What is obstructive sleep apnea and is it possible to cure it?

By Andrew Sokol and Vladimir Marchenko

1. About sleep apnea
2. What can sleep apnea lead to
3. What causes sleep apnea
4. How do I know if I have sleep apnea?
5. How to cure sleep apnea
6. Does sleep apnea make you tired?

Obstructive Sleep Apnea (OSA) is not just snoring and shortness of breath, it is a serious nervous system disorder. What are the signs of sleep apnea and are there proven methods to relieve the symptoms of this dangerous syndrome.

About sleep apnea

Obstructive sleep apnea is recurring episodes of complete blockage of the airways, often characterised by the shortness of breath when sleeping. During sleep, the lower jaw is displaced downward and the tongue is partially retracted. The muscle tissue of the pharynx walls at this time is excessively relaxed, and the air passing through the upper respiratory tract causes them to oscillate. This is exactly how the snoring occurs during inhalation. Most often it appears when a person sleeps on his back with his head thrown back slightly. Sometimes the soft palate and the uvula hanging from it as well as the tonsils collapse under the influence of such vibration, completely blocking the access of air to the trachea so that the air cannot enter the lungs. There occurs either a short-term or long-term respiratory arrest, and the person wakes up or moves into a less deep sleep stage. After awakening, the muscles tone, the lumen of the pharynx opens and breathing is restored. OSA affects up to 3-5% of the world's adult population.

Here's what happens in the nasopharynx during apnea:

The main differences between snoring and obstructive sleep apnea are the following:

• A person can snore evenly throughout the night and a significant part of the time he breathes the organs receive oxygen and snoring does not harm health, in comparison with apnea. Snoring sometimes stops and sometimes reappears.
• During apnea, snoring is either loud or with a changing volume. Sometimes it ends abruptly. After a pause in breathing a noisy breath follows, and after, the person breathes frequently and deeply for some time.
• Snoring, however, can eventually turn into apnea or act as a component of it.
• During apnea, the sleeping person tries to breathe and fails (this is especially noticeable from the outside) and often turns from side to side.
• People who suffer from apnea wake up not from their own snoring, but from a stressful reaction, caused, for example, by a drop of the level of oxygen in the blood.

OSA occurs at almost any age, from infancy to senility, so knowing how to check for sleep apnea is very important. A typical portrait of a patient looks like this: a man over 40 years old, overweight, with specific features of the skull (people with a round head snore more often than those whose skull is stretched), specific features of neck, tonsils and tongue, as well as the presence of chronic diseases (f.e. sinusitis). By the age of 60, OSAS occurs in 30% of men, provoking partial disabilities.

Can sleep apnea cause death? Definitely, yes. Moreover, both directly (cardiac arrest during sleep due to lack of oxygen) and indirectly (death in an accident due to persistent lack of sleep). The most common cause of death is a drop in blood oxygen levels below 70% due to the fact that a person cannot breathe normally during apnea. With prolonged oxygen starvation, myocardial hypoxia occurs, which over time can lead to clinical and then biological death. The likelihood of a stroke is also significantly increased (one of the other reasons why death occurs during sleep). Yes, normally a person should wake up every 15-30 seconds after breathing stops, but this is not always the case. With a frequency of respiratory arrests at the level of 20-30 times per hour, the body simply cannot cope and does not give the command to wake up. In severe cases, a person does not breathe for up to 1.5 hours in total per night. How serious is sleep apnea? Let’s take a look.

The severity of obstructive sleep apnea

Accordingly, unlike periodic episodes of snoring and waking up, which happen to almost everyone, you should consult a doctor when snoring interferes with your sleep or the sleep of the others. If you wake up from a lack of air, you are overtaken by excessive daytime sleepiness and this continues more than three times a week - these all are warning signs. However, if someone close to you has noticed serious manifestations of apnea from your side, you should definitely pay a visit to the doctor.

What can sleep apnea lead to

Obstructive sleep apnea can also lead to a number of serious diseases. Although causal relationships have not been established for all of them (in 90% of cases, the cause is a complex stress reaction), sleep apnea can provoke:

• hypertension and angina pectoris;
• stroke;
• heart failure and myocardial infarction;
• arterial hypertension;
• chronic headaches;
• tissue necrosis;
• depression.

However, before finding out how to stop sleep apnea learn what causes it and what is the diagnosis.

What causes sleep apnea

There are dozens of known causes of obstructive sleep apnea. Here are just the most common ones:

!All of the following MAY sometimes contribute to the development of sleep apnea!

• hypertrophy of the pharyngeal tonsil;
• overweight;
• obstructive pulmonary disease;
• neurological diseases (encephalitis, meningitis, etc.);
• endocrine disorders (diabetes, thyroid dysfunction, etc.);
• violation of the nervous regulation of breathing;
• deviations in the structure of body parts (shape of the skull, narrow nasal passages, elongated soft palate or tonsils);
• brain injury;
• stress;
• uncontrolled use of certain medications, including sleeping pills;
• abuse of cigarettes and alcohol;
• significant curvature of the nasal septum;
• rhinitis, tonsillitis;
• heart failure;
• menopause in women;
• hereditary factors, etc.

If we talk about what can cause sleep apnea in children:

• Injury to the posterior cricoidal laryngeal muscle or its paralysis;
• Cerebral palsy;
• Down syndrome;
• Laryngospasm;
• Slow growth of cartilage and bones;
• Anomalies in the structure of the jaw, tongue and respiratory tract, etc.

Although overweight is the characteristics of about 2/3 of apnea sufferers, it is not a 100% cause of the syndrome. Lean people can also suffer from respiratory arrest, while obese people, on the contrary, may not experience any problems with sleep at all.

