Sleep apnea is a condition that temporarily stops or impairs breathing during sleep. Obstructive sleep apnea is due to throat muscles relaxing and narrowing or blocking the airways. Central apnea occurs when the brain doesn't correctly control breathing, which may be due to living at high altitude, heart failure, brainstem strokes, or opioids.
The subsequent lack of oxygen usually activates a survival reflex that wakes people up just enough to start breathing again. This cycle can occur several times an hour throughout the night. The result is disrupted and restless sleep, which can affect how people feel and function during the day. The condition also has been linked to health problems such as dementia, stroke, diabetes, heart disease, and increased risk of earlier death.
Obstructive sleep apnea is more common in men, and in women after menopause. About 39 million Americans (including children) have the condition, but only about 6 million are currently being treated. Being overweight increases the risk of obstructive sleep apnea—excess fat in the throat can block airways—and losing weight can reverse it.
Symptoms include snoring, waking up repeatedly during the night, and pauses in breathing or unusual patterns such as fast breathing while sleeping that gets deeper, then shallower again. Other symptoms are insomnia, night sweats, restlessness, waking up feeling short of breath or choking, being tired or exhausted after a full night's sleep, mood changes such as depression and anxiety, memory loss, difficulty concentrating, sexual dysfunction, and headaches, especially upon waking.
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In children, sleep apnea may manifest as hyperactivity, poor performance in school, bed-wetting, and frequent arm or leg movements while asleep.
Diagnosing the condition can involve a thorough exam, a sleep study, and a referral to a sleep specialist. Until recently, it often involved an overnight stay in a sleep laboratory where technicians placed small sensors on the head and body. The sensors and other devices monitored breathing and oxygen levels and differentiated the stages of sleep. For the last few years, at-home sleep studies have been used. Patients receive a kit, approved by the U.S. Food and Drug Administration (FDA), that includes easy-to-attach sensors, a finger clip that measures oxygen levels, and an airflow sensor that fits into the nostrils. The data from the devices are downloaded and interpreted by health care providers.
Treatment for sleep apnea depends on its type and severity. If it's mild, patients may be encouraged to exercise more often, stick to a regular sleep schedule, maintain a healthy weight, treat nasal congestion, limit alcohol and caffeine, quit smoking, and start sleeping on their sides to keep airways open.
If symptoms persist or are more severe, patients may be prescribed a continuous positive airway pressure (CPAP) machine. The device provides constant air pressure throughout the upper airways to keep them open and help patients breathe while they sleep.
For those who can't or don't want to use a CPAP machine, doctors may recommend oral appliances that are custom-fitted by dentists and placed in the mouth to open airways during sleep. Another option is upper airway stimulation therapy, which opens airways by moving the tongue forward so it doesn't block breathing passages. The FDA-approved, surgically implanted device includes a progammable neurostimulator, a lead that detects changes in breathing, and another lead that stimulates the tongue muscles. Once the device and leads are implanted, the stimulation can be controlled remotely by users.
For about 50 percent of obese patients, sleep apnea can be cured with significant weight loss either through bariatric surgery or by taking newer weight loss medications. Surgery to remove tonsils and adenoids may eliminate sleep apnea in children. For some patients, especially those with facial anomalies, reconstructive surgery may help. In cases of central sleep apnea, reducing the use of opioids and treating conditions like heart failure and Chiari malformations (caused when the lower part of the brain presses on and through the opening in the base of the skull and cerebellum into the spinal canal) may resolve symptoms.
Dr. Johnson is professor of neurology at UMass Chan Medical School–Baystate and medical director of the Baystate HealthRegional Sleep Program in Springfield, MA.
