Sleep apnea is when you stop breathing during your night’s sleep. Therefore, one can also speak of a sleep apnea syndrome, in which a narrowing of the upper airways occurs. In addition, the cause can also be a malfunction or disorder of the respiratory muscles. Sometimes other diseases (e.g. heart failure) are also responsible for sleep apnea.
What is sleep apnea?
Sleep apnea is characterized by cessation of breathing (apnea) lasting more than ten seconds during sleep. The number of apneas per hour determine the severity of the disease. Due to a short-term lack of oxygen, these respiratory arrests often lead to unnoticed wake-up reactions that interrupt sleep at night. A restful sleep is no longer possible. See bittranslators for About Messie Syndrome.
In Germany, up to four percent of the population are affected. Males are more likely to suffer from sleep apnea. Classic symptoms are heavy snoring, headaches, dizziness, dry mouth and pronounced tiredness during the day. The latter leads to a significantly reduced performance, microsleep can occur.
Chronic stress can lead to depression, high blood pressure with the risk of heart attacks or strokes and erectile dysfunction. The diagnosis is made by history and by monitoring in a sleep laboratory.
Causes
A distinction is first made between central and peripheral obstructive sleep apnea. The obstructive form is much more common. This leads to a relaxation of the throat muscles during sleep. During inhalation, part of the trachea collapses and blocks the airway (obstruction). If the airway does not collapse completely, the severity is weaker (so-called hypopnea).
Obstructive sleep apnea syndrome is favored by being overweight, obstructed nasal breathing (polyps in children, tumors or deformities) and drugs (alcohol, nicotine, sleeping pills). But a predisposition to slack throat muscles can also be a trigger. The central form is caused by damage (e.g. morphine intoxication) or diseases (e.g. Lyme disease) of the CNS. The result is a disturbed respiratory regulation in the brain. Central sleep apnea is usually hereditary.
Symptoms, Ailments & Signs
A common symptom of sleep apnea is excessive daytime sleepiness. This can occur despite having had an adequate night’s sleep. After sleeping in a shared bedroom, life partners often report irregular, loud snoring noises. The cessation of breathing causes the body to go into an alarm state due to the reduced oxygen content in the blood.
Blood pressure rises and the respiratory muscles are activated. Cardiac arrhythmias can also occur. A sudden brief awakening is possible. Those affected feel exhausted in the morning. You are already yawning at the breakfast table and seem to have no energy. The poor quality of sleep due to the stressful influences of numerous breathing pauses can significantly limit the ability to concentrate and perform.
The so-called microsleep at the wheel represents a great danger. In addition, the chronic lack of sleep can lead to headaches or depressive moods on a daily basis. Anxiety can also occur. Erectile dysfunction and reduced sexual desire are also possible symptoms of sleep apnea.
In addition, a decrease in memory and dry mouth are possible signs . The lack of nocturnal rest can also be expressed through irritability. The oppressive feeling of drowsiness and sleepiness persists throughout the day. Sudden onset of dizzy spells can also be signs of sleep apnea. Symptoms also include morning sore throat and heartburn due to the intensive mouth breathing.
Complications
Cardiovascular diseases are among the most common complications of sleep apnea: Many sufferers suffer from high blood pressure, which is difficult to positively influence with medication. Cardiac arrhythmias can also occur, and in the long term the disease promotes the development of coronary heart disease. The reduced oxygen content of the blood causes the blood to thicken, patients with sleep apnea are therefore at an increased risk of suffering a stroke or heart attack.
An above-average number of those affected die of sudden cardiac death. Another complication is diabetes (diabetes mellitus), which in sleep apnea sufferers is often associated with a dyslipidemia and in many cases responds poorly to drug treatment. During operations, incidents that require the intervention to be stopped occur more frequently than usual: the reason for this can be acute lung failure, a pulmonary embolism or a blood pressure imbalance.
Problems that result in longer hospital stays often arise during follow-up care. In everyday life, sleep apnea is noticeable in the form of severe tiredness and concentration problems, and those affected are no longer able to cope with their professional tasks. In many cases, it is not possible for those affected to drive a motor vehicle or operate machines due to the tendency to microsleep. Constant fatigue and poor performance can trigger depression. Left untreated, sleep apnea can shorten life expectancy by up to ten years.
When should you go to the doctor?
