Sleep apnea • The device can help with breathing pauses at night

Sleep apnea syndrome is characterized by nocturnal breathing pauses. During this period you are hardly supplied with oxygen – which can have far-reaching health consequences in the long run. What symptoms occur in men and women, what you can do and what device is used as a treatment.

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Sleep apnea syndrome (SAS) characterized by nocturnal pauses in breathing

With sleep apnea (Latin: obstructive: to prevent; Greek: apnea: not breathing), breathing stops during sleep. The body is not adequately supplied with oxygen due to the reduced oxygen uptake. In addition, there is carbon dioxide, which is not exhaled quickly enough. A distinction is made between obstructive sleep apnea (OSA) and central sleep apnea (CSA).

Obstructive sleep apnea

The much more common form of sleep apnea is characterized by breathing pauses, the cause of which is caused by mechanical disorders of the upper respiratory tract. Sleep is then interrupted by an awakening reaction (arousal). According to a study, 30 percent of men and 13 percent of women in Germany suffer from moderate sleep apnea. If further symptoms of OSA occur as a result, it is referred to as obstructive sleep apnea syndrome (OSAS).

Central (non-obstructive) sleep apnea

With this form disturbances in the respiratory regulation arise. Even if a person can voluntarily influence breathing, the body controls breathing in and out by itself, especially at night. For example, if the brain no longer sends signals to the respiratory muscles at night, breathing stops even though the airways remain open. In central sleep apnea, so-called Cheyne-Stokes breathing often occurs. The carbon dioxide sensitivity in the breathing center of the brain is reduced. This means that a high concentration of carbon dioxide has to accumulate in the blood before the respiratory center sends the command “inhale”.

Recognizing sleep apnea: typical symptoms

You rarely recognize sleep apnea yourself. Mostly, partners become aware of nocturnal breathing pauses. Loud snoring is usually added to the breathing pauses. Breathing pauses last ten seconds or more and occur at least five times an hour.

Other symptoms of sleep apnea:

  • Daytime sleepiness: Since the pauses in breathing often mean that those affected do not get a restful sleep, they often suffer from extreme tiredness during the day. This can lead to dangerous microsleep, which in certain situations, for example when driving a car, can be life-threatening.

  • Concentration and memory disorders: Sleep serves, among other things, to restore and recover important physical and mental functions overnight. If this cannot take place due to the nocturnal breathing pauses, concentration and memory may suffer.

  • Headache: Those affected often wake up in the morning with a headache.

  • Depressive mood: If the body and mind cannot regenerate overnight, depressive moods can arise.

  • Potenzstörungen: Potency disorders and loss of libido are also possible symptoms of sleep apnea.

Causes and Risk Factors of Sleep Apnea

The causes of sleep apnea differ according to the present form. In the more common obstructive sleep apnea, the airways narrow during sleep. During sleep, the muscles in the nasopharynx relax. If there is an OSA, the slack muscles and the tongue that falls back in the supine position lead to a blockage of the airways – the air stays away.

Risk factors that favor sleep apnea:

In the case of central sleep apnea, other reasons for the breathing pauses come into question. Disturbances in the central nervous system caused, for example, by encephalitis (inflammation of the brain), neuroborreliosis (stage of borreliosis), brainstem infarction or a lack of thyroid hormones (hypothyroidism) are possible causes.

Diagnosis of sleep apnea

The diagnosis of sleep apnea begins with an examination of the oral cavity and throat. This can be carried out by an ear, nose and throat specialist, orthodontist or oral and maxillofacial surgeon. An examination of the nose is particularly relevant here. Furthermore, body height and body weight should be determined in order to find out the body mass index (BMI).

Whether sleep apnea is present can be determined by a doctor in a sleep laboratory or specialized clinics. The diagnostic criteria for sleep apnea are:

  • Breathing pauses that last for at least ten seconds
  • Decreased oxygen content (hypoxemia) and increased carbon dioxide content in the blood (hypercapnia)
  • This leads to a wake-up reaction (arousal),
  • increased heart rate and blood pressure

The wake-up reactions are usually not noticed, but they lead to fewer deep sleep and REM phases, which means that sleep is no longer restful.

