Have you been told that you snore loudly? Do you wake up feeling tired after a full night's sleep? Are you sleepy during the day? If so, you may have sleep apnea. In this potentially serious sleep disorder, breathing repeatedly stops and starts during sleep.

Obstructive sleep apnea occurs two to three times more often in older adults and is twice as common in men as in women. Treatments for sleep apnea may involve using a device to keep your airway open or undergoing a procedure to remove tissue from your nose, mouth or throat.

Signs and symptoms

The most common signs and symptoms of obstructive sleep apnea includes:

• Excessive daytime sleepiness (hypersomnia)
• Loud snoring
• Observed episodes of breathing cessation during sleep
• Abrupt awakenings accompanied by shortness of breath
• Awakening with a dry mouth or sore throat
• Morning headache

Causes

Obstructive sleep apnea occurs when the muscles in the back of your throat relax during sleep. These muscles support the soft palate, the triangular piece of tissue hanging from the soft palate (uvula), tonsils and tongue.

When the muscles relax, your airway narrows or closes as you breathe in, and breathing momentarily cuts off. This may lower the level of oxygen in your blood. Your brain senses this inability to breath and briefly rouses you from sleep so that you can reopen your airway. This awakening is usually so brief that you don't remember it.

You can awaken with a transient shortness of breath that corrects itself quickly, within one or two deep breaths, although this is rare. You may make a snorting, choking or gasping sound. This pattern can repeat itself 20 to 30 times or more each hour, all night long. These disruptions impair your ability to reach those desired deep, restful phases of sleep, and you'll probably feel sleepy during your waking hours.

People with obstructive sleep apnea may not be aware that their sleep was interrupted. In fact, many people with this type of sleep apnea think they sleep well all night.

When to seek medical advice

Consult one of our physicians if you experience, or if your partner observes, the following signs of obstructive sleep apnea:

• Snoring loud enough to disturb the sleep of others or yourself
• Shortness of breath that awakens you from sleep
• Intermittent pauses in your breathing during sleep
• Excessive daytime drowsiness, which may cause you to fall asleep while you're working, watching television or even driving

Evaluation and diagnosis

Your doctor will evaluate you based on your signs and symptoms and may refer you to a sleep disorder center for a sleep test (polysomnography).  During this test, you're hooked up to equipment that monitors your heart, lung and brain activity, breathing patterns, arm and leg movements, and blood oxygen levels while you sleep. This test helps your doctor to arrive at an accurate diagnosis.

Complications

Sleep apnea is considered a serious medical condition that requires treatment. Complications of untreated sleep apnea may include:

• Cardiovascular problems.Sudden drops in blood oxygen levels that occur during sleep apnea increase blood pressure and strain the cardiovascular system. About half of people with sleep apnea develop high blood pressure (hypertension), which raises the risk of heart failure and stroke. If there's underlying heart disease, these repeated multiple episodes of low blood oxygen (hypoxia or hypoxemia) can lead to sudden death from a cardiac event.

The more severe the obstructive sleep apnea, the greater the risk for high blood pressure.

A study published in November 2005 in the New England Journal of Medicine reported that obstructive sleep apnea greatly increases the risk of stroke, regardless of whether a person has high blood pressure. However, effectively treating obstructive sleep apnea can lower blood pressure and the risk of other cardiovascular diseases.

• Daytime fatigue.The repeated awakenings associated with sleep apnea make normal, restorative sleep impossible. People with sleep apnea often experience severe daytime drowsiness, fatigue and irritability. They may have difficulty concentrating and find themselves falling asleep at work, while watching TV or even when driving. Children and young people with sleep apnea may do poorly in school or have behavior problems.
• Complications with medications and surgery.Obstructive sleep apnea also is a concern with certain medications and general anesthesia. People with sleep apnea may be more likely to experience complications following major surgery because they're prone to breathing problems, especially when sedated and lying on their backs. Before you have surgery, tell your doctor that you have sleep apnea. Undiagnosed sleep apnea is especially risky in this situation.
• Sleep-deprived partners.Loud snoring can keep those around you from getting good rest and eventually disrupt your relationships. It's not uncommon for a bed partner to sleep in another room, or even on another floor of the house, to be able to sleep. Many bed partners of people who snore are sleep deprived as well.

People with obstructive sleep apnea may also complain of memory problems, morning headaches, mood swings or feelings of depression.

