zlotys, but it is subject to partial reimbursement by the National Health Fund. It is worth investing in a device with a humidifier, which will prevent drying of the airways.
Cognitive-behavioral therapy in the treatment of sleep apnea
Cognitive-behavioral therapy has a wide range of applications in sleep disorders, and consequently in OBS. It can be carried out both individually, directly in the office, or online. Also group classes in people with similar sleep problems. To be most effective, CBT should be tailored to specific sleep problems. In this case, to sleep problems resulting from sleep apnea. The duration of such therapy will depend on the severity of the condition, among other factors. Usually, after just 5-8 weeks of therapy sessions, results are visible, in the form of improved patterns, and quality of sleep.
CBT for treating sleep apnea can focus on several aspects:
- Managing the symptoms and concerns associated with OBS. CBT can help patients better adjust to using CPAP, which is one of the most effective treatments for OSA. Behavioral techniques can reduce anxiety and discomfort associated with using the device.
- Improving sleep hygiene. CBT-I (Cognitive Behavioral Therapy for Insomnia) can be useful for sleep apnea patients who also suffer from insomnia. This can include techniques such as establishing regular bedtimes, avoiding caffeine and alcohol before bed, and creating a conducive sleep environment.
- Modifying behavior and lifestyle habits. CBT can help patients make lifestyle changes, such as promoting a healthy diet, regular physical activity and weight reduction, which can in turn reduce the severity of OBS.
- Reducing stress and improving mental health. Sleep apnea often coexists with anxiety and depression, which can affect sleep quality. CBT can help manage these comorbid disorders, which can indirectly improve sleep quality and reduce the severity of sleep apnea.
Although CBT is not the standard first-line therapy for treating sleep apnea, it can be a valuable adjunct to other forms of treatment, especially in cases where patients have difficulty adapting to conventional methods or have comorbid psychiatric problems. Integrating CBT with conventional treatments can lead to better therapeutic outcomes and improved quality of life for patients.
Sleep apnea – home remedies
Every person, after a diagnosis of obstructive sleep apnea, will absolutely face a change in lifestyle. It will be important to introduce an appropriate diet, preferably under the supervision of a nutritionist. It will also be necessary to increase physical activity and reduce body weight. It is advisable to give up alcohol, absolutely in the evening. Cigarettes should also be excluded. Particularly important will be, observing the appropriate number of hours of sleep, and ensuring that external factors do not interfere with it. If possible, you should also adopt sleeping positions on the side; with obstructive sleep apnea, sleeping on the back is discouraged. The last resort is to sleep on the stomach. Increasing the humidity in the bedroom, through various ionizers or even wet towels on the radiator, will also help. It is also worth investing, in a special medical pillow.
Complications of untreated sleep apnea – sleep apnea can kill
Untreated obstructive sleep apnea, can lead to all sorts of dangerous complications. The worst of these can even turn out to be death. Sleep apnea patients, are twice as likely to develop high blood pressure as healthy people. In addition, in people with OBS, the risk of ischemic heart disease increases as much as fourfold. Therefore, the consequences of sleep apnea that goes untreated can prove fatal. People suffering from sleep apnea, very often contribute to traffic accidents, due to increased daytime sleepiness. Obstructive sleep apnea ,in addition to those mentioned above, can also contribute to diabetes, stroke, metabolic syndrome, gastroesophageal reflux, depression, pulmonary hypertension, cardiac conduction and rhythm disorders, cognitive dysfunction, emotional disorders and many other conditions.
The scale of devastation that sleep apnea leads to can be enormous. Untreated OBS can cause a host of dangerous diseases. A driver suffering from sleep apnea also poses a danger to others, as he or she may fall asleep at the wheel. Even with some of the symptoms that can indicate sleep apnea, it is important to see a doctor immediately.
There is no one-size-fits-all, effective method, of treating apnea. Treatment for OBS can range from invasive methods such as surgery to cognitive-behavioral therapy. It should be selected depending on the severity of the apnea, and its causes. CBT therapy will work well to support other methods of controlling sleep apnea. Changing the negative thoughts that drive the sleep problems that have occurred is extremely important in the fight against OBS.