Struggling for Breath in Sleep? The Truth About Obstructive Sleep Apnea

When you lie down on your bed after a busy day and close your eyes to imagine a world that goes silent, your heartbeat calms down, and every breath that you inhale becomes steady and soft. That is sleep, a simple, natural phenomenon that the human body uses to naturally heal itself after working nonstop throughout the day. It is simply the time when your heart finds its rhythm back, the brain organizes your memories, and the body repairs itself from the attrition throughout the day. The oxygen that you take in while you are asleep fuels every organ, thought, and heartbeat. Strange, without even realizing its true value, we spend nearly one-third of our lives depending on this quiet natural rhythm to be alive and healthy.

Imagine an obstruction in this process that disrupts this natural rhythm, causing the oxygen that’s meant to flow freely into your body to stop repeatedly throughout the night. This is what happens in obstructive sleep apnea, a condition in which the muscles in your throat relax too much during sleep, creating an airway blockage. Breathing stops for seconds, sometimes much longer, and the brain rushes to wake you up from sleep just for you to catch a gasp of breath. Imagine this repeating hundreds of times every night. You don’t realize it is happening until you wake up due to it, but your body knows it’s happening. Each gap in catching your breath means your body gets less oxygen, which puts pressure on the heart and causes continuous disturbances when the body needs complete rest.

The result of this is that the next morning, the body wakes up tired, no matter the hours you have slept. Obstructive sleep apnea leads to experiences like constant headaches, decreased concentration, irritability, and mood swings. As it progresses, the continuous lack of oxygen, with irregular patterns of sleep, leads to the development of other serious health issues like high blood pressure, irregular heartbeats, heart disease, and diabetes. The normal functioning of the brain is also greatly affected without proper rest; memory weakens, decision-making slows down, and the ability to balance emotions completely collapses.

But there is light at the end of every dark tunnel, a ray of hope. Obstructive sleep apnea, if diagnosed, can be treated easily and successfully. Lifestyle changes, like maintaining a healthy weight, exercising, and avoiding alcohol before going to bed, are beneficial. Medical devices like CPAP (continuous positive airway pressure) offer mechanical help in keeping the airway open throughout the night. This allows the breathing to normalize and helps in having a good sleep. Even small steps like sleeping on one side and managing the nasal condition can provide relief. When individuals affected by obstructive sleep apnea sleep effectively, comfortable nights and energetic mornings return normally.

1. Is The Silent Stopping Of Breathing At Night Obstructive Sleep Apnea?

Obstructive sleep apnea is both a respiratory and a sleep disorder, described in simpler terms as a condition where the air passage breaks down or gets blocked during sleep. This breakdown is due to the temporary relaxation of muscles that support the soft tissue in the throat, like the tongue and the soft palate.

During an apneic event, the moment when breathing pauses during an obstructive sleep apnea episode, a chain of events starts, beginning from the obstruction, where the relaxed throat muscles cause the upper airway to become narrow and completely close, cutting the air flow. Followed by a drop in oxygen levels, where an interruption in air reaching the lungs leads to a drop in the level of oxygen in the blood (desaturation) and a buildup of carbon dioxide. This causes the brain to release waking signals, which briefly wake the person for the throat muscles to tighten and open the air passage. This process often happens so briefly that the affected individual does not remember the event to recall it later. At last, the breathing resumes, either with a loud gasp, snort, or choke. This process can repeat many times in an hour during the night, severely disturbing sleep, leading to excessive daytime sleepiness and other health-related problems.

Obstructive sleep apnea is a health problem that affects people from all over the world, with estimates suggesting that it troubles approximately 1 billion people worldwide (that is, about 20% of the global adult population). In India, the frequency of obstructive sleep apnea is very high and on continuous rise, with a recent meta-analysis estimating that about 104 million Indians might be affected, emphasizing the negative impact of obstructive sleep apnea on public health in the country.

There are three main types of sleep apnea, differentiated based upon what causes the breathing disruption, especially if the problem is mechanical (that is, a blockage), or due to an underlying neurological condition (that is, a central nervous system disorder, or brainstem dysfunction).