Treatment

For milder cases of sleep apnea, your doctor may recommend lifestyle changes such as losing weight or quitting smoking. If these measures don't improve your signs and symptoms or if your apnea is moderate to severe, a number of other treatments are available. Certain devices can help open up a blocked airway. In other cases, surgery may be necessary.

Lifestyle changes

• Lose excess weight.  Even a slight loss in excess weight may help relieve constriction of your throat.
• Avoid sedatives, hypnotics and muscle relaxants. Alcohol and medicines such as tranquilizers and sleeping pills relax the muscles in the back of your throat, interfering with breathing.
• Sleep on your side or abdomen rather than on your back.Sleeping on your back can cause your tongue and soft palate to rest against the back of your throat and block your airway. To prevent sleeping on your back, try sewing a tennis ball in the back of your pajama top.
• Keep your nasal passages open at night.Use a saline nasal spray to help keep your nasal passages open. Talk to your doctor about using nasal decongestants or antihistamines because these medications are generally recommended only for short-term use.

Non-surgical therapies

• Continuous positive airway pressure (CPAP).If you have moderate to severe sleep apnea, you may benefit from a machine that delivers air pressure through a mask placed over your nose while you sleep. With CPAP (SEE-pap), the air pressure is somewhat greater than that of the surrounding air, and is just enough to keep your upper airway passages open, preventing apnea and snoring.

Although CPAP is a preferred method of treating sleep apnea, some people find it cumbersome or uncomfortable. With some practice, most people learn to adjust the tension of the straps to obtain a comfortable and secure fit. You may need to try more than one type of mask to find one that's comfortable. Some people also benefit from using a humidifier along with their CPAP system.

Don't just stop using the CPAP machine if you experience problems. Check with your doctor to see what modifications can be made to make you more comfortable. Additionally, contact your doctor if you are still snoring despite treatment or begin snoring again. If your weight changes, the pressure settings may need to be adjusted.

• Oral appliances.Another option is wearing an oral appliance designed to keep your throat open. CPAP is more effective than oral appliances, but oral appliances may be easier for you to use.  Some are designed to open your throat by bringing your jaw forward, which can sometimes relieve snoring and mild obstructive sleep apnea.

A number of devices are available from your dentist. You may need to try different devices before finding one that works for you. Once you find the right fit, you'll still need to follow up with your dentist at least every six months during the first year and then at least once a year after that to ensure that the fit is still good and to reassess your signs and symptoms.

Surgery or other procedures
The goal of surgery for sleep apnea is to remove excess tissue from your nose or throat that may be vibrating and causing you to snore, or that may be blocking your upper air passages and causing sleep apnea. Surgical options may include:

• Uvulopalatopharyngoplasty (UPPP).During this procedure, your doctor removes tissue from the rear of your mouth and top of your throat. Your tonsils and adenoids usually are removed as well. This type of surgery may be successful in stopping throat structures from vibrating and causing snoring. However, it may be less successful in treating sleep apnea because tissue farther down your throat may still block your air passage. UPPP usually is performed in a hospital and requires a general anesthetic.
• Maxillomandibular advancement.In this procedure, the upper and lower part of your jaw is moved forward from the remainder of your face bones. This enlarges the space behind the tongue and soft palate, making obstruction less likely. This procedure may require the cooperation of an oral surgeon and an orthodontist, and at times may be combined with another procedure to improve the likelihood of success.
• Tracheostomy.You may need this form of surgery if other treatments have failed and you have severe, life-threatening sleep apnea. In this procedure, your surgeon makes an opening in your neck and inserts a metal or plastic tube through which you breathe. You keep the opening covered during the day. But at night you uncover it to allow air to pass in and out of your lungs, bypassing the blocked air passage in your throat.
• Other types of surgerymay help reduce snoring and sleep apnea by clearing or enlarging air passages.
  • Nasal surgery to remove polyps or straighten a crooked partition between your nostrils (deviated nasal septum)
  • Surgery to remove enlarged tonsils or adenoids
  • Procedures to stiffen the palate (Pillar implants) may also improve snoring.
  • Removing tissues in the back of your throat with a laser (laser-assisted uvulopalatoplasty) or with radiofrequency energy (radiofrequency ablation) are procedures that doctors sometimes use to treat snoring.

If you have questions or concerns, talk to one of our physicians.  Most cases of snoring and sleep apnea can be easily treated.