Obstructive Sleep Apnea (OSA)

Obstructive sleep apnea occurs when the muscles in the back of your throat relax too much to allow normal breathing. These muscles support structures including the soft palate, uvula, tonsils, and tongue. When these muscles relax, your airway narrows or closes as you breathe in, and you can't get an adequate breath.

Your brain senses this inability to breathe and briefly rouses you from sleep so you can reopen your airway. This awakening is usually so brief that you don't remember it. You may make a snorting, choking, or gasping sound. This pattern can repeat itself 5 to 30 times or more each hour, all night long.

These disruptions impair your ability to reach the deep, restful phases of sleep, leaving you feeling sleepy during your waking hours. People with obstructive sleep apnea may not be aware that their sleep was interrupted. Many people with this type of sleep apnea don't realize they haven't been sleeping well.

The signs and symptoms of obstructive sleep apnea can overlap with other conditions, making diagnosis important. Many symptoms occur during sleep and may be noticed by a bed partner.

Nighttime Symptoms

• Loud snoring: Often disturbing to others
• Apnea episodes - breathing cessation witnessed by others
• Abnormal breathing sounds - gasping, choking, or snorting
• Restless sleep with frequent position changes
• Sweating during sleep
• Frequent awakening to urinate (nocturia)

Daytime Symptoms

• Excessive daytime sleepiness (hypersomnia)
• Fatigue despite adequate sleep time
• Morning headaches
• Mouth dryness or sore throat upon awakening
• Difficulty breathing during physical activity
• Difficulty concentrating
• Memory problems
• Mood changes, irritability, or depression

Associated Symptoms

• Shortness of breath that awakens you
• Insomnia - difficulty staying asleep
• Weight gain and difficulty losing weight
• Difficulty in swallowing (in severe cases)
• Abnormal involuntary movements during sleep
• Decreased libido

Several factors can increase your risk of developing obstructive sleep apnea:

Physical Factors

• Excess weight: Fat deposits around upper airway can obstruct breathing
• Neck circumference: Thicker necks may have narrower airways
• Narrowed airway: May be inherited or due to enlarged tonsils/adenoids
• Male gender: Men are 2-3 times more likely to have sleep apnea
• Age: More common in older adults, but can occur at any age
• Family history: Genetic factors may play a role

Medical Conditions

• High blood pressure (hypertension)
• Type 2 diabetes
• Heart disorders
• Chronic nasal congestion
• Asthma
• Parkinson's disease
• PCOS (Polycystic ovary syndrome)
• Hormonal disorders
• Prior stroke

Lifestyle Factors

• Smoking: Increases inflammation and fluid retention
• Alcohol use: Relaxes throat muscles
• Sedative use: Relaxes throat muscles
• Sleeping position: Back sleeping worsens apnea

Untreated obstructive sleep apnea can lead to serious health complications:

Cardiovascular Problems

• High blood pressure or worsening of existing hypertension
• Heart attack and heart failure
• Irregular heartbeats (arrhythmias)
• Stroke
• Sudden cardiac death

Metabolic Issues

• Type 2 diabetes and insulin resistance
• Metabolic syndrome
• Nonalcoholic fatty liver disease
• Abnormal cholesterol levels

Other Complications

• Daytime fatigue leading to accidents
• Complications with medications and surgery
• Liver problems
• Sleep-deprived partners
• Memory problems and cognitive decline
• Depression and mood disorders
• Decreased quality of life

Diagnosis typically involves a sleep study and evaluation by a sleep specialist. Your doctor will evaluate your symptoms and may refer you for testing.

Diagnostic Tests

Polysomnography (Sleep Study)

• Overnight monitoring in a sleep lab
• Records brain waves, oxygen levels, heart rate, breathing
• Monitors eye and leg movements
• Most comprehensive test for sleep apnea

Home Sleep Apnea Testing

• Simplified version of polysomnography
• Measures breathing patterns, oxygen levels, heart rate
• More convenient but less comprehensive
• May need follow-up lab testing

Severity Classification

Based on the Apnea-Hypopnea Index (AHI) - events per hour:

• Mild OSA: 5-15 events per hour
• Moderate OSA: 15-30 events per hour
• Severe OSA: More than 30 events per hour

Treatment for obstructive sleep apnea depends on the severity of the condition and individual factors. The goal is to normalize breathing during sleep.

Continuous Positive Airway Pressure (CPAP)

• Most common and reliable treatment
• Delivers air pressure through a mask
• Keeps airway open during sleep
• Various mask styles available
• May take time to adjust

Other Airway Pressure Devices

• BiPAP: Provides more pressure on inhalation
• Auto-CPAP: Automatically adjusts pressure
• ASV: Adaptive servo-ventilation for complex sleep apnea

Oral Appliances

• Designed to keep throat open
• Bring jaw forward or hold tongue in place
• Easier to use than CPAP
• Best for mild to moderate OSA
• Custom-fitted by dentist

Surgery

When other treatments fail, surgical options include:

• Tissue removal: Uvulopalatopharyngoplasty (UPPP)
• Tissue shrinkage: Radiofrequency ablation
• Jaw repositioning: Maxillomandibular advancement
• Implants: Soft palate implants
• Nerve stimulation: Hypoglossal nerve stimulator
• Tracheostomy: For life-threatening cases

CPAP Success Tips

• Start using CPAP for short periods while awake
• Try different mask styles to find best fit
• Use a humidifier with CPAP
• Clean equipment regularly
• Join a support group
• Be patient - adjustment takes time

Monitoring Your Condition

• Regular follow-ups with sleep specialist
• Track daytime sleepiness levels
• Monitor blood pressure
• Report any new symptoms
• Ensure CPAP settings remain appropriate
• Annual sleep studies if recommended

Travel Considerations

• Bring CPAP as carry-on luggage
• Get letter from doctor for security
• Check power requirements for international travel
• Consider portable CPAP devices
• Bring extra supplies

While not all cases of sleep apnea can be prevented, you can reduce your risk:

• Maintain a healthy weight
• Exercise regularly
• Avoid alcohol and sedatives
• Sleep on your side
• Keep nasal passages open
• Quit smoking
• Manage allergies effectively
• Treat acid reflux if present