What is sleep apnea?
Obstructive sleep apnea is a serious sleep disorder in which breathing repeatedly stops and starts during sleep.

What happens in obstructive sleep apnea?
Obstructive sleep apnea occurs when your throat muscles relax and block your airway. Snoring is the most noticeable sign of obstructive sleep apnea.

Who has obstructive sleep apnea?
Anyone can have obstructive sleep apnea and commonly affects older adults, common in men and especially when overweight.

How to know that you have obstructive sleep apnea?
Excessive daytime sleepiness: Not able to keep awake when in active
Loud snoring: Disturbs other from resting
Observed episodes of breathing stopping during sleep
Suddenly waking up with shortness of breath
Dry mouth or sore throat in the morning
Morning headache
Difficulty staying asleep after suddenly getting up at night

What is happening during obstructive sleep apnea?
We have muscles and tissues in the back of our throat [the soft palate, tonsils and back part of the tongue] and these will relax when we are in deep sleep.

This will cause the airway to get narrow or closes during our sleep for 10 to 20 seconds causing the level of oxygen to decease in the blood.

The brain instructs to reopen you is airway when this happens thus awakening the patient briefly but it does not actually wake us to be fully conscious.

This may be in the form of snorting, choking or gasping sound, which would repeat itself 20 to 30 times or may be even more all night long. This type of sleep will cause the patient to be tired and sleepy throughout the daytime.

Patients would deny that such a thing happens to them at night as they feel that the night has been a restful one.

What are the risk factors?
Excess weight. Obstructive sleep apnea patients are usually are overweight and fat deposits around your upper airway may obstruct breathing. Overweight may not be the sole criteria to have this disorder as thin people can develop it too.

Neck circumference. A neck circumference greater than 17 inches is associated with an increased risk of obstructive sleep apnea, which relates to fat around the upper airway

High blood pressure (hypertension). Obstructive sleep apnea is relatively common in people with hypertension.

A narrowed airway. A natural narrow upper airway or enlarged tonsils and adenoids can block your airway.

Chronic nasal congestion. 50 % of patients with obstructive sleep apnea will have nasal obstruction and may require medication or surgery

Diabetes. Commonly seen in obstructive apnea patients

Being male. Common in males

Menopause. Commonly seen older females after menopause

Alcohol Consumption. This condition may be seen worse after alcohol consumption

Smoking. Obstructive sleep apnea is 3 times worse in smoking

When do you need to see your doctor?
Snoring loudly and disturbing your sleep or that of others

Shortness of breath and it wakes you from sleep

Bed partners notices pauses in your breathing during sleep

Excessive daytime sleepiness such that you could easily fall asleep while working, watching television or even driving in slow moving traffic. Sometimes drivers fall asleep in high constant speed in highways resulting in fatal accidents

Do you feel that snoring is something normal?
Patients usually feel that snoring is not a sign of anything serious. However, it is a fact that everyone who has sleep apnea may not snore.

Consult your doctor when there is loud snoring, which suddenly stops and you feel tired, sleepy and irritable during the day, which may be worse in the afternoons.

How can the doctor confirm this problem?
The ENT doctor would examine the upper airway to look for obstruction, which includes an endoscope examination of the nose, throat and lower airway [laryngeal]. If there are significant signs of obstruction; the doctor will recommend:

Nocturnal Sleep Study. The patient will have a small miniature device strap on the abdomen that monitors your heart, lung and brain activity, breathing patterns, arm and leg movements, and blood-oxygen levels while you sleep.

This could be done in the hotel room or at your residence.

Should the results be inconclusive; a detailed polysomnography could be arranged.

What happens if I do not want to have myself treated?
Patients would usually have complications and some of these are:

Heart Complications. Apnea results in sudden drops in blood-oxygen levels, which increases blood pressure and indirectly causes stress to the cardiovascular system. High blood pressure (hypertension) is known to be about 50% in apnea patients, which raises the risk of heart failure and stroke.

Patients with heart disease and repeated multiple episodes of low blood oxygen (hypoxia or hypoxemia) can lead to sudden death from a cardiac event.

World medical literature shows that severe the obstructive sleep apnea, leads to higher risk of high blood pressure.

Daytime tiredness. Restful sleep is not possible if one wakes up repeatedly at night, which will cause severe daytime drowsiness, fatigue and irritability.

These patients will easily fall asleep at work, while watching TV or even when driving.

Students with sleep apnea may perform badly in school with reduced mental development or adverse behavior problems.

Complications with medications and surgery. General anesthesia can cause complications in patients with sleep apnea and may have breathing problems after sedation while lying on their backs.

Your doctor must know that you have sleep apnea as un-diagnosed sleep apnea can cause a higher risk in general anesthesia.

Sleep-deprived partners. Snoring loudly disrupt your relationships as it keeps people around you awake and disturbed. Partners will resort to sleep in another room.

Memory problems, Morning headaches, mood swings, depression, and frequent urges to urinate at night. Gastroesophageal reflux disease (GERD)

What are the treatment options?
The sleep study will prove if you have:

Mild apnea
You will have to change lifestyle by losing weight, quitting smoking and refrain from excessive consumption of alcohol.
Moderate to Severe Apnea

Continuous positive airway pressure (CPAP).

This machine that delivers air pressure through a mask placed over your nose while you sleep which produces air pressure is slightly higher than that of the environment air, which will keep your upper airway passages open, thus preventing apnea and snoring.

Patients may find it difficult in using the CPAP but with some practice they would learn to adjust the mask to have a restful sleep.

Different types of masks suites different facial size and patients could select a suitable one. Modern CPAP machines have special adaptive pressure functions to improve comfort together humidifier.

I don’t like the CPAP?
Many patients will stop using the CPAP machine just because they experience problems. Modifications can be made adjust to the comfort of the patient. Your overall weight changes and nasal obstruction may need the pressure settings may need to be adjusted.

Oral appliances easier to use but not as good as CPAP. These devices open the airway by bringing your jaw forward, which may relieve snoring and mild obstructive sleep apnea.

Some devices are available from your dentist but some are molded to the shape of your jaws after immersing in hot water.

Surgery or other procedures will assist in removing excess tissue from your nose or throat that may be vibrating and causing you to snore. Some surgeries may relieve blocking upper air passages and relieve sleep apnea.

Uvulopalatopharyngoplasty (UPPP). Maxillomandibular advancement. Tracheotomy. Implants. The Pillar procedure (laser-assisted uvulopalatoplasty) or (radiofrequency ablation)

Nasal surgery is usually performed to remove polyps or straighten a crooked partition between your nostrils (deviated nasal septum) and using RF to reduce the size of the bones within the nose [turbinate]

Tonsils removal surgery