The symptoms of obstructive sleep apnea.
Sleep apnea is a common sleep disorder that many people struggle with. Left unmanaged, it can be very dangerous.
Those with sleep apnea experience irregular breathing as they sleep, where breathing repeatedly stops and then restarts after a period of cessation, during which the individual is in effect being strangled. This is termed a apneic ‘event’.
This can lead to cardio-vascular (heart) problems, high blood pressure, stroke, an increased risk of type 2 diabetes, and other serious medical conditions.
The tree major issues are, not in order of priority, lowering the blood oxygen levels (“oxygen desaturation” – hence the measurements being terms “sats”), this causes hypoxia (oxygen down) and hypercapnia (carbon dioxide up). Carbon dioxide increase stimulates breathing, not oxygen.
The pressure change as a result of the inability to allow air into the chest as the diaphragm contracts (down) causes a fierce lowering of the chest (intra-thoracic) cavity and is believed to predispose to atrial fibrillation and major vessel disease.
The major vessels leaving the top of the hear are together described as the “great vessels” ( the superior and inferior vena cava, the pulmonary artery, the pulmonary vein, and the aorta.)
It also acts in unison to release stress hormones (adrenaline, cortisol) in order to “jolt” the individual awake.
As this may happen repeatedly, the individual is unable to sink into deep (SWS – slow wave sleep) or indeed REM (rapid eye movement sleep). This causes sleep deprivation and is part of the reason that OSA may cause excessive daytime sleepiness (EDS).
Regarding the number of apneic events or episodes. Less than 5 per hour is considered normal. No one really knows but it allows the insurance companies to reject people with some evidence.
From 5-15 is considered “mild” which in my opinion was stupid thing to call it – all that says is “its only mild, don’t worry about it” Now before I get doctors throwing things at me, I didn’t say less than 15 had to be treated, it’s just that (in my opinion) it would have been better to have described it as stage 1.
From 15-30 events per hour, is considered moderate (stage 2?) and then those over 30, severe (I can live with that, as it is) still if we did the first two, we’d have to call it “stage 3 severe”, which I could live with if it meant that people recognised it as a potential killer.
Sleep apnea can be diagnosed by using a home sleep apnea test or by participating in an in-lab sleep study. If you suspect that you or your partner may have sleep apnea, see your doctor to discuss your symptoms and possible treatment options. If in doubt it is vital that he or she pursue it. I
f you have a history of any of the causes (cardio-vascular (heart or stroke) high blood pressure, an increased risk of type 2 diabetes, etc.) it is also important that OSA be ruled out as they are very commonly missed as a cause. Left unchecked, it is unlikely you’ll get a whole lot better.
Do you regularly snore loudly?
Regular loud snoring is one of the most common symptoms that those with sleep apnea share, while it doesn’t always mean that you do have OSA. When snoring exists without OSA it is termed ‘primary snoring’.
Snoring is caused by the airway being blocked partially or obstructed in some way, keeping air from moving freely. The obstruction in the airway leads to changes in the pressure of the airflow resulting in vibrations which produce the snoring sounds.
It is uncommon for the person snoring to be aware of the sounds they are making (as they are usually asleep). Most frequently it is a partner that shares the same bed that notices the snoring and their sleep may suffer horribly as a result of it.
They often suffer from sleep deprivation themselves with the attendant moodiness and lethargy. There is (strangely enough) only a fraction of the time, money and resources for studies aimed at understanding the effect on the bed-partner as opposed to the sufferer.
If you have been told that you snore continually throughout the night, this issue could be a symptom of sleep apnea.
Are you constantly fatigued?
It can be frustrating to wake up tired, knowing that you went to bed early enough to have at least 7-8 hours of sleep. However, if you have sleep apnea, constant fatigue—properly named excessive daytime sleepiness (EDS)—is a common but not always present symptom. You can distinguish EDS from other potential sources of exhaustion by reviewing the common signs of EDS:
- A general lack of energy
- Difficulty waking up in the mornings
- Needing to take naps to function
- Struggling to focus and remember things
- Dozing off at the wrong times
- Excessive exhaustion during the day
- Just because you have these doesn’t mean there may not be other issues, but they are consistent with OSA. Equally if you don’t experience these but do show other signs or symptoms doesn’t mean that you do not. Excessive daytime sleepiness (EDS) is not always present in OSA.
