Recognizing Sleep Apnea and Breathing Pauses During Sleep - Sleep Disorders and Obstructive Sleep Apnea Syndrome

Deep, sound, and restful sleep is important for your health. During sleep, the body recovers and you recharge your energy for the next day. Sleep disorders can therefore have serious consequences.

Sleep apnea refers to pauses in breathing that occur during sleep. These pauses occur irregularly and can last a few seconds or even several minutes.

The body is alerted by the lack of oxygen in the blood caused by these pauses in breathing. This warning system prevents suffocation during sleep.

Many people with this condition cannot remember these nighttime pauses in breathing. In some cases, they do not even wake up completely, but simply transition to a different sleep stage.

This condition is also known as sleep apnea syndrome (SAS) or obstructive sleep apnea (OSA). In some cases, it is referred to as central sleep apnea (CSA).

People who live alone are particularly at risk of developing sleep apnea that goes undetected and untreated. They may only notice the initial, obvious symptoms, such as daytime sleepiness.

In many cases, narrowed or obstructed airways contribute to sleep apnea. People who snore are particularly at risk. However, existing sleep apnea is also easy to detect in these individuals: If they snore loudly and this snoring then stops for a few seconds or even minutes, they are suffering from sleep apnea. In most cases, breathing resumes with a single, loud snore.

When the airways are narrowed, this is referred to as obstructive sleep apnea. Although the nervous system sends the signal to take a breath, this signal cannot be carried out due to the narrowed airways. The body would have to exert more force than the respiratory muscles can provide. This leads to breathing pauses.

There are several causes of airway narrowing. It is particularly notable that a large proportion of those affected are overweight. Adipose tissue can also accumulate in the upper airways, leading to problems.

In addition, however,

• an oversized tongue,
• enlarged tonsils, or
• a lower jaw that is set too far back

can block the airways.

Central sleep apnea occurs much less frequently than obstructive sleep apnea. In this case, the cause lies in the brain. A disorder prevents the brain from sending the breathing signal to the respiratory muscles.

The brain does not resume breathing until the oxygen level in the blood drops to a dangerous level.

These are the potential consequences of untreated sleep apnea:

• Daytime sleepiness
• Difficulty concentrating
• High blood pressure
• Heart attack
• Stroke

Because of the sometimes frequent pauses in breathing, the person affected does not feel rested or well-rested. This carries over into the next day. The fatigue can be so severe that it leads to limitations in professional life.

However, daytime fatigue and difficulty concentrating are just a few of the symptoms. The low oxygen levels in the blood can damage vital organs, such as the heart and brain.

When the body is put into a state of alarm by the dropping oxygen levels, blood pressure also rises. Left untreated, high blood pressure can lead to heart attacks or strokes.

If no cause for the abnormal readings can be found in patients with high blood pressure, sleep apnea could be the underlying cause. This condition is often not mentioned because patients are completely unaware that they have it.

The symptoms are not always easy to diagnose, as the patient may not be able to identify them. It is not uncommon for partners to be the ones to point them out. If this is the case, a doctor should be consulted as soon as possible.

Treatment is often provided by a specialist. In many cases, the patient is referred to a sleep lab. There, specialists monitor the patient’s sleep to gain insights into the exact symptoms and signs.

To make a diagnosis, the following are performed, among other things:

• measurements of heart and brain activity (ECG and EEG) are performed, and
• blood pressure and muscle relaxation are measured.

Alternatively, the doctor may also provide the patient with monitoring devices to take home. These devices are then used to monitor various parameters, including

• blood oxygen saturation,
• breathing movements,
• respiratory airflow, or
• the general sleeping position.

For example, lying on one’s back can, in some cases, contribute to narrowing of the airways.

If the patient is overweight, they should lose weight. In addition, avoid or limit alcohol and nicotine before bedtime. Furthermore, sleeping pills and muscle relaxants can cause symptoms.

A mouthguard is used to correct the position of the jaw.

In particularly severe cases, using a breathing mask is the last resort for alleviating symptoms. This breathing mask is connected to an oxygen machine and helps ensure that the air supply is not interrupted. However, these devices are very expensive, and health insurance companies often only cover part of the cost.

In most—milder—cases, the measures mentioned above are sufficient.

What is sleep apnea?

Sleep apnea is a sleep disorder in which breathing may repeatedly stop during sleep. Obstructive sleep apnea syndrome is particularly common; in this condition, the upper airways relax or narrow. Typical symptoms include breathing pauses, snoring, and nighttime breathing interruptions.

What are the symptoms of sleep apnea?

Typical symptoms include loud snoring, fatigue, difficulty concentrating, and pauses in breathing at night. Many people with the condition also experience microsleep, irregular breathing, or frequent nighttime awakenings. Symptoms of sleep apnea can also include headaches or a reduced quality of life.

How is sleep apnea diagnosed?

Sleep apnea is usually diagnosed in a sleep lab or on an outpatient basis through specialized tests. These tests measure brain waves, breathing patterns, blood oxygen levels, and airflow through the mouth and nose. The diagnosis and treatment depend on the number of breathing pauses and the severity of the apnea.

What treatment options are available?

The primary treatment for obstructive sleep apnea syndrome is CPAP therapy, which uses positive airway pressure delivered through a nasal mask. Continuous Positive Airway Pressure ensures that the airways remain open and reduces breathing pauses. Other treatment options include mandibular advancement devices, abstaining from alcohol, weight loss, and avoiding sleep aids and sedatives.

Why is sleep apnea dangerous?

People with obstructive and central sleep apnea have a higher risk of cardiac arrhythmias, high blood pressure, heart attacks, and strokes. The drop in blood oxygen levels and impaired breathing increase the long-term risk of cardiovascular disease. Treatment should be initiated early, especially in cases of nocturnal breathing pauses or mild to moderate sleep apnea.