Everyone has a bad night of sleep now and then. But if you have sleep apnea, every night’s sleep could be troubled.
An estimated 22 million Americans suffer from the sleep disorder, in which breathing repeatedly stops and starts throughout the night, with some 80 percent of moderate to severe cases undiagnosed, according to the American Sleep Apnea Association. Undiagnosed sleep apnea, and the sleep deprivation it causes, puts people at higher risk for a host of health conditions, including heart disease, high blood pressure, stroke, type 2 diabetes, depression, obesity and accidents caused by falling asleep during the day.
There are different types of sleep apnea. Obstructive sleep apnea, the most common, occurs when throat muscles relax; central sleep apnea occurs when your brain fails to send the proper signals to the muscles that control breathing; complex sleep apnea is a combination of both.
Fortunately, there is growing awareness of sleep apnea’s health effects, how to determine if you have it, and expanding treatment options.
Who has sleep apnea?
Children as young as 2 can have sleep apnea, but the chronic disease is more likely to affect those over 40, and more men than women. Women’s risk increases after menopause. Although you don’t have to be overweight to have sleep apnea, at least 60 percent of those with obstructive sleep apnea are overweight, reports SleepFoundation.org. “The two cardinal features are sleepiness during the day and snoring at night,” says Dr. Amit Khanna, with the Yale New Haven Health Northeast Medical Group. “If you’re having those two symptoms, that’s a good enough reason to see your doctor.”
Not everyone who snores has sleep apnea, and not everyone with sleep apnea snores. But if your sleeping partner is kept awake by your snoring or gaps in your breathing while you sleep, Khanna and Dr. Belachew Tessema, of the Connecticut Sinus Institute in Farmington, suggest talking with your doctor.
Sleep apnea and weight
Insufficient sleep causes weight gain, and when people with sleep apnea receive treatment, they often lose weight without any other lifestyle changes. Sleep apnea sufferers don’t get enough restful sleep, Tessema says, “so you don’t have the energy to do the things you need to do to lose the weight, and when you’re tired, the No. 1 thing is you eat the wrong things.”
When people are sleep deprived, the hormones in their brain responsible for hunger control (leptin and ghrelin) don’t work well, so they feel hunger when their body isn’t really hungry, Khanna adds. “I’ve seen people lose 30 pounds in a year just from sleeping better. Sleep is just as important to health as exercise.”
Diagnostic and treatment advances allow people to undergo in-home sleep studies and telemedicine visits with doctors, so they can be diagnosed without having to leave home — especially since some of those with suspected sleep apnea also are at higher risk of complications from COVID-19.
“Home testing has really taken off and it is as valid as a sleep study done in a sleep center,” says Khanna, whose specialty is sleep medicine. Some people may still be candidates for sleep lab tests, but, until the pandemic is under control, many patients use disposable sleep-testing equipment that is mailed to them. One part of the home-testing kit goes on the wrist like a watch, with one sensor on a fingertip and one on the chest. The readings sync with an app on the patient’s smartphone, which sends information to the doctor about how the patient is breathing and oxygenating, sleep stages, the body’s positioning and heart-rate variability, he says.
The continuous positive airway pressure (CPAP) machine, is the gold standard and most common treatment for moderate to severe sleep apnea, say Khanna and Tessema. The CPAP machine delivers air pressure to a mask you wear while you sleep to keep the upper airway passages open. The machines wirelessly transmit data to patients’ doctors so they can see how effective the therapy is working.
For those with mild to moderate sleep apnea, a dental appliance that pulls the jaw forward slightly while you sleep helps keep the airway open. Doctors who diagnose sleep apnea can recommend dentists who have extra training to fit people for these oral appliances.
Ofer M. Doron, a dentist with Dental Associates of Farmington and a member of the American Academy of Dental Sleep Medicine, sought out courses after he was fitted for an oral appliance following his own sleep apnea diagnosis. The oral appliance is bulkier than a dental retainer, but less cumbersome than a CPAP machine, so patients tend to wear it longer, he says.
Doron begins with a dental exam to see if the patient is a good candidate. If they don’t have periodontal disease, loose or missing teeth, Doron runs tests to determine the correct positioning for the jaw. Once he fabricates the appliance, patients return for follow-up appointments where he checks the fit and comfort, and ensures the teeth are not moving. “If they’re not using it, I didn’t do my job,” Doron says. Medical insurance typically covers the cost since it’s a treatment for a chronic illness.
The newest treatment option, for patients who qualify, is an implantable device called Inspire, in which a doctor implants a nerve stimulator beneath the clavicle, a tunneled lead that senses breathing and another that stimulates the tongue so it moves out of the way and stops obstructing the airway, Tessema says. The stimulator is paired to a battery-operated, remote-controlled device the patient turns on when they sleep.
The most dramatic treatment option, which targets those with small jaws and a large overbite, is reconstructive surgery that involves breaking the jaw and moving it forward, Tessema says.
There are other surgical options that involve tissue removal or tissue shrinkage, according to the Mayo Clinic. During an uvulopalatopharyngoplasty, the doctor removes tissue from the rear of the mouth and top of the throat, and usually removes tonsils and adenoids as well. But this is not considered a reliable treatment for obstructive sleep apnea and is less effective than a CPAP machine, according to the Mayo Clinic. Doctors also use radiofrequency ablation to shrink tissue at the rear of the mouth for those with mild to moderate sleep apnea.
Sleep apnea obstructs breathing the most when people are in rapid eye movement (REM) sleep, which is essential to health, Tessema says, adding, “If you don’t get into that deep sleep, you don’t regenerate your body and your mind.”
Symptoms of sleep apnea
- Obstructive sleep apnea can impact day-to-day living and quality of life. Common symptoms include:
- Disrupted breathing: a person’s breathing becomes labored or even stops for up to a minute at a time
- Snoring, including loud snoring that may involve gasping, choking or snorting
- Excessive daytime sleepiness
- Morning headaches
- Limited attention span or difficulty thinking clearly
- Awaking with a dry mouth or sore throat
- Frequent need to awake to use the bathroom
- A sleep partner disrupted by their partner’s snoring and labored breathing
- Source: sleepfoundation.org
You can take a sleep apnea screening test at sleepapnea.org.