Is Sleep Apnea A Respiratory Disorder
Sleep Apnea is considered a sleep disorder because it affects you during sleep rather than all the time. With this disorder, your breathing is interrupted while you sleep, for up to 30 seconds or even longer at a time. This can happen all night, causing as many as hundreds of disruptions to your breathing and sleep. The result is that your brain and body can lack proper oxygen levels and you lose sleep, which is important to health.
While it is a sleep disorder, Sleep Apnea syndrome is included in the list of chronic respiratory diseases by the World Health Organization in the International Classification of Diseases . According to the National Cancer Institute, a respiratory disease is simply a disease involving the respiratory system, including the lungs. So Sleep Apnea is generally classified as a sleep disorder in America, yet it can be seen as a respiratory disease as well and is classified as such in the ICD.
First What All Types Of Sleep Apnea Have In Common
Because these awakenings are typically very brief, the person with sleep apnea may not even be aware that they are experiencing interrupted sleep. But the episodes can wreak havoc on the sleep cycle and prevent the person with sleep apnea from reaching the deep, restful phases of sleep. And thats why people who have sleep apnea can experience significant exhaustion and drowsiness the next day, despite getting what they thought was a full night of sleep.
Sleep Apnea Signal: Your Snoring Is Earth
Next to daytime sleepiness, loud snoring is the second major marker of sleep apnea. Not everyone who has sleep apnea snores , notes Dr. Breus, but its an extremely common symptom.
Breathing into a partially collapsed airway causes a vibration, which makes the snoring sound, says Dr. Rapoport.
This can point to a blockage that predisposes you to sleep apnea. But its actually the pausing between snores that can be more concerning: This is the part where youre not breathing.
If theres no air moving, there cant be any noise, says Dr. Rapoport.
Along with severe snoring, your bed partner may notice a gasping, snorting, or struggling as you return to breathing, he says. This can be pretty dramatic and alarming for someone you sleep next to, but you probably won’t notice, he adds.
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Signs And Symptoms Of Sleep Apnea
Family members or bed partners often pick up on the signs of sleep apnea first. Many people with sleep apnea don’t know they’re snoring and gasping for breath at night. If you have any of the following signs, see your doctor:
- daytime sleepiness
- loud snoring followed by silent pauses
- gasping or choking during sleep
- morning headache
- poor concentration or memory loss
- lowered sex drive
Snoring by itself doesn’t necessarily mean that you have sleep apnea. It is true that loud snoring is common in people with this disorder, but there’s a big difference between simple snoring and sleep apnea.
Untreated sleep apnea can cause serious health problems. If it’s not treated, sleep apnea can lead to:
- high blood pressure
- work-related injuries
Does Sleep Apnea Qualify As A Disability
According to the Nolo legal network, the Social Security Administration doesnt have a disability listing for sleep apnea. It does, however, have listings for breathing disorders, heart problems, and mental deficits that might be attributed to sleep apnea.
If you dont qualify for the conditions listed, you may still be able to receive benefits through a Residual Functional Capacity form. Both your doctor and a claims examiner from Disability Determination Services will fill out an RFC form to determine whether youre able to work due to:
- your sleep apnea
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What Are The Treatments For Sleep Apnea
Conservative treatments: In mild cases of obstructive sleep apnea, conservative therapy may be all that is needed.
- Overweight persons can benefit from losing weight. Even a 10% weight loss can reduce the number of apneic events for most patients. However, losing weight can be difficult to do with untreated obstructive sleep apnea due to increased appetite and metabolism changes that can happen with obstructive sleep apnea.
- Individuals with obstructive sleep apnea should avoid the use of alcohol and certain sleeping pills, which make the airway more likely to collapse during sleep and prolong the apneic periods.
- In some patients with mild obstructive sleep apnea, breathing pauses occur only when they sleep on their backs. In such cases, using a wedge pillow or other devices that help them sleep in a side position may help.
- People with sinus problems or nasal congestion should use nasal sprays or breathing strips to reduce snoring and improve airflow for more comfortable nighttime breathing. Avoiding sleep deprivation is important for all patients with sleep disorders.