Symptoms such as difficulty sleeping through the night and headaches, dry mouth or dizziness after getting up can indicate sleep apnea. The family doctor must be consulted if these symptoms appear on several nights a week and seriously affect well-being. If there are other symptoms such as heavy night sweats or a tendency to fall asleep during the day, an immediate visit to the doctor is recommended. Obstructive sleep apnea syndrome is favored by obesity and increased age. The use of sedatives or sleeping pills is also a risk factor and should be clarified promptly.
Central sleep apnea is triggered by neurological diseases, but can also occur after a tick bite and the resulting Lyme disease. A stroke also increases the suffering. If the symptoms mentioned occur in connection with the risk factors, the family doctor or a sleep laboratory must be consulted. The actual treatment usually takes place in a specialist clinic. The family doctor can prescribe the prescribed medication and, if necessary, carry out regular follow-up checks after the diagnosis.
Treatment & Therapy
The most effective treatment for sleep apnea – after reducing the risk factors – is CPAP ventilation (CPAP: Continuous Positive Airway Pressure). This is done using a ventilation mask for the mouth or nose. Recently, nasal cannulas can also be used. The ventilation mode is set in such a way that a permanent positive pressure (overpressure of approx. 5 to 20 millibars) is maintained.
This can prevent the pharyngeal muscles from collapsing (“internal splinting”). This can also prevent snoring. Even if the masks look frightening at first, users are not affected much. You get used to it quickly and your quality of life improves immediately.
If this type of ventilation is not possible, BIPAP ventilation can be used (BIPAP: Biphasic Positive Airway Pressure). In contrast to CPAP ventilation, this usually has to be carried out continuously at night. If the patient refuses ventilation, a so-called protrusion splint can be inserted into the mouth, which prevents the airways from collapsing. A supply with a nasopharyngeal stent has a very similar principle of action.
Modafinil (a drug used to treat narcolepsy) can be used to reduce daytime sleepiness. In milder cases, treatment with theophylline (classic indication for asthma and COPD) is possible, which has central stimulating effects.
If the conservative therapies are not sufficient or if the patient wants a causal therapy, surgical intervention can be carried out. In bimaxillary surgery, the pharynx is surgically enlarged. The results are good. Tissue in the pharynx can also be “burned” by electricity. The scarring shrinkage expands the space behind the tongue.
Prevention
One of the most important measures against sleep apnea is weight reduction. A normal weight should be the goal. Alcohol and nicotine should be avoided or consumption should be limited. Sleeping pills should also be used sparingly. It could be shown that playing wind instruments has a protective effect. This is explained by the fact that blowing strengthens the throat muscles.
Aftercare
The diagnosis of sleep apnea usually requires lifelong use of the prescribed breathing therapy device, so continuous follow-up care is essential for a sustainable lifestyle. The estimated aftercare routines for this may differ depending on the service provider, but they are usually carried out annually. With the help of special measuring devices, which the patient can borrow for one night, all vital values are recorded during sleep.
These include, for example, heart rate measurements, the duration of individual sleep phases and the oxygen saturation in the blood. The evaluation is carried out on the following day by the doctor treating you. Over the years, the patient’s sleeping habits can change, so that adjustments to the breathing apparatus may have to be made.
It is also possible that the patient’s needs will change over time. For example, it can happen that the breathing air is perceived as too dry. The prescription of an additional device that moistens and warms the breathing air with water can provide relief in this case.
With daily use of the breathing mask, natural signs of wear cannot be avoided. A call to the responsible service provider is enough to ensure that filters, breathing hoses, breathing masks and other small parts are delivered again.
You can do that yourself
Patients suffering from sleep apnea have numerous options for self-help in everyday life. These options can both help prevent sleep apnea from occurring in the first place or combat the symptoms.
Changing your sleeping position so that you avoid lying on your back is simple and effective. This has already helped many patients. For overweight patients, weight reduction is an important building block on the way to restful and healthy sleep. Sport plays a doubly important role: On the one hand, regular exercise helps to lose excess pounds. On the other hand, physical activity effectively supports the fight against sleep apnea.
Avoiding nicotine is also obvious. Smoking directly and negatively affects breathing. Sleep apnea patients should therefore stop smoking in general, also with a view to their health. It is less drastic with alcohol. A complete renunciation is not absolutely necessary here, but moderation is the order of the day. For example, it is recommended not to drink alcohol four hours before going to sleep and to avoid excessive consumption of alcoholic beverages altogether.
In addition, all recommendations that apply to healthy sleep also apply to sleep apnea patients. This includes not too high a temperature in the bedroom, a good mattress or adequate ventilation of the bedroom.
