Sleep Apnea: Causes, Types & Treatments

The American Sleep Apnea Association (ASAA) estimates that 22 million Americans have sleep apnea, a sleep disorder. What’s worse, 80 percent range from moderate to severe undiagnosed obstructive sleep apnea cases,[i] which, if left untreated can have serious health consequences.

Could you be one of them?

The National Institute of Neurological Disorders and Stroke describes sleep apnea as a condition that causes repeated, brief interruptions of around ten seconds or more to a person’s breathing while they are sleeping. If left untreated, sleep apnea can contribute to many serious health issues, including:[ii]

• Hypertension (High blood pressure)
• Stroke
• Heart arrhythmias (irregular heartbeats)
• Cardiomyopathy (enlarged heart muscle)
• Heart failure
• Diabetes
• Obesity
• Heart Attacks

When it comes to sleep apnea symptoms, the list goes on and on. Good, restful sleep has everything to do with living a healthy lifestyle. When a disorder like sleep apnea constantly wakes you during the night, the sleep apnea symptoms will take a toll on your mood and your health. The Mayo Clinic lists the following symptoms for people with sleep apnea:[iii]

• Loud snoring
• Periods where breathing stops (usually noticed by another person)
• Gasping for breath during sleep
• Dry mouth
• Headaches the following morning
• Difficulty staying asleep during the night (insomnia)
• Excessive daytime sleepiness
• Problem with the attention span
• Irritability
• Night sweats
• Frequent nighttime urination [v]
• Sexual dysfunction
• Dizziness [iv]

Sleep apnea symptoms may be plaguing you throughout the day and night, but connecting them to sleep apnea is not always apparent. If you are having any of the above sleep apnea symptoms, speak with your doctor as soon as you can to see if sleep apnea is the cause of your symptoms. A whole host of health issues can come from this disorder. Identify your sleep apnea symptoms and take steps with your doctor to find healthy ways to get a full night's sleep

Some causes are biological. A blockage in the airway causes one kind of sleep apnea. [vi] Another type of sleep apnea occurs when the central nervous system stops communicating with the brain about breathing.

Other conditions contribute, too. Some conditions that affect the central nervous system can cause sleep apnea, like strokes or ALS or Lou Gehrig’s.[vii] People with advanced forms heart disease or kidney failure can also develop sleep apnea. Genetic conditions that contribute to smaller facial bones or alter tongue position are particularly concerning. Sleep apnea is also associated with some hormonal disorders. Babies born before 37 weeks are more likely to develop a sleep disorder.[viii]

There are two main types of sleep apnea. These include Obstructive Sleep Apnea and Central Sleep Apnea. 

Obstructive sleep apnea occurs when you have a partial or complete blockage in your upper airway when you sleep. Among the usual symptoms of sleep apnea, obstructive sleep apnea causes a low flow of oxygen to your body and organs, and heart arrhythmias. [ix]

Central sleep apnea occurs when the brain stops telling the muscles they need air. It is usually the result of a serious illness, particularly one that influences your brain’s stem that controls your involuntary actions, like breathing.[x]

It is not unusual for patients to have obstructive and central sleep apnea, called mixed sleep apnea or treatment-emergent central sleep apnea. [xi]  

Diagnosing sleep apnea happens with your medical doctor. Before they arrive at a sleep apnea diagnosis, your doctor will want to rule out any other cause of your symptoms. They will take a medical history, a list of your medications, and travel history, as altitudes higher than 6,000 feet can affect oxygen levels in the bloodstream after you return and disrupt your sleep. Moreover, they look for your risk factors and whether existing conditions are associated with undiagnosed sleep apnea, such as high blood pressure, type 2 diabetes, or irregular heartbeats.

Next comes a physical exam for physical factors that can increase your risk. Narrow upper airways, enlarged tonsils, or large neck circumferences are some other things the doctor is looking for in that physical examination, as well as your tongue position and jaw size and structure. Then, doctors will listen to your lungs and heart and test your neurological systems for any irregularities associated with sleep apnea. 

