Sleep apnea is a common yet often underdiagnosed sleep disorder that affects millions of people worldwide. This condition, characterized by pauses in breathing during sleep, can have significant impacts on both your health and quality of life. Dr. Seth Willen, an Otolaryngologist (ENT) at Western Reserve Hospital, sat down with us to explain the causes of sleep apnea, its symptoms, diagnosis methods, and various treatment options available.

What is Sleep Apnea?

Sleep apnea is a sleep disorder where breathing repeatedly stops and starts during sleep. Dr. Willen explains, "Apnea means stopping or pausing, and what we're referring to during sleep is pauses in breathing."

There are two main types of sleep apnea:

1. Obstructive Sleep Apnea (OSA): This is the most common form. Dr. Willen describes it as follows: "In obstructive sleep apnea, there is something in the airway that is responsible for that pause in breathing. There's an attempt to breathe while you're sleeping, but if there's something in the way, then that can cause a pause in breathing."
2. Central Sleep Apnea: This less common type occurs when the brain fails to send proper signals to the muscles that control breathing.

Some individuals may experience mixed sleep apnea, which is a combination of both types.

Causes of Sleep Apnea and Risk Factors

Understanding the causes of sleep apnea and associated risk factors is crucial for both prevention and treatment. Dr. Willen outlines several anatomical factors that can contribute to obstructive sleep apnea:

1. Enlarged tonsils
2. Elongated soft palate
3. Large tongue that collapses into the airway
4. Nasal obstructions, such as a deviated septum

Other risk factors for sleep apnea include:

1. Obesity: Excess weight can lead to fat deposits around the upper airway, obstructing breathing.
2. Age: Sleep apnea risk increases as you get older.
3. Gender: Men are more likely to develop sleep apnea than women.
4. Family history: Having family members with sleep apnea increases your risk.
5. Smoking: Smokers are three times more likely to have obstructive sleep apnea.

Symptoms of Sleep Apnea

Recognizing the symptoms of sleep apnea is crucial for early diagnosis and treatment. Dr. Willen describes the most common symptoms:

"The most obvious symptom of obstructive sleep apnea would be a noticeable pause in breathing. For the patient, what you experience is primarily fatigue during the day, so you wake up even after sleeping for a full night, and you don't feel rested."

Other symptoms include:

1. Loud snoring
2. Gasping or choking during sleep
3. Morning headaches
4. Difficulty concentrating
5. Mood changes or irritability
6. High blood pressure
7. Night sweats

Dr. Willen adds, "Some of the other manifestations of apnea are high blood pressure, heart issues, and arrhythmias. There's a lot of other things that you may not even be aware of, but what most people will describe is they just don't feel rested, and they really just feel tired all the time."

Sleep Apnea Diagnosis

Diagnosing sleep apnea typically involves a sleep study, which can be  conducted either at home or in a sleep lab. Dr. Willen explains the process:

"You need a sleep study in order to diagnose apnea. You can get a home sleep study, which is the easiest and most inexpensive way to do a sleep study. In-lab studies certainly are more accurate, and they can also help to determine treatment."

During a sleep study, doctors measure various factors, including:

1. Breathing patterns
2. Blood oxygen levels
3. Heart rate
4. Brain waves
5. Arm and leg movements

The severity of sleep apnea is often determined by the Apnea-Hypopnea Index (AHI), which measures the number of breathing pauses per hour of sleep. Dr. Willen breaks down the AHI scale:

"0 to 5 times per hour is considered in the normal range, 5 to 15 times per hour is considered mild obstructive sleep apnea, 15 to 30 times per hour is considered moderate, and 30 and above is considered severe."

Health Implications of Untreated Sleep Apnea

Leaving sleep apnea untreated can lead to serious health complications. Dr. Willen warns, "Over many years of having apnea, there is significantly increased stress on the cardiovascular system, which means that people may develop atrial fibrillation or other arrhythmias. They may have increased risk of heart failure and hypertension, which can lead to heart attack and stroke."

Other potential complications include:

1. Cognitive decline and increased risk of dementia
2. Type 2 diabetes
3. Liver problems
4. Complications with medications and surgery
5. Increased risk of motor vehicle accidents due to daytime sleepiness

Treatment Options for Sleep Apnea

There are several treatment options available for sleep apnea, depending on the severity and underlying causes:

• Continuous Positive Airway Pressure (CPAP) Therapy: This is often the first-line treatment for moderate to severe sleep apnea. Dr. Willen explains, "CPAP or BiPAP are devices which provide a cushion of air in the airway to prevent that obstruction."

• Lifestyle Changes: For mild cases or in conjunction with other treatments, doctors may recommend:
  • Weight loss
  • Avoiding alcohol and sedatives
  • Changing sleep position
  • Quitting smoking
• Oral Appliances: Dr. Willen mentions, "There is something called the dental appliance, which can pull the jaw forward a little bit and may provide a lot of benefit for some people, especially if they have mild apnea."
• Surgery: In some cases, surgical interventions may be necessary. These can include:
  • TonsillectomySoft palate procedures
  • Tongue base reduction
  • Jaw advancement surgery
• Hypoglossal Nerve Stimulation: Dr. Willen describes a newer treatment option: "Hypoglossal nerve stimulator therapy, like the Inspire device, has a sensor in the chest that senses when an attempt to breathe is made, and it sends a little signal up to the nerve that controls the tongue, gently stimulating it to move the tongue out of the way."

Living with Sleep Apnea

Adapting to life with sleep apnea, especially when using CPAP therapy, can be challenging. Dr. Willen advises, "Be patient because it is not always so natural to put a device on your face that covers your nose and/or mouth that is on you the entire night. People take time to adjust to using that."

He adds, "Some people, after a few months, start to find that they can't sleep without it. There's people that use it for years, and they decide that they can't use it anymore. But it requires patience."

When to Seek Help

If you suspect you might have sleep apnea, it's crucial to seek medical attention.  Dr. Willen recommends, "If you have symptoms like daytime fatigue, loud snoring, or observed pauses in breathing during sleep, you should discuss these with your primary care physician. They may refer you to a sleep specialist or an otolaryngologist for further evaluation."

Restoring Your Health Through Better Sleep: Taking the Next Steps to Address Sleep Apnea

Sleep apnea is a serious sleep disorder that, left untreated, can significantly impact your health and quality of life. However, with proper diagnosis and treatment, most people with sleep apnea can manage their condition effectively. Dr. Willen emphasizes, "It's important to address sleep apnea concerns early. With the range of treatment options available today, from CPAP to newer therapies like hypoglossal nerve stimulation, we can help most patients achieve better sleep and improved overall health."

If you're experiencing symptoms of sleep apnea or have concerns about your sleep quality, don't hesitate to reach out to a healthcare professional. Remember, good sleep is crucial for good health, and addressing sleep apnea is an important step towards achieving both.