Sleep Apnea – things I should know

    Sleep Apnea

    Snoring can make a bad and uncomfortable sleep experience for you and your bed mate. But if it happens because you have obstructive sleep apnea (OSA), it’s a sign of a bigger problem that you should worry about.

    The condition raises your risk for other health issues like high blood pressure and diabetes. Moreover, it can even make you more dangerous on the road. But when you treat thisyou can ease or even cure some of these issues.

    How common is Sleep Apnea ?

    Dangers of Sleep Apnea

    The American Sleep Apnea Association estimates that 38,000 people in the United States die each year from heart disease with sleep apnea as a complicating factor.

    People with this complication have difficulty breathing or stop breathing for short periods while sleeping. This treatable sleep disorder often goes undiagnosed.

    According to the American Heart Association, 1 in 5 adults have sleep apnea Trusted Source to some degree. It is more common in men than in women. Children can also have sleep apnea.

    What may happen if I develop Sleep Apnea ?

    Without treatment, sleep apnea can lead to serious complications.

    1. High blood pressure. If you already have it, sleep apnea can make it worse. When you wake up often during the night, your body gets stressed. Which boosts your blood pressure levels. 

    2. Heart disease. People with OSA are more likely to have heart attacks. The cause may be low oxygen, Stroke & atrial fibrillation. 

    3. Type 2 diabetesSleep apnea is common among people with this Type 2 diabetes. 80% or more of them may have OSA. Moreover, obesity raises a person’s risk for both disorders. 

    4. Weight gain. Extra pounds raise your chances of getting sleep apnea, and the condition also makes it harder to slim down. 

    5. Metabolic syndrome Metabolic syndrome means you have at least three of these conditions:

    Metabolic syndrome can make you more likely to get heart disease, diabetes, or stroke, so it’s important for healthy lifestyle changes.

    6. Daytime sleepiness. The sun’s up, yet you feel tired. That’s a common symptom of OSA. And, it can take a toll on everything from your mood to how clearly you think.

    7. Car accidents. When you feel groggy, you raise your risk of falling asleep at the wheel. Incidentally, People with sleep apnea are up to five times more likely than normal sleepers to have traffic accidents.

    8. Memory loss.  Research suggests that memory slips show up when someone has a “sleep-disordered breathing” condition like OSA.

    9. DepressionPoor sleep might make you more likely to get depressed. And depression may raise your chances of getting worse shut-eye

    What exactly Sleep Apnea is ?

    Sleep Apnea

    Sleep apnea is a sleep disorder characterized by abnormal pauses in breathing or instances of abnormally low breathing, during sleep.

    Each pause in breathing, called an apnea, can last from a few seconds to minutes, and may occur 5 to 30 times or more an hour. Similarly, each abnormally low breathing event is called a hypopnea

    What are the different types of Sleep Apnea ?

    1.   Central type (CSA), 0.4% of total case are CSA

    2. Obstructive Type ( OSA ), 84 % of the total case are OSA

    3. Mixed Type ( This is the co-existence of CSA & OSA ), 15% of the total case are MSA

    What is Central Sleep Apnea ?

    Breathing is interrupted by a lack of respiratory effort. Additionally, brain’s respiratory control centers are imbalanced during sleep. There is no effort made to breathe during the pause in breathing. Therefore, there are no chest movements and no struggling. After the episode of apnea, breathing may be faster (hyperpnea) for a period of time, a compensatory mechanism to blow off retained waste gases and absorb more oxygen. Any sudden drop in oxygen or excess of carbon dioxide (even if tiny) strongly stimulates the brain’s respiratory centers to breathe.

    In central sleep apnea, the basic neurological controls for breathing rate malfunction and fail to give the signal to inhale, causing the individual to miss one or more cycles of breathing. If the pause in breathing is long enough, the percentage of oxygen in the circulation will drop to a lower than normal level (hypoxaemia) and the concentration of carbon dioxide will build to a higher than normal level (hypercapnia).


    Brain cells need constant oxygen to live, and if the level of blood oxygen goes low enough for long enough, the consequences of brain damage and even death will occur. 

