Type of sleep apnea

Obstructive vs. Central Sleep Apnea: Key Differences and Treatment Options

Sleep apnea is a common sleep disorder that affects thousands of individuals. With this condition, you have an interruption in your breathing while sleeping that occurs through repetitive pauses, referred to as apneic events. There are several types of sleep apnea, but two prominent types include obstructive sleep apnea (most common) and central sleep apnea.

As a sleep technologist, it’s important for you to know the key differences between central and obstructive apnea so you know how to best treat your patients who may have one or the other disorder.

Discover the essential steps to defining, scoring, and treating central hypopneas.

1. Obstructive Sleep Apnea

What is it?

Obstructive Sleep Apnea (OSA) is where your upper airway gets partially or completely blocked while you sleep. This obstruction causes your chest muscles and diaphragm to work harder to open up the blocked airway and draw air into your lungs.

Behavioral and general measures, such as avoiding alcohol for four to six hours before bedtime, weight loss, and sleeping on your side instead of your back or stomach are components of conservative nonsurgical treatment.

Both positional therapy and weight loss were rated as “guidelines” in a 2006 practice parameter, indicating a strategy for patient care with a significant degree of evidence.

Since obesity is a significant predictive aspect for OSA, when you lose weight, you reduce your risk of obstructive sleep apnea. In fact, according to some data, you reduce your respiratory disturbance index (RDI) by 26 percent when you have a 10 percent reduction in weight.

There are other benefits of weight loss in patients with sleep disordered breathing (SDB), including:

  • Lowered blood pressure
  • Decreased RDI
  • Improved snoring and sleep structure
  • Improved arterial blood gas values and pulmonary function
  • Potential reduction of required optimum continuous positive airway pressure (CPAP) pressure

Weight gain is a prominent source of OSA relapse after surgical treatment. Even though accomplishing and maintaining weight reduction are often tough, the results are very beneficial when you’re able to do so. The SBD treatment approach isn’t complete if you don’t have your obesity addressed with weight reduction.

Treatment depends on how severe your apnea is. If you have a mild apnea, you have a number of options available to you, while if your apnea is moderate-to-severe, it requires treatment with CPAP.

2. Central Sleep Apnea

With central sleep apnea (CSA), cessation of respiratory drive results in a lack of respiratory movements. During sleep, your breathing is disrupted regularly because of how your brain functions. It’s not that you’re not able to breathe (like when you have OSA), but rather your brain doesn’t tell your muscles to breathe, and therefore, you don’t try to breathe.

CSA is typically associated with severe illness, particularly an illness where your lower brain stem, which is what controls your breathing, is affected. With newborns, CSA produces up to 20-second pauses in breathing.

Hypopneas – Obstructive and Central

As a sleep technologist, you may be very familiar with central apneas, obstructive apneas, and mixed apneas. You may know the proper way of identifying and breaking hypopneas apart into what is recognized by Medicare as the criteria or definition for a hypopnea as well as how other entities recognize them.

But, as of late, the biggest questions seem to be focused on what the difference between central hypopnea and obstructive hypopnea is and why you should know the difference.

Hypopneas aren’t necessarily apneas, where you stop breathing completely. They’re reductions in your respiratory effort and airflow but without full breath cessation. This means your lungs are still getting some air. So, hypopneas are these reductions.

Obstructive Hypopneas

You can think of obstructive hypopneas as if you’re covering a vacuum cleaner’s suction nozzle with your hand.

Central Hypopneas

With central hypopneas, however, it’s more like you’re using less electricity to run the vacuum cleaner. In both cases, although you’re getting some air through, it’s not enough to do its job properly. Central hypopneas are typically characterized by a reduction in blood oxygen. When you suffer from sleep apnea, you often have hypopneas, and when they happen on their own, it typically means you’re developing sleep apnea.

How to Recognize Which One It Is

So how can you tell the difference between obstructive and central hypopneas?

It’s an obstructive hypopnea if you experience:

  • An increase in PAP flow signal or the flattening of nasal pressure flow
  • Snoring during the event
  • Paradoxical breathing

It’s only central hypopnea if you’re experiencing none of the above.

How to Properly Score Each Type of Apnea

The distinction between central and obstructive hypopneas got lost somewhere along the line, and labs started to score and report them as a single entity. This has changed.

