Obstructive Sleep Apnea Explained

Do you snore? Do you snore loudly? Do you find yourself waking up feeling groggy or feeling tired all day, even though you know good and well that you had a good night's sleep? Does your loved one say that you often wake up in the middle of the night choking or gasping for air? If so, you may have obstructive sleep apnea.  Now, sleep apnea is not just about snoring and it's actually not funny. It is a very serious disease because it can lead to things like high blood pressure and abnormal heart rhythms like atrial fibrillation. It can even lead to heart attacks. This is obstructive sleep apnea explained.

Obstructive Sleep Apnea Explained

What is Obstructive Sleep Apnea?

Sleep apnea is when you stop breathing for periods of time while you are sleeping. Apnea means the absence of flow, the absence of airflow. So when we breathe, air normally flows through your nose, your mouth, through the back of your throat, or your pharynx, down through your windpipe, or the trachea, and into the lungs. We all have muscles around our throats or our pharynx. These muscles help us to speak. They help us to swallow and when we sleep, it's natural for these muscles to relax some.

But if these muscles relax too much or if they're compressed, it can cause a narrowing of the airway. Now if you get this narrowing of the airway, it can cause you to make a sound as you breathe or to snore or to snort. But if this airway is compressed all the way while you sleep, if it is blocked or obstructed, it causes you to stop breathing for periods of time. And this is the obstructive sleep apnea. So the classic scenario is a person who's snoring, they're snoring louder and louder, and then all of a sudden there's no noise. They're not making any sound because at that point they're not breathing. Their airway is obstructed. After this period of silence or no flow, they may gasp or snort or choke, and that's when the airway is opening again and they're trying to catch up on these breaths, trying to get the oxygenation going again. This is a classic presentation for obstructive sleep apnea.

Now, a lot of times the people who snore, even though it's very loud and everyone in the house knows that they snore, a lot of times they don't even know that they snore, and if they fall right back asleep after these gasping episodes, they won't even recall that these episodes are happening. So when people have obstructive sleep apnea, it's oftentimes a surprise to them, unless they have loved ones or bed partners who have told them.


What Are the Symptoms of Obstructive Sleep Apnea?

One is symptom is loud snoring. You also can have daytime somnolence, or being very, very tired during the day, even though you've had a large quantity of sleep. You may fall asleep easily, which is what puts people with obstructive sleep apnea at risk for accidents like motor vehicle accidents. And if you have sleep apnea, you may also wake up with a dry mouth or a sore throat. You may get morning headaches or be very groggy throughout the day. You can also have low energy.


Types Of Sleep Apnea

Now there are two types of sleep apnea. The obstructive sleep apnea, which I just described, there's also something called central sleep apnea. And central sleep apnea is when the message from the brain is not being delivered properly to the muscles to tell yourself to breathe. But obstructive sleep apnea is the one that is more common and the one that we're usually talking about when we say sleep apnea.


What Are the Risk Factors for Obstructive Sleep Apnea?

A family history of sleep apnea is a risk factor. Also, if there's something that's different about the anatomy, if you're a person with a very small mouth or narrow airway, especially if you have a relatively large tongue, that can put you at risk for obstructive sleep apnea. Obesity is also a very big risk factor for sleep apnea. Being obese or overweight, especially if you have a thick or a wide neck. If your neck is greater than 17 inches in circumference if you are a man, or if it's greater than 16 inches if you are a lady, that puts you at a higher risk for obstructive sleep apnea. If you are a heavy alcohol drinker or if you take any type of a sedating substance, especially close to bedtime, that could put you at risk because the airway muscles may really relax and it may be more difficult for you to arise or awaken during an apneic episode.

Obstructive sleep apnea is more common in men than women, but women can definitely get sleep apnea as well. Postmenopausal women are at a higher risk. And having increased age, being elderly, is also an independent risk factor of sleep apnea, but children can get sleep apnea as well. Especially children with large tonsils.


Consequences Sleep Apnea

Well, one is that daytime somnolence, that being sleepy, because if you are not getting good rest and you're sleepy all the time, you're at risk of falling asleep in the middle of important activities, such as driving. Some studies have shown that patients with obstructive sleep apnea get into more motor vehicle accidents than patients who do not have sleep apnea. So it is serious. Other risk factors include cognition. If you are blocking your airway and you're not getting proper oxygenation and you're sleepy, well then this could affect your concentration and your cognition. It can make you forgetful. You are also at a higher risk of having a stroke if you have sleep apnea. You're at a higher risk of having a myocardial infarction, or a heart attack, and you are at risk for having abnormal heart rhythms, arrhythmias like atrial fibrillation. You're also at risk for something called pulmonary hypertension. So there are some very real physical consequences to having obstructive sleep apnea.


Sleep Apnea Diagnosis

See everyone who snores does not have sleep apnea. If you snore a little bit, if you make some sounds, that doesn't necessarily mean that you have sleep apnea. Now, if you are one of those people and your loved ones have told you that you stop breathing frequently in the night, then, yes, you very likely do have sleep apnea, but you should get a professional diagnosis. There are physicians who specialize in sleep medicine and you can actually have a sleep study done, something in the lab called polysomnography and that's when you get your most accurate diagnosis of sleep apnea. But there are also some things called HST or a home sleep test where you can be tested at home to see if you have sleep apnea. The gold standard though is the in-lab test, the polysomnography.


Man with obstructive sleep apnea treatment CPAP


Obstructive Sleep Apnea Treatment

There are treatments, there are some lifestyle adjustments. If you are obese and if this obesity is causing you to have a very thick neck, then weight loss is definitely something that can help the obstructive sleep apnea. But people with skinny necks can have sleep apnea as well. So in some cases, there are devices that can be worn, but the most effective treatment is a CPAP or continuous positive airway pressure. And that's pretty tricky and they have different devices trying to make it a little less bothersome, but it's when you literally wear a device or mask on your face or on your nose and it helps to keep that airway open even while you sleep so you don't get the obstruction, you don't get the blockage and you get good oxygenation all through the night. So definitely being properly diagnosed so that you can be treated is very important.


Obstructive Sleep Apnea Explained, Conclusion

This concludes my overview of obstructive sleep apnea explained.  If you do believe that you or a loved one has obstructive sleep apnea, remember again, it's not a funny thing. It's not just, "Ha, ha, ha, that person's snoring." It's real. It's a real disease with real consequences.


Dr. Frita - Frita McRae Fisher, M.D.
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