    What is Obstructive Sleep Apnea / OSA ( The most common of all )

    Breathing is interrupted by a physical block to airflow despite respiratory effort, and snoring is common.

    The muscle tone of the body ordinarily relaxes during sleep, and at the level of the throat the human airway is composed of collapsible walls of soft tissue which can obstruct breathing during sleep.

    Individuals with low muscle tone and soft tissue around the airway (e.g., because of obesity) and structural features that give rise to a narrowed airway are at high risk for OSA.

    Sleep Apnea patho physiology
    Sleep Apnea patho-physiology

    How do I understand that I am having Sleep Apnea ?

    An individual with sleep apnea, is rarely aware of having difficulty breathing, even upon awakening. Hence, this is recognized as a problem by others witnessing the individual during episodes or is suspected because of its effects on the body.

    Symptoms may be present for years (or even decades) without identification, during which time the sufferer may become conditioned to the daytime sleepiness and fatigue associated with significant levels of sleep disturbance.


    Initially this may be only a few apneas per night. As the number of apneic events increases, both physical and mental symptoms develop. But, these are usually not noted until there are at least 50 or more events per night. Moreover, in more severe cases, it is possible for a person to experience 500 to 600 episodes of sleep apnea each night.

    What are the potential sign & symptoms of having Sleep Apnea ?

    Sleepy during driving
    daytime sleepiness
    The most common symptoms are as
    • Daytime
      , no matter how much time you spend in bed
    • Tired/fatigue  appearance
    • Frequent urination at night
    • Loud and chronic
    • Choking, snorting,
      or gasping during sleep
    • Long pauses in
    • Insomnia
    • Weight gain

    May also associated with these cognitive
    (mental) dysfunctions: Poor concentration

    • Inappropriate asleep
    • Poor memory
    • Increased irritability
    • Chronic fatigue
    • Decreased libido
    • Some depression
    • Claustrophobia
    • Rapid sleep onset
    • Avoidance of social events
    • Awakening with a headache
    • Sweating in sleep

    Always consult with your doctor before deriving any
    conclusion by your own just by seeing some sign & symptoms. As because of, these might be
    due to some different health complication as well. 

    How likely I may develop Sleep Apnea ?

    Below are some risk factors for developing Sleep Apnea:


    • One is overweight or obesity. Obesity is considered by the American Lung Association (ALA) to be the most important risk factor. According to Johns Hopkins Medicine, it affects over 20 percent of people with obesity compared to about 3 percent of people of moderate weight.
    • You’re male. According to the ALA, men are 2 to 3 times more likely to have OSA than premenopausal women.
    • Having a family history. If OSA has been diagnosed in other family members, according to the Mayo Clinic, you may be at higher risk.
    • If you’re older. According to the ALA, obstructive sleep apnea becomes increasingly frequent as you age, levelling off once you reach your 60s and 70s.
    • Smoking. Obstructive sleep apnea is more common in people who smoke.
    • If you have certain medical conditions. Your risk of developing OSA may increase if you have high blood pressure, diabetes, or asthma.
    • Having chronic nasal congestion. OSA occurs twice as often in people with chronic nasal congestion at night.
    • Crowded pharynx. Anything that makes the pharynx, or upper airway smaller — such as large tonsils or glands — can result in a greater chance for obstructive sleep apnea.

    Self evaluation of Sleep Apnea ?

    Is it just snoring or is it sleep apnea?

    Not everyone who snores has sleep apnea, and not everyone who has sleep apnea snores. The biggest sign is how you feel during the day. Normal snoring doesn’t interfere with the quality of your sleep as much as sleep apnea does.

    What’s Your Snore Score?

    Your answers to this quiz will help you decide whether you may suffer from sleep apnea:

    • Are you a loud and/or regular snorer?
    • Have you ever been observed to gasp or stop breathing during sleep?
    • Do you feel tired or groggy upon awakening, or do you awaken with a headache?
    • Are you often tired or fatigued during the wake time hours?
    • Do you fall asleep sitting, reading, watching TV or driving?
    • Do you often have problems with memory or concentration?

    If you have one or more of these symptoms you are at higher risk for having obstructive sleep apnea.