The goal of a sleep professional is to treat your patients and ensure their breathing patterns are stabilized. For you to do this, you have to have the proper equipment. Where CPAP works well for obstructive apneas and hypopnea events, other treatment modalities work better for most central events. Central apnea episodes are typically better controlled with either Bi-level pressure support or additional backup support through a Bi-level ST.

But, central hypopneas aren’t always controlled by any of these devices. For a more complex case of central hypopnea, you’ll have to give your patients Adaptive Servo Ventilation (ASV) which is a more advanced therapy.

If you don’t know the difference between central and obstructive hypopneas, you’ll find it difficult to determine which device is best suited for the job.

Your patients that have complex breathing patterns might not have central apneas but may have central hypopneas involved in the waxing and waning pattern of breathing. When you don’t have enough documentation on central events, it can be difficult to obtain insurance coverage.

When you score and report central and obstructive hypopneas separately instead of together, you’ll get the documentation you require to show that the device you use is best for your patient’s needs. With some observation and practice, you’ll be able to distinguish between the two and determine which pressure and device modality are correct for your patient. You can find information on how to score each type of apnea correctly by reading this blog.

Treatment Options

CPAP

CPAP, or Continuous Positive Airway Pressure is a treatment technique for your patients who have sleep apnea. The CPAP devices keep your patient’s airways open using mild air pressure and are used by patients who have problems breathing while they sleep. CPAP therapy, more specifically, helps to ensure that your patient’s airway doesn’t collapse when they breathe while sleeping.

CPAP therapy uses a CPAP device that includes:

  • A mask that covers your patient’s mouth and nose, a mask that only covers their nose, or prongs you fit into their nose.
  • A tube connecting the mask to the CPAP device’s motor.
  • A motor for blowing air into the tube.

CPAP therapy is a highly recommended treatment option for your patients who have OSA when they’re not getting enough air in their lungs. It’s also used for treating newborns whose lungs haven’t developed completely. This machine blows air into the newborn’s nose, inflating their lungs.

Oral appliances are recommended for patients who have mild to moderate OSA.

BPAP

This therapy is best for OSA. BPAP (also BiPAPTM) refers to Bilevel Positive Airway Pressure and the device functions similar to a CPAP device.

Both the CPAP and BPAP devices are similar in their design and function as both are noninvasive types of therapy for patients with sleep apnea. BPAP treatments, like CPAP treatments, are created to keep your patient’s airway from collapsing and allows them to breathe regularly and easily while they sleep.

The biggest difference between CPAP and BPAP machines is that the BPAP machines have the two pressure settings: a lower pressure for exhalation, or EPAP, and one pressure for inhalation, or IPAP.

The BPAP device is made to increase the pressure when your patients inhale so their airways in their throat and nose don’t close while they sleep. It provides EPAP that keeps the airway open. Your patients may find the BPAP device more comfortable than the CPAP devices.

BPAP may be used as well for your patients who need assistance breathing. This machine can also be prescribed for your patients who are suffering from congestive heart failure and other severe illness that affects their lungs and heart.

Patients who have muscle and nerve problems may benefit more from the BPAP device instead of the CPAP device. You can set BPAP devices to ensure your patients breathe a certain number of times each minute.

The CPAP device is typically used for your patients with mild to moderate sleep apnea, however, depending on how severe their sleep apnea is, you may want to use the BPAP device instead.

ASV

Adaptive Servo Ventilation (ASV) is a ventilatory treatment option that’s non-invasive and made specifically for patients (adults) who have OSA and central sleep apnea. It’s good for complex sleep apnea as well. It’s a newer PAP unit that continuously monitors your patient’s breathing issue. It’s also the best option for central apnea.

There are similarities between ASV and CPAP therapy, but substantial differences. You adjust the pressure target of ASV to your patient’s input, meaning the target value isn’t fixed but instead adapts to the breathing patterns of your patient. Since the device adjusts itself continuously to meet the needs of your patient, your patients experience less discomfort and the pressure subtly changes in a way that keeps them feeling comfortable.

When abnormalities in breathing are detected by the ASV machine, it intervenes to maintain your patient’s breathing at 90 percent of what was normal for your patient prior to their sudden breathing change. Once your patient’s breathing issue ends, the device adjusts itself again to the normalcy.

