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Sleep apnea is one of the worst types of sleep disorders that not only entails short term distress, but many of its long term consequences are life-threatening. There are three types of sleep apnea: obstructive, central and complex.
It essentially results in repeated involuntary cessations in breathing during sleep. Though all of them are essentially breathing-related sleep disorders, the sleep apnea symptoms and causes are different. Of these three types, the obstructive sleep apnea is most common.
Sleep Apnea Causes
Before we discuss the various causes of sleep apnea in detail let us quickly recapitulate what these conditions are all about.
Obstructive sleep apnea affects more than 50% of those diagnosed with the condition. It is a condition marked by repeated pauses in breathing during sleep when all the muscles of the body are in a relaxed state, including those responsible for breathing.
These are the muscles that keep the air passage open during sleep and allow air to flow into the lungs. The muscles of the upper throat are open during sleep to allow air to pass through. However, sleep apnea happens when the muscles in the back of the throat relax.
What happens when the breathing muscles collapse? The breathing muscles offer support to the soft palate, the uvula (the soft triangular piece of tissue hanging from the soft palate), the tonsils and the tongue. When such muscles relax, the airway narrows or closes causing obstruction to normal airflow.
This results in reduction in blood oxygen saturation because of reduced airflow through the air pipe. Such a drop in oxygen levels may cause breathing to stop temporarily. The brain reacts instantly by disturbing sleep and triggers breathing which starts with a gasp or choking.
The narrowing of the air passage can be due to obstructions created by excess tissues in the airway, enlarged tonsils, large tongue; defective anatomical structures of the jaw, etc. Other than the respiratory tract, the obstruction can also be located in the nasal passage.
Obstructive Sleep Apnea Causes
- When the muscles of the throat and tongue relax more than normal.
- The tongue and tonsils are large compared to the opening into the windpipe.
- Obesity is clearly one of the most critical triggers for the onset. When the breathing muscles are affected by obesity, they become weak and flaccid thus becoming vulnerable to collapse during sleep. The extra fat tissues thicken the wall of the windpipe, causing it to narrow and it becomes difficult to keep it open. This narrows the inside of the windpipe, which makes it harder to keep open.
- Over-relaxation of breathing muscles may also occur due to excessive alcohol consumption.
- Nasal blockage caused by anatomical defects like septal deviation, crooked bone at the bridge of the nose, enlarged tongue, misaligned jaw, etc.
- Nasal blockage can also be caused by common cold, allergies, sinus infections, etc.
- The shape of your head and neck could result in a smaller airway size in the mouth and throat area.
- Advancing age can impede the ability of brain signals to keep the throat muscles open during sleep. This may result in the muscles narrowing or collapsing during sleep.
- Some medical conditions could result in this kind of sleep apnea. These include Down syndrome, glaucoma , tonsillitis, insomnia, pulmonary venous hypertension, etc.
Central Sleep Apnea Causes
This type of sleep apnea happens when the brain temporarily ceases to send breathing signals to the muscles responsible for breathing. Thus there is no effort to breathe for brief periods. A less common type of sleep apnea, it has more to do with the central nervous system, rather than airway obstruction.
The patient usually wakes up feeling shortness of breath and finds it difficult to go back to sleep or remain asleep. The most common cause for onset of this type of sleep apnea is heart failure and less commonly, stroke.
Though it can affect anyone, it is mostly seen in people who have certain medical conditions or use certain medications. It can occur along with obstructive type or alone.
Medical conditions that can cause or lead to the condition are:
- Any life-threatening problem affecting the brainstem, which controls breathing.
- Arthritis and degenerative changes in the cervical spine
- Bulbar poliomyelitis
- Complications after cervical spine surgery
- Encephalitis or stroke affecting the brainstem
- Parkinson’s disease and similar other neurodegenerative conditions
- Radiation of the cervical spine
- Primary hypoventilation syndrome
- Certain medications including narcotic-containing painkillers; opioids like morphine, oxycodone or codeine
- Cheyne-Stokes breathing (associated with congestive heart failure)
- High-altitude (more than 15,000 feet) periodic breathing
Sleep Apnea Symptoms
The statistics related to obstructive sleep apnea, the more common type of apnea is alarming to say the least. Approximately 25 million American adults are affected by it and as if this was not all, of those affected, 10 million are still undiagnosed.
So long as the symptoms remain undetected and the condition undiagnosed, treatment is also delayed. Why should it be like this? Why are the symptoms of sleep apnea so difficult to catch? This is because a majority of the symptoms appear only during sleep. Thus it is usually the person sharing the same bed or room, who notices the distress that the patient is experiencing during sleep.
Before we start to discuss about the elusive symptoms, let us get a better understanding of what obstructive sleep apnea is.
Recurrent breathing pauses, called apnea episodes are the hallmark of this condition. Such pauses accompanied by shallow breathing happen when the muscles at the back of the throat are unable to keep the airway open for free flow of air to and from the lungs. A single pause may last for 10 seconds or more and based on how serious the condition is, a patient could experience 5 to 30 such pauses in one hour.
