SLEEP APNEA – What is Sleep Apnea - Healthy Sleep Solutions

What is Sleep Apnea?

Sleep apnea (also spelt as sleep apnoea) is not just snoring or feeling tired during the day – it is a serious medical condition.

It not only affects your sleep but can severely impact your health and your quality of life.

Someone with sleep apnea will either:

Completely stop breathing (known as an apnea) and/or
Have their breathing severely restricted (a hypopnea).

These events can happen hundreds of times per night.

Each cycle, the apnea or hypopnea starves the body of vital oxygen and increases carbon dioxide (waste product of breathing) in the blood. The lack of oxygen in the body signals the brain to “wake” the body to start breathing again.

Untreated sleep apnea is associated with a decreased quality of life and other serious medical conditions like obesity , heart disease and diabetes

“Other serious medical conditions may be associated with sleep apnea”

Symptoms of Sleep Apnea

- Snoring

- Waking feeling unrefreshed

- Falling asleep during the day

- Morning headaches

- Irritability

How can I tell if my partner suffered an apnea or hypopnea?

Most people with sleep apnea will have a combination of apneas and hypopneas during their sleep. These can happen from as little as 5–to over 100–times per hour.

Apneas and hypopneas can sound like snoring so it is important to recognise the difference.

An apnea is where the body completely stops breathing. This may be caused by a throat obstruction or less commonly, the brain “forgetting” to breathe. This can be identified by either no sound or a gasping/choking noise followed by an inhalation of air. It may be more noticeable if someone has been snoring previously.

A hypopnea occurs when the breath is severely restricted and will often sound like a loud snore followed by an inhalation of air. While a hypopnea and a snore may sound similar, a hypopnea results in a restriction of vital oxygen to the blood whereas a snore does not.

“Oxygen-restricting apneas and hypopneas can occur hundreds of times a night”

Apnea / hypopnea cycle “A sleep apnea sufferer may not remember waking up but their brain and body will start to feel the effects if it is left untreated.”

Sleep apnea disturbs more than just your sleep

Untreated sleep apnea is associated with:

• Increased heart rate • Higher blood pressure • Changes in metabolism

• Impaired liver function • Nerve dysfunction • Severe tiredness

These symptoms are associated with serious medical conditions including diabetes, hypertension, stroke, fatty liver disease and erectile dysfunction.

Are you at risk?

The severity of sleep apnea increases in certain patient groups.1 The below figures are based on 78,145 patients tested by Healthy Sleep Solutions over 7 years.

92% of obese males over 45 tested by Healthy Sleep Solutions were diagnosed with sleep apnea
86% of all obese patients were diagnosed with sleep apnea compared to 60% who were in a healthy weight range

“80% of sleep apnea patients in Australia remain undiagnosed”²

Other patient conditions associated with untreated sleep apnea patients include:

Depression

Metabolic disease
(Type 2 diabetes)

Cardiovascular disease (stroke, heart attack, high blood pressure)

Inhibited weight loss

Our study is based on a patient base of 78,145 across Australia, the Independent Sleep Physician Cohort (ISPC) shows how instances of Sleep Apnea can increase along with common risk factors. The patients in the sample were assessed for eligibility for a sleep test according to criteria set by the ISPC.

Sleep apnea treatment benefits

With the right support, sleep apnea can be treated and some symptoms can be controlled within days Some benefits of treatment include:

Longer lifespan – studies have shown that sleep apnea patients on treatment lived longer than sleep apnea patients who were untreated³
Reduced chance of suffering a stroke or heart attack – sleep apnea treatment reduces the relative risk of cardiovascular events such as stroke and high blood pressure^4,5
Help to control type 2 diabetes⁶
Reduce the risk of having a workplace or motor vehicle accident⁷

The importance of dedicated care was highlighted in this study as:

Cardiovascular improvements require optimal therapy and dedicated patient care - this recent study stated that while treating sleep apnea improved patients’ quality of life, it did not decrease their risk of cardiovascular events. The patients in this study were on suboptimal treatment. Severe patients who used their treatnent for the recommended amount of time showed a decreased risk in CV events.^{12, 13}

“Our sleep technicians spend the time with you to make sure your treatment is comfortable and effective“

Types of sleep apnea

Obstructive sleep apnea (OSA) is the most common form of sleep apnea.

It occurs during sleep when the walls of the upper airway (including the tongue) relax and either completely block (an apnea) or partially restrict (a hypopnea) the airway.

Obstructive sleep apnea is highly prevalent in obese patients, especially those with heart conditions or type 2 diabetes.

Most people with sleep apnea are diagnosed with obstructive sleep apnea.

What happens in sleep apnea?

Normal sleep

No obstruction and no snoring.

Hypopnea

Caused by a partial obstruction of the upper airway resulting in vibrating airway tissues and oxygen restriction

Apnea

The flow of air is totally blocked, restricting oxygen

Determining sleep apnea severity

The severity of sleep apnea is determined by how many times per hour breathing has stopped or been restricted.

Normal - <5 per hour Mild sleep apnea - 5-14 per hour Moderate sleep apnea - 15-29 per hour Severe sleep apnea - 30+ per hour

Central sleep apnea

Central sleep apnea is caused by a malfunction in the brain’s respiratory centre.

Unlike OSA, central sleep apnea (CSA) does not physically block the upper airway; central apneas occur when the brain “forgets” to tell the body to breathe. Central sleep apnea is caused by a malfunction in the brains respiratory centre.

People with brain stem injuries such as stroke and brain tumours, those with chronic respiratory conditions or people with heart conditions such as congestive heart disease or atrial fibrillation are more at risk of developing CSA.

Central sleep apnea is uncommon, occurring in less than 10% of the number of patients presenting for a sleep test14 and 1% of the total population.¹⁵

Mixed sleep apnea

Mixed sleep apnea is a combination of obstructive sleep apnea and central sleep apnea. Often the central apnea will occur first, followed by an obstructive apnea or hypopnea.

Positional sleep apnea

Positional sleep apnea is a form of obstructive sleep apnea that occurs when a patient sleeps on their back, but not when they sleep on their side.

References: 1. Healthy Sleep Solutions, data on file 2. Medical Services Advisory Committee, Public Summary Document, Application No. 1130 – Unattended Sleep Studies in the Diagnosis and Reassessment of Obstructive Sleep Apnoea March 2010 3.Young, Terry, et al. “Sleep disordered breathing and mortality: eighteen-year follow-up of the Wisconsin sleep cohort.” Sleep 31.8 (2008): 1071-1078. 4. Marin, Jose M., et al. “Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study.” The Lancet 365.9464 (2005): 1046-1053. 5. Buchner, Nikolaus J., et al. “Continuous positive airway pressure treatment of mild to moderate obstructive sleep apnea reduces cardiovascular risk.” American journal of respiratory and critical care medicine 176.12 (2007): 1274-1280. 6. ibid 7. Naughton, M., and R. Pierce. “Sleep apnoea’s contribution to the road toll.” Internal Medicine Journal 21.6 (1991): 833-834. 9. McEvoy, R. Doug, et al. “CPAP for prevention of cardiovascular events in obstructive sleep apnea.” New England Journal of Medicine 375.10 (2016): 919-931. 10. Babu, Ambika R., et al. “Type 2 diabetes, glycemic control, and continuous positive airway pressure in obstructive sleep apnea.” Archives of internal medicine 165.4 (2005): 447-452. 11. Panossian LA, Avidan AY. Review of sleep disorders. Med Clin North Am. 2009 Mar. 93(2):407-25, ix.