Obstructive Sleep Apnea (OSA) Causes & Symptoms
What is sleep apnea (OSA)?
Sometimes, snoring leads to a more severe condition called obstructive sleep apnea (OSA). OSA occurs when a person suffers from multiple episodes of paused breathing during sleep. Episodes last for 10 seconds or more and result in lower amounts of oxygen in the blood. In turn, the heart must work harder and the natural sleep cycle is disrupted due to constant awakenings (arousals). Patients who suffer from OSA can experience anywhere from dozens to hundreds of arousal episodes each night.
What causes sleep apnea?
OSA occurs when something blocks (obstructs) the airway during sleep and oxygen cannot easily flow through the nose or mouth during sleep. Common conditions that can cause OSA include:
- Nasal passage obstruction – A stuffy nose or nasal obstruction can cause a narrowing of the nasal passageway and play a substantial role in OSA. Additionally, swelling of the tissues that line the airway (nasal mucosa) can also impact a person’s ability to breathe properly. Nasal passageway obstruction can be caused by enlarged nasal turbinates, deviated septum, enlarged adenoids or nasal polyps.
- Mouth Structure – The soft palate is a cluster of tissues that lines the roof of the mouth and runs all the way to the back of the throat. The uvula is attached to the soft palate and hangs down in the back of your throat. If a soft palate is thick, long, or oversized, your airway can be narrowed. Additionally, if the uvula or tonsils are enlarged it can also cause an obstruction, especially during sleep.
- Excess Body Weight – Being overweight is often affecting a person’s ability to breathe and impact a risk for developing OSA. Excessive weight and weakness of the soft tissue around the neck or throat can narrow the airway and make it more difficult to breathe.
What are the effects of sleep apnea?
The immediate results of OSA include an inability to enter a deep sleep because throat muscles are tense throughout the night to keep airflow going to the lungs. Long-term results of OSA often include daytime fatigue, increased risk of other medical conditions, including heart attack, stroke and impaired job or school performance.
What are the signs of sleep apnea?
Often patients with OSA are not aware that they have a sleep disorder. Usually the sleep partner is observing episodes of awakening (arousals) or complaining about snoring. Sleep apnea episodes can occur throughout the night without the patient awaking fully or being conscious of the fact that they have stopped breathing. For this reason, it is important to recognize other sleep apnea symptoms, including excessive daytime sleepiness, snoring, trouble concentrating, irregular heartbeat, high blood pressure, waking up with a dry mouth or sore throat, gasping during sleep and feeling tired in the morning.
Most people suffering from sleep apnea are not aware of their nightly episodes because they don’t attribute their daytime symptoms with what’s happening to them at night. Those suffering from this sleep condition are often made aware of their snoring or sleep apnea episodes at night because of the effect it can have on their bed partner.
What sleep apnea treatment options are available?
The goal of treatment is getting you back to having regular breathing during sleep. Your primary care physician may recommend lifestyle changes such as losing weight or changing your sleeping position. Alternatively, other measures may be prescribed such as a mouthpiece (mouth guard) that helps keep your airway open, or a breathing device that pushes air down your throat into your lungs (APAP/ CPAP machine).
In cases where these other treatments don’t work or if you have a deviated nasal septum, enlarged uvula or large tonsils, your doctor may want to send you to an ENT specialist to evaluate a surgical treatment option. However, it’s important to keep in mind that a surgery is usually the last resort and should only be considered when all conservative treatments failed to provide improvement.
A continuous positive airway pressure (CPAP) or automated positive airway pressure (APAP) therapy is a frequently used conservative therapy which opens the airway by feeding oxygen into the airway. This technique is comprised of a mask that delivers air to the nose and mouth through a specific mask. It is highly effective for people without an upper airway resistance, but patients with a deviated nasal septum often have often a difficult time tolerating the therapy.
What are the surgical procedures to treat sleep apnea?
The alignment of the bones and tissue in the jaw, mouth, and throat can cause sleep apnea. The most common surgical options rearrange or reduce the tissue in the throat that is blocking your airway while you sleep. This tissue can be in the soft palate (which is at the back of the roof of your mouth) the uvula, your tonsils and adenoids (which are in the back of your throat) or your tongue. There are also surgeries to correct the alignment of the bones in the mouth, nose, and face.
Surgical treatment options may include: turbinate reduction, nasal septoplasty, tonsillectomy, u, Laser-assisted tonsil ablation and radiofrequency ablation of the tongue. If you are suffering from OSA, the first step towards feeling better is to schedule an evaluation with an experienced ear, nose and throat doctor.
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