Sleep Apnea

(Central, Mixed, or Obstructive Apnea)

While breathing is an automatic function that most people take for granted, persons who have sleep apnea stop breathing repeatedly for anywhere from 10 seconds to 2 or 3 minutes during sleep. The majority of these persons are unaware of such episodes, although their bed partners may complain of their loud snoring and fitfulness.

Overweight middle-aged or older men are the ones most commonly afflicted, but sleep apnea can occur at any age and in either sex. Adults with the disorder have an increased risk of sudden death from a heart attack while sleeping. Infants who have experienced sleep apnea account for about 5 percent of all cases of crib death, or sudden infant death syndrome.

In obstructive apnea, the most common form, the upper air passages in the nose and mouth are temporarily blocked. Also referred to as the Pickwickian syndrome, this type occurs most often in obese people. Typically, the person is sleeping on his back and snoring loudly. The snoring and breathing suddenly stop briefly, then resume as the person thrashes about or gasps for breath. During the day, the sufferer may be inordinately drowsy, and will often nod off, only to awaken feeling starved for air. The restless sleep and reduced oxygen intake can lead to personality changes.

A variation called central apnea is caused by a malfunction in the brain's respiratory center. The airway is open, but the respiratory structures in the chest and abdomen do not receive the proper messages from the brain.

Diagnostic Studies and Procedures

Diagnosing sleep apnea in an awake individual is difficult because breathing usually appears to be normal in this state. A physical examination may reveal a deviated septum or polyps in the nose, enlarged tonsils, large adenoids, or some other predisposing abnormality, but many people with apnea do not have such anomalies. A diagnosis may require a night being monitored in a sleep laboratory. As sleep apnea is often associated with arrhythmias and other cardiac complications, a cardiovascular workup may also be ordered.

Medical Treatments

A positive air flow machine, which blows air into the nose during the night, can help keep the upper airways open. Surgery to widen the air passages in the throat can cure apnea in some persons. In others, a tracheostomy may be necessary. This is a surgical procedure in which a small hole is made in the trachea, or windpipe, at the base of the neck. A tube is inserted into the hole and at bedtime, a valve is opened so that air can flow directly through the tracheostomy to the lungs. When the patient is awake, the valve is closed, allowing normal speech and breathing.

Alternative Therapies

There are no alternative therapies for sleep apnea itself. If the problem is related to obesity, a nutritionist can help devise a weight-loss plan.

Self-Treatment

Mild cases can be treated with the self-care remedies for snoring that prevent sleeping on the back.

A baby who has frequent bouts of sleep apnea may be fitted with a monitor that sounds if breathing stops.

Other Causes of Apnea

Symptoms Nasal infections, allergies, and obstructions in the nose, mouth,