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Sleep Apnea Symptoms causes and treatment

The apnea sleep manifested by involuntary cessation of breathing , the “apnea” occurring during sleep. Sleep apnea usually occurs in people who are overweight, elderly or who are snoring heavily.

These breathing pauses last by definition more than 10 seconds (and can reach more than 30 seconds). They occur several times a night, at a variable frequency. Doctors consider that they are problematic when there are more than 5 per hour. In severe cases, they occur up to more than 30 times per hour.

These apneas disrupt sleep and result mainly in fatigue when waking up, headaches or drowsiness during the day.

Causes of Sleep apnea

In the majority of cases, apneas are due to loosening of the tongue and throat muscles, which are not sufficiently tonic and block the passage of air during breathing . Thus, the person tries to breathe, but the air does not circulate because of the obstruction of the airways. That’s why doctors talk about obstructive apnea, or obstructive sleep apnea (OSA) syndrome . This excessive laxity is especially important for the elderly, whose muscles are less tonic. Obese people are also more prone to sleep apnea because excess neck fat decreases the size of the airways.

More rarely, apneas are due to a malfunction of the brain, which stops sending the “order” of breathing to the respiratory muscles. In this case, unlike obstructive apneas, the person does not make respiratory effort. This is called central sleep apnea . This type of apnea occurs mainly in people with a serious condition, such as heart disease (heart failure) or a neurological disease (eg meningitis, Parkinson’s disease …). They can also appear after a stroke or in cases of very significant obesity. The use of sleeping pills, narcotics or alcohol is also a risk factor.

Many people have “mixed” sleep apnea with alternating obstructive and central apnea.

Prevalence of Sleep apnea

The frequency of sleep apnea is very high: it is comparable to other chronic diseases such as asthma or type 2 diabetes. Sleep apnea can affect adults and children, but its frequency increases. Strongly with age.

It is 2 to 4 times more common in men than women, before 60 years. After this age, the frequency is the same for both sexes.

The prevalence estimate varies according to the degree of severity taken into account (number of apneas per hour, as measured by apnea-hypopnea index or AHI). Some studies in North America estimate the frequency of obstructive sleep apnea (more than 5 apneas per hour) at 24% for men and 9% for women. About 9% of men and 4% of women would have a moderate to severe form of obstructive sleep apnea syndrome.

Possible complications

In the short term, sleep apnea causes fatigue, headaches, irritability … It can also inconvenience the spouse, because it is often accompanied by snoring sound .

In the long term, if left untreated, sleep apnea has many health consequences:

Cardiovascular diseases. Sleep apnea significantly increases the risk of cardiovascular disease through mechanisms that are not fully decoded. However, it is known that each respiratory pause causes a deficiency of oxygenation of the brain (hypoxia), and that each sudden micro-awakening causes an increase in blood pressure and heart rate. In the long term, apneas are associated with an increased risk of cardiovascular problems, such as: hypertension, stroke, myocardial infarction (heart attack), cardiac arrhythmias (heart arrhythmia) and heart failure. Finally, in case of significant apnea, the risk of dying suddenly during sleep is increased.

Depression. Lack of sleep, fatigue, need for naps and sleepiness are associated with sleep apnea. They diminish the quality of life of those affected, who often suffer from depression and isolation. A recent study has even shown a link between sleep apnea and cognitive impairment in older women.

Accidents. The lack of sleep induced by apnea increases the risk of accidents, especially accidents at work and on the road. People with obstructive sleep apnea syndrome are 2 to 7 times more likely to be victims of a traffic accident.

Complications in case of surgery. Sleep apnea, especially if not yet diagnosed, may be a risk factor for general anesthesia. Indeed, anesthetics can increase the relaxation of the muscles of the throat and thus aggravate apneas. Pain medication given after surgery may also increase the risk of severe apnea. It is therefore important to inform your surgeon if you have sleep apnea.

When to consult

Doctors think that the vast majority of people with sleep apnea do not know it. Most often, it is the spouse who notices the presence of apneas and snoring. It is advisable to consult a doctor if:

  • your snoring is loud and disrupts your spouse’s sleep;
  • you often wake up at night feeling like you’re not breathing well or going to the bathroom several times a night;
  • your spouse notices breathing stops while you sleep;
  • you feel tired in the morning and fall asleep frequently during the day. The Epworth Sleepiness Test measures the degree of sleepiness during the day.

