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Obstructive Sleep Apnea (OSA)

 

What is OSA?

Obstructive sleep apnea (OSA) is a condition in which a person’s airway becomes blocked or closed off repeatedly during sleep. Those with OSA may have episodes during sleep in which they stop breathing, called apneas, waking up gasping or choking and/or snore loudly.

Causes and Risk Factors of OSA

OSA occurs when the muscles in the back of the throat relax too much to allow for proper breathing. These muscles support the back of the roof of the mouth, as well as the tongue and side walls of the throat. When these muscles relax, the airway narrows or closes as you breathe in. This can lower the level of oxygen in the blood and cause a buildup of carbon dioxide.

When this occurs, your brain senses this buildup of abnormal breathing and briefly interrupts your sleep so you can reopen your airway. People who experience this typically have no recollection of the interruption. Others may awaken with shortness of breath that quickly corrects itself within one or two deep breaths. Some make a snorting, choking or gasping sound. These interruptions in your sleep can occur 5 to 30 times or more in an hour, all night long. 

Anyone can develop OSA, but certain factors can put you more at risk, including:

  • Being overweight.
  • Older age.
  • Narrowed airway.
  • High blood pressure.
  • Chronic nasal congestion.
  • Smoking.
  • Diabetes.
  • Male sex.
  • Family history of sleep apnea.
  • Asthma.

Symptoms of OSA

The primary symptom of OSA is waking up gasping or choking and/or snoring loudly. Other common symptoms of OSA include:

  • Excessive daytime sleepiness.
  • Loud snoring.
  • Observed episodes of stopped breathing during sleep.
  • Waking up during the night and gasping or choking.
  • Awakening in the morning with a dry mouth or sore throat.
  • Morning headaches.
  • Trouble focusing during the day.
  • Mood changes.
  • High blood pressure.
  • Decreased interest in sex.

Certain symptoms can be more severe and require medical intervention. Consult your provider if you or your partner observes any of the following:

  • Snoring loud enough to disturb your sleep or the sleep of others.
  • Snoring that is interrupted by periods of silence.
  • Waking up gasping or choking.
  • Pausing in your breathing during sleep.
  • Having excessive daytime drowsiness.

Diagnosing OSA

Your provider will perform a physical examination and review your medical history. This may involve an examination of the back of your throat, mouth and nose. Your neck and waist circumference may be measured, and blood pressure may be checked. Based on your symptoms and exam, you may be referred to a sleep specialist.

OSA is most commonly diagnosed with a sleep test, called a polysomnography, that is performed by a sleep specialist. Sleep testing can be done in a sleep lab or with a home test (when applicable). Depending on your current health status and risk factors, your healthcare provider will determine which test is most appropriate for you. During the sleep test, your oxygen levels will be monitored, heart, lung and brain activity monitored and the number of times you experience apnea will be recorded. Depending on your specific sleep activity during the test, your sleep specialist may also place you on a Continuous Positive Airway Pressure (CPAP) device to treat your apnea and assess for improvement.

Treatment for OSA

The most common treatment for OSA is CPAP therapy. CPAP delivers air (with or without oxygen) into a mask on your nose or mouth that helps keep your airway open during sleep. The flow and pressure of air is based on the amount needed to keep your airway open. 

For individuals with airway crowding or other anatomical features creating apnea, oral appliances designed to keep your airway open may be used. This is done by bringing the lower jaw forward, which can help to relieve snoring and OSA. Other devices hold the tongue in a different position. These are a good alternative for some people with mild or moderate OSA or for those who can’t use a CPAP.

Surgical intervention may be necessary for those with airway crowding caused by enlarged tonsils and adenoids and for those that other therapies haven’t been effective. Surgical options may include:

  • Surgical removal of tissue – involves removing tissue from the back of the mouth and top of the throat. 
  • Upper airway stimulation – recommended for people with moderate to severe OSA that are not able to tolerate CPAP. In this procedure, a small, thin impulse generator is implanted under your skin in the upper chest. The device stimulates the nerve that controls the movement of the tongue, moving it forward instead of moving backward and blocking the tongue. 
  • Deviated septum surgery – a type of nasal surgery to remove polyps or straighten a crooked deviated septum (partition between the nostrils).

Living with OSA

In most cases, OSA can be treated at home with lifestyle changes, including:

  • Losing weight.
  • Exercising.
  • Not drinking alcohol.
  • Using anti-anxiety medications or sleeping pills.
  • Sleeping on your stomach rather than your back.
  • Keeping your nasal passages open while you sleep. 

OSA left untreated does not just interrupt sleep or make you feel tired. OSA can make you feel tired all the way to the point you may fall asleep while driving and result in car accidents. Untreated OSA can also lead to heart disease, high blood pressure, stroke and even early death. Talk to your healthcare provider if you notice signs or symptoms of OSA to see what treatment is right for you.