Breathing is an essential activity which sustains life. This process of taking in air (oxygen) and getting rid of waste materials like carbondioxide must take place continuously for an individual to remain alive and healthy. Breathing has two components: one is the signal from the brain and the other is the movement of the respiratory muscles. The part of the brain known as the brain stem regulates how an individual breathes. Electrical impulses are sent from this center to the muscles used for respiration. These signals determine the rate at which we breathe. Besides, breathing also involves the movement of the intercostals muscles and the diaphragm. Together, these two components ensure that breathing takes place smoothly.
When ,however, this process of breathing is interrupted during sleep, a disorder known as sleep apnea develops. 1 in every 15 or 18 million Americans are said to have a form sleep apnea. Though it usually last for a short period of time (10 to 30 seconds), apneas may arise hundreds of times each night (Harvard Health Publication,2016). Therefore, it is a serious condition that requires prompt medical attention. It is dangerous because breathing is paused during those short intervals and oxygen would not be able to get into bloodstream thereby depriving sensitive body tissues such as the brain the much needed ingredient for its functions.
The body would try to restore to normal the resultant low level of oxygen in the blood .The brain carries out this adjustment by increasing signals to the muscles used for respiration which ultimately increases the rate of breathing. As this happens, the individual gasps for breath and is jolted from the deep to the shallow phase of sleep. Because this is repeated several times during the night, sleep may become unpleasant and far from what is good for the body.
Types of Sleep Apnea
Three types of sleep apnea have been identified .These are:
- Obstructive Sleep Apnea.
- Central Sleep Apnea.
- Complex Sleep Apnea.
Obstructive Sleep Apnea
Obstructive Sleep Apnea –This is the usual type of apnea that is prevalent in any given population. In this case, the air passage becomes clogged with tissues thereby obstructing the flow of air to the lungs during sleep. The tissues that may cause this blockage include: adenoids and tonsils (lymphoid tissues), muscles of the throat, the base of the tongue and soft tissues arising from obesity. These tissues tend to fall backwards and thus obstruct or narrow the pathway for air flow during sleep. The severity (number of apnea per hour) of this sleep disorder has been used as a means of classifying it as follows:
- None/minimal – < 5 apneas per hour
- Mild – < 15 apneas per hour
- Moderate – 15 -30 apneas per hour
- Severe – > 30 apneas per hour. (Harvard Medical School, 2011)
Certain factors or health conditions may predispose an individual to developing Obstructive Sleep Apnea. Age, genetic predisposition, frequent use of alcohol and smoking are some of these factors. Others are sinusitis and menopause.
Central Sleep Apnea
Central Sleep Apnea – As noted earlier, the brain (Brain Stem) regulates the breathing mechanism via signals sent to respiratory muscles. Whenever this fails to happen, there is a temporary cessation of breathing .The brain carries out this adjustment by increasing signals to the muscles used for respiration which ultimately increase the rate of breathing. As this happens, the individual gasps for breath and is jolted from the deep to the shallow phase of sleep. Because this is repeated several times during the night, sleep may become unpleasant and far from what is good for the body. This abnormal occurrence is referred to as Central Sleep Apnea. Unlike Obstructive Sleep Apnea, snoring by the individual does not occur since there is no obstruction as a result of the relaxed tissues. It is an ‘’electrical’’ rather than a “mechanical’’ fault. The likelihood of developing this disorder is high in people using certain medication like those for relieving pain and people who recently climbed high altitude (Davis, 2016).
Complex Sleep Apnea
Complex Sleep Apnea – Mixed Sleep Apnea is another name for this disorder. This is because an individual with the disorder manifest the symptoms of both Obstructive Sleep Apnea and Central Sleep Apnea. It is usually diagnosed when a Continuous Positive Airway Pressure (CPAP) therapy is used to treat Obstructive Sleep Apnea. Although there is marginal improvement with the treatment, the cessation in breathing resurfaces and signals of Central Sleep Apnea begin to appear.
Although the risk of developing sleep apnea is high among middle-aged individuals, the disease can affect anyone including children. It is estimated that 2-3.5 % of children between two to eight years old develop Obstructive Sleep Apnea. (Chang et al, 2010). In spite of the similarities with the nature of the sleep apnea found in adults, childhood apneas have slightly different causes from those in adults. The primary cause of Obstructive Sleep Apnea in children is the increase in the size of tonsils and the adenoids. It is not unusual for tonsils to enlarge as a child grows through the adolescent phase of development. This may be due to the protective function of the tonsils and adenoids in fighting germs. Beyond this phase, however, the tonsils frequently shrink and so do not pose any health risk. But an infection can make the tonsils to become enlarged thereby obstructing the free –flow of air to and from the lungs. Another cause of sleep apnea in children is obesity. Obesity results in the deposition of fat in the body including the soft tissues in the throat. These tissues not only narrow the air passage, they also fall backwards when relaxed to block the free movement of air during sleep.
