Obstructive sleep apnea is a sleep-disordered breathing problem found commonly in older males. People with obstructive sleep apnea (OSA) experience a tightening sensation in the upper airway which occurs when respiratory muscles relax during sleep.

During an apneic episode, a patient temporarily stops breathing for more than ten seconds, about five times in an hour.

Patients with obstructive sleep apnea suffer a wide range of symptoms that affect their sleep quality and cardiovascular health. Luckily, modern medications, continuous positive airway pressure (CPAP therapy) and OSA oral appliances are available for breaking free from this interrupted breathing cycle.

What is Obstructive Sleep Apnea?

Obstructive sleep apnea (OSA) is a sleeping disorder that causes the upper airway to repeatedly collapse when a person is asleep. It occurs when the muscles supporting the soft tissue in your respiratory system such as the tongue and soft palate ease up during sleep.

When the upper airway dilator muscle relaxes, it can narrow the airway and leave inadequate space for healthy breathing. It then puts stress on the chest muscles and diaphragm to draw air into the lungs.

Patients with obstructive sleep apnea may briefly stop breathing for a few seconds due to this obstruction and wake up gasping for air. When left untreated, obstructive sleep apnea can develop into a serious cardiovascular disease such as heart failure, arrhythmia, or heart attack.

Symptoms of Obstructive Sleep Apnea

Breathing with your mouth open, snoring, tossing, and turning are the most common signs of a sleep disorder. As for OSA, an individual will likely experience shortness of breath, a spell of bad mood, grogginess, painful morning headaches, and dry throat. Often, they feel as if they were holding their breath during sleep and wake up abruptly one or more times in the night. Obstructive sleep apnea symptoms include-

• Loud snoring (often with long pauses)
• Irregular sleep-wake cycle
• Waking up gasping for air
• Poor sleep quality
• Getting up frequently throughout the night

These are common night-time symptoms among patients with obstructive sleep apnea. However, severe sleep apnea have aftereffects that linger on well into the mornings. Here’s what they look like in adults-

• Morning headaches
• Excessive daytime sleepiness
• Forgetfulness
• Sluggish cognitive performance
• Loss of libido

The symptoms of obstructive sleep apnea are different among children. OSA in children is called pediatric sleep apnea, and the symptoms are-

• hyperactivity during the day
• snoring with pauses
• heavy breathing while asleep
• daytime sleepiness, forgetfulness
• Poor performance in school
• bedwetting/frequently waking up to pee
• sleepwalking

If you look carefully, what sets OSA apart from other ailments is the loud snoring, choking, and frequent awakenings through the night.

How is It Diagnosed?

Untreated obstructive sleep apnea can damage your sleep quality, cognitive performance, and not to mention, your heart health. So, it’s best to know early on whether you have OSA with a medical diagnosis. It commonly starts with a thorough physical exam.

1. Polysomnography (PSG):

This diagnostic test entails sleeping overnight at a hospital or sleep center while different devices collect your physiologic values. PSG, also called sleep study, consists of five tests.

• Electroencephalogram (EEG) to record brain activity
• Electrocardiogram (ECG) to monitor heart rate and rhythm
• Electrooculogram (EOM) to observe eye movement
• Electromyography (EMG) to check for nerve dysfunction
• Pulse oximetry test to measure variations in your blood oxygen level

Any abnormal pattern during sleep can be accurately monitored during polysomnography.

2. Home Sleep Apnea Testing:

If you think you obstructive sleep apnea (OSA), you can opt for an at-home sleep test. It’s a simplified version of PSG for monitoring your sleep-wake cycle, blood oxygen level, and nasal and oral airflow. For at-home sleep apnea testing to be accurate, you need to sleep for at least four hours.

Alternatively, you can use the Epworth sleepiness scale for reference. The Epworth sleepiness scale measure a patient’s sleepiness subjectively on a scale of 0 to 3.

What Causes Obstructive Sleep Apnea Syndrome?

