Causes of Sleep Apnea

*Nothing in this article constitutes medical advice. Seek the guidance of a physician if you have any questions.*

Sleep apnea is a condition that affects over 3 million Americans each year. There are many types, treatments, and symptoms, and understanding the entire condition can be complex. Today, we’ll dive into some of the different causes of sleep apnea to better understand the condition.

Sleep Apnea Basics

First, let’s take some time to better understand sleep apnea and its symptoms. We’ll dive into some of the fundamental questions surrounding sleep apnea.

What is Sleep Apnea?

Sleep apnea is a condition whereby a person’s breathing starts and stops during the course of a night’s sleep. There are several reasons that this may be the case (which we’ll discuss momentarily). This pattern of start-stop breathing can occur anywhere from 5 to 30 times an hour, proving extremely detrimental to overall sleep quality.

Who is affected by sleep apnea?

Anyone may be affected by sleep apnea. Roughly 10% of adult women 25% of adult men suffer from some variation of sleep apnea. Studies show that 2-3% of children are affected by sleep apnea. While there are a variety of risk factors leading to a higher prevalence of the condition in certain populations, two of the most significant factors are obesity and age.

What are the symptoms of sleep apnea?

There are many, many different symptom profiles related to sleep apnea, and not all patients will exhibit all symptoms. Here are some of the most commonly experienced:

• Snoring, especially loud and erratic snoring (i.e. not following a consistent pattern)
• Excessively dry mouth upon awakening
• Instances where an individual appears to be gasping for air while asleep. This will often be noticed by a partner or someone else who is present in the room during sleep.
• Insomnia, difficulty staying asleep
• Hypersomnia, difficulty staying awake during the day
• Headaches or other head pain upon awakening
• Irritability
• Difficulty concentrating on normal tasks throughout the day

What Causes Sleep Apnea?

Now that we understand the basic symptoms and presence, let’s better understand the root causes of sleep apnea. Broadly, there three different types of sleep apnea: Obstructive sleep apnea (OSA), central sleep apnea, and complex sleep apnea.

Obstructive Sleep Apnea

Obstructive sleep apnea can be a very serious condition. OSA is the most common type, more prevalent than complex sleep apnea or central sleep apnea. OSA is caused by intermittent relaxation of the throat muscles that periodically restrict breathing. Specifically, these muscles support two structures: the roof of the mouth (soft palate), and soft tissue that dangles down from the soft palate (uvula).

This process causes a restriction in the airway which leads to inadequate levels of oxygen and elevated levels of carbon dioxide. The brain senses these altered levels and wakes a person experiencing them in order to resume normal breathing. These wake-events are typically short enough that a patient will not consciously remember them. This process continues for five to 30 times per hour. The lack of deep sleep is the root cause of many sleep apnea symptoms that patients experience.

The symptoms of OSA are similar to the general symptoms of sleep apnea but include several other things to look out for.

• Mood changes, possibly depression and irritability
• Decreased libido
• High blood pressure
• Profuse night time sweating

Treatment regimens for OSA often include the use of continuous positive airway pressure (CPAP) therapy. These machines deliver constant, steady air pressure to patients that suffer from OSA. A doctor may prescribe a mouthpiece as well. The purpose of this device is to physically push the jaw forward, which can alleviate some of the symptoms of OSA.

Central Sleep Apnea

Central sleep apnea has a radically different cause than obstructive sleep apnea. Whereas OSA is caused by a physical obstruction of the airway, central sleep apnea is due to a miscommunication between the brain and the muscles. Essentially, the brain doesn’t send the right signals at the right time to your breathing muscles. This type of sleep apnea can be caused by other conditions such as a stroke. There are several unique symptoms of central sleep apnea.

• Chest pain during the evening
• Lower exercise tolerance
• Shortness of breath that can be alleviated by sitting up

There are many different types and causes of central sleep apnea. After a stroke, individuals may develop Cheyne-Stokes breathing. At its worst, this manifests as central sleep apnea. Certain drugs like opioids, high altitudes, and continual CPAP use can also cause central sleep apnea.

Complex Sleep Apnea

Complex sleep apnea is the rarest form of sleep apnea. Generally, it is considered a form of central sleep apnea, but it manifests itself as obstructive sleep apnea. This specific condition can be extremely difficult to diagnose. Typically, a physician will notice obstructive sleep apnea-like symptoms, but the patient will not experience a complete alleviation from the use of a CPAP machine.

Sleep Apnea Treatments

Typically, the first method of non-invasive sleep apnea treatment is a CPAP machine. Depending on the specific condition of the individual, CPAP, BiPAP, or APAP (all types of machines) may be the best and most appropriate option. The most invasive method to treat sleep apnea is surgery. Three types of surgery include nasal surgeries, upper airway surgeries, and maxillomandibular advancement surgeries.

Nasal surgeries aim to increase the airflow through the nose. Sometimes, this involves straightening a deviated nasal septum. In other instances, this involves removing specific tissues in the nasal cavities.

Upper airway surgery, medically referred to as a uvulopalatopharyngoplasty (UPPP), aims to remove tissue from behind the tongue. The goal of this procedure is to widen the airway, thus making breathing easier.

Maxillomandibular advancement surgeries aim to accomplish the same goal as the mouthpieces discussed previously. The surgeon fractures a patient’s jaw and physically moves the entire jaw forwards, creating more space in the airway. This procedure is relatively new, but research suggests that the results can be more beneficial than UPPP.

Written by: Partick O'Hare