Obstructive sleep apnea (OSA) is a sleep-related breathing disorder that involves a decrease or complete halt in airflow despite an ongoing effort to breathe. It occurs when the muscles relax during sleep, causing soft tissue in the back of the throat to collapse and block the upper airway. This leads to partial reductions (hypopneas) and complete pauses(apneas) in breathing that last at least 10 seconds during sleep. Most pauses last between10 and 30 seconds, but some may persist for one minute or longer. This can lead to abrupt reductions in blood oxygen saturation, with oxygen levels falling as much as 40percent or more in severe cases.
The brain responds to the lack of oxygen by alerting the body, causing a brief arousal from sleep that restores normal breathing. This pattern can occur hundreds of times inone night. The result is a fragmented quality of sleep that often produces an excessive level of daytime sleepiness.
Most people with OSA snore loudly and frequently, with periods of silence when airflowis reduced or blocked. They then make choking, snorting or gasping sounds when theirairway reopens.
A common measurement of sleep apnea is the apnea-hypopnea index (AHI). This is an average that represents the combined number of apneas and hypopneas that occur per hour of sleep.
Involuntary sleepiness during activities that require little attention, such as watching TV or reading.
Involuntary sleepiness during activities that require some attention, such as meetings or presentations.
Involuntary sleepiness during activities that require more active attention, such as talking or driving.
Sleep apnea must first be diagnosed at a sleep center or lab during an overnight sleep study, or “polysomnogram.” The sleep study charts vital signs such as brain waves, heart beat and breathing.
CPAP is the standard treatment option for moderate to severe cases of OSA and a good option for mild sleep apnea. First introduced for the treatment of sleep apnea in1981, CPAP provides a steady stream of pressurized air to patients through a mask that they wear during sleep. This airflow keeps the airway open, preventing pauses inbreathing and restoring normal oxygen levels. Newer CPAP models are small, light and virtually silent. Patients can choose from numerous mask sizes and styles to achieve a good fit. Heated humidifiers that connect to CPAP units contribute to patient comfort.
An oral appliance is an effective treatment option for people with mild to moderateOSA who either prefer it to CPAP or are unable to successfully comply with CPAP therapy. Oral appliances look much like sports mouth guards, and they help maintain an open and unobstructed airway by repositioning or stabilizing the lower jaw, tongue, soft palate or uvula. Some are designed specifically for snoring, and others are intended to treat both snoring and sleep apnea. They should always be fitted by dentists who are trained in sleep medicine.
Surgery is a treatment option for OSA when noninvasive treatments such as CPAP or oral appliances have been unsuccessful. It is most effective when there is an obvious anatomic deformity that can be corrected to alleviate the breathing problem. Otherwise, surgical options most often address the problem by reducing or removing tissue from the soft palate, uvula, tonsils, adenoids or tongue. More complex surgery may be performed to adjust craniofacial bone structures. Surgical
Narcolepsy is a neurological sleep disorder that causes a potentially disabling level ofdaytime sleepiness. This sleepiness may occur in the form of repeated and irresistible“sleep attacks.” In these episodes a person suddenly falls asleep in unusual situations,such as while eating, walking or driving. Narcolepsy affects less than one percent of menand women, typically appearing in teens and young adults and then persisting for alifetime. It is classified as a hypersomnia, which is a group of sleep disorders that all havedaytime sleepiness as a primary symptom. Sleepiness in narcolepsy is not the result ofinadequate sleep; people with narcolepsy still experience daytime sleepiness even whenthey sleep well at night. Sleepiness is more likely to occur in boring, monotonoussituations that require no active participation (such as watching television).Scientificresearch shows instead that the cause of most cases of narcolepsy is the brain’s loss ofneurons that contain hypocretin, which is a protein that helps your brain stay alert. About90 percent of people with narcolepsy have low levels of hypocretin in their cerebrospinalfluid.
