What is Obstructive Sleep Apnea (OSA)?
Does your patient complain of waking up with a headache in the morning or tell you they're just as tired the next morning as they were before they went to sleep the night before? Does their spouse sleep in a separate room because your patient’s snoring, choking, or gasping exhaust them each night?
If your patient comes to you with complaints like these, chances are they're struggling with obstructive sleep apnea (OSA). You'll need to be ready to answer the most common next question that your patient will likely ask, "What is Obstructive Sleep Apnea?"
Discover key terms that every sleep technologist should know in our free eBook.
What is Obstructive Sleep Apnea?
Obstructive sleep apnea is a sleep disorder that occurs when your patient has a partially or completely blocked upper airway during sleep. OSA affects over 12 million people in the U.S. alone.
OSA causes your patient’s chest muscles and diaphragm to work harder to open up their obstructed airway to draw air into their lungs. When their breathing resumes, it's usually followed by a loud snort, gasp or body jerk. And, although your patient isn't sleeping well, they're probably not even aware that this is happening to them — unless their partner or spouse tells them or they’ve had a sleep test that diagnosed them with the condition.
With OSA, your patient's tongue will fall back against their soft palate leading to their uvula and soft palate falling back against the back of their throat. This closes their airway, and when they go to expand their chest to inhale, they don't get air in their lungs.
OSA seems to occur more in patients who are middle-aged, overweight, and sleep on their back. It seems to affect more males than females, although it's seen in both genders of all body types, ages, and favored sleep positions.
Many researchers speculate that the involuntary failings that lead to obstructive sleep apnea initially are neurological. They believe the brain gives off inadequate or improper signals that lead to throat and tongue muscle flaccidity.
Regardless of the cause, if OSA isn't treated, it can become a serious issue. Often, it can lead to debilitating symptoms, such as morning headaches, excessive daytime sleepiness, and an overall sense of unwellness and depression. And, overtime, life-shortening and life-threatening diseases may arise such as:
- High blood pressure
- Heart disease
It's this outcome that makes OSA diagnosis and treatment crucial for your patients.
What Are the Symptoms and Risk Factors of Obstructive Sleep Apnea?
There are symptoms and risk factors associated with OSA.
Symptoms of OSA
Obstructive sleep apnea symptoms often indicate that your patient's health is being affected negatively. Perhaps they've been told they snore loudly. Maybe they wake up too many mornings feeling as though they never even slept.
These are signs that there's obviously something up with your patient's sleep. However, when it comes to OSA where your patient actually stops breathing during their sleep frequently, it may be significantly trickier to pinpoint the problem.
Chronic and loud snoring is the most common symptom or sign of OSA. Your patient may pause in their snoring followed by gasping or choking. But, these momentary events of breathing cessation don't cause your patient to become fully alert. Rather, their sleep is disrupted enough where they feel groggy and tired in the mornings. More importantly, they put your patient at risk for more severe health issues, often without them even knowing there's an issue.
Not all people with OSA snore either. Since they're often unaware of their brief breathing cessation events, you may have to rely on their spouse or partner to give details about their symptoms. Most definitely, you'll need to conduct a sleep study, also known as a polysomnogram or PSG.
Some symptoms of obstructive sleep apnea may include:
- Loud snoring
- Morning headaches
- Waking up with an extremely dry and sore throat
- Lack of energy or sleepiness during the day
- Restless sleep
- Sleepiness while driving
- Mood changes, forgetfulness, personality changes
- Night sweats
- Decreased interest in sex
- Learning problems
- Insomnia or recurrent awakenings
- Depression, trouble concentrating, or irritability
- Weight gain
- Difficulty getting up in the morning
Children's OSA symptoms might not be as obvious and may be mistaken as normal child behavior or may be misdiagnosed as attention deficit hyperactivity disorder. OSA symptoms in children may include:
- Drooling or choking
- Problems at school
- Sweating excessively during the night
- Behavior and learning disorders
- While exhaling ribcage moves inward
- Teeth grinding
- Sleepiness or sluggishness (often mistaken as laziness in school)
- Absence or pauses in breathing
- Restlessness in bed
- Unusual sleep positions (neck hyperextended, sleeping on knees and hands)
Be sure you get as much information on all symptoms as you can since there are many other conditions that could cause these symptoms as well.
