What is sleep apnea?

Sleep apnea is characterised by frequent periods of absence of breathing during sleep. There are three types of sleep apnea: obstructive, central, and mixed. Obstructive sleep apnea (OSA) is the most common; central sleep apnea is rare; mixed sleep apnea is a combination of the previous two with treatment being the same as OSA.

Obstructive Sleep Apnea can be visualised by thinking about what happens when you block the hose of a vacuum cleaner - the vacuum continues to try and suck up air, but the pathway is physically blocked. Obstructive Sleep Apnea is usually caused by an obstruction or collapse of the upper airway/throat. This frequently causes a drop in blood oxygen levels, making the body wake up to resume breathing. This is called an apnea event. The body continues to make an effort to breathe.

Central Sleep Apnea is like turning off the power to the vacuum cleaner, there is no "signal" telling the vacuum to suck air. Central Sleep Apnea is considered a neurological condition where the body stops making an effort to breathe frequently during sleep. CSA often results in a drop in blood oxygen levels. The part of the brain that controls breathing shuts down and there is no physical effort to breathe. Central Sleep Apnea will cause the body to wake up frequently in order to resume breathing. The effects of Central Sleep Apnea are essentially the same, however due to the different cause, they are entirely different conditions.

Mixed Apnea

Mixed sleep apnea, is a combination of both Obstructive and Central Sleep Apnea. An episode of mixed sleep apnea usually starts out as central but then becomes obstructive and the body begins to make an effort to breathe. Often, on treating the Obstructive Apnea, the Central Apnea poses less of a problem.

Hypopnea can be thought of as a partial apnea event. The difference between an apnea event and a hypopnea event is that during apnea, the airflow is blocked 100% - during a hypopnea, the flow is still partially able to get through. Both however disrupt the quality of your sleep and both can cause your oxygen levels to drop, both therefore need to be treated.

Often, your bed partner is the one to tell you you have a problem while you're sleeping, (such as snoring and cessation of breathing). Sleep Apnea will usually present with some or all of the following symptoms.

• Loud, frequent snoring especially combined with periods of silence for 10 seconds or more
• Loud snorts or gasps, moans or mumblings
• Unrefreshing sleep with groggy feeling in the morning
• Excessive daytime sleepiness and / or fatigue
• Inability to concentrate and remember things
• Falling asleep at inappropriate times, eg, when you're sitting down, driving, watching TV
• Morning headaches
• Dry mouth
• Mood Swings

It is important to remember that although common, not everybody that suffers from sleep apnea snores.

Wouldn't I know if I snore or wake up struggling to breathe?

Chances are you wouldn't. When you wake from an apnea event, most of the time it is only a partial awakening, just enough for your body's functions to resume to normal. While you are not necessarily aware of it, this does disrupt your different stages of sleep meaning the sleep experienced is unrefreshing. Very often the amount of time spent in REM and deep sleep is reduced. Many people do not know that they have sleep apnea

The same applies to daytime sleepiness, people aren't always aware the feel tired or abnormally sleepy. Sleep Apnea often develops over a long period of time, therefore the symptoms increase gradually. It is not uncommon for someone to only realise how tired they really were AFTER receiving treatment.

What should I do if I think I may have sleep apnea?

The best thing to do is see your doctor. Even today, many doctors know too little about sleep disorders and don't take them seriously. With this in mind, it may be necessary you insist that your doctor refer you to a sleep specialist. You can contact the sleep disorder foundation to find your nearest accredited sleep specialist or sleep disorders unit.

The only real way to diagnose Sleep Apnea is to have a polysomnogram also known as a Sleep Study. This involves spending a night in a sleep lab. For more details visit the Sleep Study page.

Does the fact that I snore mean I have sleep apnea?

While snoring is one of the most common symptoms of apnea, snoring is not a diagnostic tool as some who snore don't have apnea, and in some cases people who don't snore do have apnea.

When does it Require Treatment?

It is considered normal for people to have a minimal number of apnea events in any given night. However if this number of events is above five per hour, and longer than ten seconds in duration, it is considered as possibly requiring treatment. Other things to be considered are the associated daytime symptoms of excessive sleepiness. This can only be determined through a sleep study.

What are the effects of Sleep Apnea?

Apnea is something that makes you stop breathing, therefore, it is potentially life threatening. In addition, studies have also shown that apnea can increase your risk of stroke and heart disease. Poor quality sleep on a long term basis will also cause other potentially dangerous symptoms such as depression, loss of memory, inability to concentrate and will put you at risk of falling asleep while driving or operating machinery. Some doctors now state that untreated sleep apnea is one of the leading causes of heart attack and stroke.

What treatments are available?

There is no cure for sleep apnea, but there are effective ways of treating it. By far the most effective is by means of treating apnea is with a CPAP machine. There are some dental appliances that may help mild cases, and depending on the cause of your apnea, weight loss may help too (treatment should NOT be delayed until you have lost weight. Use a CPAP first, then once you have lost the weight you may be able to give up the CPAP - you will need another sleep study to confirm this).