Sleep specialists measure the severity of daytime sleepiness with the Multiple SleepLatency Test (MSLT). The MSLT is a daytime nap study that is performed after an overnight sleep study (polysomnogram). It documents how quickly people fall asleep during quiet daytime situations. During the MSLT most people with narcolepsy fall asleep in an average of less than eight minutes, and often in less than five minutes. They also show a tendency to enter the stage of rapid eye movement (REM) sleep much faster than normal sleepers.
The primary distinguishing features of most cases of narcolepsy are EDS and cataplexy:
EDS usually is the most disabling of the symptoms and the first to occur. Daytime sleepiness is defined as the inability to stay awake and alert during the major waking periods of the day. Excessive sleepiness produces repeated naps or lapses into sleep across the daytime. In narcolepsy these naps tend to be short and refreshing, but sleepiness reoccurs in two or three hours. This repetitive pattern varies in severity and can be hard to distinguish from the sleepiness caused by sleep deprivation or other sleep disorders.
In severe cases of sleepiness another symptom called “automatic behavior” may appear. This occurs when a person continues an activity without any conscious realization of what he ors he is doing. The resulting work tends to make no sense, and the person has no memory of what took place.
Cataplexy involves a sudden loss of muscle tone that occurs most often in the knees, face and neck. These episodes of muscle weakness usually are provoked by strong emotions such as laughter, excitement or surprise. A mild occurrence may cause a person’s head to drop or knees to buckle. A severe episode may cause his or her legs to give out and body to collapse. These episodes are brief, tending to last only for seconds or a few minutes. Recovery usually is immediate and complete.
Three other symptoms are common in narcolepsy, although each one also can be found in normal sleepers and in people with other sleep disorders. These symptoms are:
For a few minutes a person is unable to speak or move as he or she falls asleep or wakes up. It also may involve the feeling of being unable to breathe.
These are vivid perceptual experiences that occur as a person falls asleep. He or she has a realistic awareness of the presence of someone or something that really is not there. Hallucinations tend to produce feelings of fear or dread, and they often occur together with sleep paralysis
People with narcolepsy often have the problem of waking up during the night.
Making lifestyle changes can help manage the symptoms. Examples include maintaining a consistent sleep schedule and planning to take short naps during the day. Otherwise, treatment for narcolepsy typically involves a combination of medications. Because narcolepsy is a lifelong illness, treatment is ongoing. These medications commonly are used to treat narcolepsy:
This stimulant is a unique chemical compound that has replaced amphetamines asa first-line treatment for EDS. Modafinil (Provigil) is an effective, FDA-approved treatment for narcolepsy with few side effects and a low potential for abuse.
Amphetamines were formerly the most common treatment option for EDS in narcolepsy, but they carry a strong risk of addiction. Methylphenidate, pemoline and mazindol also have been used. Selegiline (Eldepryl) is a methamphetamine derivative. It may treat both sleepiness and cataplexy. Relatively few side effects have been reported with its use.
GHB (Xyrem) can improve alertness and also reduce cataplexy. It tends to take about six weeks to nine weeks before it consistently reduces sleepiness. It is a preferred option to treat cataplexy because it has few side effects. Although theFDA approved Xyrem in 2002 for the treatment of cataplexy, all other uses ofGHB are banned by the U.S. government’s controlled-substance laws.
Tricyclic antidepressants formerly were the first treatment option for cataplexy.Severe side effects now make them a last resort. Other antidepressants (atomoxetine, clomipramine, fluoxetine, venlafaxine, zimeldine) have been effective and have produced fewer side effects. The use of antidepressants to treat cataplexy is not approved by the FDA.
Insomnia is a common sleep complaint that occurs when you have one or more of these problems:
These symptoms of insomnia can be caused by a variety of biological, psychological and social factors. They most often result in an inadequate amount of sleep, even though the sufferer has the opportunity to get a full night of sleep. Insomnia is different from sleep deprivation, which occurs when an individual does not have the opportunity to get a full night of sleep. A small percentage of people who have trouble sleeping are actually short sleepers who can function normally on only five hours of sleep or less.
