Types of Sleep Apnea - DME Health Services

Types of Sleep Apnea - DME Health Services

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What is it? Obstructive sleep apnea, or OSA, is a sleep related breathing disorder that causes your body to stop breathing during sleep. OSA occurs when the tissue in the back of the throat collapses and blocks the airway. This keeps air from getting in to the lungs. This is a very common sleep disorder. It happens because the muscles inside the throat relax as you sleep. Gravity then causes the tongue to fall back and block the airway. Blockage of the airway can happen a few times a night or several hundred times per night. Who gets it? OSA can occur in men and women of any age, but it is most common in obese, middle-aged men. There is a strong relationship between weight and OSA. Your neck gets thicker as you gain weight. This increases the level of fat in the back of the throat, narrowing the airway. With more fat in the throat, your airway is more likely to be blocked. People with OSA are often obese and have a neck size of more than 17 inches. Many people with OSA also have high blood pressure. Children with large tonsils may also have OSA. See obstructive sleep apnea in children. How do I know if I have it? 1. Do you experience any of these problems? Unintentionally falling asleep during the day General daytime sleepiness Unrefreshing sleep Fatigue Insomnia 2. Do you ever wake from sleep with a choking sound or gasping for breath? 3. Has your bed partner noticed that you snore loudly or stop breathing while you sleep? If your answer to each of these questions is yes, then you might have obstructive sleep apnea. Almost all people with OSA snore loudly, and about half of the people who snore loudly have OSA. Snoring is a sign that your airway is being partially blocked. While you may not think you snore, ask the person who sleeps next to you. He or she can tell how often you snore and whether or not you stop breathing. Many people with OSA are sleepy during the day. They find that they are still tired even after a nap. When you stop breathing, your body wakes up. It happens so quickly, you aren’t even aware of it. This disrupts your sleep process. You can stop breathing hundreds of times in one night. This will make you feel very tired the next day. Are You at Risk? Find out if you are at risk for obstructive sleep apnea. Click here. Do I need to see a sleep specialist? Yes. This is a serious disorder that needs to be treated. Sleep specialists have training and expertise in this area. They will review your history and symptoms. If needed, they will schedule you for an overnight sleep study. This kind of study is called a polysomnogram. The sleep study will help them evaluate your problem. Then they can put together an individual treatment plan just for you. It is also important to know if there is something else that is causing your sleep problems. A sleep specialist can look for other conditions that may mimic or make the symptoms of OSA worse, such as: Another sleep disorder A medical condition Medication use A mental health disorder Substance abuse What will the doctor need to know? The doctor will need to know your symptoms and how long you have had them. He or she will also want to know if your symptoms began when you gained weight or stopped exercising. Get information from those who sleep with you or have seen you sleep. This includes spouses, relatives, friends, teammates, and roommates. You will also need to provide a complete medical history. Keep a sleep diary for two weeks. Information you should write down includes the following: What time you went to bed each night What time you got up in the morning How many times you woke up during the night Whether you felt rested when you woke up If you took naps during the day Whether you felt sleepy or rested throughout the day The sleep diary will help the doctor see your sleeping patterns. The sleep diary information gives the doctor clues about what is causing your problem and how to correct it. Will I need to take any tests? If your doctor thinks that you have a problem with breathing during sleep, then he or she will have you do an overnight sleep study. This study is called a polysomnogram. It will chart your brain waves, heart beat, and breathing as you sleep. It will also record how your arms and legs move. This will reveal if you have OSA. It will also show how bad the problem is. If you have OSA, you may be asked to return to the sleep center for a second polysomnogram. This time, you will be given continuous positive airway pressure (CPAP) treatment as you sleep. This is called a CPAP study. How is it treated? 1. Continuous positive airway pressure (CPAP) is the treatment most often used to treat OSA. It is delivered through a mask worn over the nose or face. The air gently blows into the back of the throat. This keeps the airway open so you are able to keep breathing as you sleep. The amount of air pressure needed is different for each person. A CPAP study will show what level is right for you. 2. Weight loss is very important as this decreases the amount of obstruction in the throat. Often a significant amount of weight loss is enough to stop the symptoms. 3. Position therapy may work for patients with mild OSA. Staying off of the back while sleeping and raising the head of the bed may reduce symptoms. 4. You can also sleep with an oral appliance in your mouth. This device is much like a sports mouth guard and is used to move the jaw forward. This causes the airway to stay open. 5. Surgery is another option that may help an OSA patient. The size of the upper airway is increased to prevent collapse of the airway and make breathing easier. 6. Several other treatments may be successful. You will need to see a physician to discuss these other options. By Norman J. Wilder, MD Updated January 12, 2006

