The list of basic human needs is not excessive – food, water, shelter, clothing, and good Wi-Fi. In addition to these, however, don’t forget another primitive human function that is essential for survival – sleep. In our modern world, there can be quite a few hindrances to good sleep (one of these being Wi-Fi and the dark rabbit holes of YouTube, Instagram, and TikTok). There are also a number of medically-recognized sleep disorders that can get in the way of getting enough ZZZs every night. In the top four key sleep disorders listed by the CDC (Centers for Disease Control and Prevention), is sleep apnea.
Sleep Apnea Is More Than Snoring
When thinking of sleep apnea, many people may immediately think of snoring. While snoring can be a symptom of sleep apnea, it’s not the only problem that comes with this sleep disorder. Sleep apnea is a serious medical condition where a person is unable to regulate their breathing throughout the night. Instead, their breathing stops and starts, resulting in periods of time where no fresh oxygen is getting into the body. Because your body needs oxygen, the brain then rouses you from sleep to kickstart your breathing again. While this gets you a lungful of air, it can also prevent you from reaching those deep, restful stages of sleep.
Other than an annoyed partner who isn’t getting any sleep because of your snoring and snorting, the potential complications of sleep apnea can include:
· Severe drowsiness, fatigue, and irritability during the day. This heavy brain fog due to sleep deprivation can impact your ability to perform at work, operate a motor vehicle safely, or concentrate at school.
· Increased insulin resistance and type 2 diabetes. Insulin is a hormone produced by the body to manage the absorption of glucose digested from food and drink from the bloodstream into the muscles. Diabetes is a disease that comes with a whole list of its own complications.
· Cardiovascular disease, including hypertension (high blood pressure), heart attacks, abnormal heartbeat, and stroke.
· Increased risk of complications during medical procedures. Sedation during a surgical procedure can place a person with sleep apnea at a greater likelihood of complications due to the pre-existing breathing problems.
· Metabolic syndrome. This is a condition involving hypertension, elevated triglyceride levels with low HDL cholesterol levels, wide waist circumferences (abdominal obesity), and high blood sugars. All together, this group of disorders increases your risk of diabetes, heart disease, and stroke.
The Types of Sleep Apnea
Many diseases rely on accurate identification of the subcategory of the condition for effective treatment. When it comes to sleep apnea, doctors have divided it into three types:
· Obstructive sleep apnea. This is the most common type of sleep apnea, accounting for around 84% of sleep apnea cases.
· Central sleep apnea. This makes up only 0.4% of sleep apnea cases.
· Complex sleep apnea. This type accounts for around 15% of sleep apnea cases.
So, what’s the difference between the three?
Obstructive Sleep Apnea
This type of sleep apnea occurs when the muscles around the back of your throat relax and collapse when you sleep. This results in your airway narrowing or closing completely, preventing you from taking another breath in. Eventually the brain realizes you’re not getting enough oxygen and so briefly wakes you from sleep to get your breathing going again. However, this obstruction of your airway can happen many times during the night, meaning your brain needs to keep rousing you.
Loud snoring is a common symptom of obstructive sleep apnea, but your partner (or anyone else within earshot of your bedroom) may also report a gasp or snort during your sleep. You may find you wake with a dry mouth in the mornings, or with a headache.
There are several known factors that can increase your risk of developing obstructive sleep apnea. These include:
· Obesity and being overweight. Excess fat around the upper airway makes it more likely to become obstructed.
· A thicker neck circumference. For men, the risk increases past 17 inches and for women, 16 inches.
· Male gender. Men are up to three times more likely than women to have obstructive sleep apnea.
· Older age. Sleep apnea can affect anyone of any age, even children, but is more likely in those over the age of 50.
· Genetics. Having a family history of sleep apnea may make you more likely to experience it too.
· Smoking. Smoking can increase your risk up to three times more compared to someone who has never puffed a cigarette.
· Nasal congestion. If you have a pre-existing issue with getting air in, you may be at a greater risk of developing obstructive sleep apnea. Nasal congestion can come from anatomical abnormalities or allergy.
· There are a number of other medical conditions that have been associated with an increased risk of obstructive sleep apnea. These include Parkinson’s disease, type 2 diabetes, congestive heart failure, hypertension, polycystic ovarian syndrome, and asthma.
To treat obstructive sleep apnea, we need to keep the upper airways open as you sleep. For some, this can be achieved by simply sleeping on your side instead of your back. Managing your risk factors where possible is also useful, such as losing weight, quitting smoking, or controlling your allergies. Depending on your severity of sleep apnea, your doctor may recommend a CPAP machine (continuous positive airway pressure), oral appliances, or even surgery.
Central Sleep Apnea
Central sleep apnea refers to a type of sleep apnea where the brain fails to continue sending signals to the body to keep breathing during sleep. Unlike obstructive sleep apnea, which involves a physical obstruction to the airways, central sleep apnea is a neurological condition. It’s much less common than obstructive sleep apnea, and is more likely to be found in people with neuromuscular disease, such as a stroke or ALS (amyotrophic lateral sclerosis). Those with heart failure, kidney, or lung disease may also be at a greater likelihood of central sleep apnea.
Some of the known risk factors for central sleep apnea are similar to those for the obstructive type. They include:
· Older age
· Male gender
· Having congestive heart failure
· Sleeping at high altitudes
· Certain drugs or medications, such as opiates like methadone
· Idiopathic – this is the medical term for “no known reason”
Managing the underlying condition of central sleep apnea can help to resolve the sleep disorder side of things, but not always. Your doctor may also suggest a CPAP machine, though some people may need a more specialized form of oxygen delivery. These therapies include adaptive servo ventilation, which is a machine that continuously monitors the patient’s breathing to deliver a customized degree of air pressure. Supplementing oxygen intake by pumping extra oxygen into the airways may also help to reduce sleep apnea.
Complex Sleep Apnea
You were promised three types of sleep apnea, so here is the third one. Basically, complex sleep apnea is a combination of obstructive and central sleep apnea. The symptoms are essentially the same as those of obstructive sleep apnea, but the condition fails to resolve with conventional obstructive sleep apnea therapies.
As anticipated, the treatment for complex sleep apnea is a mix of those for obstructive and central sleep apnea. Your ENT doctor will investigate any underlying causes as well as perform a physical examination and thorough history-taking to identify which management strategy would be most effective for you.
Remember, sleep apnea is much more than snoring. If you think you’re experiencing any sleep apnea symptoms, it’s important not to ignore them. As you’ve learned, leaving this sleep disorder untreated can lead to a number of undesirable complications. Speak to your family physician or ENT doctor if you suspect you have sleep apnea.