Snoring is very common and can often be just a minor nuisance. However, it can sometimes be an indication of a more serious problem, such as sleep apnea. Sleep apnea is a condition in which a person stops breathing for periods of time during sleep. These abnormal pauses in breathing are called “apneas.” In obstructive sleep apnea (OSA), the most common type, apneas occur due to a temporary blockage of air movement through the upper airway on the way to the windpipe. The blockages—or obstructions—happen when some structure along the path abnormally collapses against another, requiring increased breathing muscle effort to restore air flow. OSA is common and can be found in both men and women, and in both adults and children.
When to Suspect Obstructive Sleep Apnea
Snoring is usually noted when a person has OSA, although many people without OSA snore as well. If a bed partner reports hearing snoring and noting apneas during a person’s sleep, the possibility of OSA may be considered easily. However, the clues are often more subtle; many people with OSA feel poorly rested even after a full night’s sleep or are excessively sleepy during the day, dozing off at times when they want to be alert. Other symptoms can include waking up with headaches in the morning or with gasping sensations overnight. If a person has noted any of these issues, a medical provider, such as a physician assistant (PA), can evaluate further and order testing if needed.
The evaluation includes checking for factors that increase the risk that a person may have OSA. Being overweight can increase the odds of having OSA. Development of high blood pressure or difficulty getting blood pressure under control can be associated with OSA as well. Certain findings noted on an examination may also suggest that OSA could be present: having a small lower jaw, a large tongue, large tonsils, a long soft palate (the back part of the roof of the mouth), or a large neck circumference can be associated with OSA.
How to Know for Sure
When signs and symptoms suggest the possibility that a person has OSA, a sleep study is the best next step. This test determines whether a person has OSA and will also indicate the severity of the condition. A sleep study is performed either in a sleep center or in a patient’s home. Although testing in a sleep center is more thorough, there are pros and cons for each type, and a PA can help decide which is more appropriate for a certain patient. In both types, monitors are worn during sleep to detect apnea episodes by recording oxygen levels, breathing muscle movements and other measurements. The number of apneas per hour helps to determine whether OSA is mild, moderate or severe.
What are the Treatment Options for Obstructive Sleep Apnea?
Various treatments for OSA are available. The decision of which treatment to select is made jointly by the patient and PA based on the consideration of several factors. These include patient preference and lifestyle, severity level of OSA, sites of obstruction and other health issues. Continuous positive airway pressure (CPAP) devices prevent apneas by directing air pressure into the upper airway using a mask, which prevents collapse when the person inhales. CPAP devices are usually considered the best treatment to try first, as they can provide effective treatment for mild to severe OSA and do not carry the risks of surgery.
Although CPAP is typically well-tolerated, it is not for everyone. Other options include oral appliances, surgical procedures and weight loss. Oral appliances are worn during sleep to keep the jaw and tongue from moving backward and blocking the throat. Unfortunately, they do not fully treat more severe cases of OSA. Surgical treatment options include a myriad of different procedures that address the anatomic site(s) causing the person’s obstructions. Weight loss is helpful and is recommended for all patients who are above their ideal weight. With enough weight loss, a person’s OSA can decrease in severity and sometimes even resolve. Because weight loss efforts take time, other treatments are used while working toward that goal. All people with sleep apnea should try to avoid things that can worsen OSA, including sleeping flat on the back, consuming alcohol near bedtime, and taking sedating medications.
Why is Treatment Important?
Knowing if OSA is present is important so treatment can be started, as untreated sleep apnea carries risks. If severe OSA is left untreated, a person may have a higher risk of developing serious cardiovascular issues, like high blood pressure, stroke or heart problems. However, even milder cases of OSA benefit greatly from treatment. Because excessive daytime sleepiness—including that from untreated OSA—can increase the risk of accidents, treatment can reduce this risk. Also, treating OSA helps a person feel better by reducing associated symptoms and improving sleep quality, positively impacting daytime performance. For people with OSA, diagnosis and treatment of the condition can be important steps toward living their best life.
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