Patient Education

Sleep Apnea

What is sleep apnea? Sleep apnea is a sleep disorder where your breathing repeatedly stops and starts throughout the night. This can happen because of a blocked airway (obstructive sleep apnea) or because your brain doesn’t send the proper signals to breathe (central sleep apnea). Both types cause you to wake up gasping for air or experience periods of shallow breathing, disrupting sleep and reducing oxygen levels.
Symptoms of sleep apnea Sleep apnea disrupts your sleep, often without you even realizing it. Watch out for daytime sleepiness, even after a full night’s sleep. You might also experience restless sleep, frequent urination at night, morning headaches, difficulty concentrating, or irritability. Partners may notice loud snoring or episodes where you gasp for breath during sleep.

Sleep Apnea Self-assessment tools: Try the following sleep apnea self-assessment tools to determine your risk for sleep apnea.

STOP-BANG Questionnaires

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Epworth Sleepiness Scale

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Obstructive Sleep Apnea

Obstructive sleep apnea (OSA) is one of the most common forms of sleep-related breathing disorders. It occurs when the muscles in your airway relax, leading to complete or partial collapse and a subsequent decrease in oxygen saturation or arousal from sleep. Due to OSA, your brain and body may become oxygen-deprived, leading to multiple awakenings throughout the night, which can disturb your sleep quality. If you wake up in the morning feeling tired or unrefreshed despite having slept through the night, it could be a sign of sleep apnea. The following questions will help you assess your risk for sleep apnea: 1. Do you experience any of these problems?

Daytime sleepiness
Unrefreshing sleep
Fatigue
Insomnia

2. Do you ever wake from sleep with a choking sound or gasping for breath? 3. Has your bed partner noticed that you snore or stop breathing while you sleep? 4. Do you have any of these other symptoms?

Waking frequently during the night to go to the bathroom
Morning headaches
Difficulty concentrating
Memory loss
Decreased sexual desire
Irritability

5. Do you have any of these physical features?

Obesity, body mass index of 30 or higher
Large neck size, 17 inches or more for men, 16 inches or more for women
Enlarged tongue or tonsils
Recessed or small jaw
Nasal polyps or deviated septum

6. Do you have any of these other medical problems that are common in people with sleep apnea?

High blood pressure
Mood disorders
Coronary artery disease
Stroke
Congestive heart failure
Heart attack
Atrial fibrillation
Type 2 diabetes

Central sleep Apnea

What is central sleep apnea?Unlike obstructive sleep apnea, central sleep apnea disrupts your breathing due to a communication breakdown between your brain and breathing muscles. During sleep, your brain fails to send proper signals to respiratory muscles, causing your breathing to pause or become shallow. This can happen repeatedly throughout the night, leading to fragmented sleep and daytime fatigue. Central sleep apnea often arises as a secondary condition to other medical issues like heart failure, stroke, or medications. While less common than obstructive sleep apnea, it’s still important to seek a professional evaluation if you suspect you might have it.
Symptoms of central sleep apneaCentral sleep apnea disrupts your breathing during sleep due to malfunctioning signals from your brain to your breathing muscles. Unlike obstructive sleep apnea where the airway is physically blocked, central sleep apnea causes these muscles to briefly stop working altogether. This can lead to a cluster of symptoms that might go unnoticed. You might experience excessive daytime sleepiness, even after a full night’s sleep, or wake up feeling unrefreshed and fatigued. Fragmentation of sleep due to these breathing pauses can also lead to difficulty concentrating, morning headaches, and irritability. While some people might report gasping for air during sleep, this is less common with central sleep apnea compared to obstructive sleep apnea.
Risk factors for central sleep apneaCentral sleep apnea risk factors are linked to brain function, not airway blockage. These include factors like age (over 65), being male, certain health conditions (heart failure, stroke), some medications, and even high altitude sleeping.

Snoring

What is snoring?

Snoring is the noisy breathing that occurs during sleep when air movement is obstructed in the upper airway. This obstruction can happen due to relaxed throat muscles, enlarged tissues like tonsils or the tongue, or even a blocked nasal passage from allergies or a sinus infection. As air struggles to flow through the narrowed airway, the surrounding tissues vibrate, producing the characteristic snoring sound. While occasional snoring may be harmless, chronic snoring can disrupt sleep for both the snorer and their partner. It can also be a sign of a more serious sleep disorder called obstructive sleep apnea, where breathing repeatedly stops and starts during sleep. If you or your partner snores regularly, consulting a doctor to rule out sleep apnea and discuss treatment options is recommended.