Your doctor may refer you to a center specializing in sleep studies. In this case, an exam called polysomnography will be performed. This examination makes it possible to study the different phases of sleep and to measure several parameters to detect sleep apnea and to assess their severity. In practice, you have to spend a night in the hospital or in a specialized center. Electrodes are placed in different places on the body to observe parameters such as brain or muscle activity, oxygen levels in the blood (to ensure that breathing is effective) and the various phases of the body Sleep. This makes it possible to know if the person enters the phase of deep sleep or if apneas prevent it.

In general, people with sleep apnea do not notice that they are having respiratory breaks during the night. However, apneas cause ”  micro-awakenings  ” that alter the quality of sleep. The most common symptoms are those that result from fragmented sleep and poor quality.

  • Significant fatigue during the day and when waking up;
  • sleepiness and frequent and uncontrolled sleepiness (watching TV, work, driving …)
  • Loud snoring ;
  • Of headaches wake up;
  • irritability , depression feeling;
  • Of memory disorders ;
  • A drop in school results among the children concerned;
  • A feeling of suffocating or suffocating at night.

 People at risk

Several factors increase the risk of sleep apnea:

  • Obesity . It is the main risk factor for obstructive sleep apnea, especially because excess neck fat causes narrowing of the airways. Obesity increases the risk of sleep apnea by approximately 7 times;
  • Age . The frequency of sleep apnea syndrome is double or triple after age 65;
  • Sex . Men are 2 to 3 times more affected than women ;
  • Ethnicity . African-Americans and Asians have a higher risk of sleep apnea;
  • Some abnormalities of the airways or jaws . In some people, the airways are too narrow or the tonsils (ganglions at the back of the throat) are too big and hinder the passage of air. This is often the case in children with obstructive sleep apnea syndrome. An anomaly of the jaws can also make the passage of the air more difficult. These abnormalities may be accompanied by snoring;
  • Genetic factors . In some families, obstructive sleep apnea syndrome is very common due to genetic susceptibility. The risk of suffering from sleep apnea is multiplied by 2 to 4 among close relatives of a person with obstructive sleep apnea syndrome;
  • The circumference of the neck . The wider the neck (more than 43 cm or 17 inches of circumference in men, more than 40 cm or 16 inches in women), the higher the risk of apnea.

 Risk factors

  • Nasal obstruction People who often have a stuffy nose, for example due to allergies, are more prone to sleep apnea;
  • The consumption of alcohol . Alcohol causes relaxation of throat muscles which increases the frequency and duration of sleep apnea;
  • Some drugs , such as sleeping pills, muscle relaxants or anxiolytics, aggravate apnea for the same reasons as alcohol;
  • Smoking . Smoking increases the risk of obstructive sleep apnea syndrome, probably because it causes inflammation of the airways. Smokers are 2.5 times more likely to suffer from sleep apnea than non-smokers;
  • Type 2 diabetes . Type 2 diabetes is associated with a high risk of sleep apnea, for reasons that are still poorly understood, but often linked to obesity. In diabetics, the prevalence of obstructive sleep apnea syndrome can be as high as 23%.

 

Can we prevent?
Since obesity is the leading risk factor for sleep apnea, maintaining a healthy weight by eating a balanced diet and exercising regularly is an effective preventive measure.

The fight against diabetes also helps to reduce the risk of obstructive sleep apnea. Finally, if you have hypertension, it is important to take your medications regularly to reduce the overall risk of cardiovascular disease.

Measures to prevent aggravation
If you suffer from sleep apnea , you can improve the quality of your sleep and reduce your symptoms by adopting simple lifestyle measures. These measures sometimes make it possible to eliminate apnea in mild cases:

  • Lose weight . If you are overweight, losing a few pounds is often enough to improve the quality of your sleep. Thus, a loss of 10% of the weight reduces by 26% the gravity (frequency and duration) of the apneas;
  • Sleep on the side . For anatomical reasons, the narrowing of the airways is greatest when you sleep on your back. Sleeping on your side often reduces sleep apnea. There are special pajamas (with a bullet stitched in the back) that prevent the sleeper from getting back on his back during the night;
  • Raise the bed . You can elevate the head of the bed by a few centimeters, to have the neck and torso slightly inclined during the night (for example, by putting wedges under the legs of the bed). This facilitates the opening of the airways and can be effective in case of mild apnea;
  • Avoid sleeping pills and alcohol . When you sleep badly, it is tempting to use sleeping pills. However, these increase the relaxation of the muscles of the throat and tongue and have the effect of aggravating apnea. Similarly, alcohol is to be consumed in moderation;
  • Stop smoking . Tobacco aggravates apneas by creating inflammation of the airways and loosening of the muscles that keep these lanes open. In addition, smoking increases the risk of cardiovascular problems. It is therefore essential to stop smoking. Do not hesitate to ask your doctor for help;
  • Treat your allergies . Nasal congestion impedes breathing and worsens snoring and sleep apnea. If you have recurring allergies, talk to your doctor to find a suitable treatment. Be careful, however, antihistamine drugs, which have a sedative effect and can worsen apnea. Consult our page Allergic Rhinitis for more information.
Measures to prevent complications
Sleep apnea is a potentially serious condition that must be taken seriously. In addition to trying to lose a few pounds if you are overweight, it is important to follow the doctor’s instructions and wear your breathing mask every night. See the treatments section.