How are the breathing pauses linked to brain function? In fact, the pauses happen when the relevant breathing muscles are incapacitated and unable to follow the commands to breathe, as sent out by the brain. Such lapse in coordination between the sender and recipient of the signals happen when there is an obstruction in the respiratory tract.
Of the three types of apnea – namely, obstructive, central and complex sleep apnea, obstructive sleep apnea happens when throat muscles collapse during sleep; central sleep apnea is a result of the brain’s inability to send out breathing signals and complex sleep apnea is a combination of these two types.
Common Sleep Apnea Symptoms in Men and Women
The initial signs of sleep apnea in adults as noticed by the bed or room partner are:
- Loud and persistent snoring
- Restless sleep with frequent tossing and turning in bed.
- Snoring interrupted by frequent pauses when it seems that the sleeper has stopped breathing.
- Gasping and choking
Fortunately, the patient soon notices several signs, especially when they start to interfere with his or her daily activities. The signs are:
- Pauses in breathing severely impacts quality and quantity of sleep. This causes excessive daytime lethargy and reduced energy to do daily activities.
- Quick and unexplained weight gain. The chronic sleep disturbance eventually impacts the functioning of two important appetite-related hormones – Grehlin and Leptin. This in turn makes the patient indulge in irrational eating which makes him or her put on excess weight.
- Sore throat, headaches and dry mouth in the morning.
- Irritability and depression
- Forgetfulness, problems with concentration – after-effects of severe sleep disturbance.
Sleep Apnea Symptoms in Children?
Though sleep apnea can affect anyone no matter what age and gender, as far as children are concerned, approximately 1 to 10% children get affected. Most of these children are between 2 and 8 years old.
The signs that children show are:
- Excessive daytime sleepiness
- Mouth breathing
- Frequent pauses in breathing during sleep, including gasping and choking
- Loud snoring
- Restless sleep
- Irregular breathing
- Heavy sweating during sleep
- Pulling in of chest in younger children
- Adopting strange positions during sleep which is usually with mouth open
- Feeling of confusion on waking; irritability
- Adenotonsillar hypertrophy, neuromuscular disease, and craniofacial abnormalities.
- Facial deformities like smaller jaw, smaller opening at the back of the throat
- Enlarged tonsils or adenoids, large tongue or tissues partially blocking the airway
- Deviated septum causing nasal blockage
What are the consequences of sleep apnea in children?
Sleep apnea in children can quickly become life-threatening if not treated on time. when the condition remains undiagnosed it could lead to :
- Failure to grow
- Heart ailments
- High blood pressure
- Changes in personality
- Sleep walking
- Learning and developmental problems
- Interpersonal relationship problems
- Frustration and depression
- Excessive daytime sleepiness
- Bed wetting
Sleep Spnea Symptoms in Men and Women : Are They Same?
Many symptoms are similar. These include snoring, gasping and choking, pauses in breathing, interrupted sleep, etc. However, a study revealed that close to 50% of women do not report these to the doctor; instead, they report non-specific complaints like sleeplessness, depression, lethargy, tiredness, headaches in the morning, etc.
This makes it tough for the treating doctor to diagnose and treat women for sleep apnea. In fact, the cases are either misdiagnosed or not diagnosed at all, though close to 90% women may be suffering from moderate to severe apnea.
It is also to be noted that symptoms as experienced by women are more subtle and likely to be REM related and differ from the typical clinical symptoms of the condition.
Is there are any symptom that is unique to men only? While many symptoms are similar between men and women, there is one though, which is unique for men: lack of sexual interest and erectile dysfunction (ED).
In a research study published in The Journal of Sexual Medicine in 2009, German researchers showed that close to 69% of men suffering from sleep apnea experienced ED as well. This is explained by the fact that apnea causes major oxygen deprivation and even a small drop in oxygen levels can impair sexual desire and erectile function.
It is also a fact that most of the male hormone, testosterone, is produced during sleep. Since sleep apnea interrupts sleep repeatedly, there is less generation of this hormone. This reduces sex drive in men and causes reduction in muscle mass and bone strength.
How prevalent is sleep apnea in women?
Though at one point in time it was thought that sleep apnea affected more men than women, recent research on the subject of prevalence shows that the current ratio of men to women is 2:1. 18 million Americans suffer from this condition; this includes one in four women over the age of 65.
Sleep Apnea Symptoms And Causes Conclusion
Becoming aware of the sleep apnea causes and the consequences of this dreadful ailment can go a long way in preventing the onset. Though there are plenty of treatment alternatives available for managing these two types of sleep apnea, some simple home remedies including lifestyle modifications can prevent further worsening of both obstructive as well as central sleep apnea.
It is clear from the above, that loud and persistent snoring is perhaps one of the most easily-identifiable symptoms of sleep apnea. Therefore prevention of sleep apnea, unless it is fallout of an existing medical condition, should ideally begin with early treatment of snoring, before it worsens into another more serious sleep disorder.