If people with daytime sleepiness, snoring and nocturnal breathing pauses (observed by relatives) visit a medical practice, a so-called “small sleep laboratory” (cardiorespiratory polygraphy) should first be carried out.

This includes for a period of six hours:

  • ECG (Electrocardiogram)
  • Determination of oxygen saturation
  • Measurement of respiratory flow
  • Recording of the body position by means of position sensors
  • Videokontrolle (optional)
  • Ventilation control under nCPAP conditions (nasal Continuous Positive Airway Pressure, breathing mask)

If the examination reveals any abnormalities, the diagnosis of OSA is confirmed. If the “small sleep laboratory” is normal and there is still suspicion of sleep apnea, further examinations should be carried out. As a rule, a polysomnography is then carried out.

This method also determines brain waves, eye movements and the transmission of stimuli to the muscle. This produces more precise results that can confirm the diagnosis of sleep apnea.

Treatment of sleep apnea

The treatment depends on the severity and cause of the sleep apnea.

Lagetherapie

People whose sleep apnea only occurs in the supine position (around 25 to 30 percent of people with OSA) should be prevented from sleeping on their back with aids. Special rucksacks or pillows that are strapped to the back overnight should no longer make it possible to turn on the back (passive position therapy). It is also possible to work with a position trainer (active position therapy). The supine position should be avoided by a vibration alarm.

Surgical procedure

Surgery is an option if nasal breathing is prevented and therefore no CPAP therapy (breathing mask) is possible. If CPAP therapy is unsuccessful or if it cannot be used for various reasons, it is also possible to shift the lower and / or upper jaw forward – insofar as the anatomy of the jaw is the reason for the sleep apnea. Likewise, removal of the tonsils if they are enlarged and obstructing breathing is an alternative treatment.

CPAP ventilation

The device for sleep apnea is used for moderate and severe forms. It can also help with central sleep apnea. CPAP (continuous positive airway pressure) means that a continuous airway pressure is generated. This is done through a nasal mask that is worn at night. The ventilator also feeds room air with slight pressure into the airways. As a result, the airways are not blocked by slack muscles. Ventilation with a BiPAP (biphasic positive airway pressure) device is also possible. It works with two pressure levels, which aids inhalation and facilitates exhalation.

Bite splints

Bite splints can help exercise the tongue in sleep apnea and keep it from falling back down the throat. Other splints move the lower jaw forward in addition to the tongue. This position is designed to keep the airways open.

Possible consequences of sleep apnea

Nocturnal pauses in breathing can have serious health consequences in the long run. These include:

  • High blood pressure: Obstructive sleep apnea syndrome is a risk factor for high blood pressure. The question of whether the nocturnal wake-up reactions or accompanying circumstances such as obesity, smoking and alcohol consumption are the cause has not yet been conclusively clarified. The National Institutes of Health consider OSAS to be a single risk factor for high blood pressure.

  • Coronary heart disease: Various studies have found a link between coronary artery disease (CHD) and sleep apnea. The development of arteriosclerosis is also said to be related to it.

  • Stroke: Whether a stroke is the cause or consequence of sleep apnea cannot yet be said with certainty based on the current study situation. However, some results suggest that OSAS could be a risk factor for developing a stroke.

  • Accident risk: Since those affected by sleep apnea tend to be extremely tired during the day, car or work accidents caused by microsleep are possible.

  • Depressive mood: Studies show that people with sleep apnea are more prone to depression and a reduced quality of life.

Almost all the consequences of sleep apnea can be reduced through targeted therapy, including CPAP.

Tips for preventing sleep apnea

A risk factor for the development of sleep apnea is obesity. In order to avoid this, a healthy and balanced diet is particularly important. More tips for a more peaceful sleep:

  • Avoid large meals and alcohol before bed

  • Have a doctor clarify the use of medication and possibly switch to another preparation after medical advice

  • Get enough exercise to prevent obesity

If you notice symptoms of sleep apnea in yourself or your partner, it is advisable to go to the doctor’s office. Appropriate treatment can reduce health consequences.

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Source: Lifeline | Das Gesundheitsportal by www.lifeline.de.

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