Sleep apnea is when breathing stops during nighttime sleep. Therefore, it can also be referred to as sleep apnea syndrome, in which a narrowing of the upper airway occurs. In addition, the cause may also be a malfunction or disorder of the respiratory muscles. Sometimes other diseases (e.g., heart failure) are also responsible for sleep apnea.
What is sleep apnea?
Schematic diagram showing the anatomy of the pharynx in snoring and sleep apnea syndrome. Click to enlarge. Sleep apnea is characterized by cessations of breathing (apneas) lasting more than ten seconds during sleep. The number of apneas in an hour determines the severity of the condition. Due to a short-term lack of oxygen, these apneas often lead to unnoticed waking reactions that interrupt nighttime sleep. Restful sleep is no longer possible. In Germany, up to four percent of the population is affected. The male sex suffers more frequently from sleep apnea. Classic symptoms are massive snoring, headaches, dizziness, dry mouth and pronounced daytime sleepiness. The latter leads to a significantly reduced performance, microsleep can occur. Due to the chronic stress, depression, high blood pressure with risk of heart attacks or strokes, and erectile dysfunction may occur in the course. Diagnosis is made by history and monitoring in the sleep laboratory.
Causes
A first distinction is made between central and peripheral obstructive sleep apnea. The obstructive form is significantly more common. In this case, relaxation of the pharyngeal muscles occurs during sleep. Thus, during inhalation, a part of the trachea collapses and obstructs the airway. If the airway does not collapse completely, there is a weakened manifestation (so-called hypopnea). Obstructive sleep apnea syndrome is favored by considerable overweight, obstructed nasal breathing (polyps in children, tumors or malformations) and drugs (alcohol, nicotine, sleeping pills). However, a predisposition to slack throat muscles can also be a triggering factor. The central form results from damage (e.g., morphine intoxication) or disease (e.g., Lyme disease) to the CNS. The result is disturbed breathing regulation in the brain. Central sleep apnea is usually hereditary.
Symptoms, complaints, and signs
A common symptom of sleep apnea is marked daytime sleepiness. This may occur even though there has been an adequate amount of nighttime sleep. After sleeping in a shared bedroom, life partners often report irregular loud snoring sounds. The cessation of breathing causes the body to become alarmed due to reduced oxygen levels in the blood. Blood pressure rises and the respiratory muscles are activated. Cardiac arrhythmias may also occur. Sudden momentary awakening is possible. Those affected feel as if they are exhausted in the morning. They yawn even at the breakfast table and seem to lack energy. The poor quality of sleep caused by the stressful effects of numerous breathing pauses can significantly reduce concentration and performance. The so-called microsleep at the wheel poses a great danger. In addition, the chronic sleep deficit can lead to daily headaches or depressive moods. Anxiety can also occur. Other possible symptoms of sleep apnea are erectile dysfunction and reduced sexual desire. Other possible signs include a decline in memory and dry mouth. The lack of nightly rest can also manifest itself in irritability. The oppressive feeling of drowsiness and sleepiness persists throughout the day. Signs of sleep apnea may also include sudden attacks of dizziness. Likewise, due to intense mouth breathing, morning sore throat and heartburn are among the symptoms.
Complications
Among the most common complications of sleep apnea are cardiovascular diseases: Many sufferers have high blood pressure, which is difficult to positively affect with medication. Cardiac arrhythmias can also occur, and in the long term the condition favors the development of coronary heart disease. The lowered oxygen content of the blood causes the blood to thicken, patients with sleep apnea therefore have an increased risk of suffering a stroke or heart attack.An above-average number of sufferers die of sudden cardiac death. A further complication is diabetes mellitus, which is often accompanied by a lipometabolic disorder in sleep apnea sufferers and in many cases responds poorly to drug treatment. During operations, there are more incidents than usual that require an abortion of the procedure: The reason may be acute lung failure, pulmonary embolism or blood pressure derailment. Problems also occur more often during follow-up care, resulting in a longer hospital stay. In everyday life, sleep apnea is noticeable in severe fatigue and concentration problems, and those affected are no longer able to cope with their professional tasks. In many cases, the tendency to microsleep makes it impossible for sufferers to drive a motor vehicle or operate machinery. Constant fatigue and loss of performance can trigger depression. If left untreated, sleep apnea can shorten life expectancy by up to ten years.
When should you see a doctor?