    Source: American Sleep Apnea Association

    The STOP-BANG survey below is a self-evaluation you can take to assess the chances of having sleep apnea.
    However, to get a proper diagnosis, you must see a healthcare practitioner

    These four yes-or-no “STOP” questions can help you determine your risk for sleep apnea:


    S: Do you snore loudly?

    T: Do you often feel tired, fatigue, or sleepy during the day?

    O: Has anyone observed you not breathing during sleep?

    P: Do you have or have you been treated for high blood pressure?

    You have a high risk of sleep apnea if your answer is “yes” to two or more of these questions. Hence, you are strongly encouraged to discuss these results with your medical provider.


    The questionnaire has an even higher predictive value when you answer four more questions:


    B: Is your Body Mass Index more than 35 kg/m2?

    A: Is your age more than 50 years old?

    N: Is your neck circumference greater than 40 cm?


    G: Is your gender male?

    What are the clinical diagnosis test for Sleep Apnea ?

    1.  Evaluation of clinical symptoms (e.g. excessive daytime sleepiness and fatigue) 


    2.  The results of a formal sleep study (polysomnography, or small channels home based test). 

    What is a Polysomnography test ?

    Polysomnography, also popular as a sleep study or Sleep Test, is a comprehensive test used to diagnose sleep disorders. Therefore, Sleep  Study records your brain waves, the oxygen level in your blood, heart rate and breathing, as well as eye and leg movements during the study.

    This test may be done at a sleep disorders unit within a hospital or at a sleep center. While it’s typically performed at night, polysomnography is occasionally done during the day to accommodate shift workers who habitually sleep during the day.


    In addition to helping diagnose sleep disorders, polysomnography may be useful to help initiate or adjust your treatment plan if you already have some types of sleep disorder.

    Sometimes you may be able to do the sleep study at home. Home sleep apnea testing uses a limited number of sensors to focus primarily on diagnosing OSA.

    What are the parameters for Polysomnography / Sleep Test

    A PSG is a diagnostic tool used to determine if your patient has a sleep disorder. This test is conducted overnight at the sleep center or hospital.

    This test monitors your patient’s sleep cycles and stages to identify any disturbances caused by their sleep disorder. Your patient will be connected to a variety of equipment to help monitor things like their:

    • Brain activity ( Sleep stages etc. )
    • Breathing activity ( Snoring, Oxygen Saturation etc. )
    • Muscle activity ( Leg movement, Chest efforts etc )

    Critical Parameters of Sleep Study / Polysomnography Report

    1.   AHI: What was the overall Apnea/Hypopnea Index (AHI)? The AHI is the measure of how bad the patient’s sleep apnea is. The scale of AHI is:

    a.  < 5 = normal in an adult.

    b.  5-15 = mild

    c.  15-30 = moderate

    d.  >30= severe

    2.   Sleep Position: In conjunction with the AHI you will also usually find information about sleep position and the AHI when the patient is sleeping supine versus on their side.

    3.   O2 Saturation: What is the O2 saturation nadir (lowest point), and how much time did the patient spend with an O2 saturation below 90%?

    4.   Sleep Stages: How much time the patient spent in the different levels of sleep during the study.  

    Home Study vs Lab Test : Which one to select ?

    Home Sleep Test
    Sleep Test at the convenience of own home

    What are the treatment options for Sleep Apnea

    Some treatments involve lifestyle changes, such as avoiding alcohol or muscle relaxants, losing weight, and quitting smoking. 

    Many people benefit from sleeping at a 30-degree elevation of the upper body or higher, as if in a reclinerDoing so helps prevent the gravitational collapse of the airway. Lateral positions (sleeping on a side), not to supine positions (sleeping on the back), are also recommended as a treatment for sleep apnea, largely because the gravitational component is smaller in the lateral position. Moreover, some people benefit from various kinds of oral appliances to keep the airway open during sleep.

    Continuous positive airway pressure
    (CPAP) is the most effective treatment for obstructive sleep apnea. Therefore, talk to your physician regarding the benefits of CPAP machine to ease your problems.

    There are also surgical procedures to remove and tighten tissue and widen the airway.

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