Next, the doctor may order blood tests to check hormone levels to determine if an endocrine disorder interrupts your sleep. Sometimes, the doctor will do a pelvic ultrasound for women to see if cysts are present indicative of polycystic ovary syndrome (PCOS).[xii]

A sleep study might be the next step. Doctors will refer you to a sleep specialist for the study, called a polysomnogram (PSG). The PSG monitors several factors. It identifies breathing activity (or inactivity) indicative of sleep apnea, monitors the movement in the muscles that control breathing, determines your blood oxygen levels, and watches your heart and brain activity while you are asleep. Then, the doctor can diagnose you mild, moderate, or severe sleep apnea depending on what they discover in the study.[xiii]

There are many treatment options for sleep apnea. For example, mild cases of sleep apnea might not require treatment, per se. Instead, your doctor might prescribe lifestyle changes, like losing weight or quitting smoking. For some patients, it might be as simple as treating nasal allergies. Additional options here might be reducing sleeping pill or alcohol use, wearing a nasal breathing strip to keep nasal passages open, or getting a pillow that encourages and supports side sleeping over back sleeping. [xiv]

Suppose your sleep apnea falls into the moderate to severe range. In that case, your treatment options might include a medical device to help open the airway or an oral appliance worn to improve breathing conditions while sleeping. 

A typical medical device to treat sleep apnea is the CPAP machine. The CPAP requires wearing a mask when you sleep. The mask then applies air pressure to keep the upper airway open, allowing for improved breathing and preventing snoring.

However, some patients do not like the CPAP. Sometimes the air pressure exerted by the machine wakes them up throughout the night. In some cases, an auto-CPAP, which adjusts the air pressure throughout the night as necessary, or a BPAP (bi-level positive airway pressure), changes the air pressure depending on whether you are inhaling or exhaling. Another option is an oral appliance that assists in opening the airway. While the oral appliance is not as reliable as the CPAP, it is easier to use. 

Some other treatments for sleep apnea include the following:[xv]

• They are treating the related condition causing sleep apnea, like the heart or neuromuscular disorders.
• Adaptive servo-ventilation (ASV) is a machine that learns your regular breathing pattern and then maintains it once you sleep to prevent apnea.
• Surgery for tissue removal or shrinkage, jaw repositioning, implants in the soft palate, inserting a nerve stimulator to control tongue movement, tonsil removal, bariatric surgery for weight loss, or creating a new air passageway (tracheostomy). 

Sleep apnea affects people of all ages and gender. However, some people have more sleep apnea risk factors than others. For example, Cleveland Clinic says that sleep apnea occurs in about 25 percent of men and 10 percent of women. It is also more prevalent in people over 50 and overweight.  

Per the National Heart, Lung, and Blood Institute, some other risk factors include:[xvi]

• Age: While sleep apnea can occur in anyone, from babies to the elderly, its risk increases as we get older. One reason could be how the brain controls breathing while sleeping changes as we age. Another might be how fatty tissue increases in the neck and tongue as we age.
• Lifestyle Choices: Participating in unhealthy habits like smoking, drinking, poor diet, and lack of exercise can contribute to the development of sleep apnea. 
• Family History: If someone in your bloodline has sleep apnea, you could develop it, too, although healthy lifestyle choices can decrease that risk. The structure of your face and skull and how the brain controls breathing during sleep affect your risk factors also, which comes from heredity. In addition, research shows that your genes also dictate your probability of having inflammation or being obese.  
• Race or Ethnicity: Sleep apnea is more common in minority groups than in Caucasians. 

Because sleep apnea affects people of all ages and genders, everyone is at risk for the condition.  If you think you or someone you love might have symptoms or an increased risk for sleep apnea, why not have them evaluated? Finding out now and getting treatment can help prevent some of the complications of untreated sleep apnea and improve the quality of your sleep—and the quality of sleep for your partner.

To have an airway evaluation by a Smile Generation dentist who can provide a referral for a sleep apnea diagnosis from a medical professional, use our Smile Generation Find a Dentist Tool to find a trusted dentist near me.