What is obstructive sleep apnea?
Obstructive sleep apnea (OSA) is abnormal breathing during sleep caused by obstructions in adequate airflow to the lungs. The obstructions to airflow occur above the trachea (windpipe) in the back of the mouth, most often caused by the soft palate (soft, floppy part of the mouth’s roof) or the tongue collapsing against the back of the throat. It is a very prevalent condition in the United States. It is associated with snoring but the presence of snoring does not always predict the presence of OSA and OSA can occur without loud snoring.
What causes obstructive sleep apnea?
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.
What are OSA symptoms?
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.
How is obstructive sleep apnea diagnosed?
Testing can be done to assess for interruptions in airflow during sleep. The traditional test is a sleep study in a sleep center with many ways of monitoring sleep and breathing patterns. However, home testing equipment has been created that reliably detects obstructive sleep apnea within their own home, bed, and normal sleep routine.
What are OSA treatment options?
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).