Then when your patient’s breathing is stable, the device puts out just enough pressure support to give an approximate 50 percent reduction in the patient’s efforts to breathe, making the device comfortable for the patient.

Phrenic Nerve Stimulation

Phrenic Nerve Stimulation (brand name remedē®, www.respicardia.com ) is an FDA-approved, implantable, non-mask therapy for moderate to severe central sleep apnea in adult patients. The device activates automatically each night to send signals to the breathing muscle (diaphragm) via the phrenic nerve to restore a normal breathing pattern. It monitors respiratory signals while you sleep and helps restore normal breathing patterns. Because the device is implantable and activates automatically, it does not require wearing a mask; however, as with any implantable device procedure, there is a risk of implant site infection.

Key Takeaways

  • Two main types of sleep apnea include obstructive sleep apnea (most common) and central sleep apnea.
  • OSA is where your upper airway gets partially or completely blocked while you sleep.
  • Central sleep apnea (CSA), cessation of respiratory drive results in a lack of respiratory movements.
  • Treatment options include CPAP, BPAP, ASV, and Phrenic Nerve Stimulation.
  • Hypopneas aren’t necessarily apneas where you stop breathing completely. They’re reductions in your respiratory effort and airflow, but without full breath cessation.

To learn more about telling the difference between obstructive and central apneas, diagnosing them, and treating them properly, you can watch this video titled “Are We Ready to Define Central Hypopneas?”

Types of sleep apnoea

There are three main types of sleep apnoea:

  • Obstructive Sleep Apnoea (OSA)
  • Central Sleep Apnoea (CSA)
  • Mixed sleep apnoea

Obstructive Sleep Apnoea (OSA)

Obstructive sleep apnoea is the most common type of sleep apnoea, making up 84% of sleep apnoea diagnoses.1

In most cases of obstructive sleep apnoea, air stops flowing to the lungs because of a blockage (or obstruction) in the upper airway-that is, in the nose or throat.

The upper airway could become blocked due to:

  • The muscles relaxing too much during sleep, which blocks sufficient air from getting through*
  • The weight of your neck narrowing the airway
  • Inflamed tonsils, or other temporary reasons
  • Structural reasons, like the shape of the nose, neck or jaw

Read more about Obstructive sleep apnoea

Central Sleep Apnoea (CSA)

Central Sleep Apnoea (CSA) is rare in general,1 and can be caused by certain drug therapies used in pain management, such as opioids, as well as heart failure, or a disease or injury involving the brain, such as:

  • Stroke
  • Brain tumor
  • Viral brain infection
  • Chronic respiratory disease

In cases of CSA the airway is actually open but air stops flowing to the lungs because no effort is made to breathe. This is basically because the communication between the brain and the body has been lost, so the automatic action of breathing stops.

Those with CSA don’t often snore, so the condition sometimes goes unnoticed.

Noticeably, in case of heart failure, CSA is very frequent, with up to 1 patient over 4 being affected.2 CSA also has a specific pattern in Heart Failure, known as Cheyne-Stokes Respiration (CSR).

People with CSR have an abnormal, cyclic pattern of breathing that alternates deeper and sometimes faster breathing with a temporary stop in breathing (apnoea).

Together, Central Sleep Apnoea and Cheyne-Stokes respiration are known as CSA-CSR, which occurs in 30 to 50% of people with heart failure.1

Read more about Central sleep apnoea

Mixed sleep apnoea

This is a combination of both OSA (where there is a blockage or obstruction in the upper airway) and CSA (where no effort is made to breathe). Your doctor can help you understand more about this if you need to.

If you have any concerns that you may have any type of sleep apnoea, please consult your doctor.

Obstructive Sleep Apnea (OSA)

There are several surgical operations available for sleep apnea. These are not usually offered unless both CPAP and oral appliances have not worked. It is important to select the right operation and an experienced surgeon is essential.

A number of other remedies have been marketed, some of which have value for selected patients while many others have been shown to be of no benefit. Your doctor will be able to advise you.

9. Other things you can do if you have sleep apnea
In many people, being overweight contributes to sleep apnea. Losing weight may help or even cure the OSA and is extremely beneficial for other health problems, including high blood pressure, diabetes, high cholesterol and joint problems.

