We have all had the feeling of waking up short of breath as if something had deprived us of oxygen. Sometimes ephemeral alcohol abuse, a bad cold… when these small incidents of nocturnal ventilation do not occur regularly, it is not necessary to pay more attention to them.
But when the pattern is repeated every night, there is a reason to be concerned. Because obstructive sleep apnea-hypopnea syndrome (OSAHS), or sleep apnea, can have serious consequences on the quality of life and health of sleepers who present symptoms.
An overview of a sleep disease that is often poorly understood, but that should be treated seriously.
What Is Sleep Apnea?
Obstructive sleep apnea-hypopnea syndrome (OSAHS), better known as “sleep apnea”, is characterized by involuntary pauses in the sleeper’s breathing.
Sleep apneas are divided into two categories:
- Obstructive apneas, explained by physiological causes (collapse of the respiratory tracts blocking the patient’s ventilation). Lasting more than 10 seconds (up to 30 seconds for the most serious cases), these stops can occur completely uncontrollably from 5 to more than 100 times per night.
- Central apnea (much rarer), due to the brain’s reduced ability to command the respiratory system to function.
In general, this syndrome is correlated with snoring and excessive daytime sleepiness, as it seriously impacts the quality of nighttime rest.
Who Is Concerned About Sleep Apnea?
In France, it is estimated that 4% of the population suffers from obstructive sleep apnea-hypopnea syndrome. Who are they?
People At Risk.
If sleep apnea can affect all categories of the population, including pediatric populations, and older men who are overweight, who are nevertheless over-represented among the patients.
Thus, some people are at greater risk than others:
- Overweight or Obese people: fat accumulated in the neck causes the airways to narrow. Also, obese people multiply by 7 their risk to develop an OSA
- Elderly People: the older you are, the more likely you are to develop sleep apnea. After 65 years, the proportion of the population affected by this disease doubles at least.
- Men Are More Affected Than Women: before the age of 60, they are 2 to 4 times more likely to be affected than women.
- African-Americans And Asians are more likely to be affected, according to some studies (Prog Cardiovasc Dis. 2009 Jan-Feb;51(4):285-93. Epidemiology, risk factors, and consequences of obstructive sleep apnea and short sleep duration. Al Lawati NM, Patel SR, Ayas NT) would be more affected by sleep apnea
- People with malformations of the jawbones or the upper airways (narrowness of the ducts, hypertrophy of the tonsils, especially in children).
- Family History: one is 2 to 4 times more likely to suffer from it when a close family member is affected.
- People with a large neck: if the circumference exceeds 43 cm for men, and 40 cm for women, the risk of suffering from OSA is multiplied.
- Diabetics with type II diabetes: 23% of them suffer from sleep apnea.
Viot-Blanc V. Sleep apnea syndrome in neurology: in whom and how to look for it?
How and why to treat it? Neurol.com. 2009;1(3):79-83.
What Are The Causes Of Sleep Apnea?
The obstructive sleep apnea-hypopnea syndrome has above all a physiological origin. But certain behaviors can also increase the risks. Here is a review of the causes of sleep apnea.
In most patients, sleep apnea can be explained by physical factors :
- A muscular relaxation at the level of the tongue and the throat. By collapsing, the palate obstructs, partially or totally, the passage of air to the lungs.
- Abnormalities of the jaw such as retrognathism.
- The length of the soft palate: if it is too long, it collapses more easily
- Narrowing of the airways: this is particularly the case with overweight people, whose neck fat crushes the respiratory tracts. It is also the case with children, hampered by vegetation.
- A bad functioning of the brain in the case of central apnea. It is important to know that in this case, sleep apnea is only a symptom related to a pre-existing disease (heart disease, stroke, neurological disease such as Parkinson’s disease).
- Nasal obstruction: the blocked nose (sinusitis, chronic rhinitis) of allergic people, for example, is a breeding ground for the appearance of sleep apnea
- The existence of type II diabetes, perhaps in connection with the obesity of patients who suffer from it.
If sleep apnea is generally explained by physical elements, certain behaviors can increase the risk:
- Alcohol consumption, particularly because of the muscular relaxation it causes.
- The use of sleeping pills, anxiolytics, or muscle relaxants, which reduce muscle tone.
- Smoking, which has an inflammatory effect on the respiratory tract and promotes airflow obstruction. Smokers thus run a risk 2.5 times higher than non-smokers.
How To Know That You Suffer From Sleep Apnea: The Symptoms?
It is not easy to realize that you suffer from sleep apnea for a good reason: it appears when you sleep! But some elements can put us on the way.
A Partner Who Complains.
For those who sleep together, the recognition of sleep apnea can be facilitated. As apnea is generally associated with snoring, the person who shares a bed with a partner will quickly spot the brutal interruptions of the breathing rhythm.
In case of doubt, the partner should not hesitate to record the person he/she believes to have sleep apnea. This could be useful during a medical consultation (see: how is sleep apnea diagnosed).
Numerous Awakenings During The Night.
Sleep apnea prevents people with the condition from falling into a deep sleep.
