With sleep apnea, patients suffer from repeated pauses in breathing during sleep. Here you can find out how the syndrome develops and what works against it.
What is sleep apnea?
With sleep apnea (apnea = Greek for calm, also “sleep apnea syndrome”), those affected have repetitive, nocturnal breathing pauses during sleep. In many cases, heavy snoring is one of the symptoms. Usually the patient does not even notice the sleep apnea – it is more the partners who notice the individual breathing pauses, because these usually last between ten and 30 seconds. Since sleep apnea can lead to secondary diseases such as high blood pressure and above all makes you tired, it should definitely be treated, for example with a special breathing mask that is worn at night.
Consequences: how dangerous is sleep apnea syndrome?
Slow breathing always triggers an alarm signal in the brain and also in the body. This does the following:
- Heart rate is increased
- Blood pressure increases
- The vegetative nervous system is activated
Prof. Ingo Fietze, head of the Interdisciplinary Sleep Medicine Center, specialist in internal medicine, pulmonology and somnology at Charité Berlin
© Anke Illing
In the case of high blood pressure, and especially high blood pressure at night, it should always be checked whether sleep apnea is present so that it can be treated. Because the otherwise permanently high blood pressure can trigger secondary diseases such as stroke or heart attack, as Prof. Ingo Fietze, head of the Interdisciplinary Sleep Medicine Center, specialist in internal medicine, pulmonology and somnology at the Charité Berlin confirms: “Breathing interruptions put a strain on the cardiovascular system, the nocturnal oxygen drops on the brain. Diabetes, dementia and other diseases. ”
The bad sleep can also following common symptoms appear:
- Reduced efficiency
- Difficulty concentrating
- Persistent tiredness, which also favors the occasional nodding off. In road traffic, for example, this can be extremely dangerous.
Causes and Risk Factors: Obstructive and Central Sleep Apnea
Medicine distinguishes between two different forms of sleep apnea, which also describe the main causes:
Obstructive sleep apnea
Obstructive sleep apnea is the more common of the two forms and occurs when the upper airways collapse at night. There is a cause and various provoking circumstances for this: The cause is a malfunction of the nerves that control / activate the muscles in the throat at night. Provoking factors are:
- Overweight: Obesity is one of the risk factors for sleep apnea – the disease is common among overweight people. “Obesity provokes snoring and respiratory disorders through low fat deposits in the throat and the increasing neck circumference, but is usually not the only cause,” explains Prof. Fietze.
- Supine position: If the muscles in the throat relax, so do the base of the tongue. In the supine position, the tongue therefore plays a crucial role in temporarily obstructing the airway.
- Excessive muscle relaxation: Certain stimulants such as medication, cigarettes, drugs or alcohol can increase muscle relaxation and thereby promote sleep apnea.
- Anatomy: Anatomical peculiarities such as a strongly recessed lower jaw or extremely enlarged tonsils increase breathing resistance and narrow the pharynx.
Once the airways are narrowed, the breathing muscles continue to receive orders from the brain to take a breath. But the muscles are not strong enough to transport the air through the closed airways. There is a pause for breath – and for this moment the body lacks oxygen. This in turn reduces the oxygen content in the blood, and carbon dioxide accumulates in the blood, in the tissue and in the brain. In the latter, an alarm is automatically triggered. The body instantly increases its activity through a wake-up stimulus, which means that it can suddenly breathe again. This ensures that the body is supplied with oxygen again until the next breathing pause occurs.
This process is repeated several times up to hundreds of times during the night in people with sleep apnea. Patients usually cannot remember the next day, However, sleep apnea ensures that your sleep is not very restful. As a result, those affected usually suffer from extreme tiredness during the day.
Obstructive sleep apnea mainly affects older men: Between the ages of 40 and 60, around 20 percent of them suffer from sleep apnea syndrome, between 65 and 70 it is already 60 percent. Women are often spared sleep apnea until they reach menopause. But why is it like that? “It has not yet been clarified whether it is due to different hormones or the anatomy, or whether it is simply inherited differently,” says Prof. Fietze.