Incidentally, you can get tired because of working hard mentally or physically, in fact we all know that we can get “over tired” and then find it difficult to sleep. If we know what’s what with sleep, we can better help ourselves and those around us.
Sleep apnea creates an inability to breathe while you sleep, pulling you out of deep sleep multiple times a night. With your ability to reach a deep, restorative (level 3) of sleep compromised, excessive daytime sleepiness (EDS) is a natural consequence.
Do you suffer from high blood pressure (hypertension)?
Do you suffer from high blood pressure (hypertension)?If you do you should consider the possibility that you may have obstructive sleep apnea which is often a related health concerns.
When your airway is regularly blocked at night, your body reacts to the lower oxygen levels. It does this by restricting your blood vessels, which raises your blood pressure and puts your cardiovascular system into overdrive.
Having increased blood pressure as a result of untreated sleep apnea will take a toll on your body. It trains your body to remain in a heightened state, even when you are inhaling plenty of oxygen during the day.
Do you frequently stop breathing or gasp while sleeping?
When you experience obstructive sleep apnea, the fatty tissue around the tongue and throat are relaxed and fall to block your airway as you sleep.
This blockage is enough to stop you from breathing for a few seconds, which lowers your blood oxygen levels. The lower oxygen levels trigger your brain to wake up just enough to start your breathing again.
It is very common for those with sleep apnea to experience breathing stoppages more than once a night; but during this whole process, it is unlikely that you will wake up completely.
However, as the disorder stops you from breathing and takes you out of deep sleep, it can lead to many other health complications.
It is not uncommon for breathing stoppages due to sleep apnea—also called apnea events—to interrupt your sleep anywhere from 5 to 30 times in just one hour.
The duration of these apnea events can last from 10-20 seconds at a time or even more. In actual fact they can last longer than you can consciously and you know how that fees don’t you – hold your breath – scary isn’t it. If the sleep apnea is severe enough, it is possible for someone to experience several hundred apnea events in a single night.
Do you suffer from recurrent morning headaches?
Much like how the lack of oxygen due to sleep apnea can affect your blood pressure, it can also trigger recurrent headaches when you wake up.
As the blood vessels in your head widen to bring in more oxygen, it can trigger a vascular headache (migraine). More often however, it manifests as a fuzzy “frontal” (forehead) headache.
Do you suffer from mood swings and/or depression?
Not being able to enjoy deep sleep can take a significant toll on your emotional equilibrium. If you have noticed that you have become more irritable, depressed, or experience mood swings, these can all be symptoms of your struggle with sleep apnea.
Are you overweight or obese?
Are you overweight or obese? Do you have problems with your weight. If a man do you seem to be developing that “upside down light bulb” shape that you always hated when you were younger?
Being overweight is a major trigger for obstructive sleep apnea. If there is excess fatty tissue built up around the throat and neck, it can fall toward the back of your throat when you relax into sleep, blocking your airway.
Men with necks measuring 17+ inches in circumference and women with necks 16+ inches in circumference are at a higher risk for sleep apnea. Equally so, OSA can aggravate both eating (through appetite ) and weight gain too.
In fact, not only is being overweight or obese a trigger for sleep apnea, but it can be a symptom of sleep apnea. As you are unable to enjoy quality, restorative deep sleep due to apnea events, your body is not able to rest enough to provide you with the energy to tackle weight loss.
Also, the lack of deep sleep can make it harder for your body to process waste products for removal.
Other potential symptoms of obstructive sleep apnea
Along with the major symptoms of sleep apnea, there are a host of other signs which can indicate that you have sleep apnea. Other potential symptoms include:
- Diabetes
- Lowered libido
- Stroke/Heart attack
- Dry mouth in mornings
- Awaken gasping
- Insomnia
- Erectile dysfunction in men.
- Problems during pregnancy in women.
If in doubt, check with your doctor and if dissatisfied get a second opinion – this is important, and damage done can’t be undone.
Your doctor will often refer you someone who will not only test but offer treatment. Again, if in doubt get a second opinion – for instance most Continuous positive airway pressure – CPAP providers will not even mention other options like Oral Appliance Therapy (OAT) , or Mandibular Advancement Device (MAD)which often work very well too.
There are other options coming along the way like implantable devices. Losing weight is a good start but for most, very unlikely to resolve the problem. Incidentally, let’s remember that weight is not always the problem (although it frequently is).
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Good sleep is crucial to good health and longevity
Dr. Stephen Bray 2020