If you are diagnosed with OSA, it is a good time to make sure that you are doing everything right to improve your sleep. Alcohol and sleeping tablets relax muscles and may worsen sleep apnea. Their use should be minimised. It is also important to make sure that you are having a regular sleep pattern and sleep as well as possible. See Good Sleep Habits.

Where can I find out more about treatment options for OSA?

Download a printable copy of this Fact Sheet.

Everything You Need to Know About the 3 Types of Sleep Apnea

Treating Mixed Sleep Apnea

Treatment options are surprisingly still in development, but most doctors today will suggest the patient use a CPAP machine at a low-pressure setting. This helps ensure the individual doesn’t cause too much stress on their system and trigger an onset of CSA. CPAP and BiPAP machines are often suggested, with the sleep clinic determining which machine is providing the greatest benefit to the patient5.

For more information on Sleep Apnea check out our article “Everything You Need to Know About Sleep Apnea and How to Treat It” a comprehensive resource, and will help you better understand the condition and find out more information.

If you believe you have the symptoms of Sleep Apnea, make sure to contact your physician for a diagnosis and medical recommendations. You should also sign up for our newsletter! Our newsletter keeps you informed about the latest developments in Sleep Apnea, and also notifies you of the latest deals and money-saving coupons.

1. American Lung Association. Obstructive Sleep Apnea (OSA) Symptoms, Causes & Risk Factors. Published on the American Lung Association’s official website. Accessed on September 27, 2018.

2. American Association of Sleep Technicians. Obstructive vs. Central Sleep Apnea: Key Differences and Treatment Options Published on the American Association of Sleep Technicians official website. Accessed on September 27, 2018.

3. Eckert, Danny J. et al. Central Sleep Apnea: Pathophysiology and Treatment. Published in the medical journal Chest in 2007. Accessed on September 27, 2018.

4. Mayo Clinic. Mayo Clinic Discovers New Type Of Sleep Apnea Published in the health news magazine Science Daily on September 4, 2006. Accessed on September 27, 2018.

5. Wang, Juan et al. Complex Sleep Apnea Syndrome Published in the medical journal “Patient Preference and Adherence” in 2013. Accessed September 27, 2018.

Daniela has researched and published over 60 articles covering topics that aim to inform and empower people living with Sleep Apnea. As an avid reader and researcher, Daniela continues to grow her knowledge about Sleep Apnea and CPAP therapy everyday with the help of coworkers, CPAP.com customers, and members of other CPAP communities online.

Obstructive Sleep Apnea

A diagnosis of sleep apnea begins with a complete history and physical examination. A history of daytime drowsiness and snoring are important clues. Your doctor will examine your head and neck to identify any physical factors that are associated with sleep apnea. Your doctor may ask you to fill out a questionnaire about daytime drowsiness, sleep habits, and quality of sleep. Tests that may be performed include:

Polysomnogram

A polysomnogram usually requires that you stay overnight in a hospital or a sleep study center. The test lasts for an entire night. While you sleep, the polysomnogram will measure the activity of different organ systems associated with sleep. It may include:

  • electroencephalogram (EEG), which measures brain waves
  • electro-oculogram (EOM), which measures eye movement
  • electromyogram (EMG), which measures muscle activity
  • electrocardiogram (EKG or ECG), which measures heart rate and rhythm
  • pulse oximetry test, which measures changes in your oxygen levels in your blood
  • arterial blood gas analysis (ABG)

EEG and EOM

During an EEG, electrodes are attached to your scalp that will monitor brain waves before, during, and after sleep. The EOM records eye movement. A small electrode is placed 1 centimeter above the outer corner of the right eye, and another is placed 1 centimeter below the outer corner of the left eye. When the eyes move away from the center, this movement is recorded.

Brain waves and eye movements tell doctors about the timing of the different phases of sleep. The phases of sleep are non-REM (non rapid eye movement) and REM (rapid eye movement). Dreaming, decreased muscle tone and movement, and paralysis occur during REM sleep.

EMG

During the EMG, two electrodes are placed on the chin: one above the jawline and the other below it. Another electrode is placed on each shin. The EMG electrodes pick up the electrical activity generated during muscle movements. Deep muscle relaxation should occur during sleep. The EMG picks up when your muscles relax and move during sleep.