Symptoms such as difficulty sleeping through the night and headaches, dry mouth or dizziness after getting up can indicate sleep apnea. The family doctor must be consulted if these symptoms occur several nights a week and severely affect well-being. If other symptoms such as heavy night sweats or the tendency to fall asleep during the day are added, an immediate visit to the doctor is recommended. Obstructive sleep apnea syndrome is favored by obesity and increased age. Taking tranquilizers or sleeping pills is also one of the risk factors and should be clarified quickly. Central sleep apnea is triggered by neurological diseases, but can also occur after a tick bite and the resulting Lyme disease. Likewise, a stroke favors the condition. If the symptoms mentioned occur in connection with the risk factors, the family doctor or a sleep laboratory must be consulted. The actual treatment usually takes place in a specialized clinic. The family doctor can prescribe the prescribed medication and, if necessary, carry out the regular progress controls after the diagnosis.
Treatment and therapy
The most effective treatment for sleep apnea – after reduction of risk factors – is CPAP ventilation (CPAP: continuous positive airway pressure). This is done using a mouth or nose ventilation mask. Recently, nasal cannulae can also be used. The ventilation mode is set to maintain a continuous positive pressure (overpressure of about 5 to 20 millibars). This prevents the throat muscles from collapsing (“internal splinting”). Snoring can also be prevented in this way. Even if the masks seem frightening at first, users are little affected. They quickly become accustomed to them and the quality of life is immediately improved. If this form of ventilation is not possible, BIPAP ventilation can be used (BIPAP: Biphasic Positive Airway Pressure). In contrast to CPAP ventilation, this usually has to be carried out continuously at night. If the patient refuses ventilation, a so-called protrusion splint can be inserted into the mouth, which prevents the airways from collapsing. A naso-pharyngeal stent has a very similar principle of action. Modafinil (drug for narcolepsy therapy) can be used to reduce daytime sleepiness. In milder cases, treatment with theophylline (classic indication in asthma and COPD), which has centrally stimulating effects, is possible. If conservative therapies are not sufficient or if the patient wants causal therapy, surgical intervention can be performed. In bimaxillary surgery, the pharyngeal space is surgically enlarged. The results are good. In addition, tissue in the pharynx can be “burned” by electricity. Scarring shrinkage expands the space behind the tongue.
Prevention
One of the most important measures against sleep apnea is weight reduction. A normal weight should be the goal. Alcohol and nicotine should be avoided or consumption should be limited. Sleeping pills should also be used sparingly. It has been shown that playing wind instruments has a protective effect. This is explained by the fact that blowing strengthens the throat muscles.
Aftercare
A diagnosis of sleep apnea typically requires lifelong use of the prescribed respiratory therapy device, so ongoing follow-up care is essential for a sustainable lifestyle. The follow-up routines estimated for this purpose may vary depending on the health care provider, but they are usually performed annually. With the help of special measuring devices, which the patient is given on loan to take home for one night, all vital values are recorded during sleep. These include, for example, pulse measurements, the duration of individual sleep phases, and oxygen saturation in the blood. The data is analyzed by the attending physician the following day. Over the years, the patient’s sleep habits may change, so that adjustments may have to be made to the breathing device. It is also possible that the patient’s needs change over time. For example, the breathing air may be found to be too dry. Prescribing an additional device that moistens and warms the breathing air with water may provide relief in this case. With day-to-day use of the breathing mask, natural wear and tear is not absent. A call to the responsible service provider is sufficient to ensure the new supply of filters, breathing tube, breathing mask as well as other small parts.
What you can do yourself
Patients who suffer from sleep apnea have numerous options for self-help in their daily lives. These options can both help prevent sleep apnea from occurring in the first place or help combat the symptoms. It is simple and effective to change the sleeping position so that the supine position is avoided. This has already helped many patients. For overweight patients, weight reduction is an important component on the path to restful and healthy sleep. Sport plays a doubly important role here: on the one hand, regular exercise helps to shed excess pounds. On the other hand, sporting activity effectively supports the fight against sleep apnea. It is also obvious to give up nicotine. Smoking directly and negatively affects breathing. Sleep apnea patients should therefore also stop smoking in general with a view to their health. The situation is less drastic with alcohol. Here a complete renouncement is not absolutely necessary, but moderation is announced. It is recommended not to drink any more alcohol four hours before going to sleep and to avoid excessive consumption of alcoholic beverages altogether. In addition, sleep apnea patients should follow the same recommendations that apply to healthy sleep. This includes not too high temperature in the bedroom, a good mattress or adequate ventilation of the bedroom.