So, if you notice that you wake up frequently during the night, with the feeling of suffocating, if you go to the bathroom more often and more regularly, don’t hesitate to make an appointment with your doctor, or at least talk to your pharmacist.
Increased Drowsiness During The Day.
So far as it deteriorates the conditions of recovery of a sleeper, sleep apnea is also detectable by the inconveniences it causes during the day.
If you wake up already tired, if you are particularly irritable during the day, if you feel morose or even depressed, if you suffer from memory loss, if you suffer from repeated migraines, or if you sleep for a long time during the day and you fall asleep without realizing it, including while driving, you should consult a doctor.
In the same way, parents who notice that their child is not focused on his or her school results are at half-mast, should not delay in going to see a doctor.
Dentists can also be a valuable ally in making an initial diagnosis. As they are perfectly capable of detecting certain anatomical problems related to the disease. We should therefore talk to them about our sleep problems if we suspect that we suffer from sleep apnea.
How Is Sleep Apnea Diagnosed?
When you realize that the symptoms you feel are converging towards sleep apnea, the right reflex is to make an appointment with your doctor.
Set up a medical review to verify the existence or not of obstructive sleep apnea-hypopnea syndrome, including consultation with sleep specialists.
The Epworth Sleepiness Test.
One of the first steps in making a diagnosis is to check how sleepy the patient is.
The use of the Epworth sleepiness test is then recommended.
Sleep tests, performed in a specialized center, are currently the most reliable means of diagnosing sleep apnea.
It consists in recording the patient during his sleep, at night, in order to detect the disorders that affect him, and then, if necessary, to observe the state of his vigilance during the day.
Several parameters are observed :
- the patient’s heart rate
- his brain activity
- electrical activity of the muscles
- eye movements
- his respiratory movements
- his blood circulation
Interpreting The Results Of These Tests.
Sleep specialists believe that there are several degrees of sleep apnea syndrome, evaluated from the number of apneas/hypopneas per hour of sleep: this is the apnea/hypopnea index or AHI.
Here are the different stages of the disease:
- Mild sleep apnea: AHI between 5 and 15
- Moderate sleep apnea: AHI between 16 and 30
- Severe sleep apnea: AHI greater than 30
What Are The Consequences On The Health Of The Patients?
The pathology, because it interrupts sleep and regenerative capacities of the state of sleep, has heavy consequences on the life of those who suffer from it.
People whose sleep quality is poor are more prone to drowsiness, or even to falling asleep uncontrollably at work, in front of the television, and while driving.
The number of road accidents or accidents at work is higher among those who suffer from sleep apnea than among good sleepers.
The micro-awakenings associated with sleep apnea also affect the brain capacities of people with this pathology: lack of concentration, memory lapses, lack of efficiency at work… and many more.
When one is extremely tired, certain character traits are amplified: angry people are more inclined to be irritable, moody people to be depressed.
In the long term, sleep apnea cuts individuals off from their sociability and can lead to depression syndromes.
Sleep apnea must be treated with care, because not only does it cause isolation and depression in the long term, but it also has repercussions on the cardiovascular health of those who present symptoms.
They are in fact among the aggravating factors of heart and vascular diseases. It is assumed that the lack of oxygenation of the brain stem due to repeated apneas and the increase in the number of heartbeats and blood pressure at each micro-awakening, eventually tire the body.
Also, people suffering from this pathology are more exposed to certain diseases such as:
- myocardial infarction
- cardiac arrhythmia
- heart failure
Sleep apnea would also increase the risk of sudden death in sleep.
Operative / Post Operative Complications.
In case of surgery, it is essential to inform your surgeon of the sleep disorders you suffer from. And this is for two reasons:
- When we are given a general anesthetic, the muscles of the throat relax more than usual, without the possibility of a wake-up reflex. The risk of complications on the operating table is therefore multiplied.
- In the postoperative period, painkillers are generally prescribed. However, the latter also has the effect of promoting sleep apnea, and therefore reinforce an already present problem. Close monitoring is therefore recommended.
How To Prevent Sleep Apnea.
It is possible to adopt a few preventive measures to avoid sleep apnea from becoming established.
You Are Overweight Or Obese.
You try to lose weight by adopting a healthy and balanced diet, and by practicing a physical activity adapted to your condition. Good to know: losing 10% of your weight reduces the frequency and duration of sleep apnea by 26%.
You Are Diabetic.
You follow your treatment and you observe a diet inadequacy with your pathology.
You Tend To Snore When You Sleep On Your Back.
You get into the habit of lying on your side, you “wedge” yourself with a pillow, or you buy nightwear specially designed to maintain the side position during the night.
We Tend To Snore When We Sleep Flat.
We raise the head of the bed so that our sleeping position is slightly “sitting”.
We Often Resort To Sleeping Pills.
When we have sleep problems, it can be tempting to rely on chemical solutions to sleep. However, they cause a greater relaxation of the muscles of the tongue and throat, favoring sleep apneas, and reinforcing the problem of chronic fatigue.