There are two types of insomnia – primary and secondary. Primary insomnia is sleeplessness that cannot be attributed to an existing medial, psychiatric or environmental cause (such as drug abuse or medications). Secondary insomnia is when symptoms of insomnia arise from a primary medical illness, mental disorders or other sleep disorders.It may also arise from the use, abuse or exposure to certain substances.
Insomnia is considered a disorder only when it causes a significant amount of distressor anxiety, or when it results in daytime impairment. The International Classification of Sleep Disorders, 2nd Edition, documents the following types of insomnia:
This is also called acute insomnia or short-term insomnia. It is usually caused by a source of stress and tends to last for only a few days or weeks. Epidemiologic studies indicate that the one-year prevalence of adjustment insomnia among adults is likely to be in the range of 15-20%. Adjustment insomnia can occur at any age, although establishing a relationship between a particular stress and sleep disturbance may be difficult in infants. Adjustment insomnia is more common in women than men and in older adults than younger adults and children.
Two primary types of insomnia affect children. Sleep-onset association type occurs when a child associates falling asleep with an action (being held or rocked), object (bottle) or setting (parents’ bed), and is unable to fall asleep if separated from that association. Limit-setting type occurs when a child stalls and refuses to go to sleep in the absence of strictly enforced bedtime limits.Approximately 10-30% of children are affected by this condition.
An insomnia that begins in childhood and is lifelong, it cannot be explained by other causes. Information suggests that this condition is present in approximately 0.7% of adolescents and 1.0% of very young adults.
This form of insomnia is caused by bad sleep habits that keep you awake or bring disorder to your sleep schedule. This condition is present in 1-2% of adolescents and young adults. This condition affected 5-10% of sleep-clinic populations.
Symptoms of insomnia often result from one of these causes. Insomnia is associated more often with a psychiatric disorder, such as depression, than with any other medical condition. Surveys suggest approximately 3% of the population has insomnia symptoms that are caused by a medical or psychiatric condition.Among adolescents and young adults, the prevalence of this form of insomnia is slightly lower. 2% of the general population is affected by this type of insomnia.Approximately 3.5% of all sleep-center patients are affected by this condition.
A complaint of severe insomnia occurs even though there is no objective evidence of a sleep disturbance. The prevalence in the general population is not known. Among clinical populations, this condition is typically found in less than 5% of patients with insomnia. It is thought to be most common in young and middle-aged adults.
A complaint of insomnia occurs along with an excessive amount of anxiety and worry regarding sleep and sleeplessness. This condition is found in 1-2% of the general population and 12-15% of all patients seen at sleep centers. It is more frequent in women than in men. It rarely occurs in young children but is more common in adolescents and all adult age groups.
Severe daytime sleepiness typically is an effect of sleep deprivation and is less common with insomnia. People with insomnia often underestimate the amount of sleep they get each night. They worry that their inability to sleep will affect their health and keep them from functioning well during the day. Often, however, they are able to perform well during the day despite feeling tired.
CBT can have beneficial effects that last well beyond the end of treatment. It involves combinations of the following therapies:
Most of these sleep aids contain antihistamine. They can help you sleep better, but they also may cause severe daytime sleepiness. Other products, including herbal supplements, have little evidence to support their effectiveness.
Prescription hypnotics can improve sleep when supervised by a physician. The traditional sleeping pills are benzodiazepine receptor agonists, which are typically prescribed for only short-term use. Newer sleeping pills are nonbenzodiazepines, which may pose fewer risks and may be effective for longer-term use.
Drugs from a variety of classes have been used to treat insomnia without FDA approval. Antidepressants such as trazodone are commonly prescribed for insomnia. Others include anticonvulsants, antipsychotics, barbiturates and nonhypnotic benzodiazepines. Many of these medications involve a significant level of risk.
COPD is a medical term that stands for Chronic Obstructive Pulmonary Disease.
