What Is Sleep Apnea? (Obstructive and Central)
If your patient comes to you reporting poor quality of sleep, there's a good chance they may be suffering from sleep apnea. A few sleep study tests can usually help provide a diagnosis.
What is Sleep Apnea?
Sleep apnea is a sleep disorder that's serious and occurs when your patient experiences an interruption in their breathing while they're sleeping. In some cases, this can occur hundreds of times each night. If left untreated, their sleep apnea can cause them to stop breathing repeatedly while they sleep . And, when this happens, your patient's body and brain aren't getting enough oxygen.
Pauses in breathing could last anywhere from several seconds to minutes. These pauses may even occur 30 or more times in an hour. After these pauses, regular breathing then begins again, sometimes with a snort or loud choking sound.
When your patient's breathing becomes shallow or pauses, they'll arouse briefly, which disrupts their sleep. Because of this, their sleep quality tends to be poor, making them tired throughout the day. Also, sleep apnea often leads to excessive daytime sleepiness, particularly when their condition is chronic.
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What Are the Different Types of Sleep Apnea?
Obstructive Sleep Apnea (OSA) and Central Sleep Apnea (CSA) are the two primary forms of sleep apnea.
Obstructive Sleep Apnea (OSA)
OSA occurs when your patient's upper airway becomes blocked either partially or completely while they're sleeping. The obstruction causes their diaphragm and chest muscles to work harder to open the airway up and draw air into their lungs.
General and behavioral measures your patient can take to help their apnea are:
- losing weight
- avoiding alcohol for four to six hours before bedtime
- sleeping on their side
Because obesity is a substantial risk factor for OSA, your patient may reduce their risk of OSA by losing weight. Data shows patients can experience a 26 percent respiratory disturbance index (RDI) reduction simply by losing 10 percent of their weight.
Benefits your OSA patient may experience by losing weight include:
- Lowered blood pressure
- Improved pulmonary function
- Improved sleep
- Reduced snoring
- Decreased RDI
- Improved arterial blood gas values
- Possible reduction of CPAP therapy pressure
If your patient gains or regains lost weight, it can lead to OSA relapse. But, while being able to lose and maintain the weight is often difficult, your patients will benefit greatly from doing so.
OSA treatment depends on the severity of your patient's OSA. If it's mild, they have several treatment options available to them. If they have a more moderate-to-severe case of apnea, they'll require CPAP or another form or treatment.
Central Sleep Apnea (CSA)
With CSA, your patient has a loss of respiratory effort. While sleeping, your patient's brain function disrupts their breathing regularly. They can breathe, but instead, their brain isn't telling their muscles to breathe.
Often, a patient's CSA is linked to a dysfunction that affects the lower part of their brain stem controlling breathing.
What Causes Sleep Apnea / Who’s At Risk for Sleep Apnea?
Anyone at any age can get sleep apnea, even children. There are many potential causes of sleep apnea, but common risks include:
- Being overweight
- Being male
- Being older than 40 years old
- Having a large tongue, large tonsils, or a small jaw
- Having a large-sized neck that's 16 to 17 inches or greater
- Having GERD (gastroesophageal reflux)
- Having a history of sleep apnea in the family
- Having a nasal obstruction caused by allergies, deviated septum, or sinus problems
With children, usually enlarged tonsils or adenoids are the cause of their OSA. Dental problems, like a large overbite, are also a common cause.
What Are the Symptoms of Sleep Apnea?
A common sign of sleep apnea is chronic and loud snoring. While snoring, your patient's breathing may pause, with gasping or choking following. Their snoring is louder when they sleep on their back and may get quieter when they turn over on their side. They may not snore every night, but their snoring can get louder or occur more often over time.
Your patient is sleeping when their snoring occurs. They will likely not even realize they're having breathing issues and won't be able to tell you how severe their breathing issues are. A bed partner will often be the person who notices the issue.
Another common sleep apnea symptom is your patient trying to fight sleepiness in the daytime. They may struggle to stay awake while driving or at work. During quiet moments during the day, they may find themselves falling asleep quickly when they're not active.
