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Sleep apnea syndrome – description, symptoms and diagnosis
Sep 3, 2020

Von: Fynn S.

Sleep apnea syndrome is usually related to snoring. Snoring, however, does not automatically mean that sleep apnea is involved. While less than one in ten people snore at the age of 20, 40 to 50% of people are affected from the age of 65. So-called primary or simple snoring is characterized by loud breathing noises that occur in the upper airways. It does not in itself pose a health risk and therefore does not need to be treated in most cases. Irregular, loud snoring, however, is not only an annoying feature, but can also indicate serious breathing disorders.

What is sleep apnea?

Sleep apnea is counted by sleep physicians among sleep-related breathing disorders. They occur exclusively or primarily during sleep.

Interesting fact: The term “sleep apnea” comes from the Greek: “A-Pnoe” and means “without breath”.

Sleep apnea disturbs sleep and ensures that one you do not wake up in the morning. This often also applies to the bed partner, who feels disturbed by the particularly loud and irregular snoring. Sleep apnea is dangerous because the respiratory failures during sleep can extend to a prolonged, threatening respiratory standstill. The duration of the breathers is very different here and cannot be said in general terms. However, such respiratory failures can last up to more than 60 seconds.

Exact figures of how often sleep apnea occurs is not the reason is that not every “snorer” goes to the doctor. However, it is estimated that around two to four percent of the total adult population between 30 and 60 years of age are affected by sleep apnea. The frequency increases with age. Obese men in particular are affected: around 80 percent of patients with sleep apnea syndrome have a few kilos too much on their ribs.

Sleep apnea syndrome differs between obstructive and central sleep apnea.

Obstructive sleep apnea (OSAS)

Obstructive sleep apnea syndrome is the most common form of sleep apnea. During sleep, the muscles of the soft palate slacken and the tongue falls back. As a result, the airways close and the sleeping person gets too little or no air. The sagging muscles are also the reason for the snoring. The tighter airways increase the flow rate and the soft muscles begin to flutter.

The problem here, however, is not snoring, at least not primarily, but that the oxygen content in the blood decreases due to the lack of breathing (hypoxemia). There is a lack of supply of the tissue. As a result, the body starts a “wake-up reaction”. It abruptly activates the respiratory muscles of the diaphragm and chest, also the heart increases its performance and blood pressure increases.

The sleeping person usually wakes up for a short time. If breathing is then re-entered, several deep breaths usually follow. The respiratory arrests can last ten seconds to two minutes and occur up to 100 times a night. The next morning, those affected usually can’t remember waking up.

Central sleep apnea

The second form of sleep apnea, the central sleep apnea, is slightly different. The trigger in this form is a malfunction in the central nervous system (CNS). Here, the upper airways remain open, but due to the disturbance in the central nervous system, the respiratory muscles of the chest and diaphragm do not move sufficiently. Central sleep apnea mainly affects the elderly.

Symptoms

As can now be clearly assumed after the explanation, respiratory failures are a typical symptom of sleep apnea. Respiratory arrests can usually last between 10 and 120 seconds and occur more than five times per hour slept. There is also a key figure for this. It is called ODI (Oxygen Desaturation Index). This is followed by periods of excessive air-taking (hyperventilation) as well as loud and irregular snoring. While the person concerned often does not notice any of all this, as a rule, the bed partners perceive the snoring and also the respiratory failures.

Disturbed sleep is a common consequence of sleep apnea and is logically linked to a chronic sleep deficit. As a result, daytime fatigue, forgetfulness and lack of concentration follow. Everyday risks, such as an increased risk of accidents on the road, are also increasing among those affected. Some. In part, the respiratory disorder leads to headaches (especially in the morning hours) and decreased sexual desire. In men, erectile dysfunction can even occur.

Children may also be affected by obstructive sleep apnea syndrome (OSAS). According to experts, the respiratory disorder may have something to do with sudden infant death. Older children with OSAS often appear sluggish and often notice poorperformance at school.

Causes and risk factors

There are many different beneficial factors that provoke sleep apnea. There is usually no one reason or cause. Some of these beneficial factors are:

Too high body mass index (overweight)

Age (the older, the more vulnerable to sleep apnea)

Taking sleeping pills or sedatives (muscles in the palate slacken faster and close the airways)

A lower jaw that is too small or falls backwards

A crooked nasal septum

Other risk factors include smoking, alcohol, pregnancy or existing conditions such as rheumatism, acromegaly or thyroid dysfunction. Even a tongue that is too large, enlarged tonsils, nasal polyps or a lot of fat and connective tissue at the entrance of the respiratory tract can promote sleep apnea, as this additionally presses on the airways and thus narrows them. Generally, irregular bedtimes can exacerbate symptoms.

Central sleep apnea is rare and is caused by disturbances in the central nervous system (CNS). Due to neurological damage, the control of the respiratory muscles functions poorly. One cause may be, for example, neuroborreliosis. Neuroborreliosis is a stage of tick-borne Lyme disease.

Diagnosis

Since snoring often first notices the partner, the diagnosis begins ready in your own bedroom. If respiratory arrests occur, it is advisable to consult a doctor. Here, an ENT doctor or a sleep physician is recommended. Unfortunately, there is no “one” sleep apnea test. The doctor will first ask you about your medical history (anamnesis).

The ENT doctor then looks for anatomical abnormalities in the nasal and ravenous area – for example, curvatures of the nasal septum or nasal and throat polyps.

Sometimes, however, going to the sleep lab is inevitable. Doctors analyze your sleep patterns, breathing and other factors. As a rule, the stay in the sleep laboratory lasts one to two nights. The doctors measure the air flow of breathing, the pulse rate, the oxygen content in the blood as well as the movements of the chest via electrodes on the skin. This type of study is understood as “polysomnography”.

Treatment

Sleep apnea can be treated with various methods. Which is most suitable depends on the individual case and must be discussed individually with a doctor.

With mild obstructive sleep apnea, even simple measures can help to reduce the number of respiratory failures. One of the most effective measures is often weight loss. As already described, additional kilos promote sleep apnea. Alcohol, smoking and the intake of sleeping pills are also considered to be beneficial factors and should be omitted if possible.

It is also possible to avoid sleeping in a back position with simple aids. For example, a tennis ball can be sewn into the back of the pyjamas. Of course, there are also aids for those who like to sleep topless. There are devices that alert as soon as the person is turned on his back. Sometimes even a higher pillow can help, so that the upper body is higher.

The most effective way to treat obstructive sleep apnea syndrome is with a special breathing mask. In this case, you put on a mask at night, which is connected to a device that blows room air into the nose and partly into the mouth with a slight overpressure. This prevents your airways from closing.

There are different types of masks. Which best fits should be discussed individually with your doctor. There are also different ventilation methods:

CPAP = Continuous Positive Airway Pressure

BiPAP = Bilevel Positive Airway Pressure, the pressure is adjusted to inhalation and exhalation

APAP = auto CPAP, the pressure is re-determined by the device with each breath

If patients suffer from a dry nasal cavity, the air may be enriched with water using a humidifier. In certain cases, additional oxygen is added to the air.

I hope I was able to convey the subject to you well. I would also like to tell you that you need not be afraid of sleep apnea or treatment. Many patients quickly get used to night-time ventilation and feel more powerful and rested during the day.

If you can’t get used to the nightly ventilation directly, it makes sense to test different mask models. It is best to consult your doctor.
If you have any further questions or requests for topics, please write to me in the comments or write me directly via our email address to 😊

Important note:
This article contains only general notes and must not be used for self-diagnosis or treatment. He cannot replace a visit to the doctor.

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