Some doctors will recommend surgery. There are only two types of surgery you should seriously consider for treatment of apnea. The first involves"fixing" your nasal passages to remove any obstructions. This is not a cure for apnea, but may help you tollerate CPAP treatment more eaisly. The second is a tracheotomy (hole in throat to bypass the obstructed airway).

UPPP or LAUP are surgeries that were promoted at one point but the long term side effects are very poor, some say as low as 10%. It is extreemly painful, can cause aweful side effects (such as food coming out your nose when you try to eat) and will often result in CPAP treatment no longer being an option. If you are considering this kind of surgery, speak to as many people as you can who went through it at least 3 years ago. This will give you an idea of just what the long term sucess rates are really like. If you're researching surgery online, be sure to note who the site belongs to, if someone who makes money from the surgery is promoting the site, you'll find the sucess rate is listed as being above 50%. Another thing to note about "success rate" when it comes to these surgeries, is that success is defined as someone being able to reduce the pressure on their CPAP.....not necessarily get rid of it altogether.

"Nasal CPAP" is the treatment of choice for most people with obstructive and mixed apnea. It is the most reliable and effective treatment in most cases. Hundreds of thousands of CPAP devices are now in use treating obstructive sleep apnea. More details on the CPAP page.

How often do I need a Sleep Study?
There is no hard and fast rule. Some recommend a sleep study be done every 1-2 years. If you have had a significant weight change or if you find you are returning to your pre-CPAP symptoms, it is a good idea to have another study done, your pressure needs may change over time.

If you have had surgery to correct apnea, it is also a good idea to have a followup study done to be sure the surgery has been sucessful.

If you have been prescribed a dental device rather than CPAP, a sleep study wearing the device will tell you whether or not the treatment is working.

The term Sleep Apnea (sometimes spelt apnoea) is based on the Greek word "apnea" which means "without breath." People who suffer sleep apnea stop breathing repeatedly during sleep. There are three types of sleep apnea, the most common of which is Obstructive Sleep Apnea (OSA). Obstructive Sleep Apnea occurs when the airways become blocked. The others are Central Sleep Apnea, which means the problem is in the brain (the brain "forgetting" to tell the body to breathe) and Mixed Sleep Apnea, which is a combination of both Obstructive and Central Sleep Apnea.

You may well ask, if someone stops breathing while they sleep, how do they start breathing again? Fortunately, our body's reaction to absence of breath when we sleep is to wake us up. With Obstructive Sleep Apnea, while sleeping, the body's muscles relax and this causes excess tissue in the nose or throat to block the airways, when the body wakes up, the muscles are no longer relaxed and the airway blockage is removed enabling the body to begin breathing again. Apnea "events" can occur hundreds of times a night and may even last more than a minute! With this in mind, it becomes obvious why people with Sleep Apnea feel so sleepy during the day. Their sleep is being disturbed possibly hundreds of times a night. People with Sleep Apnea are often not aware that they wake up so frequently during the night.

Symptoms of Sleep Apnea usually include: Snoring, Excessive Daytime Sleepiness (EDS) and often the sufferer will wake up during the night gagging or coughing....this is more often noticed by the partner. If your partner tells you you snore and also stop breathing or wake up gasping for air, you may have Sleep Apnea and you should see your doctor. Remember that even though someone with Sleep Apnea will wake many times during the night, they may not be at all aware of it (I know I wasn't!). The reason for this is that you usually don't wake up fully, just enough to disturb your sleep and for your breathing to return to normal. This disturbed sleep means that you get very little or no REM or Stage 4 sleep. These are the deep sleep stages your body requires to do all it's repair work and get you ready to face the day.

The only way to be sure you have Sleep Apnea is to have a Sleep Study (called a polysomnogram) done in a Sleep Lab. This requires an overnight stay while your brain waves, heart beat, breathing rate and limb movement is monitored. Sleep Apnea is most common in over weight men over 40 but can affect anyone of any age, even children, regardless of their size.

Treatment can take several forms. Surgery, although still used, is known to have a low success rate and in some cases makes the condition worse and even sometimes results in it being untreatable by other methods. There are also mouth pieces available that will help to prevent the blockages in the case of Obstructive Sleep Apnea. The most common and by far the most successful treatment for Sleep Apnea is the Continuous Positive Airways Pressure (CPAP) machine. This consists of an air pressure device and a mask the sufferer wears over their nose (or in some cases nasal pillows which are worn at the nostrils). The machine's air pressure will be set by a technician during a monitored sleep study to ensure the most beneficial results for each individual. The machine works by forcing ordinary air through the airways at a pressure which keeps the airways from becoming blocked when the muscles relax during sleep. It can be difficult to get used to but most people after using a CPAP for the first time see a very significant difference in how they feel when they wake up. It is not uncommon for a person to not realise how tired they were until they spend their first night with CPAP machine.

Some people's tissue is more "elastic" than others and tends to stretch or sag sooner. Combine that with a basic structure where the throat has difficulty maintaining structural integrity. (e.g. more elliptic than circular) with sides unable to maintain weight. Someone once mentioned neck size in proportion to body size as an indicator.