Groaning

What is groaning?

Sleep-related groaning, also known as catathrenia, presents as a unique sleep disorder characterized by the emission of loud and long-lasting groans during sleep. These episodes typically occur nightly, disrupting the sleep of bed partners and causing concern. The groans themselves can manifest in various ways, ranging from low moans and hums to even cracking sounds. Interestingly, the duration can vary significantly, lasting anywhere from a few seconds to over 40 seconds. Notably, these groaning episodes tend to conclude with a sigh or grunt. Further investigation into the characteristics of sleep-related groaning reveals a distinct pattern in breathing. During a groaning episode, individuals will take a deep breath followed by an unusually slow exhalation that coincides with the production of the groaning sound. These groaning episodes often appear in clusters lasting anywhere from 2 minutes to a full hour, and can recur multiple times throughout the night. Importantly, despite the potentially alarming sounds, facial expressions remain calm during these episodes, suggesting a lack of any emotional connection to the groans themselves. Additionally, while groaning can occur in any sleep position, it appears to be somewhat position-dependent. A change in sleep position may cause the groaning to temporarily cease, though it can resume later in the night. Perhaps most interestingly, individuals experiencing sleep-related groaning are often entirely unaware of the sounds they produce, highlighting the need for reports from bed partners or family members for proper diagnosis. It is crucial to differentiate sleep-related groaning from other conditions that may present with similar moaning sounds. Epileptic seizures can involve moaning, but these occurrences lack the regularity characteristic of sleep-related groaning. Snoring, while sometimes involving a moaning sound, is primarily characterized by noise produced during inhalation, as opposed to groaning which occurs during exhalation. Lastly, stridor is a condition that produces a harsh, high-pitched sound during breathing, mainly during sleep. However, unlike groaning which occurs in clusters, stridor happens frequently throughout the night. The exact cause of sleep-related groaning remains a mystery. It is not associated with any underlying medical conditions, breathing difficulties, abnormal brain activity, or mental health issues. While sleep-related groaning may lead to mild sleep disruption or daytime fatigue, it is generally considered a benign condition. Interestingly, groaning episodes appear to be more frequent during REM (Rapid Eye Movement) sleep, one of the four stages of a sleep cycle. Individuals typically experience four to six sleep cycles per night, with groaning being most prevalent during the later REM sleep stages, which tend to be longer in duration. Groaning can also occur occasionally during other sleep stages, but REM sleep appears to be the primary culprit. In conclusion, sleep-related groaning, or catathrenia, is a sleep disorder characterized by loud vocalizations during sleep. Although the cause is not fully understood, it is considered harmless in most cases. If you suspect you or someone you know may be experiencing sleep-related groaning, consulting a healthcare professional for proper diagnosis and management strategies is recommended.

How to diagnose groaning?

While sleep-related groaning itself may not necessitate extensive diagnostic workup, a structured approach can help differentiate it from other conditions and ensure optimal sleep hygiene for both partners. The initial evaluation typically involves a detailed medical history focusing on the onset, frequency, and duration of groaning episodes. Additionally, a comprehensive review of current and past medications is crucial. Diagnostic tests are generally not required unless the groaning significantly disrupts sleep quality or daytime alertness for either you or your bed partner. In such cases, a sleep study (polysomnography) may be recommended. This overnight evaluation records brain waves, heart rate, breathing patterns, and limb movements while you sleep, aiding in the differentiation of catathrenia from other sleep disorders. An ear, nose, and throat (ENT) specialist consultation may also be warranted to rule out any underlying anatomical abnormalities in the upper airway that could contribute to the groaning sounds. It’s important to understand that there is no specific treatment for catathrenia itself. However, non-invasive management strategies can help minimize its impact, particularly on your bed partner’s sleep. Earplugs can be an effective solution to mitigate noise disruption. In extreme cases, separate bedrooms may be a temporary or long-term approach to ensure optimal sleep for both individuals.

