Sleep Apnea
It has been estimated that two out of three adult males snore some or all of the time during nocturnal sleep and almost that number of women following menopause also experience snoring. Of one hundred people who snore approximately one third will not have sleep apnea, one third will have mild to moderate sleep apnea and one third will have severe sleep apnea. All people who have sleep apnea snore but not all snorers have sleep apnea. Snoring is a sign that the airway is not fully open, and the distinctive sound of snoring comes from efforts to force air through a narrowed passageway in the throat.
The "typical" patient with sleep apnea is an overweight middle-aged male who habitually exhibits loud snoring throughout the night. The problem with these patients is that they can't breath properly in a recumbent position because their upper airway either collapses under it's own weight or the tongue and uvula (the small tissue that hangs on the soft palate in the back of the throat) close over the back of the throat causing air to be blocked. The person literally chokes himself or herself at the level of the upper airway.
In order to "break the blockage" the body chooses breathing over sleep and the person undergoes a brief awakening-usually without awareness, to allow the muscles of the throat to contract and open up the passage. This pattern can happen 5 to over one hundred times per hour. During the time they are not breathing, their oxygen level falls and carbon dioxide builds up. Because of this constant interruption of sleep the patient becomes chronically sleep deprived. This directly leads to daytime sleepiness, which can be severe. Other consequences of untreated sleep apnea are high blood pressure, heart failure, heart attacks and strokes. Chronic sleep deprivation leads to impaired concentration, poor memory and a significant increase in automobile accidents and fatalities. It is important to note that continued weight gain can make the apnea worse over a long period of time and ingestion of any sedative or tranquilizer including alcohol can turn mild apnea into severe apnea in one night.
One does not need to be overweight, middle aged, or male to have sleep apnea. Persons with enlarged tonsils, posterior displaced jaws, or masses in the throat can all experience the same symptoms and signs that the "typical" patient described above can exhibit.
Snoring loudly every night calls for a visit to your physician or referral to a sleep specialist connected with a sleep laboratory where overnight studies are performed to evaluate and treat the sleep apnea.
Warning signs include:
•Snoring, so loud, it rivals a "jackhammer" and can be heard in other rooms of the house.
•Abnormal pattern of snoring with long relative periods of silence then resumption of the snoring with loud gasps or snorts.
•Awakening each morning with a headache and/or a dry mouth.
•Daytime sleepiness with problems concentrating or experiencing poor short-term memory.
•Sexual dysfunction with loss of desire or impaired sexual functioning.
•Awakening during the night either gasping or choking and experiencing "air hunger".
Sleep Apnea can also be seen in children. As in adults these kids are usually overweight but also have enlarged tonsils and or adenoids and small throats. Children with sleep apnea may snore, squeak, have difficulty breathing, and sleep fitfully. School age children with sleep apnea typically have problems at school or at home with observations that they are sluggish, slow, lazy, on drugs, or seem to daydream. Many in fact are incorrectly diagnosed as attention deficit disorder and sometimes inappropriately treated with medication.
Sleep apnea in newborns has been linked to some cases of Sudden Infant Death Syndrome (SIDS), although the exact relationship is still far from certain.
All muscles relax during sleep and depending on what phase of sleep the relaxation of the muscles of the entire body (with the exception of the diaphragm) can relax completely and become limp or atonic. For most people this is not a problem because the diaphragm continues to contract and there is enough room in the back of the throat to allow free movement of air into and out of the lungs. However, in some people, the throat muscles relax too much or the weight of the tissues in the back of the throat is such that the throat collapses and causes a temporary obstruction to the normal to and fro movement of air. This leads to the condition of obstructive sleep apnea (OSA).
OSA can also be caused by a narrower-than-normal throat passage caused by the presence of tonsils (enlarged or not), abnormal masses in the throat, a large tongue (several medical illnesses can cause this) or a congenital malformation of the lower jaw or poor dental states. In some cases the problem is not in the upper airway but instead has to do with the master control of breathing by the brain; the brain appears to "forget" to breath by temporarily stopping the nerve signals that go to the diaphragm, which is the master muscle of breathing, as well as the muscles of the chest wall. This is called Central Sleep Apnea (CSA).
A third type of apnea is called Mixed Sleep Apnea (MSA), which is a combination of central sleep apnea and obstructive sleep apnea. The apnea starts when the brain stops sending signals to contract and relax the muscles of respiration, so no "effort" of breathing is seen. But then the brain resumes its function of sending out the nerve signals and the diaphragm and chest muscles resume their movement. However there remains an obstruction in the upper airway and the throat stays closed until the body causes a slight awakening to signal the muscles of the throat to open up the passage. This is the obstructive portion of a mixed apnea.