Hypoglossal nerve stimulator: A stimulator is implanted under the skin on the right side of the chest with electrodes tunneled under the skin to the hypoglossal nerve in the neck and to intercostal muscles in the chest. The device is turned on at bedtime with a remote control. With each breath, the hypoglossal nerve is stimulated, the tongue moves forward out of the airway and the airway is opened.
Causes Of Sleep Apnea
To treat sleep apnea, or to get rid of it for good, youll need to get down to the root cause. Some causes of sleep apnea include:
- Weight Being overweight or obese is a common cause. The extra tissue in the upper airway and around the neck can obstruct your airway, keeping you from breathing during sleep.
- Sleep Position Some people only have periods of apnea while sleeping on their backs .
- Anatomy Sometimes your anatomy can be the cause of your sleep apnea. This could be from large tonsils that narrow the upper airway or a deviated septum, for example.
- Alcohol Alcohol can relax muscles and tissues that can block the airway.
- Smoking Smoking can cause inflammation in the airway, contributing to sleep apnea.
- Medication Certain medications may also play a role in causing sleep apnea.
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What Are The Treatments For Central Sleep Apnea
Managing underlying medical conditions is the first line of treatment for central sleep apnea. Medications can help control congestive heart failure, Parkinsons disease, and other heart or nervous system conditions.
You may need to stop using opioid medications if these drugs are causing your breathing to stop during sleep. Your doctor may also prescribe medications such as acetazolamide to stimulate your breathing mechanism.
Oxygen supplementation and the regulation of air pressure during sleep are effective treatments for many people with central sleep apnea.
How Many Apneas Per Hour Is Severe
As we mentioned, there are different levels of sleep apnea. A lot of the time, the number of apnea events someone experiences during the night depends on the form of sleep apnea they have. Overall, there are 3 forms:
- Central sleep apnea
- Obstructive sleep apnea
- Mixed sleep apnea
Central sleep apnea is less common than obstructive sleep apnea . This occurs when the brain fails to send a signal to the breathing muscles. Most of the time, conditions that influence the brain stem are found to be the leading cause of central sleep apnea.Obstructive sleep apnea is when an airway becomes completely or partially blocked. The fatty tissue in the neck or the tongue will fall into the back of the mouth as the throat muscles relax during sleep. This leads to the airflow becoming blocked.Mixed sleep apnea is a combination of central sleep apnea and obstructive sleep apnea and can cause many apnea events per night.When it comes to the severity of this condition, it is generally found with how many sleep apnea events and hypopnea events take place during sleep. This classification takes place through the Apnea-Hypopnea Index.
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What Are The Causes Of Sleep Apnea
Obstructive sleep apnea occurs when a persons airway becomes blocked during sleep. Multiple factors have been found to increase the risk of blockage and OSA:
- Anatomical characteristics. The size and positioning of a persons neck, jaw, tongue, tonsils, and other tissue near the back of the throat can directly affect airflow.
- Obesity. Being overweight is a leading cause of OSA and may be an underlying risk factor in up to 60% of cases. Obesity contributes to anatomical narrowing of the airway, and research has found that a 10% increase in weight can equate to a six-fold increase in OSA risk.
- Sleeping on your back. This sleeping position makes it easier for tissue to collapse around the airway and cause blockages.
- Nasal congestion. People whose ability to breathe through the nose is reduced because of congestion are more likely to experience OSA.
- Hormone abnormalities. Hormone conditions like hypothyroidism and acromegaly may increase the risk of OSA by causing swelling of tissue near the airway and/or contributing to a persons risk of obesity.
In CSA, breathing is affected in a different way than in OSA. Instead of an obstruction causing breathing lapses, the problem arises in how the brain communicates with the muscles responsible for respiration. In particular, the brain stem fails to adequately perceive the levels of carbon dioxide in the body, leading to breathing that is slower and shallower than it should be.