EKG

A 12-lead EKG can help your doctor determine if heart disease is present. Long-standing high blood pressure can also cause changes in an EKG. Monitoring heart rate and rhythm lets doctors see if any cardiac disturbances occur during episodes of apnea.

Pulse Oximetry

In this test, a small device called a pulse oximeter is clipped onto a thin area of your body that has good blood flow, such as the fingertip or earlobe. The pulse oximeter uses a tiny emitter with red and infrared LEDs to measure how much oxygen is in your blood. The amount of oxygen in your blood, or oxygen saturation, decreases during episodes of apnea. Normally, oxygen saturation is around 95-100 percent. Your doctor will interpret your results.

Arterial Blood Gas (ABG)

In this study, a syringe is used to obtain blood from an artery. Arterial blood gas measures several factors in arterial blood, including:

  • oxygen content
  • oxygen saturation
  • partial pressure of oxygen
  • partial pressure of carbon dioxide
  • bicarbonate levels

This test will give your doctor a more detailed picture about the amount of oxygen, carbon dioxide, and the acid-base balance of your blood. It will also help your doctor know if and when you need extra oxygen.

Two Types of Sleep Apnea: Obstructive and Central

If you’re at all familiar with sleep disorders, you’ve heard the term OSA, standing for obstructive sleep apnea. In fact, OSA is often used interchangeably with “sleep apnea”. But they’re not the same thing. OSA is only a certain type of sleep apnea, which can be caused by multiple factors. This article will teach you more about the different types and causes of sleep apnea.

Two Types of Sleep Apnea

There are two main types of sleep apnea. Though they share many symptoms (like fatigue and headaches) and risk factors (like being overweight and male), they have different causes and different treatments.

Obstructive Sleep Apnea (OSA)

Obstructive Sleep Apnea is by far the more common type of sleep apnea, accounting for at least 80% of cases. It occurs when the muscles in the throat relax, causing the airway in the back of the throat to narrow or even close completely. This blocks the flow of air, making it difficult or impossible for the sleeper to breathe, which in turn causes a partial awakening and disrupted sleep.

In other words, people with OSA have a “mechanical” problem with the tissue in their mouth and throat. OSA can be treated with a simple CPAP machine, which blows pressurized air through the windpipe, keeping it open and allowing the patient to breathe normally.

Central Sleep Apnea (CSA)

A rarer, more complex version is Central Sleep Apnea, which accounts for less than 20% of cases. This occurs when the brain fails to signal the body to breathe.

Central sleep apnea is a neurological problem. Patients with this condition are physically able to breathe, except their brain is not telling them to do so. This causes carbon dioxide to build up in the body and oxygen levels to dip.

Oftentimes (but not always), CSA is associated with other serious medical conditions such as congestive heart failure, kidney failure, or neurological diseases like Parkinson’s disease.

One way to treat CSA is using adaptive servo-ventilation (ASV). This is similar to a CPAP machine, except it measures the patient’s breathing and adjusts pressure levels to his specific breathing patterns. CPAP or Bi-level machines can also be used to treat CSA.

Diagnosing the Difference Between Obstructive and Central Apnea

The two types of sleep apnea can be difficult to diagnose because their symptoms often overlap. Both conditions result in feeling very sleepy during the day, excessively loud snoring, accounts by others that they have stopped breathing while asleep, and waking with a dry or sore throat. They might also have difficulties concentrating and may have insomnia. On top of that it is also possible to have OSA and CSA at the same time!

One thing is clear: if you have the symptoms of either type of sleep apnea, it is very important to be tested for a sleep disorder. Sleep apnea is associated with heart problems, complications with medication and surgery, liver problems, accidents, and other serious health threats.

Talk to your doctor about having a sleep study. A Home Sleep Test can even be conducted from the comfort of your home. Or, you can contact us at Advanced Sleep Medicine to help set you up with a sleep study appointment.

Check our our guide: Other posts you may find interesting:

  • How Does Sleep Apnea Impact the Brain?
  • How Does Sleep Apnea Affect the Heart?
  • What is CPAP? The Difference Between CPAP, APAP and Bilevel
  • Does CPAP Save Lives?

