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What is Sleep Apnea?

Sleep Apnea

What is Obstructive Sleep Apnea (OSA)?

Sleep apnea is a serious, potentially life-threatening condition that is far more common than generally understood. First described in 1965, sleep apnea is a breathing disorder characterized by brief interruptions of breathing during sleep. It owes its name to a Greek word, apnea, meaning "want of breath." There are two types of sleep apnea: central and obstructive. Central sleep apnea, which is less common, occurs when the brain fails to send the appropriate signals to the breathing muscles to initiate respirations. Obstructive sleep apnea is far more common and occurs when air cannot flow into or out of the person's nose or mouth although efforts to breathe continue.

In a given night, the number of involuntary breathing pauses or "apneic events" may be as high as 20 to 60 or more per hour. These breathing pauses are almost always accompanied by snoring between apnea episodes, although not everyone who snores has this condition. Sleep apnea can also be characterized by choking sensations. The frequent interruptions of deep, restorative sleep often leads to excessive daytime sleepiness and may be associated with an early morning headache.

Early recognition and treatment of sleep apnea is important because it may be associated with irregular heartbeat, high blood pressure, heart attack, and stroke.

How is OSA Diagnosed?

Medical History: Be prepared to give your Doctor medical and family history. Report incidence and frequency of any related symptoms and features, providing a written diary if possible. Also helpful is an audio recording to illustrate snoring patterns and characteristics and/or bed partner interview. 
Physical Examination: Your Doctor will assess upper airway for abnormalities, assess upper body obesity and possibly take measurements of chest/body mass as well as neck circumference. An EKG may be ordered to display distinct heart rhythms.

Polysomnography Testing: Your Doctor may refer you for testing at a sleep center. These are typically overnight procedures involving electronic monitors and should be conducted by certified sleep study specialists or polysomnographers. Monitors will track the frequency and duration of apnea and hypopnea. These tests clearly show presence or absence of sleep-apnea, and indicate the severity of the problem. Continuously monitored functions include air flow, respiratory effort, blood oxygen level, snoring, and body position. Brain waves, eye movements, and muscle activity may also be monitored.

Multiple Sleep Latency Test: Involves machine testing of time it takes to fall asleep while lying in a quiet room during the daytime. For people without sleep-disorders, this takes about 10-20 minutes. People suffering from sleep-apnea usually take about 5 minutes. Based on the cumulative clinical picture, your Doctor will determine the most appropriate treatment.

What Are The Symptoms of Sleep Apnea?

  • Snoring (particularly loud snoring)
  • Fatigue and daytime tiredness 
  • Difficulty concentrating 
  • Morning headaches 
  • Dry mouth upon waking 
  • Excessive perspiration during sleep 
  • Heartburn 
  • Change in personality (moodiness, irritability) 
  • Memory lapses 
  • Waking up and feeling as though you haven't been to sleep or rested 
  • Frequent night urination (nocturia) 
  • Confusion and grogginess in the morning 
  • Reduced sex drive 
  • Small jaw / thick neck 
  • Obesity 
  • Rapid weight gain 
  • Excessive daytime sleepiness while working or driving

What Are the Effects of Sleep Apnea?

Because of the serious disturbances in their normal sleep patterns, people with sleep apnea often feel very sleepy during the day and their concentration and daytime performance suffer. The consequences of sleep apnea range from annoying to life-threatening. They include symptoms suggesting depression, irritability, sexual dysfunction, learning and memory difficulties, and falling asleep while at work, on the phone, or driving. It has been estimated that up to 50 percent of sleep apnea patients have high blood pressure. It has recently been shown that sleep apnea contributes to high blood pressure. Risk for heart attack and stroke may also increase in those with sleep apnea.

Sleep Disordered Breathing (SDB) affects around 20% of the adult population, making it as widespread as diabetes or asthma. However, awareness is low and we believe that about 90% of people who have OSA remain undiagnosed and untreated. Along with an increasing understanding of the morbidity and mortality caused by SDB, this discrepancy has created one of the fastest growing segments of the respiratory industry. Our Hybrid is positioned to meet the growing challenges of this under-diagnosed series of conditions with the comfort of the patient in mind.

What Causes OSA?

Certain mechanical and structural problems in the airway cause the interruptions in breathing during sleep. In some people, apnea occurs when the throat muscles and tongue relax during sleep and partially block the opening of the airway. When the muscles of the soft palate at the base of the tongue and the uvula (the small fleshy tissue hanging from the center of the back of the throat) relax and sag, the airway becomes blocked, making breathing labored and noisy and even stopping it altogether.

Sleep apnea also can occur in obese people when an excess amount of tissue in the airway causes it to be narrowed. With a narrowed airway, the person continues his or her efforts to breathe, but air cannot easily flow into or out of the nose or mouth. Unknown to the person, this results in heavy snoring, periods of no breathing, and frequent arousals (causing abrupt changes from deep sleep to light sleep). Ingestion of alcohol and sleeping pills increases the frequency and duration of breathing pauses in people with sleep apnea.

Who Gets Sleep Apnea?

Sleep apnea occurs in all age groups and both sexes but is more common in men (it may be under diagnosed in women) and possibly young African Americans. It has been estimated that as many as 18 million Americans have sleep apnea. 

Four percent of middle-aged men and 2 percent of middle-aged women have sleep apnea along with excessive daytime sleepiness. People most likely to have or develop sleep apnea include those who snore loudly and also are overweight, or have high blood pressure, or have some physical abnormality in the nose, throat, or other parts of the upper airway. Sleep apnea seems to run in some families, suggesting a possible genetic basis.

How is normal breathing restored during sleep?

During the apneic event, the person is unable to breathe in oxygen and to exhale carbon dioxide, resulting in low levels of oxygen and increased levels of carbon dioxide in the blood. The reduction in oxygen and increase in carbon dioxide alert the brain to resume breathing and cause an arousal.

With each arousal, a signal is sent from the brain to the upper airway muscles to open the airway; breathing is resumed, often with a loud snort or gasp. Frequent arousals, although necessary for breathing to restart, prevent the patient from getting enough restorative, deep sleep.


Some additional sleep and apnea resources from Harvard Medical SchoolHarvard Sleep and Health