US Pharm. 2022;47(7):15-16.

Disruptive Pauses in Breathing

Sleep apnea is a sleep disorder where abnormal breathing patterns occur during sleep. These patterns may lead to short periods when deep sleep is interrupted, resulting in an overall lighter sleep cycle. The breathing disruptions can often awaken the sleeper with a cough or choking sounds. Sleep apnea is one of the leading causes of daytime sleepiness and can lead to more severe health concerns. Because it only occurs during sleep, many people who suffer from sleep apnea are unaware they have the problem. Sleep apnea affects as many as 10% to 30% of the U.S. adult population.

Common Disorder With Common Symptoms

There are three types of sleep apnea: obstructive, central, and complex (a combination of obstructive and central). In obstructive sleep apnea, normal breathing is interrupted due to a narrowed or blocked airway, usually from excessive relaxation of muscles in the throat. When oxygen levels are low, the brain wakes the body to restart breathing. In central sleep apnea, the signal to breathe is not sent properly from the brain to the breathing muscles. Heart problems, stroke, or infections have been linked to the cause of central sleep apnea.

Lighter sleep and frequent awakening during the night mean the most noticeable symptom of sleep apnea is significant daytime drowsiness, despite an individual getting an adequate length of sleep. Other symptoms include snoring, choking, waking during the night, and waking with a headache, sore throat, or dry mouth.

Diagnosing With a Sleep Study

As a person ages, the risk of sleep apnea increases. Sleep apnea is more common in men than women, and smokers are more likely to suffer from the disorder. The most significant risk for the development of sleep apnea is excess weight, which leads to an increase in fatty tissue around the airway. Less commonly, a patient may have enlarged tonsils or a facial structure that results in a smaller airway.

Because the patient may not be aware of the problem, sleep apnea is sometimes challenging to diagnose. Patients may only become aware of their breathing issues when a family member complains about snoring, choking, or sudden awakenings. Although a physician cannot test for this condition during an office visit, a definite diagnosis can be made with an overnight sleep study (polysomnogram) in a special sleep laboratory or using an at-home sleep study kit. During sleep testing, breathing rate and airflow, oxygen levels, heart activity, eye movements, and brain activity are recorded. 

Treatment Focuses on Better Breathing During Sleep

The goal of sleep apnea treatment is to restore normal, restful sleep by treating the underlying cause of the sleep disturbance. The first recommendation is to make changes in lifestyle (e.g., losing weight, smoking cessation, avoiding alcohol, and exercise) to address the most common underlying causes.

In patients with obstructive sleep apnea, the goal is to keep the airway open during sleep. Most patients with diagnosed sleep apnea are recommended a positive airway pressure (PAP) device. Common types of PAP machines are continuous positive airway pressure (CPAP), automatic (APAP), and bilateral (BiPA). The PAP machine delivers air under pressure through a mask worn over the mouth and/or nose during sleep. The PAP machine is specially calibrated and available only by prescription. For those with certain anatomical features or who cannot tolerate a PAP machine, custom dental devices hold the jaw and tongue in place to avoid airway narrowing or blockage.

Central sleep apnea treatment focuses on treating any underlying health conditions (e.g., infection, heart disease, stroke) that are causing the problem. Breathing supplemental oxygen at night may be helpful in this type of sleep apnea. Sometimes, a special implant that stimulates the nerve that controls breathing can be used.

Sleep apnea should never be ignored. Untreated, it can lead to serious complications, such as hypertension, heart attack, stroke, and problems undergoing surgical procedures that require anesthesia. Daytime sleepiness is a considerable risk for accidents at work, in the car, or at home.

The content contained in this article is for informational purposes only. The content is not intended to be a substitute for professional advice. Reliance on any information provided in this article is solely at your own risk.

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