Obstructive sleep apnea (OSA) typically occurs when the surrounding muscles of our throats relax while we are asleep. Respiratory muscles are responsible for holding the air passage open and facilitating our breathing. So, when these muscles relax, the upper airway becomes narrow and is even temporarily closed for a couple of seconds.

An upper airway obstruction may also result from nasal congestion, tonsillitis, adenoiditis, or macroglossia. People with macroglossia have a large tongue which can block the airway when they sleep. Obstructive sleep apnea is different from central sleep apnea which is caused by neurological disorders.

Obstructive Sleep Apnea Treatment Options

Apart from CPAP therapy, there are a bunch of options for treating sleep apnea in adults. Patients with obstructive sleep disorders often start with continuous positive airway pressure (CPAP) therapy to stabilize breathing and increase their blood oxygen levels. There is also oral appliance therapy and successful medications to help you beat OSA.

1. Continuous Positive Airway Pressure (CPAP):

   Continuous positive airway pressure(CPAP) is highly effective for OSA patients. It relieves symptoms of moderate to severe OSA. The CPAP machine delivers air pressure through a face mask to be worn during sleep. The high air pressure in CPAP therapy pushes against nasal congestion and blockages so that your lungs get their desired level of oxygen.

2. Oral Appliance Therapy:

   These removable devices are also worn during sleep. They are used to bring your lower jaw forward so that your tongue does not block the passage. A dentist will fit the oral appliance as a means to treat mild obstructive sleep apnea.

3. Avoid Sleeping on Your Back:

   Supine position is not recommended for people with obstructive, sleep-disordered breathing. A new sleeping position may relieve your upper airway obstruction and facilitate deeper sleep. Patients with obstructive sleep apnea feel at ease when they sleep on their side. The fetal sleep position is also a green flag for OSA patients.

4. Maintain a Healthy Body Weight:

   Obesity can aggravate sleep apnoea. According to PubMed Central, weight management and daily exercise have proved to reduce the severity of OSA in adults. Weight loss can also help keep your blood pressure in control.

5. OSA Medications:

   Different types of medications are available to treat mild to moderate obstructive sleep apnea. They reduce drowsiness and stimulate breathing. OSA medications also treat nasal congestion so you can breathe through your nose.

6. Surgery:

   A small number of OSA patients need surgical treatment to resolve breathing disruptions and enjoy benefits in the long term. More often than not, blockages in the upper airway can be surgically corrected.

   Surgical treatment of obstructive sleep apnea will relieve most of your symptoms. The surgery is done to reposition or shape your soft palate and uvula. While it may not completely cure OSA patients, it can restore regular breathing pattern, and help OSA patients who are at risk of coronary artery disease.

It’s important not to take OSA treatment in your own hands. The American Academy of Sleep Medicine advises to take melatonin and over the counter sleep aids with caution. Healthy bedtime teas aside, see a doctor to treat obstructive sleep apnea effectively and for good.

Risk Factors for OSA and Sleep-Disordered Breathing

There are few physical features that increase your chances of experiencing OSA. Features that distort your upper airway are likely to cause an obstruction and serious health problems in turn. Look out for these risk factors for obstructive sleep apnea-

• Obesity
• Enlarged tonsils
• A large tongue, which can block your air passage
• Retrognathia, a condition where your upper jaw is bigger than your lower jaw
• A narrow palate that collapses easily
• Smoking
• Drinking excessively

You need to see a sleep specialist if OSA runs in your family and you have sustained symptoms of sleep apnoea consistently in the past seven days.

Final Words

Sleep apnea patients are at an increased risk of obesity, diabetes, hypertension, stroke, irregular heartbeat and myopathy. OSA is truly among the most debilitating sleep disorders. But the good news is that you can recover from sleep apnea and prevent it from stealing your Zs. Shred the extra weight, quit drinking, get your daily workout, and if the symptom persists, conduct a home sleep apnea testing ASAP.