How do I know if I have sleep apnea?

Given the severity of the apnea syndrome, it is very important to diagnose it early. Usually, patients are informed about their apnea by their relatives, who have to suffer from constant and loud snoring. Sometimes they also notice a sharp heavy breath after a pause, which occurs often. However, if a person sleeps alone, he may periodically ask the question “do I have sleep apnea?” One of the possibilities is to record your sleep on a dictaphone. If you snore at night, the soundtrack will clearly indicate this with characteristic "peaks" of sound activity.

You can also check the presence of any risk factors (overweight, chronic diseases), but the best option would be a comprehensive medical examination.

What are the symptoms of sleep apnea?

At night:

• snoring;
• noisy breathing or respiratory arrest;
• cough;
• excessive sweating.

During the day:

• drowsiness and lethargy;
• irritability and hyperactivity;
• nasalness;
• dry mouth, sore throat;
• headache;
• lack of concentration.

How do you know if you have sleep apnea? The factors might be the above-mentioned ones, however, we still recommend contacting specialists - a somnologist, a neurologist, and an otolaryngologist. Personal sleep indicators can be monitored using polysomnography, including electromyography, electrocardiogram, electroencephalography, as well as with the help of the nose airflow sensors, by analysing the tone of snoring during sleep and using other equipment.

How to stop sleep apnea naturally

Of course, before implementing any recommendations for self-medication, we suggest using specialist advice. The doctor will prescribe an appropriate course of treatment, depending on the severity and danger of the disease for the patient. How to treat sleep apnea naturally? Here are some recommendations:

• losing weight;
• quit smoking, reduce alcohol consumption and stop taking sleeping pills;
• pick a comfortable mattress and pillow;
• stick to a sleeping schedule;
• change your sleep position.

For example, the best head position for sleep apnea is considered to be the one in which the head is slightly elevated relative to the body. An elevated headboard and sleeping on your side considerably reduce the likelihood of sleep apnea. This is also called positional therapy. In this case, the angle "head-torso" should not exceed 30 degrees when it comes to mild forms of obstructive sleep apnea. Within the framework of this method, a simple "tennis ball therapy" is recommended, when a tennis ball or something similar is fixed on the patient's back, which prevents the patient from rolling over on his back during sleep.

How to cure sleep apnea

In case OSA is moderate or severe, patients are prescribed continuous positive airway pressure (CPAP) therapy. Although having been developed over 35 years ago, it is still considered the most effective. The technique implies creating constant positive pressure in the airway. It uses a device with a mask, which a patient wears during sleep (sometimes it is a device similar to ALV). Air under a slight pressure enters the airways and normalizes breathing. This therapy is considered one of the best sleep apnea treatment.

Johns Hopkins University study revealed that not treating apnea and avoiding CPAP therapy cause an increase in blood sugar, stress hormones, and blood pressure. In fact, during apnea, a typical reaction similar to a very stressful condition, like speaking in front of a group of people or having an interview, was observed.

Another type of non-invasive respiratory support is bi-level positive airway pressure (BPAP). This device automatically increases the pressure during inhalation and decreases it during exhalation, which makes breathing easier.

What helps sleep apnea? Sometimes it is advised to wear oral applicators or mandibular splints, which are made by dental technicians according to the doctor’s prescription.

They are a personal aid to help keep the airway open during sleep. Mandibular repositioning device (MRD) may as well be suitable for patients with mild to moderate obstructive sleep apnea syndrome. The mouthpiece keeps the lower jaw in an extended position, which expands the space behind the tongue.

Surgical intervention is less effective and considered to be the most extreme type of treatment. Most often it implies removing enlarged adenoids in children and glands in adults, correcting the nasal septum (rhinoplasty), and laser plastic surgery of the soft palate.

Among the relatively new and still experimental treatments for OSA, we would like to highlight the electrical stimulation of the hypoglossal nerve to increase the patency of the upper airways. The stimulator is inserted under the skin of the breast and the electrode is placed on the hypoglossal nerve. As a result of this therapy, syndrome indicators decreased by 68%, on average, among 126 subjects with moderate and severe obstructive apnea.

So, you roughly understand how is sleep apnea treated and what you should be prepared for. Often simple measures are enough, but sometimes professional treatment is required.

Does sleep apnea make you tired?

Since fatigue is a side effect of sleep apnea while sleep disturbance is one of the main causes, relieving those is a way to deal with the syndrome. And you can do it at home using Hypnopedia mobile app for iOS. Of course, it will not replace professional treatment and don’t answer the question “why did I stop breathing in my sleep”, but it will definitely help to normalize sleep patterns and make you feel better during the day. This is achieved by an integrated approach and thoughtful functionality of the app. In particular, users have an opportunity to fall asleep to relaxing sounds that can be combined and adjusted in individual volumes. They also turn off automatically after falling asleep.

During sleep, Hypnopedia plays affirmations that strengthen user’s mental health. They do not wake you up, yet get perceived, at the subconscious level. Such affirmation therapy reduces stress and makes you more productive. Soft awakening is provided by a smart alarm clock that easily wakes you from sleep at the best moment for the body.

If you wonder “can sleep apnea be reversed?”, the answer would be, unfortunately, not in 100% of cases. Moreover, it can lead to health problems, especially when combined with other risk factors. Usually, the treatment is about relieving symptoms. Sometimes it is enough to simply adjust the wakefulness/sleep mode, however, in some cases the use of special equipment is required. Importantly, given the severity of the disease, in no case should you delay taking serious actions hoping that everything will go away by itself.