Photo Credit: JK B

The Dangers of Uncontrolled Sleep Apnea

Sleep apnea, cardiovascular risk and metabolism

Several studies have shown an association between sleep apnea and problems like type 2 diabetes , strokes , heart attacks and even a shortened lifespan, says Jun. Why this connection? For one thing, obesity is common in sleep apnea patients, and obesity greatly increases risks of diabetes, stroke and heart attack, he says. “In most cases, obesity is the main culprit behind both conditions,” Jun explains.

Still, it’s important to note that not everyone with sleep apnea is obese. Furthermore, evidence suggests an independent link between sleep apnea and diabetes. “Our lab and others have shown that sleep apnea is associated with higher risks of diabetes, independent of obesity, and that sleep apnea can increase blood sugar levels,” says Jun.

For people who are overweight or obese, weight loss is key for treating or avoiding sleep apnea. People who accumulate fat in the neck, tongue and upper belly are especially vulnerable to getting sleep apnea. This weight reduces the diameter of the throat and pushes against the lungs, contributing to airway collapse during sleep.

Women in particular should be careful as they age. While premenopausal women tend to put on weight in the hips and in the lower body instead of the belly, this shifts with time. Weight begins to accumulate in traditionally “male” areas like the tummy, and this leads to a greater chance of sleep apnea.

“After menopause, hormones change and women tend to start looking like men in terms of where the weight gets put on. It’s a time to be paying attention to the risks of sleep apnea because women begin to catch up to men in the rates of apnea after menopause,” Jun says.

Diagnosing and treating sleep apnea for better health

It’s important to treat sleep apnea, because it can have long-term consequences for your health. While there have been some high-profile deaths linked to sleep apnea—such as with Judge Antonin Scalia —Jun says that the true risk is from damage done over time.

Obstructive sleep apnea can range from mild to severe, based on a measurement system called the apnea-hypopnea index (AHI). The AHI measures the number of breathing pauses that you experience per hour that you sleep.

Obstructive sleep apnea is classified by severity:

  • Severe obstructive sleep apnea means that your AHI is greater than 30 (more than 30 episodes per hour)
  • Moderate obstructive sleep apnea means that your AHI is between 15 and 30
  • Mild obstructive sleep apnea means that your AHI is between 5 and 15

Types of Sleep Apnea

By far the most common form of the disorder, Obstructive Sleep Apnea (OSA) occurs when the tongue, soft palate and uvula fall into the back of the throat, blocking the airway and causing the person to stop breathing for periods ranging from 10 seconds to a full minute – often hundreds of times every night. OSA is classified as mild, moderate or severe, depending on how often breathing stoppages occur. If breathing stops more than 30 times per hour, the condition is considered severe. (We need a diagram here to show visually how blockage occurs) I’ve added a couple of examples:

As airflow becomes obstructed, blood oxygen levels normally decrease, signaling the brain to wake from sleep – though the person rarely regains full consciousness. These micro interruptions or arousals are generally so brief that the person may not even remember waking up. This is often why most people with sleep apnea don’t know they have it. These repeated sleep disruptions prevent a patient from ever reaching the deep levels of sleep necessary for the body to function normally.

Scientists are unsure about the exact causes of Obstructive Sleep Apnea – though some research suggests that:

  • Sleeping on your back
  • Smoking
  • Enlarged tonsils or adenoids
  • Small jaw
  • And certain medications are associated with this chronic condition.

Two physical factors – redundant tissue in the upper airway and an anatomically narrow airway – are known to lead to OSA as well. More serious cases of OSA are generally treated by using a Continuous Positive Airway Pressure (CPAP) machine. CPAP works 100% of the time if the patient uses it regularly for at least four to five hours per night and there is no air leak in the system.

Obstructive sleep apnea is a sleep disorder in which breathing is briefly and repeatedly interrupted during sleep. The “apnea” in sleep apnea refers to a breathing pause that lasts at least ten seconds. Obstructive sleep apnea occurs when the muscles in the back of the throat fail to keep the airway open, despite efforts to breathe. Another form of sleep apnea is central sleep apnea, in which the brain fails to properly control breathing during sleep. Obstructive sleep apnea is far more common than central sleep apnea.

Obstructive sleep apnea, or simply sleep apnea, can cause fragmented sleep and low blood oxygen levels. For people with sleep apnea, the combination of disturbed sleep and oxygen starvation may lead to hypertension, heart disease and mood and memory problems. Sleep apnea also increases the risk of drowsy driving.

Who Has Sleep Apnea?