In general, alcohol consumption should be moderate. But in addition, it restricts muscle tone, especially in the neck, which favors the appearance of sleep apnea. If you want to take stock of your alcohol consumption, information sites are available:
Here again, the overall health risks of smoking should encourage you to stop smoking, especially if you want to prevent sleep apnea. Professionals can help you quit:
You Suffer From Chronic Allergies.
If they clog up your airways (sinuses, nose), allergies are an aggravating factor in the occurrence of sleep apnea. Therefore, one should take care to follow one’s treatment or, if possible, try desensitization. It is important to know that antihistamines can have a relaxing effect, and therefore favor the muscular relaxation of the mouth and throat.
Our Child Suffers From Pediatric Rhinopharyngeal Disorders.
We establish a protocol with his or her doctor to solve these problems (removal of the vegetations for example).
How Is Sleep Apnea Treated?
Sleep apnea does not have a cure at the moment. However, it is possible to limit the most annoying effects.
Continuous Positive Airway Pressure (CPAP).
CPAP is the most popular mechanical solution to relieve the pain caused by sleep apnea.
It is a machine that sends, thanks to its ventilation motor, slightly overpressurized air into the upper airways via a mask placed on the nose or mouth of the sleeper. The breath sent prevents the muscles of the tongue and throat from collapsing during inspiration, freeing the air circulation.
In France, Social Security reimburses this treatment automatically the first year and renews its coverage if the patient uses the device at least 3 hours per night.
Although the results are very good, the constraints inherent to the program discourage many patients. Also, compliance with the treatment drops rapidly after 6 months of use.
The Mandibular Advancement Orthosis.
Commonly called “aligners”, these mandibular propellers are dental appliances that advance the lower jaw. By this mechanism, they prevent the tongue from falling into the back of the throat and allow better air circulation.
Made by a dentist from a mold of the patient’s dental arches, these custom-made appliances must be worn every night, and obtain conclusive results for apneas of moderate gravity.
The French Social Security pays for this device if it is prescribed by a doctor.
No drug treatment has an impact on sleep apnea.
However, if the sleep apnea is caused by an allergy, for example, taking antihistamines can help to reduce the obstruction of the nose, and help to reduce the number of apneas during the night.
If the patient suffers from gastroesophageal reflux disease, treatment with medication can help control apneas.
Finally, if the patient has great difficulty staying awake during the day, a physician may prescribe medication to stimulate attention and concentration.
In the case of mild to moderate sleep apnea, it is possible to limit the number and duration of sleep apneas by falling asleep on one side, but especially by keeping this position throughout the night.
However, even with the best will, we do not choose the position in which we sleep: even if we take care to fall asleep in the side position, it is very possible to find ourselves on our backs a few hours later.
Therefore, there are techniques to accustom our body to adopt the side sleeping position for a long time, by making the back sleeping position impossible or difficult.
The Tennis Ball Technique.
This traditional method has been proven to work: it simply involves placing a tennis ball on the sleeper’s shirt, between the two shoulder blades, and securing it with a pocket.
In order for this technique to work, you must wear tight clothing at night: if the T-shirt or nightgown is loose, the tennis ball may slide down the body and no longer bother the sleeper, who can then return to the back position as he or she wishes.
It is also possible to find anti-snoring t-shirts in the shops.
The Backpack Technique.
Still, to avoid turning in his sleep and returning to sleep on his back, you can carry a backpack containing pillows, cushions, or any other material filling it.
The Pillow Technique.
In order to block the sleeper on his side, one can also place a large and long pillow on his back. Specific items are available from bedding manufacturers, but it is also possible to use a long bolster or a pregnancy pillow (which is U-shaped and can be passed between the legs).
The Position Alarm.
Commercially available, these devices emit a shrill sound as soon as the sleeper turns onto his or her back so that he or she wakes up and returns to the side position.
Some operations can be considered if the previous solutions have not given satisfactory results, without however being completely conclusive in the long term.
A relapse is often observed in the months/years following the surgical intervention.
This operation consists in removing a portion of the soft palate, whose vibrations cause snoring.
If it has demonstrated a certain success in reducing the noise of the sleeper, this operation, performed under general anesthesia, is only effective for half of the people with sleep apnea, since it does not intervene on the muscular relaxation of the throat.
Tonsillectomy And Adenoidectomy.
In the pediatric population, the tonsils and adenoids can be enlarged. Their excessive volume can then block the passage of air and cause obstructive sleep apnea syndrome.
If their removal helps considerably to limit the importance of sleep apnea, it is advisable to discuss it seriously with your doctor: these ganglia are useful for the immune system of children.
Nasal And Sinus Surgery.
People with a nasal septum bypass, or with polyps on the sinuses, for example, may consider surgery to improve airflow.
As a last resort, if and only if other treatments have failed, patients with the most severe cases of sleep apnea may be offered a tracheostomy. This involves cutting the trachea below the throat so that the air goes directly to the lungs, without passing through the upper airways.
Sleep apnea is a serious disorder, which should not be taken lightly but which is sometimes difficult to identify.
Fatigue, irritability, drowsiness, depression, must alert and incite to consult, so that a protocol of adapted treatment can be set up, and that the patient finds a restful sleep.