Many people with COPD have a combination of emphysema, chronic bronchitis and asthma. You may also hear COPD referred to as COAD (Chronic Obstructive Airways Disease), COLD (Chronic Obstructive Lung Disease) or CAL (Chronic Airways Limitation). COPD cannot be cured or reversed, but it can be treated.
Air flows in and out of your lungs through thousands of small air passages called bronchial tubes. When you have COPD, these tubes become narrower, making it harder to breathe. Medicine can help your tubes to work better, opening them up and making breathing easier.
With COPD, your lungs become larger than normal, so the breathing muscles around the outside of the lungs (e.g. the diaphragm and chest wall muscles) become stretched and have to work harder. This means that there is more effort involved in breathing and it makes you feel breathless. These muscles help you take deep breaths to get plenty of oxygen. With COPD you can only take smaller breaths.
The muscles in your arms and legs tire easily and this may make your shortness of breath worse.
By following the steps below, you can reduce all of your symptoms and slow down the damage being done to your lungs.
Coughing is seen in many medical conditions. It is important to take note of the duration, type and features of your cough as well as any other symptoms that come with your cough. This information will be very helpful to your healthcare provider when looking for the cause of your cough and the most appropriate treatment.
Coughing is a symptom. We can classify a cough by its duration (how long it lasts) and by other specific features:
A cough can be the only sign of an illness or it can occur with symptoms of certain diseases of the lung, heart, stomach and nervous system. Some of the symptoms that commonly occur with a cough are:
These are common causes of acute, or short-term cough:
Some causes of chronic cough include:
Risk factors for developing a chronic cough are:
See your healthcare provider if you have a cough that won't go away.
Call 911 immediately if you have sudden onset of cough associated with:
Call your doctor if you have developed a cough and:
Asthma is a chronic breathing disorder affecting both children and adults. It is characterized by:
Possible risk factors for the development of asthma include:
Asthma Can Be Controlled. Yet despite this fact:
Asthma triggers are allergens and irritants that can create breathing problems when people with asthma are exposed to them. Common triggers include:
Asthma is Controlled When:
CPAP, the abbreviation for continuous positive airway pressure therapy, is a treatment method for patients who have sleep apnea. CPAP machines use mild air pressure to keep the airways open, and are typically used by patients who have breathing problems during sleep. More specifically, what CPAP therapy helps accomplish is making sure that your airway doesn't collapse when you breathe while asleep.
CPAP therapy involves a CPAP machine, which comprises the following:
CPAP therapy is one of the most recommended treatment options for patients who have obstructive sleep apnea, in which not enough air reaches your lungs. CPAP therapy is also is used to treat infants whose lungs have not fully developed. The CPAP machine blows air into the baby's nose to help inflate his or her lungs.
When you are prescribed to a CPAP machine, you will work with your sleep technologist to make sure that the settings that are prescribed to you work best for you. It is every sleep technologist's concern that the air pressure from the machine is just enough to keep your airway open while you sleep.
There are many kinds of CPAP machines and masks. So don't be shy in letting your doctor and sleep technologist know that the type you're working with isn't the most comfortable.
The adjustment process for CPAP therapy is different for every patient. Some patients take months to adjust to CPAP therapy while others can take only a few days.
Although there is a noted adjustment period to using CPAP therapy, following this method of treatment can pay off significantly in the end.
Consider using these tips to make sure that your CPAP therapy experience is one that is easily adjustable and comfortable.
Whether it's when you're reading a book or surfing the web, try putting the mask on for short periods of time before you sleep. This will help you get used to wearing your mask to sleep.
Whether you are getting a little shut-eye or going to sleep, make sure you're in the habit of using your CPAP machine during all stages and occasions of sleep. Using CPAP therapy erratically reduces your chances of getting better soon.
The most common problems of adjusting to CPAP treatment occur when your mask is not put on comfortably. Make sure you make small adjustments to your mask to ensure that it fits right. If your mask is still not comfortable even after you make slight adjustments to it, you may need new CPAP gear.