More than 18 million American adults have sleep apnea. It is very difficult at present to estimate the prevalence of childhood OSA because of widely varying monitoring techniques, but a minimum prevalence of 2 to 3% is likely, with prevalence as high as 10 to 20% in habitually snoring children. OSA occurs in all age groups and both sexes.

What Causes Sleep Apnea?

There are a number of factors that increase risk, including having a small upper airway (or large tongue, tonsils or uvula), being overweight, having a recessed chin, small jaw or a large overbite, a large neck size (17 inches or greater in a man, or 16 inches or greater in a woman), smoking and alcohol use, being age 40 or older, and ethnicity (African-Americans, Pacific-Islanders and Hispanics). Also, OSA seems to run in some families, suggesting a possible genetic basis.

Sleep Apnea Symptoms

Chronic snoring is a strong indicator of sleep apnea and should be evaluated by a health professional. Since people with sleep apnea tend to be sleep deprived, they may suffer from sleeplessness and a wide range of other symptoms such as difficulty concentrating, depression, irritability, sexual dysfunction, learning and memory difficulties, and falling asleep while at work, on the phone, or driving. Left untreated, symptoms of sleep apnea can include disturbed sleep, excessive sleepiness during the day, high blood pressure, heart attack, congestive heart failure, cardiac arrhythmia, stroke or depression.

Treatment for Sleep Apnea

If you suspect you may have sleep apnea, the first thing to do is see your doctor. Bring with you a record of your sleep, fatigue levels throughout the day, and any other symptoms you might be having. Ask your bed partner if he or she notices that you snore heavily, choke, gasp, or stop breathing during sleep. Be sure to take an updated list of medications, including over the counter medications, with you any time you visit a doctor for the first time. You may want to call your medical insurance provider to find out if a referral is needed for a visit to a sleep center.

One of the most common methods used to diagnose sleep apnea is a sleep study, which may require an overnight stay at a sleep center. The sleep study monitors a variety of functions during sleep including sleep state, eye movement, muscle activity, heart rate, respiratory effort, airflow, and blood oxygen levels. This test is used both to diagnose sleep apnea and to determine its severity. Sometimes, treatment can be started during the first night in the sleep center.

The treatment of choice for obstructive sleep apnea is continuous positive airway pressure device (CPAP). CPAP is a mask that fits over the nose and/or mouth, and gently blows air into the airway to help keep it open during sleep. This method of treatment is highly effective. Using the CPAP as recommended by your doctor is very important.

Other methods of treating sleep apnea include: dental appliances which reposition the lower jaw and tongue; upper airway surgery to remove tissue in the airway; nasal expiratory positive airway pressure where a disposable valve covers the nostrils; and treatment using hypoglossal nerve stimulation where a stimulator is implanted in the patient’s chest with leads connected to the hypoglossal nerve that controls tongue movement as well as to a breathing sensor. The sensor monitors breathing patterns during sleep and stimulates the hypoglossal nerve to move the tongue to maintain an open airway.

Lifestyle changes are effective ways of mitigating symptoms of sleep apnea. Here are some tips that may help reduce apnea severity:

  • Lose weight. If you are overweight, this is the most important action you can take to cure your sleep apnea (CPAP only treats it; weight loss can cure it in the overweight person).
  • Avoid alcohol; it causes frequent nighttime awakenings, and makes the upper airway breathing muscles relax.
  • Quit smoking. Cigarette smoking worsens swelling in the upper airway, making apnea (and snoring) worse.
  • Some patients with mild sleep apnea or heavy snoring have fewer breathing problems when they are lying on their sides instead of their backs.

Coping with Sleep Apnea

The most important part of treatment for people with OSA is using the CPAP whenever they sleep. The health benefits of this therapy can be enormous, but only if used correctly. If you are having problems adjusting your CPAP or you’re experiencing side effects of wearing the appliance, talk to the doctor who prescribed it and ask for assistance.

Getting adequate sleep is essential to maintaining health in OSA patients. If you have symptoms of insomnia such as difficulty falling asleep, staying asleep, or waking up unrefreshed, talk to your doctor about treatment options. Keep in mind that certain store-purchased and prescription sleep aids may impair breathing in OSA patients. One exception is ramelteon, which was studied in mild and moderate OSA patients and found to not harm their breathing.

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