What Are Events With A Cpap
CPAP, or Continuous Positive Airway Pressure, therapy is a common treatment for obstructive sleep apnea. When a patient uses a CPAP machine, a hose and mask, or nosepiece, is used to deliver constant, steady air pressure.
However, these machines can run into problems with leaky masks, the patient finding it hard to fall asleep, and the onset of a stuffy nose or dry mouth. CPAP machines are the most prescribed devices for treating sleep apnea disorders. They measure how you sleep and how many interruptions or pauses in your breathing take place during this time. This is often because the throat or airways briefly collapse or something blocks them temporarily.While these machines are regularly used by sleep apnea patients, many wonder what an event is with the CPAP. These events are sometimes referred to as an Apneic Event or episode. This is a pause in the breathing that lasts for 10 seconds or more. The stoppage of breath has to last at least 10 seconds to be classified as an event.Obstructive apnea events can last as long as two minutes but this is usually in severe cases. Such long breaks in breathing are generally associated with a reduction in the oxygen levels in the blood.
Over time, this can cause potentially serious health problems as your organs are left without sufficient oxygen supplies and blood flows for some time.
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Sleep Apnea Cardiovascular Risk And Metabolism
Several studies have shown an association between sleep apnea and problems like type 2 diabetes , strokes , heart attacks and even a shortened lifespan, says Jun. Why this connection? For one thing, obesity is common in sleep apnea patients, and obesity greatly increases risks of diabetes, stroke and heart attack, he says. In most cases, obesity is the main culprit behind both conditions, Jun explains.
Still, its important to note that not everyone with sleep apnea is obese. Furthermore, evidence suggests an independent link between sleep apnea and diabetes. Our lab and others have shown that sleep apnea is associated with higher risks of diabetes, independent of obesity, and that sleep apnea can increase blood sugar levels, says Jun.
For people who are overweight or obese, weight loss is key for treating or avoiding sleep apnea. People who accumulate fat in the neck, tongue and upper belly are especially vulnerable to getting sleep apnea. This weight reduces the diameter of the throat and pushes against the lungs, contributing to airway collapse during sleep.
Women in particular should be careful as they age. While premenopausal women tend to put on weight in the hips and in the lower body instead of the belly, this shifts with time. Weight begins to accumulate in traditionally male areas like the tummy, and this leads to a greater chance of sleep apnea.
Sleep Apnoea Can Affect Your Driving Ability
People with significant sleep apnoea have an increased risk of motor vehicle accidents. Driving authorities recognise certain sleep disorders, including sleep apnoea that can affect driving fitness.
If you live in Victoria, you are legally required to notify VicRoads of any serious or chronic medical condition, injury or disability or the effects of certain treatments that may affect your ability to drive. Failure to do so may affect your insurance cover.
People with sleep apnoea will be assessed on a case-by-case basis and you may be advised to provide medical reports on the severity and treatment of your sleep apnoea. Options may include the issue of a conditional licence until your sleep apnoea is adequately treated.
People with sleep apnoea should also be aware of safety in other situations in which falling asleep could pose a danger to other people.
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What Causes Obstructive Sleep Apnea
When we sleep, our muscles relax. This includes the muscles in the back of the throat that help keep the airway open. In obstructive sleep apnea, these muscles can relax too much and block the airway, making it hard to breathe.
This is especially true if someone has large tonsils or adenoids, which can block the airway during sleep.
Other things that can make a child likely to have OSA include:
- a family history of OSA
- medical conditions such as Down syndrome or cerebral palsy
- problems of the mouth, jaw, or throat that narrow the airway
- a large tongue, which can fall back and block the airway during sleep
What Are The Risk Factors For Sleep Apnea
You are at a higher risk for obstructive sleep apnea if:
The ASAA estimates that between 1 and 4 percent of American children have sleep apnea.
Although surgical removal of the tonsils and adenoids is the most common treatment for pediatric obstructive sleep apnea, positive airway pressure therapy and oral appliances are also prescribed.