My analogy is to compare different lawn hoses. Some maintain their shape without water (pressure) others collapse flat without water (pressure). Our throats start out somewhere in between, but have a tendency towards the flat hose.

A number of things contribute to pushing our throats towards the flat hose model. Weight, muscle tension, alcohol (relaxes muscles), normal closure of the throat during sleep, stress,... Our throats begin to "learn" the closed position as the predominant tendency.

Why sooner or more severe for some - a question of combining the extent of the elasticity of tissue, level of weakness in the integrity of the throats structure and all other contributing factors.

A casual observation is that OSA is inherited for good portion of the OSA population. (Perhaps we could breed it out of the population LOL)

To confirm any or all of this would require extensive testing of the currently identified OSA population against a normal population sample.

And then tracking for a generation. One, some of the normal population could develop OSA over time. Two, need to establish if any offspring of OSA sufferers develop OSA and what characteristics they share with their parent.

Drug companies won't see much point in doing it since they are unlikely to develop a drug from it. Surgeons already have basic treatments to offer, although we may benefit from research into snoring (good money there for surgeons), and CPAP folks have a treatment that works so we can only expect refinements to existing technology as they fight for market share.

You are then left with under-funded universities to do the research. A possibility but I wouldn't hold your breath in the meantime *pun intended*

Part of the problem is, as you have noticed, researchers tend to focus on one area. Part of the problem with Sleep Apnea there are a variety of places and reasons for problems to develop. Some people have more problems with their soft palate, others the tongue, or tissue blockage elsewhere, may have complicating factors such as a deviated septum, enlarged tonsils, or a benign growth that is causing the problem. How it starts can be just as mysterious, part of it is weight related but there are thin individuals which also suffer from obstructive apnea, so there must also be something else which is adding to it, part genetics, part environmental damage, perhaps. It can't be tissue aging because there are teen -agers and young children which also suffer from the illness. Note: What follows is a discussion of body parts that may be involved in OBSTRUCTIVE apnea, Central Apnea involved the nervous system and opens a whole new list of possibilities.

Your throat is like a soft hose, attached at the top to your skull, and that's about it. The trachea is membrane stretched between stiff cartilage to which the soft hose is lining. It is amazing that in it's normal state that it doesn't collapse, when you think about it in this way. So what happens in apnea that changes our hoses? ((OK GANG standard disclaimer: I am not a doctor, I am only offering stuff I have gleaned from my own education in biology, it is strictly a personal opinion offered to give you something to get a better handle on what is going on, and also a greatly over simplified version))

Places the tube might have kinks in it: Nasal Passages: Sinuses are an amazing device, they not only warm and moisturize air they are also the first line of defense against airborne infections. They are cavities connected by short straws, and sometimes the straw gets gunk built up in it, or gets bent out of shape, making the straw much more narrow and harder to draw air through. Some times medication or surgery can correct these problems. Then there is the hole which connects the nasal passages to the top of your throat. It can be smaller than normal, or you can have a bulge in the soft hose or a thickening of the soft hose which causes a blockage, but because a bulge or thickening of the hose is soft, it can be pushed out of the way. The soft tube may be narrower than normal which means even small lumps and bumps present a problem. Then comes the soft palate and uvula. The soft palate is a muscle, and like any muscle it can get flabby or stretched out of shape, and the Uvula can be longer or thicker than normal, any of which will cause tissue to hang down, so when you lay down on your back, instead of hanging in your mouth, it hangs down into your throat. But, it is <Soft> tissue, it can be pushed out of the way. After that is the tongue and the hyoid process under your jaw, Your tongue could be thicker than normal, or you can have a build up of flabby muscle or fat in the area of your hyoid that normally give one a double chin effect (even if you can't see it in a mirror) and when you lay down on your back instead of hanging in front of your adam's apple as it does when you are sitting or standing, it will push your tongue into your throat. Or, the soft tube may be thicker down the back of it, and the spinal bones do not move out of the way, so tissue that when standing or sitting, pulls down into the stomach is now not being pulled down by gravity, it is being held in place in all its bulging glory. Tonsils, if inflamed or enlarged are an extra added lump on top or any other lump you may have, narrowing the throat. If you are carrying a bit of extra weight, you could have fatty tissue build up in your throat, think of it as being similar to what happens to fatty deposits in your arteries. You could have any one, a combination of several or all of these effects going on at the same time. They could be cause by nutritional factors, irritated lining from a mild food allergy, irritation from airborne agents (pollution, smoke, smog, incense, air freshener, etc.), muscle relaxation due to recreational substance use, a genetic factor, or some other as yet undiscovered factor. So they doctors can't tell you exactly what causes it, because there are a *LOT* of factors to cancel out, which is very difficult to do when you are talking about something you do 24 hours a day, in a variety of situations (smog or no smog, food allergy or no food allergy, air freshener or other airborne smells), and there is absolutely no way to remove their influence so that they can be studied individually. Unfortunately, what we are left with is that they can recognize the symptoms, and can minimize the effects of some of them with therapy (and CPAP is a therapy and not a cure), but they are not able to get to 100% of the root cause. Sorry.