Frequent cessation of breathing (apnea) during sleep
Your sleep partner may notice repeated silences from your side of the bed
Choking or gasping during sleep to get air into the lungs
Sudden awakenings to restart breathing
Waking up in a sweat during the night
Feeling unrefreshed in the morning after a night's sleep
Headaches, sore throat, or dry mouth in the mornings after waking up
Daytime sleepiness, including falling asleep at inappropriate times, such as
during driving or at work
Snoring and sleep apnea are not the same thing. Snoring is simply a loud
sound that you make during breathing while asleep if there is any
obstruction in your airway. While it may be unpleasant for your sleep
partner, snoring is not in itself a harmful condition. On the other hand,
people with sleep apnea are deprived of oxygen due to a complete blockage of
airways, which can have a major impact on health.
Snoring does often accompany sleep apnea, but just because you snore does
not mean you have sleep apnea.
There are three types of sleep apnea: obstructive, central, and mixed.
OSA is the most common type of sleep apnea. It is caused by a breathing
obstruction, which stops the air flow in the nose and mouth.
Central sleep apnea is a far rarer type of sleep apnea, which occurs when
the brain signal that instructs the body to breathe is delayed. This central
nervous system disorder can be caused by disease or injury involving the
brainstem, such as a stroke, brain tumor, viral brain infection, or
chronic respiratory disease. People with CSA seldom snore, which makes it
even harder to diagnose as they do not fit the "normal" profile of a sleep
apnea sufferer. However, while the causes of the breathing cessation are
different in CSA and OSA, the symptoms and results are much the same a
deprivation of oxygen and poor sleep due to repeated awakenings at night.
The treatments for CSA include specific medications that stimulate the need
to breathe and administration of oxygen.
Mixed sleep apnea is a combination of the two types of sleep apnea,
obstructive sleep apnea and central sleep apnea. A person with mixed sleep
apnea will often snore, but finds that treatments which only help
obstructions in the airways do not completely stop apnea episodes. Treatment
usually includes a combination of the treatments used for OSA and CSA.
Causes and risk factors of obstructive sleep apnea
When you have obstructive sleep apnea, your throat collapses during sleep,
blocking the airway and preventing air from getting to the lungs. Generally,
your throat muscles keep the throat and airway open.
- Shape of head and neck may create a smaller than normal airway
- Large tonsils, adenoids or other anatomical differences (a deviated
septum, enlarged tongue, or receding chin can also create difficulties
breathing during sleep)
- Being overweight or obese (almost 50% of people with sleep apnea
are not obese)
- Throat muscles and tongue relax more than normal during sleep (can be
due to alcohol or sedative)
- Snoring can cause the soft palate to lengthen, which in turn can
obstruct the airway
- Smoking or exposure to secondhand smoke
- Nasal congestion, nasal blockages, and nasal irritants
- Family history of sleep apnea - no specific genetic marker for sleep apnea
has been discovered, but obstructive sleep apnea seems to run in families
(may be a result of anatomic abnormalities that run in the family)
- Other disorders and syndromes - hypothyroidism, acromegaly, amyloidosis,
vocal cord paralysis, post-polio syndrome, neuromuscular disorders, Marfan's
Syndrome, and Down Syndrome
- Other physical conditions such as immune system abnormalities, severe
heartburn or acid reflux and high blood pressure (it isn't clear whether the
conditions are the cause or the result of sleep apnea)
What happens when you stop breathing during sleep?
If you have sleep apnea, you stop breathing during sleep and the balance of
oxygen and carbon dioxide in the blood is upset. This imbalance stimulates
the brain to restart the breathing process. The brain signals you to wake up
so that the muscles of the tongue and throat can increase the size of the
airway. Then, carbon dioxide can escape and oxygen can enter the airway.
These waking episodes are necessary to restart breathing (and to save your
life), but because of them, you become sleep-deprived.
Sleep apnea has serious health consequences and can even be
life-threatening. The main effects of sleep apnea are sleep deprivation and
Both the person with sleep apnea and the bed partner suffer from sleep
deprivation. A bed partner may lose an hour or more of sleep each night from
sleeping next to a person with sleep apnea. Along with the apnea episodes,
the person afflicted with sleep apnea may have additional trouble sleeping
caused by side effects of the condition, including a frequent need to get up
and urinate during the night, and excessive nighttime sweating.
Some trickle-down effects of sleep deprivation are a compromised immune
system, poor mental and emotional health, irritability, and slower reaction
time, among other problems.
When you stop breathing, your brain does not get enough oxygen. Drastic
problems can result from the oxygen deprivation of sleep apnea, including
heart disease, high blood pressure, sexual disfunction, and learning/memory
Approximately one in five people who suffer from depression also suffer from
sleep apnea, and people with sleep apnea are five times more likely to
become depressed. Existing depression may also be worsened by sleep apnea.
While it is not clear whether the apnea causes the depression or vice-versa,
studies show that by treating sleep apnea symptoms, depression may be
alleviated in some people.
Before you visit a doctor for a possible diagnosis of sleep apnea, ask your
spouse or sleeping partner to keep a sleep diary for you. For a few nights,
a willing sleep partner can record if you are snoring and how loud your
snoring is, how well you are sleeping, whether you are having trouble
breathing (that is, choking or gasping), and any other troubling symptoms.
If you don't have someone to record your sleep patterns, try taping
yourself. You can use a sound-activated audio recorder or a software program
that turns your computer into a recorder. If you don't have access to
recording equipment, it may be worthwhile to ask a friend or loved one to
monitor your sleep pattern for a few nights, or visit a sleep center for
With your sleep record in hand, consult a knowledgeable doctor or a sleep
specialist. To diagnose for sleep apnea, the doctor or specialist will
examine your mouth and nose to look for obstructions and possibly perform
other tests such as an endoscopy of your nose and throat, x-rays, or a CT
scan of the head and neck.
If your doctor suspects sleep apnea, he or she will likely recommend an
overnight sleep study in a sleep clinic (also known as a sleep lab or sleep
center). Sleep tests in a sleep clinic help to diagnose sleep apnea by
measuring how frequently you stop breathing.