2. It Cannot Be Just Snoring: The Risks of Obstructed Sleep Apnea.

Multiple factors work together in tandem to trigger the collapse of airways at night. The causes are a mix of the lifestyle of the individual affected, anatomical features, medical or endocrine factors, and demographic or genetic factors.

Lifestyle and behavioral factors often worsen the activity of muscle relaxation and tissue mass. Obesity is a serious lifestyle issue, as the accumulation of fat around the neck compresses the pharynx (air tube), and excessive consumption of alcohol and sedatives before going to bed is more likely to cause the relaxation of throat muscles, which makes the collapse more likely. Additionally, patients sleeping in the supine position (that is, on their back) allow the tongue’s base to pull backward by itself.

Anatomical and structural risk factors that make an individual susceptible to developing obstructive sleep apnea include patients with abnormalities in the head, neck, and throat. Underlying causes, like a thick neck circumference, recessed chin (retrognathia), a large tongue, and oversized tonsils and adenoids, physically cause the blockage of the airway. Chronic nasal obstruction forces the air through a restricted mouth and throat pathway.

Pre-existing systemic conditions also contribute to the development of obstructive sleep apnea. Hypothyroidism (a condition that develops due to less than the required level of thyroid hormone secretion) leads to weight gain and swelling in soft tissues that surround the neck and throat. Followed by acromegaly, which causes soft tissues to enlarge, these include both the tongue and throat structures.

Obstructive sleep apnea mostly affects males more than females, mostly due to the differences in the distribution of fat and the anatomy of the neck and throat region between men and women. Though post menopause (The natural, permanent stoppage of women’s menstrual cycle and reproductive ability), the chances of women developing obstructive sleep apnea do increase considerably due to changes in hormones. Genetic factors, where the family has strong inherited craniofacial traits, can also cause the airway to become narrow and develop obstructive sleep apnea.

3. Constantly Tired? Identifying and Understanding Symptoms Of Obstructive Sleep Apnea

Though Obstructive sleep apnea is invisible, its effects are far-reaching and are obvious through several clear, and often chronic, symptoms. Symptoms are divided into two types, namely, symptoms that affect the patient through the night and symptoms that affect the patient through the day.

Symptoms that affect the patient at night:

The most common symptom of obstructive sleep apnea is often loud, chronic snoring, which is then obstructed by abrupt, scary pauses in breathing. This leads to restless sleep for the patient, and they never complete their deep phases.

Waking up suddenly from sleep leads to dry mouth and sore throat, caused by breathing through the mouth for most of the night.

Nocturia, or waking up frequently at night to urinate, is also a sign, as the body’s cardiovascular system is under stress due to low oxygen, which triggers hormone secretion that increases urine production.

Night sweats are common due to the body working hard to gain a gasp of breath due to the effects of obstructive sleep apnea.

The physical stress of interrupted breathing also leads to teeth grinding themselves an involuntary response while asleep.

Symptoms that affect the patient during the day :

Patient waking up constantly, subconscious several times during night, prevents deep sleep, resulting in continuous daytime sleepiness termed as hypersomnia. This is a feeling of exhaustion and tiredness, even though the patient thinks he has had a full night’s sleep.

Poor sleep quality impacts cognitive function. This results in the patient having difficulty concentrating, focusing, and remembering things.

Stress due to chronic sleep deprivation causes irritability, quick-temperedness, anxiety, and increased risk of depression.

Patients with obstructive sleep apnea usually experience dull headaches when they wake up in the morning, which is due to the buildup of carbon dioxide levels in the body and decreased oxygen levels.

In severe cases of obstructive sleep apnea, excessive daytime sleepiness can lead to involuntary microsleeps, where the patient falls asleep within a few seconds, leading to potentially fatal situations while driving and handling machinery.

The constant fluctuation in levels of oxygen in the blood puts pressure on the patient’s heart, which in turn increases blood pressure. This increases the risk of heart attack, stroke, and arrhythmias in obstructive sleep apnea patients.

Symptoms in Children:

Most of the obstructive sleep apnea symptoms shown by adults often overlap in children; symptoms depicted by children in case of obstructive sleep apnea include hyperactivity, impulsive, and aggressive behavior, difficulty learning and paying attention, poor weight gain, Bed-wetting, sleeping in unusual positions, breathing through the mouth, or having a blocked nose.