Moreover, Down Syndrome is another condition which increases the chances of a child developing Obstructive Sleep Apnea. There is a 50-100 % incidence of Obstructive Sleep Apnea in individuals with Down Syndrome (NAPSD, 2012). This is because features of Down Syndrome such as low muscle tone in the mouth and upper airway, narrow air passage in the throat and inadequate co-ordination of airway movements are traits which make sleep apnea to thrive. Sleep apnea in children ought to be a source of worry not only for parents but also for everyone involved in providing care to them. This is because the condition often goes undetected and such children go through physical and emotional stresses. Poor sleep can result to low concentration and low performance in the school work. Therefore, it might be advisable to consult a doctor if a child shows the following symptoms:
- Loud snoring during sleep.
- Adopting abnormal positions in sleep.
- Restlessness in sleep.
- Breathing through the mouth and frequent awakenings.
Signs And Symptoms Of Sleep Apnea
Noticeable symptoms of sleep apnea include the following:
- Sleepiness or feeling sleepy during the day.
- Dry mouth after waking up from sleep.
- Frequent night urination.
- Morning headaches.
Sleeping or feeling sleepy during the day – This occurs as a result of the jolts and pauses produced by apnea during sleep. The individual would not be able to enjoy a sound sleep because of frequent awakenings from deep sleep. Since the body needs to have to have enough rest each day to function well, sleeping during the day is an attempt to make up for it.
Waking up with a dry mouth –This is caused by the snoring produced by sleep apnea (Katz, 2016). Snoring affects the flow of saliva which is a liquid that makes the mouth wet. Therefore, whenever the liquid is not produced in adequate quantity, xerostomia or dry mouth results.
Extreme tiredness or fatigue – This is another manifestation of sleep apnea. “Sleep time” ought to be “rest time” but this is hardly true in this condition because of the frequent interruption of sleep by sleep apnea. Even though the required numbers of hours have been spent sleeping, people affected by this condition are not feeling refreshed but rather they are extremely tired after waking up.
Frequent nighttime urination – This has been attributed to the hormone called atrial natriuretic peptide produced as a result of the negative pressure generated in the chest cavity as the individual vigorously try to breathe (Roberts,2014).
Sweating while sleeping – Is a common feature of sleep apnea. This is attributable to the movements of the body as a result of the restlessness and struggling during apneac episodes.
More info about symptoms of sleed apnea here.
Tests and Diagnosis
It is not always easy for an individual to know that he or she has sleep apnea disorder by himself. With the help of family members, however, the symptoms earlier discussed could be observed and thus serve as a prompt for a proper test and diagnosis.
There is a need to consult a sleep specialist who will be able to examine the individual to rule out any other possible causes and also to prescribe appropriate tests needed for the diagnosis. The following are the common tests offered to patients:
- Home – based sleep test.
- Laboratory – based sleep study (Polysomnography).
In the home – based sleep test, simple equipment are provided to be used by the patient. Adequate instructions are given on how to use them. While in the Laboratory test, an overnight sleep would be necessary for a detailed investigation. Whichever method is adopted, it is important to have data on the following parameters:
- Tone of muscle.
- Heart rate.
- Blood level of Oxygen.
- Brain wave.
- Chest movements.
Analysis of the results will enable the physician to determine the right approach to treating the disorder.
There are different approaches to treating sleep apneas depending on its severity. The following are some treatments available to individuals who have this disorder:
- Health programmes to change lifestyle.
- CPAP Therapy.
Health Programmes – As noted above, smoking and drinking are factors that promote sleep apnea in people. Therefore, avoiding its use will go a long way in resolving the disorder. It is also necessary to consult experts in diet and nutrition on how to choose appropriate food that is good for health and for the right body weight.
CPAP Therapy – Treatments always try to remove or reduce blockages and free the airway for breathing. The Continuous Positive Airway Pressure machine delivers air pressure through a mask placed over the nose while the individual sleeps so as to keep his upper airway passages open, preventing apnea and snoring (MFMER, 2016 ). (We have a lot of Cpap Machine Reviews, so, you can choose which machine is right for you). Sometimes, oral appliances which are designed to keep the throat open might be useful in resolving this syndrome. Other times, however, Expiratory Positive Airway Pressure (EPAP) device which is a valve that allows the free flow of air might bring relief.
Surgery – Here, an operation is provided to the patient to correct the anomaly by removing any obstructing tissues. The tonsils or adenoids may be removed (adenotonsillectomy) or a bypass may be necessary (tracheostomy) in an extreme condition.
- Regular physical activity.
- Adopt a good sleeping position. Avoid sleeping on your back.
- Seek medical help before taking any medication.