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People with sleep apnea stop breathing several times while they sleep. There are three forms of sleep apnea, and each has its own cause and presents slightly different symptoms.
While millions of people in the United States have this sleep disorder, sleep apnea frequently goes undiagnosed. This is because the people who have the condition may not realize that they stop breathing unless a sleeping partner notices pauses in their breathing patterns. Signs and symptoms other than pauses in breathing may appear, depending on the specific type of sleep apnea someone has.
3 Types of Sleep Apnea
Obstructive sleep apnea
Affecting as many as half of the total population, obstructive sleep apnea (OSA) is the most common type of sleep apnea.
What happens during obstructive sleep apnea?
Obstructive sleep apnea occurs when something in the person’s mouth or throat obstructs breathing. The person’s tongue may fall backward against the soft palate of the roof of the mouth, for example. This causes the soft palate and the uvula, which is the soft flap of tissue that hangs down at the back of the mouth, to fall against the throat and prevent air from flowing into the airway. With obstructive sleep apnea, the lungs work normally, but the obstruction caused by the soft palate and uvula makes it hard to draw air into the lungs.
Symptoms of obstructive sleep apnea
Obstructing the airway in this fashion can lead to snoring, as the tongue and the soft palate rattle with every breath. OSA can cause other symptoms, such as:
- Waking from sleep feeling panicked
- Feeling very tired when awake, due to waking up several times during the night
- Awaking with a dry mouth
- Gasping for air during sleep
- Frequent headaches
- Feeling confused or unable to concentrate
Treatment for obstructive sleep apnea
Treatment for OSA involves addressing the obstruction that blocks the airway. For some people, simply changing position is enough to keep the soft palate and uvula from sliding back into the airway. Others find that quitting smoking, losing weight, or getting more exercise can reduce symptoms. Other treatments include:
Continuous positive airway pressure (CPAP) – a machine continuously blows pressurized air through a mask into the throat to keep the airway open
Surgery – addresses structural issues in the mouth and upper airway by reshaping the airway or by removing excess tissue blocking the airway
Oral appliances – fitting over the teeth like a dental retainer, an oral appliance keeps the airway open by preventing the tongue from sliding back against the soft palate
Medications – certain medications, such as modafinil, can help with daytime sleepiness that does not respond to CPAP or other treatments; these medications do not address the underlying cause of OSA
Central sleep apnea
Central sleep apnea is much rarer than obstructive sleep apnea. Unlike OSA, central sleep apnea is not the result of an obstruction. Instead, it is a neurological problem that occurs when the brain fails to send the right signals to the muscles responsible for breathing.
Central sleep apnea is also different from OSA in that the body does not try to breathe, so the person does not snore. Instead, they just stop breathing intermittently.
Symptoms of central sleep apnea
Some people with central sleep apnea have no symptoms, but others may experience symptoms such as:
- Daytime sleepiness or trouble concentrating
- Waking up short of breath, or feeling panicky
Some people with central sleep apnea experience Cheyne-Stokes breathing, a respiratory pattern in which breathing alternates between hyperventilating and not breathing at all. This can occur in people with congestive heart failure, a condition in which the heart does not pump blood as efficiently as it should.
Causes of central sleep apnea
Causes of central sleep apnea include:
- Medications, especially opiates or other sedatives
- Sleeping at high altitudes
- Congestive heart failure
Central sleep apnea may be idiopathic, which means doctors cannot identify the underlying cause.
Treatment for central sleep apnea
Treatment for central sleep apnea depends largely on the underlying cause, but may include:
- Treatment for congestive heart failure or other underlying condition causing central sleep apnea
- Reducing the use of opioids or other sedatives
- Adaptive servo-ventilation (ASV) – similar to CPAP, except the machine adjusts the amount of pressure breath-by-breath when the patient inhales to smooth out the overall breathing pattern
- Bilevel positive airway pressure (BPAP) – similar to ASV, except the amount of pressure as the patient inhales is fixed rather than variable
Both ASV and BPAP devices deliver breaths when the person stops breathing.
Complex sleep apnea
Complex sleep apnea is a condition in which someone has both OSA and central sleep apnea. Complex sleep apnea is sometimes evident in an initial sleep study; at other times, the diagnosis becomes apparent when CPAP or other treatments fail to resolve the patient’s signs and symptoms.
Symptoms of complex sleep apnea
Symptoms of complex sleep apnea are similar to both OSA and central sleep apnea, and may include:
- Awakening from sleep briefly
- Daytime fatigue
- Insomnia or poor quality of sleep
- Confusion when waking up
- Headaches or dry mouth
Treatment of complex sleep apnea
Treatment of complex sleep apnea typically involves a combination of approaches that may include the use of CPAP or other positive airway pressure devices, medications, and addressing the underlying cause of the condition.
Our team of dentists at Westerville Dental Associates are sometimes the first to detect some of the warning signs of sleep apnea in our patients. Our team can screen patients for OSA-related risk factors or common signs, such as large tongue or tonsils, jaw problems that can restrict airflow, large neck circumference, choking or gasping during sleep, obesity, loud or irregular snoring, or breathing pauses during sleep as reported by a bed partner. We can also provide oral appliances to patients who have trouble with using CPAP or other treatments.
For more information on sleep apnea, consult with the team at Westerville Dental Associates. We are always glad to help diagnose and treat sleep apnea.