The most common type of sleep apnea is obstructive sleep apnea (OSA), caused by relaxation of soft tissue in the back of the throat that blocks the passage of air.

Central sleep apnea (CSA) is caused by irregularities in the brain’s normal signals to breathe. Some people with sleep apnea have a combination of both types.

Symptoms

The hallmark symptom of the disorder is excessive daytime sleepiness. Additional symptoms of sleep apnea include restless sleep, loud snoring (with periods of silence followed by gasps), falling asleep during the day, morning headaches, trouble concentrating, irritability, forgetfulness, mood or behavior changes, anxiety, and depression. Sleep apnea is more likely to occur in men than in women, and in people who are overweight or obese.

Diagnosis

The typical patient with sleep apnea is an overweight middle-aged male with a neck size of more than 17 inches. However, the condition is also common in women and not all sufferers are overweight. Almost everybody who has sleep apnea is a snorer, often a very heavy snorer. Pauses in breathing during sleep are commonly noticed by a bed partner but this history is often lacking and up to five "events" per hour are considered normal. One of the more consistent symptoms is "nonrestorative sleep" meaning that the patient wakes in the morning feeling unrefreshed no matter how much he slept during the night. Excessive daytime sleepiness is common in sleep apnea of any severity but some patients complain of fatigue rather than sleepiness. However, many patients with severe sleep apnea have no complaint of sleepiness or fatigue.

The most accurate diagnostic tool, polysomnography, can confirm the diagnosis and assist the doctor in identifying the type of sleep apnea present. In the past, this test was only done in hospitals and in specialized sleep laboratories. There are now portable sleep recording systems that can perform unattended polysomnography in the patient's home but in-laboratory testing with a technician present remains the number 1 standard and it is required by many insurers, (eg. Medicare of the United States) before they will pay for treatment of the condition.

With advances in portable electronics, patients can now use a small device that is attached to a fingertip to measure the oxygen saturation of the blood (percent of the total hemoglobin that is combined with oxygen), which is a procedure called pulse oximetry. This is a non-intrusive procedure based on the difference in the color of the oxygenated and of the deoxygenated hemoglobins. Recordings of blood oxygen saturation during sleep may give an estimate of the severity of the problem. However, oximetry is not a reliable screening tool.

Treatment

There are a variety of treatments for sleep apnea, depending on an individual’s medical history and the severity of the disorder. Most treatment regimens begin with lifestyle changes, such as avoiding alcohol and medications that relax the central nervous system (for example, sedatives and muscle relaxants), losing weight, and quitting smoking. Some people are helped by special pillows or devices that keep them from sleeping on their backs, or oral appliances to keep the airway open during sleep. If these conservative methods are inadequate, doctors often recommend continuous positive airway pressure (CPAP), in which a face mask is attached to a tube and a machine that blows pressurized air into the mask and through the airway to keep it open. There are also surgical procedures that can be used to remove tissue and widen the airway. Some individuals may need a combination of therapies to successfully treat their sleep apnea.

Helpful Links

• http://en.wikipedia.org/wiki/Sleep_Apnea
• http://www.sleepapnea.org/
• http://www.helpguide.org/life/sleep_apnea.htm

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