Apnea

During normal sleep, breathing continues rhythmically and automatically. In people with apnea, this automatic process is interrupted, causing breathing to stop temporarily. These pauses, called apneas, trigger the brain to briefly awaken the person to resume breathing - often without the person being aware of these micro-awakenings. This cycle can repeat hundreds of times per night, preventing restorative deep sleep and causing oxygen levels to drop repeatedly.

The most common form is obstructive sleep apnea (OSA), where the airway physically collapses or becomes blocked during sleep. This happens when throat muscles relax excessively, allowing soft tissues to obstruct airflow. Central sleep apnea, less common but equally serious, occurs when the brain fails to send proper signals to the breathing muscles. Some people have complex sleep apnea, combining both types.

The consequences extend far beyond poor sleep and daytime fatigue. Each apnea episode stresses the cardiovascular system as oxygen levels drop and carbon dioxide rises. The body's fight-or-flight response activates repeatedly throughout the night, raising blood pressure and stress hormones. Over time, this nightly stress contributes to serious health problems, making diagnosis and treatment essential.

Nighttime Symptoms

• Loud snoring: Often disturbs bed partner
• Breathing pauses: Witnessed by others
• Gasping or choking: Abrupt awakenings
• Restless sleep: Frequent position changes
• Night sweats: From breathing effort
• Frequent urination: Multiple times nightly
• Insomnia: Difficulty staying asleep
• Dry mouth: From mouth breathing

Daytime Symptoms

• Excessive sleepiness: Despite adequate time in bed
• Morning headaches: From oxygen deprivation
• Difficulty concentrating: Brain fog
• Memory problems: Forgetfulness
• Irritability: Mood changes
• Depression: Common comorbidity
• Decreased libido: Sexual dysfunction
• Falling asleep: During activities, driving

Physical Factors

• Obesity: Major risk factor, especially neck circumference >17" men, >16" women
• Neck anatomy: Thick neck, narrow airway
• Age: Risk increases with age
• Gender: Men 2-3x more likely until menopause
• Enlarged tonsils: Airway obstruction
• Deviated septum: Nasal obstruction
• Jaw structure: Receding chin, small jaw

Medical Conditions

• High blood pressure: Strong association
• Heart disorders: Atrial fibrillation, heart failure
• Type 2 diabetes: Insulin resistance
• PCOS: Hormonal factors
• Hypothyroidism: Metabolic changes
• Acromegaly: Tissue overgrowth
• Stroke history: Central apnea risk

Lifestyle Factors

• Alcohol use: Relaxes throat muscles
• Sedatives: Muscle relaxation
• Smoking: Airway inflammation
• Sleeping position: Back sleeping worse
• Family history: Genetic component

Initial Evaluation

• Medical history review
• Sleep history questionnaire
• Epworth Sleepiness Scale
• Physical examination
• Airway assessment
• Blood pressure check
• Partner interview

Sleep Studies

• Polysomnography (PSG): Gold standard overnight lab study
• Home sleep test: Simplified monitoring at home
• Parameters measured: Brain waves, oxygen levels, heart rate, breathing
• AHI calculation: Apnea-hypopnea index
• RDI measurement: Respiratory disturbance index
• Oxygen saturation: Desaturation episodes

Additional Tests

• Multiple sleep latency test (MSLT)
• Maintenance of wakefulness test
• Upper airway imaging
• Drug-induced sleep endoscopy
• Cardiac evaluation

CPAP Success Tips

• Start slowly - wear while awake first
• Find the right mask fit
• Use humidification
• Clean equipment regularly
• Address mask leaks promptly
• Join support groups
• Track your progress
• Communicate with your provider

Lifestyle Adjustments

• Inform healthcare providers
• Carry medical alert info
• Plan for travel with CPAP
• Regular follow-ups
• Monitor blood pressure
• Maintain healthy weight
• Stay consistent with treatment

Partner Support

• Understand the condition
• Encourage treatment compliance
• Adjust to CPAP noise
• Monitor for apneas
• Support lifestyle changes
• Attend appointments together

• Cardiovascular: Hypertension, heart disease, stroke, arrhythmias
• Metabolic: Type 2 diabetes, metabolic syndrome
• Liver: Fatty liver disease, scarring
• Cognitive: Memory loss, dementia risk
• Mental health: Depression, anxiety
• Accidents: Drowsy driving, workplace injuries
• Surgical risks: Anesthesia complications
• Quality of life: Relationship problems, work performance
• Mortality: Increased risk of sudden death

Schedule an Evaluation If You Have:

• Loud snoring that disturbs others
• Witnessed breathing pauses during sleep
• Gasping or choking during sleep
• Excessive daytime sleepiness
• Morning headaches
• Difficulty concentrating
• High blood pressure
• BMI over 30

Seek Immediate Care For:

• Chest pain with sleep apnea
• Irregular heartbeat
• Severe shortness of breath
• Confusion or memory loss
• Falling asleep while driving