If you feel like the air pressure is too high, then try using the ramp mode on your CPAP machine. What this will do is gradually increase the air pressure as you fall asleep.
Try using a nasal spray or decongestant if you easily suffer from nasal decongestion.
If you want to quiet your CPAP machine as you fall asleep, we recommend that you use this trick.
Make sure you clean your mask, tubing and headgear at least once a week. Make sure to set a reminder for yourself, so you don't end up getting grossed out by your own CPAP gear.
Snoring is the often loud or harsh sound that can occur as you sleep. You snore when the flow of air as you breathe makes the tissues in the back of your throat vibrate. The sound most often occurs as you breathe in air, and can come through the nose, mouth or a combination of the two. It can occur during any stage of sleep.
About half of people snore at some point in their lives. Snoring is more common in men, though many women snore. It appears to run in families and becomes more common as you get older. About 40 percent of adult men and 24 percent of adult women are habitual snorers. Men become less likely to snore after the age of 70.
Sleeping on your back may make you more likely to snore. It may also occur as your throat muscles relax from use of alcohol or other depressants. Congestion from a cold or allergies can also cause you to snore.
Snoring can be a nuisance to your partner and anyone else nearby. You may even snore loudly enough to wake yourself up. Though, in many cases people do not realize that they snore. Snoring can also cause you to have a dry mouth or sore or irritated throat when you wake up.
Light snoring may not disrupt your overall sleep quality. Heavy snoring may be associated with obstructive sleep apnea, a serious sleep disorder and a risk factor for heart disease, stroke, diabetes and many other health problems.
Snoring can be a symptom of obstructive sleep apnea but not everyone who snores has the sleep disorder. Obstructive sleep apnea is a serious sleep disorder that causes you to temporarily stop breathing when you are asleep. If you are regularly tired during the day even though you have had sufficient sleep or if your snoring is paired with choking or gasping sound, you may have sleep apnea. A sleep medicine physician is trained to detect and diagnose sleep apnea using an in-lab sleep study or home sleep testing. Sleep apnea is manageable using several approaches including CPAP (continuous positive airway pressure), oral appliance therapy and surgery.
Extra tissue in the throat can vibrate as you breathe in air in your sleep, causing you to snore. People who are overweight, obese or pregnant often have extra bulky throat tissue. Genetic factors that can cause snoring include extra throat tissue as well as enlarged tonsils, large adenoids, long soft palate or long uvula.
Anything that prevents you from breathing through your nose can cause you to snore. This can include congestion from a cold or flu, allergies or deformities of the nose such as a deviated septum.
You may snore when your throat or tongue muscles are relaxed. Substances that can relax these muscles may cause you to snore. This includes alcohol, muscle relaxants and other medications. Normal aging and the prolonged effects of smoking can also relax your throat and tongue muscles.
The primary symptom of snoring is unmistakable - the often loud, harsh or hoarse noises that you make while you are asleep. Other symptoms may include waking up with a sore throat or dry mouth.
If you have any of the following symptoms you may have sleep apnea:
Does your partner complain that you snore regularly?
Have you recently gained weight or stopped exercising?
Do you have family members that snore?
If you answered yes to any of these questions you either snore or are at risk for snoring. You may want to see a sleep medicine physician if you snore regularly or loudly. If you also make choking or gasping sounds as you snore, you will need to be tested for obstructive sleep apnea.
In addition to a complete medical history, the physician will need to know how long you have been snoring. You will also need to tell the physician whether you recently gained weight or stopped exercising. Be sure to tell your physician of any past or present drug and medication use. If you can, ask your partner, roommate or family member if they have ever heard you snore.
A sleep medicine physician will recommend a home sleep apnea test, or in some cases an in-lab sleep study. A board-certified sleep physician is specially trained to diagnose sleep apnea.
This type of sleep study requires you to stay overnight at a sleep center, in a bed that may resemble a hotel room, or in some cases an actual hotel room. You will sleep with sensors hooked up to various parts of your body. These record your brain waves, heartbeat, and breathing among other things. Physicians usually recommend this test for more complicated or difficult to diagnose cases, as it is more expensive and requires you to stay overnight. Learn more about an overnight sleep study.
