Sleep apnea is a growing problem globally and the more common type, obstructive sleep apnea (OSA), is closely associated with obesity. It is estimated to affect about 2% of women and 4% of men in the United States. Collectively the different types of sleep apnea are believed to affect as many as 20 million Americans. However, a large number of sleep apnea cases remain undiagnosed for years and even decades. It is not just about the quality of sleep – sleep apnea has an effect on almost every aspect of a person’s health.
What happens in sleep apnea?
The term ‘apnea’ means that breathing has stopped. This is momentary in sleep apnea and occurs only during sleep. It impairs sleep quality and may also result in loss of sleep hours. With sleep being such an important process to recuperate from the physical and mental strain during waking hours, the body does not recover adequately. Studies have shown that sleep apnea can increase the risk of cardiovascular diseases like heart attacks and strokes, among other illnesses.
This disruption of breathing during sleep occurs through two mechanisms. There are three types of sleep apnea – obstructive, central and mixed. The most common is obstructive sleep apnea. The tissues of the upper airways becomes lax and collapses thereby causing an obstruction. Central sleep apnea is where the brain stops transmitting signals to the breathing muscles. As a result a person stops breathing. The last type is mixed type, which is a combination of both obstructive and central sleep apnea.
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How to Spot Sleep Apnea
Studies suggest that as many as 9 in 10 cases of sleep apnea remain undiagnosed. That means the vast majority of people with sleep apnea do not know that they have the condition. The signs and symptoms sleep apnea that are discussed below may not always be present from the onset of sleep apnea. Some of these symptoms may also be confused with other medical conditions.
Even if obvious symptoms like the cessation of breathing cannot be identified, sleep apnea should be considered as a possible diagnosis if there are morning symptoms such as fatigue, headaches and a sore throat upon waking. A relevant sleep study should be done particularly when these symptoms occur in people who are overweight or obese, have a family history of sleep apnea and with advancing age.
It is important to note that sleep apnea is not just a matter of snoring and having poor quality sleep. Apart from the risk of cardiovascular diseases like strokes or heart attacks, sleep apnea may also contribute to type 2 diabetes, liver problems and surgical complications. The effects of sleep apnea may also make a person prone to accidents. Therefore sleep apnea should be considered as a serious medical condition.
Although snoring is a common symptom in sleep apnea, it is not always present. Similarly snoring is not always a sign of sleep apnea. Sometimes snoring may occur with a poor sleeping position, extreme tiredness, alcohol usage and nasal congestion among other factors in a person who does not have sleep apnea.
Snoring is a result of reverberation during breathing caused by vibrating of tissue in the mouth and throat. This tissue may also cause obstruction of the airways in obstructive sleep apnea. The snoring in obstructive sleep apnea is not an occasional phenomenon but occurs on a daily basis in most cases.
One of the characteristic signs of sleep apnea is episodes where breathing suddenly stops while asleep. In obstructive sleep apnea this is marked by a sudden stopping of the snoring. There may be a short period of silence and then snorting as a person tries to regain their breath. Gasping and choking may awaken a person.
A period of shortness of breath may then follow and most people return to sleep thereafter. These episodes may not always be remembered by a person with sleep apnea upon waking. It is is instead reported by others, like a spouse. However, when snoring is absent then it may not always be as easy to identify.
Most people with sleep apnea experience restless sleep and even difficulty staying asleep. The restless sleep occurs for several reasons, including awaking out of breath, gasping and choking. There is also frequent awaking without th breathing interruption, as well as tossing and turning in bed. Nighttime urination (nocturia) and GERD (acid reflux) are common with sleep apnea and may also contribute to sleep disturbances.
Another common sign of sleep apnea is unrefreshed sleep. This is also known as non-restorative sleep. Normally a person feels refreshed and energetic after sufficient sleep, ranging between 7 to 9 hours. However, people with sleep apnea report waking up feeling unrefreshed and tired on a daily basis. Sleep does not alleviate these symptoms and it affects both physical and mental performance.
Daytime Fatigue and Sleepiness
Fatigue is a prominent symptom throughout the day. Many patients may seek medical attention for unexplained fatigue without identifying the other signs and symptoms of sleep apnea. In addition there is a constant sleepy feeling throughout the day, which is known as excessive daytime sleepiness. Initially the sleepiness may onl be experienced when idle but eventually it occurs even when alert and active, like when working or during driving.
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Morning Headache and Sore Throat
There are several other morning symptoms, apart from the fatigue upon waking. Headaches, sore throat and confusion in the morning are commonly reported in sleep apnea. In addition there is an unexplained throat dryness. Most people feel like they did not have enough sleep despite having slept for long hours. However, in the early stages these symptoms are not always attributed to sleep apnea and may be associated with other causes.
There are a host of mental health disturbances that arises with sleep apnea. This includes memory problems, poor concentration, difficulty with decision-making, anxiety, depression, irritability and mood swings. Libido is often lower as well. Sleep apnea can also cause personality changes. In addition, there may also be other symptoms like erectile dysfunction and high blood pressure (hypertension) that occurs in sleep apnea.