Central sleep apnea
Only about every tenth case of sleep apnea is referred to as central sleep apnea, the cause of which is located in the brain and can arise, for example, from a cardiovascular disease such as a weak heart or a stroke. The breathing control center in the brain no longer sends an impulse to breathe. Only when the non-exhaled carbon dioxide rises above a critical level in the blood does the brain send a new breath impulse. In some patients, breathing is very shallow before the paused breath – this is known as Cheyne-Stokes breathing.
The likelihood of developing central sleep apnea increases with age. It is estimated that one in four people over 60 is affected.
Do I have to go to a sleep laboratory if I suspect sleep apnea?
If sleep apnea is suspected, it can usually be checked at home first. For this purpose, the doctor lends the patient certain measuring devices that record all information on breathing or breathing pauses, the pulse, the oxygen content in the blood and the position of the body. This measurement is known as polygraphy and is often sufficient to make an initial diagnosis.
For a more thorough examination or to confirm the suspicion of sleep apnea syndrome, the doctor can also refer the person to a sleep laboratory, where a so-called polysomnography is performed. The examinations there are more extensive than the measurements at home, but absolutely painless and most patents do not interfere with sleep.
Therapy: How can sleep apnea be treated?
Sleep apnea is usually treated individually, Depending on the form, different types of therapy can be used. The following treatment methods can be used:
- Breathing mask: The special breathing mask is worn at night. Via a device connected by a breathing tube, room air is blown into the nose (or nose and mouth) and thus into the throat and lungs with the aid of slight excess pressure, which prevents the upper airways from becoming blocked and thus preventing breathing disorders. Usually the patient learns in the sleep laboratory how to use the mask correctly.
- Reduction of excess weight: In the case of obstructive sleep apnea, it often helps to lose excess weight in order to at least relieve the sleep apnea, and rarely get rid of it.
- Devices that prevent the supine position: Only when sleep apnea occurs almost exclusively in the supine position are devices that trigger an alarm when the sleeper tries to turn on their back. It can be enough to sew a tennis ball into the back of the pajamas. Recommended only for otherwise good sleepers.
- Sleep elevated: If the upper body is raised a little, for example, it is easier to prevent the tongue from sliding into the pharynx or liquid from accumulating in the throat area. This can also be a remedy for mild sleep apnea.
- Bite splints: In mild and moderate cases, specially made bite splints can prevent sleep apnea.
- Avoidance of luxury foods: Typical stimulants such as alcohol and cigarettes should be avoided.
- Change of medication: If drugs trigger sleep apnea, you should talk to your doctor about whether there are any alternative drugs available.
Surgery against sleep apnea: how useful is this therapy?
If the sleep apnea has anatomical reasons, an operation can be considered depending on the case, according to Prof. Fietze: “If the tongue is low and the soft palate including the uvula constricts the airway significantly, a minimally invasive operation is sometimes useful. It is indicated if in addition, the tonsils are significantly enlarged. ” In some patients, a so-called tongue pacemaker can also be used, which stimulates the nerve that controls the muscles of the tongue. This keeps the airways open at night.
Which therapy is to be considered, the patient should clarify individually with his doctor.
Reading tips: Here you can find out everything about sleep disorders, how stress management can help you and what you should know about burnout. There is even more information on sleep in Prof. Fietzes book “Germany sleeps badly: How lack of sleep makes us all sick and what you can do about it.”
If you want to exchange ideas about health topics, take a look at ours BRIGITTE Community!
Sources:
Prof. Dr. med. Ingo Fietze, head of the Interdisciplinary Sleep Medicine Center, senior physician, specialist in internal medicine, pulmonologist and somnologist at Charité Berlin
Guideline of the German Society for Ear, Nose and Throat Medicine, Head and Neck Surgery e. V .: ENT-specific therapy of obstructive sleep apnea in adults (as of September 2015)
Guideline of the Sleep Medicine Working Group of the German Society for Ear, Nose and Throat Medicine, Head and Neck Surgery eV: Diagnostics and therapy of snoring in adults (as of March 2017)
Guideline of the German Society for Sleep Research and Sleep Medicine: Non-restful sleep / sleep disorders, chapter Sleep-related breathing disorders in adults (as of August 2017)