Risk Factors for OSA
OSA is more likely in patients who are obese or overweight, have a large or thick neck, or whose throat, nose, and mouth airways are small. Patients are also more likely to develop OSA if they have extra tissue in the back of their throat, they have enlarged tonsils, or their soft palate and uvula hang down their windpipe blocking it. A deviated septum in their nose or a bigger-than-average tongue may also block a patient's airway leading to OSA.
Other risk factors include:
- High blood pressure
- Being at risk for stroke or heart failure
If your patient has obstructive sleep apnea or shows a combination of any of the above symptoms, treatment is essential. An "Apnea Risk Evaluation Screening Test" is sometimes used to screen patients for OSA.
How is Obstructive Sleep Apnea Diagnosed?
You'll first review the patient's history and ask them or their partner about their sleep habits. Then you'll set them up for an overnight sleep test either in the sleep clinic or at their home. For an in-lab polysomnogram test, you'll place monitors on the patient that measures things like:
- Blood oxygen levels
- Eye movements
- Breathing patterns
- Muscle activity
- Heart rate
- Electrical brain activity
The polysomnogram will allow you to track how many times your patient's breathing was impaired while they slept. A home sleep apnea test evaluates breathing, but cannot determine sleep, as the parameters required to evaluate sleep are typically not recorded.
What Are the Treatment Options for Obstructive Sleep Apnea?
If your patient has a milder case of OSA, the physician may start off by recommending lifestyle changes such as:
Losing Excess Weight
Even if your patient loses a slight amount of extra weight, it can help relieve their throat constriction. In some cases, they may even go into complete remission if they get back to a healthy weight. However, if they regain the weight, it's likely their OSA will return.
Suggest they exercise regularly for about 30 minutes a day a few days a week to ease OSA symptoms. Even a brisk walk each morning will do them some good.
Avoiding Certain Substances
Avoid certain medications like sleeping pills and tranquilizers and avoiding alcohol. These substances relax the throat muscles and can interfere with your patient's breathing. Encourage them to quit smoking if they smoke since it can worsen their OSA.
Changing Sleep Position
Suggest your patient sleep on their abdomen or side instead of their back. If they sleep on their back, it could cause their soft palate and tongue to rest against the back of their throat, blocking their airway.
Using Continuous Positive Airway Pressure (CPAP)
If your patient has moderate-to-severe OSA, they might benefit from a CPAP machine, which delivers air pressure through a mask they place over their nose while they sleep. The CPAP device uses pressurized room air to keep the upper airway open, which prevents snoring and apnea.
Even though CPAP is the most reliable and common treatment for sleep apnea, some of your patients may find it uncomfortable and cumbersome. If so, you'll need to teach them how to adjust the straps to reduce tension so they'll get a secure and more comfortable fit.
They may need to experiment with different masks to find a mask that's most comfortable to them. Have them use a humidifier along with their CPAP device which can benefit them even more. The physician may have to adjust the pressure settings on their CPAP machine if they continue to snore despite the treatment or their weight changes.
Using Other Airway Pressure Devices
If your patients continue to have a problem with their CPAP machines, a bilevel positive airway pressure (BPAP) device or a device that adjusts the pressure automatically (APAP) as needed when events occur may work better and be more comfortable. Devices like these provide your patient with varied pressures when they inhale and exhale or only provide higher pressures when events occur, such as when the patient sleeps on their back.
Using Oral Appliances
Your patient may also use an oral appliance that helps keep their airway open. These are easier for some patients to use than CPAP devices; however, CPAP is considered a more effective and reliable treatment option for patients with severe OSA. Oral devices bring your patient's jaw forward to open their airway, which may relieve their snoring and treat mild to moderate OSA.
Surgery may be an option for patients who have extra tissue that is blocking the airflow through their throat or nose such as enlarged adenoids and tonsils or a deviated nasal septum, as well as for patients with craniofacial abnormalities.
- Snoring, choking, gasping or excessive daytime sleepiness are all signs of OSA.
- OSA occurs when your patient has a blocked upper airway (partially or completely).
- OSA affects more men than women and seems to occur more in patients who are overweight, sleep on their back, and are middle-aged.
- Untreated OSA can lead to heart disease, stroke, diabetes or high blood pressure.
- Treatments consist of lifestyle changes, airway pressure devices, oral devices, or surgery.
Obstructive sleep apnea is just one type of sleep disorder you'll address in your sleep technology career. Grab your must-have Sleep Technology Terms and Definitions guide to learn more about the different types of sleep disorders and to advance your career as a sleep technologist.