Make an appointment with your doctor if youre exhibiting any of the symptoms of obstructive sleep apnea, especially:
- loud, disruptive snoring
- episodes of stopped breathing while sleeping
- abrupt awakenings from sleep that are frequently accompanied by gasping or choking
Your doctor may refer you to a sleep specialist, a medical doctor with additional training and education in sleep medicine.
Treatment for severe obstructive sleep apnea includes lifestyle changes, therapies and surgeries, if needed.
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Understanding Obstructive Sleep Apnea
What is obstructive sleep apnea?
Obstructive sleep apnea occurs when your breathing is interrupted during sleep. This interruption lasts for longer than 10 seconds at least 5 times an hour throughout your sleep period. When your breathing is reduced and you’re not taking in enough oxygen, it’s called hypopnea. If your breathing completely stops, it’s called apnea. Your breathing often stops because something is blocking your upper airway. This might be muscles, tongue, or other body tissues. Obstructive sleep apnea can range from moderate to severe. This is based on a measurement and rating system called the apnea-hypopnea index . The AHI measures an average number of apnea and hypopnea episodes you have per hour that you sleep.
Obstructive sleep apnea is classified by severity:
Severe obstructive sleep apnea means that your AHI is greater than 30. You have more than 30 episodes per hour.
Moderate obstructive sleep apnea means that your AHI is between 15 and 30.
Mild obstructive sleep apnea means that your AHI is between 5 and 15.
What causes obstructive sleep apnea?
When you sleep, your body is completely relaxed. This even includes the muscles that help you breathe. In people with sleep apnea, these relaxed muscles combined with a narrowed airway to interrupt breathing.
But what’s frightening is that as many as 9 in 10 people who have obstructive sleep apnea don’t know that they have it. Untreated, sleep apnea can lead to serious health problems.
Increased blood pressure.
Check If You Have Sleep Apnoea
Symptoms of sleep apnoea mainly happen while you sleep.
- making gasping, snorting or choking noises
- waking up a lot
During the day, you may also:
- feel very tired
- find it hard to concentrate
- have mood swings
- have a headache when you wake up
It can be hard to tell if you have sleep apnoea. It may help to ask someone to stay with you while you sleep so they can check for the symptoms.
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Mood Or Mental Health Issues
Johns Hopkins Medicine reports that a lack of sleep is associated with a range of brain-related issues, including a higher risk of depression, irritability, anxiety, and fuzzy thinking.
Although causality is still under active study, there is a link between sleep apnea and depression. In fact, a 2015 study published by the Journal of Clinical Sleep Medicine found that 213 out of the 293 study participants with sleep apnea also experienced clinically-significant symptoms of depression.
âSleep is key to helping our brains and neurological system recharge,â Nunez explains. âUntreated sleep apnea causes you to lose sleep, and without proper sleep, it can take a toll on mental health, resulting in depression or anxiety.â
What Are The Signs Of Sleep Apnea
There are two kinds of sleep apnea: obstructive sleep apnea and central sleep apnea. Obstructive sleep apnea happens when air cant flow into or out of the nose or mouth, although youre trying to breathe. Central sleep apnea happens when the brain fails to send the right signals to your muscles to make you start breathing.
Sleep apnea may be noticed more by the bed partner than by the sleeper, says Jun. Your bed partner might notice that your breathing pauses, or they may complain of your loud snoring.
That said, snoring itselfthough annoyingisnt the same as sleep apnea. Snoring is just the vibration sound created by airway resistance. You can snore loudly and not have sleep apnea, and you may even have sleep apnea without much snoring.
People with sleep apnea might also suffer from unexplained fatigue and mood swings, because their breathing interruptions continually wake them and prevent them from settling into a deep, nourishing sleep.
The consequences can be significant, Jun says. We’re talking about car accidents in the daytime, lost productivity at work, mood swings, waking up feeling groggy and falling asleep in class.
Other sufferers might wake up with a dry mouth, since sleep apnea tends to make you breathe with an open mouth, drying out your saliva. Some awaken with a headache, which may be caused by low oxygen or high carbon dioxide levels during sleep.
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