To reduce the risk of cardiovascular complications, also take regular physical activity and follow your treatments for high blood pressure or diabetes .

Medical treatments

To date, there are no drugs to treat sleep apnea. However, very effective mechanical treatments exist:

  • Continuous positive airway pressure (CPAP or CPAP) therapy. It is the treatment of choice for sleep apnea. An apparatus breathes air continuously through the nose, thanks to a mask that is worn at night. Several models of devices and masks are available. To designate this device, the term CPAP, which comes from the English “Continuous Positive Airway Pressure”, is often used. The blown air keeps the airway open continuously, which removes apnea. Although this treatment is extremely effective, it takes time to get used to sleeping with the mask. It may seem uncomfortable at first, but you have to be patient. The decrease in symptoms is felt after 4 to 6 weeks, provided you wear the mask every night. This treatment improves the quality of life ,alertness and memory of those affected, as well as lowering blood pressure in case of associated hypertension;

 

According to the Quebec Lung Association, the device and the mask cost from $ 1,500 to $ 2,200 and are not reimbursable by the Quebec Health Insurance Plan. However, treatment costs are eligible for the medical expense tax credit.
  • Oral appliance . It is a dentist-molded gutter that is worn at night, also called a mandibular advancement splint. It keeps the lower jaw and tongue forward (a few millimeters), which facilitates the passage of air. These devices are mainly for people with mild or moderate apnea. They are less effective than continuous positive pressure ventilation, but require less adaptation.

Medication

Although there is no medication to help remove sleep apnea , some treatments may help reduce apnea by treating the cause. Thus, if apnea is due to allergic rhinitis, nasal corticosteroids can reduce the number of apneas. Similarly, in patients with gastro esophageal reflux disease that can worsen apnea, taking an antireflux medication (omeprazole) helps reduce apnea. Finally, if somnolence is very important during the day despite CPAP treatment, stimulant medications may be prescribed. Talk to your doctor.
Other: surgery

In some cases, when CPAP ventilation treatment is not working or is not well tolerated, surgery may be considered.

There are several types of operations to reduce snoring and apnea . However, their effectiveness is relatively low and apneas tend to reappear sometime after the procedure. There is insufficient evidence to recommend these interventions for people with mild to moderate sleep apnea.

  • Uvulo-palato-pharyngoplasty (UPPP). This operation involves removing the uvula and a part of the soft palate, which vibrate during snoring, so as to clear the airways and facilitate the passage of air. It is performed under general anesthesia. It is effective in reducing snoring, but does not prevent the throat from sagging. It is effective on apneas only in 50% of cases;
  • Tonsillectomy and adenoidectomy . These procedures consist in surgically removing the tonsils and adenoids, ganglia located in the throat. If they are very swollen, which often happens in children, they can hinder the passage of air and cause apnea. This operation is especially proposed in case of obstructive sleep apnea syndrome in children;
  • Surgery of the nose and sinuses . It is useful if the apnea is related to an anomaly of the nasal septum or sinuses which hinders breathing;
  • Tracheotomy . This “radical” operation is reserved for people with severe apnea who do not have CPAP ventilation. It is therefore very rarely proposed. It consists of creating an opening in the trachea, below the throat. This “hole” allows air to enter the lungs without going through the throat during the night. It may be clogged during the day to resume normal breathing;
  • Surgery for weight loss . When sleep apnea is due to significant obesity, losing weight helps to act effectively on apneas. Bariatric surgery, reserved for severe obesity, reduces the severity of apnea 7 .
    For more information, consult our Obesity sheet.

Complementary approaches

According to our research in the scientific literature, there is no validated complementary approach to treat sleep apnea.

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