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What is it? Central sleep apnea is a breathing disorder that causes your body to decrease or stop the effort of breathing during sleep. This occurs in an off-and-on cycle. It is a result of a problem in the brain or heart. It is different from obstructive sleep apnea (OSA) because the problem is not caused by a blockage of the airway. The brain and heart normally interact to direct, monitor, and change the amount of air that we breathe. The problem in central sleep apnea syndromes (CSA) is that the brain and heart move an abnormal amount of air into the lungs. CSA syndromes in adults are divided into these five categories: Primary Central Sleep Apnea — Cause is not known. The breathing pattern consists of the repetitive absence of breathing effort and air flow. Cheyne-Stokes Breathing Pattern — Cause is heart failure, stroke, and possibly kidney failure. The breathing pattern consists of a rhythmic increase and decrease of the breathing effort and the amount of air flow. Medical Condition Not Cheyne-Stokes — CSA caused by medical conditions, but without the typical Cheyne-Stokes breathing pattern. It is caused by heart and kidney problems. It may also result from a problem in the base of the brain where breathing is controlled. High-Altitude Periodic Breathing — Caused by sleeping at altitudes higher than about 15,000 feet. The breathing pattern is similar to the Cheyne-Stokes Breathing Pattern. The difference is that there is no history of heart failure, stroke, or kidney failure. Also, the cycle time is shorter. Due to Drug or Substance — Caused by the use of drugs, mainly pain medicines in the opioid category. Breathing may stop completely or increase and decrease in a regular pattern. Breathing can also be quite irregular. It can even have elements of obstruction such as the breathing that is seen in OSA. Who gets it? Primary Central Sleep Apnea — Not known, but it appears to be quite rare and occurs in the middle-aged or elderly. Men seem to be affected more than women. There may be a tendency for inheritance. Some neurological conditions may increase the risk. These include multi-system atrophy and Parkinson disease. Cheyne-Stokes Breathing Pattern — Occurs mainly in men aged 60 or older. It is seen in 25% to 40% of men with chronic congestive heart failure. It is also found in 10% of men who have had a stroke. It is rarely seen in women and does not appear to be inherited. Medical Condition Not Cheyne-Stokes — Occurs rarely in patients with a variety of medical conditions. These include heart or kidney problems and abnormalities of the base of the brain where breathing is regulated. High-Altitude Periodic Breathing — Not known, but it appears to be more common in men. This is because men are more responsive to changes in the level of oxygen and carbon dioxide in their blood. This responsiveness is thought to be partially inherited. Some people sleeping at altitudes higher than 15,000 feet (about 5,000 meters) will have this disorder. Anyone sleeping above 25,000 feet (about 7,600 meters) will be affected. Due to Drug or Substance — Appears to occur in anyone taking long-acting opiods for longer than two months. There are no other characteristics known. How do I know if I have it? Almost all people with CSA have the following problems: Disrupted sleep with frequent awakeningsDifficulty falling asleepDaytime sleepiness Other problems often seen include the following: SnoringPauses in breathingWaking up short of breath A bed partner often can tell how often you snore and whether or not you stop breathing. Many people with CSA are sleepy during the day. They find that they are still tired even after a nap. When you stop breathing, your body wakes up. It happens so quickly, you aren’t even aware of it. This disrupts your sleep process. You can stop breathing hundreds of times in one night. This will make you feel very tired the next day. Medical conditions related to some types of CSA can also worsen the problems with sleeping and daytime sleepiness. Do I need to see a sleep specialist? Yes. Sleep specialists have training and expertise in this area. The doctor will review your medical history and symptoms. In the case of high-altitude periodic breathing, the detailed history alone should be enough to detect the problem. If needed, the doctor will schedule you for an overnight sleep study. This kind of study is called a polysomnogram. The sleep study will help the doctor to evaluate your problem. Most of the causes of CSA are serious conditions that should be evaluated and treated. A sleep specialist can put together a treatment plan just for you. First, he or she must evaluate the causes of CSA and look for other conditions that create similar problems with sleeping. These include the following: Another sleep disorderA medical conditionMedication useA mental health disorderSubstance abuse What will the doctor need to know? The doctor will need to know your symptoms and how long you have had them. He or she will also want to know if your symptoms began at the same time as other medical problems or when you slept at a high altitude. Get information from those who sleep with you or have seen you sleep. This includes spouses, relatives, friends, teammates and roommates. You will also need to provide a complete medical history. Keep a sleep diary for two weeks. Include the following information: What time you went to bed each nightWhat time you got up in the morningHow many times you awoke during the nightWhether you felt rested when you woke upIf you took naps during the day Whether you felt sleepy or rested throughout the day The sleep diary will help the doctor see your sleeping patterns. This information gives the doctor clues about what is causing your problem and how to correct it. Will I need to take any tests? If your doctor thinks that you have a problem with breathing during sleep, you will need to do an overnight sleep study. This study is called a polysomnogram. It will chart your brain waves, heart beat, and breathing as you sleep. It will also record how your arms and legs move. This will reveal if you have CSA. It will also show how bad the problem is. If you have CSA, you may be asked to return to the sleep center for a second polysomnogram. This visit will include a CPAP study. You will be given positive airway pressure (PAP) treatment as you sleep. How is it treated? Positive airway pressure (PAP) is the treatment most often used for CSA. It is delivered through a mask that you wear over the nose or face. The air gently blows into the back of the throat. This keeps the airway open so you are able to keep breathing as you sleep. The amount of air pressure needed is different for each person. A CPAP study will show what level is right for you. Often a variation of PAP, called BPAP, is used. A thorough evaluation and treatment of underlying medical conditions needs to be done. Heart failure or kidney failure needs specific treatment. Stroke may require special care such as rehabilitation. In the case of high-altitude periodic breathing, no specific treatment may be needed. But other problems that occur at high altitude may need to be addressed. Some of these may respond to medication. Others require avoiding high altitudes. In the case of CSA due to drug or substance, a change of medication may be needed. By Norman J. Wilder, MD Updated on February 3, 2006

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