Sleep Apnea Treatments

Sleep apnea treatments target the underlying airway blockage to improve sleep quality. The most common approach is a CPAP machine, which delivers continuous positive airway pressure to keep your passages open throughout the night. For milder cases, oral appliances can be used to physically hold your jaw in a position that prevents airway collapse. In severe situations or when other options aren’t effective, surgery may be necessary to reshape the airway tissues. Additionally, lifestyle changes like weight loss, quitting smoking, and avoiding alcohol before bed can significantly improve sleep patterns and reduce sleep apnea symptoms.

CPAP Therapy

What is CPAP treatment?
CPAP, or continuous positive airway pressure, is a common treatment for obstructive sleep apnea. It uses a mask to deliver a steady stream of pressurized air into your airways throughout the night. This gentle airflow keeps your airway open and prevents it from collapsing during sleep, allowing you to breathe normally and get a better night’s rest.
Benefits of CPAP treatment
CPAP therapy offers a range of benefits. It improves sleep quality by preventing airway collapse and ensuring uninterrupted breathing. This leads to increased daytime alertness, reduced fatigue, and better focus. Additionally, CPAP treatment can lower your risk of serious health problems like heart disease, stroke, and high blood pressure. Overall, it can significantly improve your quality of life.
Types of PAP therapy
PAP (Positive Airway Pressure) therapy comes in three main types to address sleep apnea:

CPAP (Continuous Positive Airway Pressure): The most common, delivering a steady stream of air pressure to keep airways open.

APAP (Auto-PAP): Automatically adjusts pressure throughout the night based on your breathing needs.

BiPAP (Bi-Level Positive Airway Pressure): Provides two pressure settings – higher for inhaling, lower for exhaling – for those needing extra breathing support.

Oral Appliance Therapy

What is Oral appliance therapy?Oral appliance therapy is a non-invasive treatment for mild to moderate obstructive sleep apnea. It involves wearing a custom-made mouthpiece while you sleep. This mouthpiece gently holds your jaw in a slightly forward position, which helps prevent your tongue and airway tissues from collapsing and blocking your breathing. It’s a comfortable and quiet alternative to CPAP machines for some patients.
Benefits of oral appliance Oral appliances offer a comfortable and convenient alternative to CPAP machines for treating mild to moderate sleep apnea. They work by gently holding your jaw forward, which opens the airway and prevents collapse during sleep. This can significantly improve sleep quality, reduce snoring, and boost daytime alertness without the need for masks or hoses.
Side effects of oral appliance While oral appliances are a good option for some sleep apnea sufferers, they can come with minor side effects. These may include temporary jaw discomfort, soreness, or dry mouth. In some cases, you might experience slight tooth movement, but this is usually monitored by your dentist. Overall, the benefits of improved sleep quality often outweigh these potential drawbacks.

Positional Therapy

Obstructive Sleep Apnea (OSA) disrupts sleep patterns due to airway collapse during sleep. For some individuals, the primary cause of these airway closures occurs when they sleep on their back. In such cases, a treatment option known as positional therapy can be a valuable tool. Positional therapy utilizes a variety of devices to discourage sleeping on the back and promote side or stomach sleeping. These devices fall into two main categories. Passive support devices physically prevent or make it uncomfortable to sleep supine. Examples include back or waist wraps that gently restrict supine positioning, backpacks worn during sleep that create an obstacle when lying flat, or even strategically placed tennis balls tucked into sleepwear. Newer technology offers a more dynamic approach through vibrational alert devices. These wearable devices employ sensors to detect when you begin to shift onto your back. Upon sensing a supine position, the device emits gentle vibrations, acting as a subtle prompt to change positions without fully waking you. The vibration intensity may even increase if you remain on your back, ensuring a persistent nudge towards a more side-oriented sleep posture. These advanced models often have the added benefit of collecting valuable sleep data, such as the frequency of snoring episodes and the number of times you change positions throughout the night. This data can be instrumental for your doctor in monitoring your progress and tailoring your treatment plan. Positional therapy can be a successful standalone treatment for mild to moderate OSA cases, particularly when supine sleep is the primary culprit behind the airway closures. For more severe cases of OSA, it can also be effectively combined with other established therapies like CPAP (Continuous Positive Airway Pressure) to create a more comprehensive treatment approach. Ultimately, your physician will work with you to determine the most suitable sleep apnea treatment based on the specifics of your diagnosis and individual circumstances. For appropriate patients, positional therapy offers a non-invasive and potentially life-changing option to improve sleep quality, reduce daytime sleepiness, and enhance overall well-being.

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