This type of sleep study lets you sleep in the comfort of your own home while a machine collects information. The testing equipment differs in that it is less complicated than what is used in an overnight sleep study. Sleep center staff will show you how to hook up the testing equipment yourself. After your home sleep apnea test, you can take the device back to the sleep center or send it by mail.
The treatment will depend on whether the board certified sleep physician finds that you have sleep apnea. If you do not have sleep apnea, the sleep physician and his or her team may offer the following treatments:
Weight loss can help reduce or eliminate your snoring for some people. If you are overweight or obese losing weight should be a priority. Weight gain can make snoring worse, and may even lead to sleep apnea.
For some people, snoring mostly occurs while they sleep on their back. If you are one of these types of snorers, you may be able to improve your snoring by changing your sleep position. There are a variety of products that you can wear when you go to sleep that prevent you from sleeping on your back. You can also attach a tennis ball to the back of your shirt or pajamas. This does not work for everyone.
These can relax your throat or tongue muscles causing you to snore. By avoiding use of these substances, you may be able to reduce or eliminate your snoring. Speak to your primary care physician about alternative medications if your medication is causing you to snore.
An oral appliance is a small plastic device that fits in your mouth over your teeth while you sleep that stops you from snoring. It may resemble a sports mouth guard or an orthodontic retainer. The device prevents the airway from collapsing by holding the tongue in position or by sliding your jaw forward so that you can breathe when you are asleep. A dentist trained in dental sleep medicine can fit you with an oral appliance.
There are a variety of elective surgeries you can have to reduce your snoring. The most common surgeries reduce or eliminate the bulky tissue in your throat. Other more complicated procedures can adjust your bone structure.
If your snoring is a symptom of obstructive sleep apnea, these treatments may not be effective. A board certified sleep medicine physician may recommend other treatments, including CPAP, the front-line treatment for obstructive sleep apnea.
We all feel tired sometimes, but roughly 20 percent of the population can be classified as having Excessive Sleepiness (sometimes referred to as Excessive Daytime Sleepiness).
Excessive sleepiness is the leading complaint of patients who visit sleep clinics. People who have excessive sleepiness feel drowsy and sluggish most days, and these symptoms often interfere with work, school, activities, or relationships. Although patients with this condition often complain of "fatigue," excessive sleepiness is different from fatigue, which is characterized by low energy and the need to rest (not necessarily sleep). Excessive sleepiness is also different from depression, in which a person may have a reduced desire to do normal activities, even the ones they used to enjoy.
Excessive sleepiness is not a disorder in itself—it is a serious symptom that can have many different causes. If you feel excessively sleepy, you and your doctor should investigate it further. The common causes are poor sleep habits, such as reduced opportunity for sleep or irregular sleep schedule, a sleep disorder like obstructive sleep apnea, side effects from certain medications, and other underlying medical conditions. Once you and your doctor have determined the cause of excessive sleepiness, you can create a treatment plan together. For most people, that involves changing sleep habits and improving behaviors and elements of the sleep environment. For others, further medical tests or sleep studies may be indicated.
If you are frequently tired, work less productively, make mistakes, have lapses in judgment or wakefulness, or feel unable to enjoy or fully participate in life's activities, don't just "push through." If you've been excessively tired for a long time, it may feel normal to you, but poor sleep and resulting excessive sleepiness can have drastic, long-term effects on your health (for example reduced sleep is tied to cardiovascular problems and weight gain), as well as how you think and feel. Not only that, when you go about your day overtired, you put yourself and others at risk, since motor vehicle accidents and other dangerous errors are often caused by sleepiness. If you're feeling the symptom of excessive sleepiness, talk to your doctor so the two of you can take a closer look at your sleep habits and take steps to improve your health, and ultimately get you on the road to sleeping and feeling better.