Obstructive Sleep Apnea, also known as OSA, is a condition where the airway collapses during sleep and causes a person’s airway to become blocked. Even though you are trying to breathe, the collapsed airway is blocking air from moving in and out of your lungs. After a period of no breathing, you take a loud, deep breath to resume breathing. This period of not breathing is called apnea. This may occur many times in an hour during the course of the night.

As a result, of these periods of apnea, air is not able to get into the lungs and oxygen is unable to get into the bloodstream. When the blood oxygen levels in the body drop, this causes stress to many vital organs including the heart and brain. The repetitive cycles of decreased oxygen levels in the body can cause damage to these vital organs.

Another effect is the reduction in the quality of sleep. When apneas occur, the decreased oxygen levels in the body causes the brain to trigger an arousal which, brings one out of the deeper sleep stages and causes you to breathe again. While a person may not completely wake up, these arousals happen many times throughout the night and the quality of sleep is significantly diminished. The most significant loss is that of deep sleep when the most restful period of sleep occurs. Because of these many arousals, the person with OSA usually wakes up in the morning still tired and frequently is very sleepy throughout the day.

Common signs and symptoms associated with OSA include snoring, daytime sleepiness, morning headaches, impaired concentration and memory, pauses in breathing during sleep, waking up gasping for air, and sexual dysfunction.

Many patients with OSA are significantly overweight although there are OSA patients that are not overweight at all. Specific body features are also associated with OSA. These include a large neck circumference, deep-set chin, and an enlarged tongue or tonsils. Research shows that middle-aged men are the most common at risk group. However, it does occur in women especially after menopause, and even occurs in children.

Clinical studies have shown when OSA goes untreated; it is associated with increased incidence of high blood pressure, heart disease, diabetes, and stroke. Untreated OSA is also associated with a significant increase in the risk of motor vehicle accidents due to daytime drowsiness. One study found the risk of accidents was greater in untreated OSA patients than in people that had been drinking alcohol.

A diagnosis of OSA is suspected based on a review of your medical history looking for the signs and symptoms mentioned previously and confirmed by performing a sleep test called “polysomnography” or PSG. During this study, many measurements are taken during sleep to determine if you are having apneas or periods when airflow is reduced substantially (called hypopneas) and how often it occurs. From the testing, your doctor calculates your Apnea Hypopnea Index or AHI. If your AHI is too high, it means you have OSA and the second part of the test puts you on treatment to determine the setting it takes to prevent the apneas from occurring.

The good news is that OSA can be effectively treated. Proper treatment has shown to reduce the risks associated with OSA (stroke, heart disease, etc.). The most common and effective treatment for OSA is continuous positive airway pressure or CPAP as it is commonly called.

CPAP works by applying a small amount of pressure to the airway through a mask that fits over the nose (called nasal mask), or nose and mouth (called full-face mask). The mask is connected via tubing to the CPAP machine that is set according to your doctor’s prescription to provide just enough pressure to the airway to keep it open during sleep and prevent the apneas. This positive pressure pushes out on the walls of the throat, creating a “splint” within the airway in much the same way that air pressure within a balloon pushes out on the walls of the balloon preventing it from collapsing.

Another type of treatment very similar to CPAP is Bi-level Positive Airway Pressure. Bi-level, or BiPAP as it is commonly referred to as, works the same way as CPAP, only it use two different pressures. One pressure is used while the person inhales and another, lower pressure while the person exhales. Many patients find the lower pressure during exhalation more comfortable and easier to breathe with as the machine cycles to match your normal breathing patterns.

Other treatments have also been tried with less success including surgery to remove tissue from the throat or advance the jaw, and use of devices that fit in the mouth to hold the jaw forward. CPAP and Bi-level therapy still remains the most effective treatment modality for the vast majority of OSA patients today.

There are also lifestyle changes you can make that will help in making your treatment more effective. Although difficult, weight loss will help. Sustained weight loss best occurs by changing long-term habits of better eating and more activity. Drinking alcohol in the evening has been shown to increase the severity of the apnea episodes. Practice good sleeping hygiene by getting up at the same time every morning and trying to allow time for at least seven hours of sleep. Reduce your consumption of caffeine, especially in the late afternoon or early evening. Physical activity will also help but should take place earlier in the day reserving relaxing activities for closer to your bedtime. Some patients have OSA worse while sleeping on their back. If this is true for you, train yourself to sleep on your side.

If you have any questions about obstructive sleep apnea, CPAP therapy, or Bi-level therapy, contact your doctor or feel free to call us to talk with our respiratory clinician.