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Johns Hopkins Symptoms and Remedies

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Sleep Apnea

What is it?

Sleep apnea is a disorder characterized by repeated cessation of breathing for brief periods during sleep. There are two basic forms of apnea: obstructive sleep apnea and central sleep apnea.Obstructive sleep apnea is commonly associated with obesity in middle- aged men. The condition is attributed to excessive relaxation of the muscles at the back of the throat during sleep, which may obstruct the upper airway either partially (hypoapnea) or completely (apnea) a dozen to hundreds of times a night. After 10 to 100 seconds, the demand for oxygen grows critical, and the sleeper gasps or snores abruptly in characteristically loud, staccato bursts in the struggle to regain normal breathing. In central sleep apnea, which is far less common, the airway remains open but the chest muscles and diaphragm don't always receive the appropriate brain signals to expand the lungs properly. Central sleep apnea syndromes include central alveolar hypoventilation (Ondine's Curse) and obesity-hypoventilation (Pickwickian syndrome). Sometimes, sleep apnea events are due to airway obstruction combined with a central sleep apnea component. The sleeper rarely awakens fully during these gasping episodes, but tends to arise tired and unrefreshed the next morning because apnea prevents the sufferer from reaching deeper stages of sleep. Severe, persistent cases of sleep apnea may promote serious cardiovascular problems such as high blood pressure, abnormal heart rhythms, and heart failure.

What Causes It?

  • Excess body weight combined with loss of muscle tone at the base of the throat is associated with obstructive sleep apnea.
  • Alcohol and sedatives promote apnea.
  • Hormonal changes due to menopause may produce sleep apnea in some women.
  • Incidence increases with age.
  • The cause of central sleep apnea is unknown.

Prevention

  • Maintain a healthy weight.
  • Avoid sleeping pills and do not consume alcoholic beverages within two or three hours of bedtime.

Diagnosis

  • Patient history and physical examination are necessary. History may include reports from roommates or bedmates. A tape recording of nighttime snoring may also be useful in making a diagnosis.
  • Further evaluation at a sleep center may be recommended to pinpoint causes and treatment.
  • Laboratory tests may include chest x-rays, electroencephalogram, electrocardiogram, and tests of blood-oxygen levels, chest wall movement, and air movement through the nose and mouth during sleep.

How to Treat It

  • Losing excess weight is crucial.
  • A tennis ball may be sewn to the back of pajamas to prevent sleeping on one's back, a position that encourages episodes of sleep apnea.
  • Medications such as the antidepressant protriptyline or the hormonal supplement medroxyprogesterone may relieve symptoms in some cases.
  • A device known as continuous positive airway pressure (CPAP) may be prescribed.With CPAP, a mask is worn over the nose; air is forced through the mask throughout the night to keep the throat open.
  • Surgery can help improve breathing in some cases. Anatomical obstruction in the back of the throat may be corrected, or in life-threatening cases a small opening in the throat (tracheostomy) may be created to bypass the blocked airway.

When to Call a Doctor

  • Make an appointment with a doctor if you develop extremely loud snoring with periods of silence, or if daytime sleepiness interferes with normal activities.