By Dr Unnikrishnan N

Many people don’t think snoring is something that we should be too concerned about. Frequent loud snoring can be a sign of sleep apnea. Sleep apnea is a potentially serious disorder in which breathing stops for a particular period of time. Sleep apnea is curable but often goes unrecognised. Being able to distinguish it from normal snoring is the first step to overcome sleep apnea.

What is sleep apnea?
Sleep apnea is when normal breathing is affected while sleeping. If sleep apnea is untreated, the breathing becomes shallow and is constantly interrupted. A pause in the breathing cycle which lasts for 10 to 20 seconds and can reoccur to hundreds of times a night and jolts the sleep pattern and results in sleep being extremely light. A deep sleep is essential for a strong mind and a productive day.
This persistent sleep deprivation leads to daytime sleepiness, slow reflexes, poor concentration and the increased risk of accidents. Sleep apnea can also cause diabetes, high blood pressure, heart disease, weight gain and stroke.

Symptoms
It is not easy to identify the signs and symptoms of sleep apnea as prominent symptoms appear while one is asleep. One should ask his/her sleep partner to check for the signs or make an audio visual recording of the sleep period.
The classical sign of sleep apnea is pause while snoring. Choking and gasping following the pauses is a major sign of sleep apnea. Feeling sleepy at work or while driving, morning headaches, memory loss  or learning problems, less concentration, restless sleep, insomnia, feeling irritable or depressed, having mood swings, personality changes, waking up frequently to urinate and dry mouth or sore throat when you wake up are some of the many symptoms of sleep apnea.

Causes and risk factors
Anyone can get affected by sleep apnea — children, adults, men or women. There are many risk factors that could lead to sleep apnea and they are:
Obstructive sleep apnea is usually seen in people who are overweight, males over the age of 65. Some of the other risk factors are smoking, a narrowed airway, family history, nasal congestion, excessive consumption of alcohol, sedatives or tranquilisers.
Central Apnea is seen in elderly people, individuals with heart disorders or if someone has suffered a stroke or has a brain tumor.

Types of sleep apnea
Obstructive sleep apnea:  It is the most common type of sleep apnea which occurs when the soft tissue in the back of your throat relaxes during sleep and blocks the airway. This often causes loud snoring.
Central sleep apnea: This is a less common type of sleep apnea that involves the central nervous system which occurs when the brain fails to signal the muscles that control breathing. People with central sleep apnea snore rarely.
Complex sleep apnea:  This form of sleep apnea is a combination of obstructive and central sleep apnea.

Complications
Sleep apnea causes various health complications and they are:
High blood pressure and heart ailments: Sudden drop of blood oxygen levels that occurs during sleep apnea may lead to high blood pressure and has the tendency to strain the cardiovascular system. Obstructive sleep apnea increases the risk of high blood pressure, stroke, atrial fibrillation, congestive heart failure and other vascular diseases.
Fatigue: Regular awakenings because of sleep apnea disrupt normal sleeping patterns. People with sleep apnea may go through daytime drowsiness, fatigue, irritability, less concentration, falling asleep at work or while driving, feel depressed and mood swings. Children suffering from sleep apnea might have behaviour problems and may perform poorly in academics.
Liver problems: Sleep apnea can cause abnormal liver functioning and affected individuals are likely to have liver scarring as well.

Prevention, treatment and care
Continuous Positive Airway Pressure (CPAP) is the most common treatment provided for sleep apnea in which a mask is worn on the nose or mouth while one is asleep. The mask is connected to a machine that provides continuos flow of air into the nose. This air flow helps keep the airways open so that breathing is regular
Surgery is essential to find and correct underlying causes of sleep apnea like deviated nasal septum or enlarged tonsils or small lower jaw with an overbite causing the throat to be too narrow. Septoplasty/Rhinoplasty, tonsillectomy and jaw correction surgeries might relieve the symptoms. Other surgeries include:

Uvulopalatopharyngoplasty (UPPP): This is a procedure to removes soft tissue on the back of the throat and palate, increasing the width of the airway at the opening of throat.
Mandibular maxillar advancement surgery: This is a surgery conducted to correct certain facial problems or throat obstructions that contribute to sleep apnea.
Various dental devices
There are many dental devices specially designed by dentists that help to keep the airway open while one is asleep.

Changes in lifestyle
Lifestyle modifications go a long way to relieve symptoms of sleep apnea. Weight reduction, alcohol restrictions, avoid consumption of sedatives and tranquilisers, quit smoking, trying and achieve a regular sleep pattern, avoid caffeinated food and beverages have all helped patients with sleep apnea.  While sleeping on your side and not on your back or elevate the head of your bed by four to six inches or elevate your body from the waist up by using a foam wedge.

Dr Unnikrishnan N is
an ENT specialist at
Aster Medical Centre, Al Ghanim

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