4. Interrupting the Interruptions of Sleep: Diagnosis of Obstructive Sleep Apnea

The diagnostic process of obstructive sleep apnea involves a detailed clinical evaluation of the patient and objective sleep evaluations for testing the severity of sleep disturbances and providing guidance on successful treatment.

Step 1: Clinical evaluation and grouping of risk factors

The patient’s visit to a doctor, which is in this case a primary physician or a sleep specialist, begins with a detailed medical history and physical evaluation of the patient.

Medical history evaluation is where the patient is questioned about their sleep habits, and sleep-related signs that include snoring, episodes of observed breathing pauses (apnea), choking or gasping while asleep, increased daytime fatigue, and feeling sleepy. Over health of the patient is also often examined with questions covering the overall health of the patient, medicines they take, and factors like use of alcohol, caffeine, or tobacco.

Physical evaluation – Focuses on conducting those tests that put a person at risk of sleep apnea.

Body Mass Index (BMI) – A high Body Mass Index (BMI) indicates a higher risk to development of developing obstructive sleep apnea.

Neck circumference – As higher the circumference of the neck is, it is associated with a much higher the risk of developing obstructive sleep apnea.

Sleep questionnaires are methodized questionnaires that help in the quantification of symptoms in the diagnosis of specific disorders. The Epworth Sleepiness Scale (ESS) asks an individual about the likelihood of falling asleep in eight different situations, from sitting and reading to driving a car. A score of above 10 is indicative of excessive daytime sleepiness.

STOP-BANG – An acronym for eight yes/no questions that are concerned with Snoring, Tiredness, Observed apnea, Pressure (High blood pressure), BMI, Age, Neck size, and Gender. A score of 5 or higher indicates a moderate to high risk of developing obstructive sleep apnea.

Step -2 Objective Sleep Testing

If the Step-1 clinical examination suggests a sleep-related breathing disorder, a sleep study is conducted first to confirm the diagnosis and later to determine its severity.

Polysomnography (PSG)

This overnight sleep evaluation technique is considered a gold standard for the diagnosis of many sleep disorders.

In this technique, a trained technician attaches several sensors to the body, which are then connected to a computer in an adjacent room, and the technician monitors the patient’s sleep. The monitored data includes the results of brain activity through electroencephalography, eye movements through electrooculography, muscle activity through electromyography, breathing, blood oxygen through oximetry, and heart rate through electrocardiography.

Home-Sleep Test (HST)

A simplified test at home can also diagnose obstructive sleep apnea; this is for patients who are highly probable of moderate to severe obstructive sleep apnea.

Unlike polysomnography, the patients themselves are given a portable device with fewer sensors to measure breathing, heart rate, and blood oxygen levels. A home sleep test does not monitor sleep patterns.

Step 3: Interpreting The Apnea-Hypopnea Index (AHI)

After the completion of a polysomnography sleep study, the collected data is scored by a technologist and then resolved by a sleep specialist to obtain a key metric that is the Apnea-Hypopnea Index (AHI).

The Apnea-Hypopnea Index (AHI) is the average number of apnea and hypopnea events per hour of sleep.

Apnea—complete stoppage of airflow for about 10 seconds.

Hypopnea—a partial stoppage/reduced breathing for 10 seconds, normally associated with decreasing levels of oxygen in the blood.

Severity classification of AHI for adults includes scoring of

AHI < 5 events per hour as normal,

An AHI of 5 to 14 events per hour is considered mild sleep apnea.

An AHI of 15 to 29 events per hour is considered moderate sleep apnea, and an

An AHI of 30 or more events per hour is a severe case of sleep apnea.

5) Breathing Easy Again: Treatment For Obstructive Sleep Apnea

Modern methods for treating obstructive sleep apnea include lifestyle changes, the use of medical devices, and surgery. The choice of treatment depends on the type and severity of apnea, along with the patient’s anatomy and lifestyle.

Lifestyle modifications:

For patients who suffer from only mild episodes of obstructive sleep apnea, changing their lifestyle habits is highly effective in managing the condition. Management of weight in patients with obesity, avoiding sedatives and alcohol, and adjusting the sleeping position by avoiding sleeping on the back and sleeping on one side can mostly reduce the repeated apnea events. Positional training devices are also used to help obstructive sleep apnea patients maintain their sleeping positions. Nasal congestion from allergies can also make breathing difficult in patients with obstructive sleep apnea; corticosteroids and saline rinses help improve the airflow here.