Common symptoms of sleep apnea may include:
- Loud snoring
- Sore or dry throat
- Waking up abruptly choking or gasping
- Restless sleep
- Morning headaches
- Learning or memory problems or inability to concentrate
- Mood changes
- Feeling depressed or irritable
- Waking up to urinate frequently
- Having personality changes or mood changes
Children with sleep apnea may be hyperactive, angry, hostile, or perform poorly in school. They may breathe through their mouths during the day rather than through their noses.
Sleep apnea can contribute to or worsen other health issues if left untreated, including:
- High blood pressure
- Irregular heartbeats, heart failure, and heart attacks
- Worsening of ADHD in children
Additionally, sleep apnea can lead to poor performance in day-to-day activities, if left untreated. It can lead to motor vehicle crashes, low productivity in school or work, or academic underachievement in kids.
How is Sleep Apnea Diagnosed?
In many cases, sleep apnea isn’t diagnosed. Physicians typically don't detect sleep apnea during the patient's regular office visit. You also can't diagnose sleep apnea with a blood test. Most individuals who have the condition don't even know it since it occurs while they're sleeping.
Patients who suspect they have sleep apnea should come into the sleep center for a polysomnogram (sleep study).
The sleep study records your patient’s physical activity while they're sleeping and records the data electronically. A qualified sleep professional analyzes the data to make a diagnosis of sleep apnea or another sleep disorder.
When your patient comes into the sleep laboratory to have the test done, you'll provide them with a private, assigned bedroom where they can be monitored while they're sleeping.
The patient will be hooked up to special equipment that typically doesn't affect their sleep. If they have a less complicated sleep apnea case, they may even be tested at home using home portable equipment.During the polysomnogram, you'll measure various parameters such as:
- EEG (electroencephalogram) that measures and records your patient's brain wave activity
- EMG (electromyogram) that records your patient's muscle activity like their chin muscle tone, teeth grinding and leg movements
- ECG (electrocardiogram) where the patient's heart rhythm and rate will be recorded
- EOG (electro-oculogram) where you record their eye movements, which are essential in determining their different stages of sleep; particularly their REM stage
- Snore microphone where the patient's snoring activity will be recorded
- Nasal airflow sensor where you'll record their airflow
- Respiratory effort sensors where you'll record beathing movements
What Are the Treatment Options for Sleep Apnea?
Treatments for sleep apnea may include lifestyle changes, CPAP, oral appliances, and surgery. There are currently no medications that treat sleep apnea.
Some lifestyle changes include:
- Avoiding alcohol
- Losing weight
- Quitting smoking
- Changing sleep positions (avoiding sleeping on their back)
Treatments may include:
With a CPAP device, you fit a mask over your patient's nose or over their nose and mouth. The device blows air gently into their airway, which stays open while they're sleeping due to the air pressure generated by the machine.
Dental devices (oral appliance therapy)
The dentist custom fits an oral appliance for your patient to keep their airway open.
The surgery your patient receives will depend on what's causing their sleep apnea. Surgeons perform surgery to widen their breathing passages. Typically this involves stiffening, shrinking, or removing extra tissue in their throat and mouth. In some cases, the surgeon repositions their lower jaw. Surgery may include:
- UPPP (Uvulopalatopharyngoplasty)
- Nasal surgery
- Mandibular maxillary advancement surgery
There are other surgical procedures that are minimally invasive that stiffen and reduce soft palate tissue to open the airway. Although effective for treating snoring, the long-term effectiveness of these procedures for sleep apnea isn't known.
- Poor quality of sleep could indicate sleep apnea
- Sleep apnea is interruptions in your patient's breathing while they're sleeping
- The primary forms of sleep apnea are OSA and CSA
- Anyone at any age can get sleep apnea
- Common symptoms of sleep apnea are loud snoring and daytime sleepiness
Knowing how a physician diagnoses and treats sleep apnea is a part of your job as a sleep technologist. But, it's only one part of it. For those who are looking to advance their sleep technology career, download this free "Sleep Technology Terms and Definitions" eBook offered to you by the American Association of Sleep Technologists.