CPAP (Continuous Positive Airway Pressure) Therapy:

This is one of the most common and effective treatments for the treatment of moderate to severe obstructive sleep apnea conditions and is considered a gold standard method.

A CPAP machine works by providing a non-stop stream of pressurized air through a mask that is worn over the nose or mouth. This constant pressure behaves as a pneumatic splint to keep the upper airway open and prevent it from collapsing.

When used effectively, CPAP successfully eliminates the interruptions in breathing, improves sleep quality, and reduces daytime sleepiness.

For patients who cannot tolerate the continuous pressure of CPAP, alternative machines do exist, namely, Bi-level PAP (BiPAP) delivers high pressure during the act of inhalation, and low pressure during the act of exhalation. Auto-adjusting PAP (Auto-PAP) automatically adjusts the pressure level throughout the night, based on the needs of patients.

Oral Appliances

Oral appliances are a very common alternative for patients with mild to moderate obstructive sleep apnea or patients who are finding it difficult to use CPAP therapy.

These custom-fitted dental devices are known as mandibular advancement devices (MADs), which work by adjusting the position of the lower jaw and tongue forward. This action expands the airway space at the back of the throat, decreasing the obstruction. Over-the-counter boil-and-bite models, Tongue-stabilizing devices that hold the tongue in a forward position, are another option, particularly in patients with insufficient teeth for mandibular advancement devices (MADs).

Surgical Treatments

When minimally invasive techniques fail, surgical methods provide a permanent, long-term solution by correcting the anatomical risk factors that cause obstructive sleep apnea.

Soft tissue surgeries like Uvulopalatopharyngoplasty (UPPP) remove excess tissue from the back of the throat, which includes the uvula and part of the soft palate. Whereas Tonsillectomy and adenoidectomy help in the removal of enlarged tonsils or adenoids and are found to be a successful method in treating pediatric obstructive sleep apnea cases.

Skeletal surgeries involve Maxillomandibular advancement (MMA), which is a procedure where the upper and lower jaws are surgically moved forward. This increases the size of the entire upper airway, making it an effective treatment technique.

Ear, Nose, and Throat corrective surgical procedures involve septoplasty and turbinate reduction that improve nasal airflow by correcting a deviated septum and by reducing enlarged turbinates.

Adjunct therapies

These are treatment techniques that are used in combination with above mentioned primary treatment techniques for managing obstructive sleep apnea. Weight loss surgeries like bariatric surgery to remove excessive fat that blocks airways, positional therapy devices that adjust sleeping positions, are some of the less invasive techniques that are being developed to help patients manage obstructive sleep apnea more smartly and successfully.

6. When to see a Doctor?

A patient dealing with potential sleep-related issues like obstructive sleep apnea has to recognize that approaching a doctor as soon as possible is extremely vital. If a patient experiences continuous symptoms like loud and chronic snoring, pauses in breathing, excessive daytime sleepiness, and waking up tired in the morning. Then there is a major issue that requires the immediate advice of an experienced ear, nose, and throat specialist.

7) Turn The Nights From Being Restless to Being Restful

Sleep is more than a time to rest – it is when a body recharges itself, restores, and then prepares for another challenging day. Obstructive sleep apnea (OSA) quietly robs people affected by it of this important phase of recovery. A ray of hope, it’s very much treatable with timely identification, lifestyle changes, and receiving the right medical help at the right time. The cycle of these interruptions in breathing and episodes of being tired can be broken. Restful and rejuvenating sleep becomes a possibility.

Management of obstructive sleep apnea is not only about reducing snoring or preventing fatigue- It’s about protecting the heart, brain, and overall well-being. This journey begins with awareness, recognizing the symptoms, seeking help, and then committing to consistent treatment. Whether it’s the use of a CPAP machine, management of weight, or a minor correction in surgery, every small step brings the body closer to balance, and the mind closer to peace.

Breathe right tonight – because every peaceful breath is the start of a better life.

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