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What Causes Obstructive Sleep Apnea

During the normal waking hours, throat muscles help keep your airway stiff and open so air can flow into your lungs. But when you sleep, these muscles are far more relaxed. Normally, the relaxed throat muscles don't prevent your airway from staying open to allow air into your lungs. However, if you have obstructive sleep apnea, your airway can be blocked or narrowed during sleep because:

• Your throat muscles and tongue relax more than normal.
• Your tongue and tonsils (tissue masses in the back of your mouth) are large compared to the opening into your windpipe.
• You're overweight. The extra soft fat tissue can thicken the wall of the windpipe. This causes the inside opening to narrow, which makes it harder to keep open.
• The shape of your head and neck (bony structure) may cause a smaller airway size in the mouth and throat area.
• The aging process limits your brain signals' ability to keep your throat muscles stiff during sleep. This makes it more likely that the airway will narrow or collapse.
• Not enough air flows into your lungs if your airway is fully or partly blocked during sleep. This can cause loud snoring and a drop in your blood oxygen level.

What Are The Health Risks Of Obstructive Sleep Apnea?

If the oxygen drops to a dangerous level, it triggers your brain to disturb your sleep. This helps tighten the upper airway muscles and open your windpipe. Normal breaths then start again, often with a loud snort or choking sound.

The frequent drops in oxygen level and reduced sleep quality trigger the release of stress hormones. These compounds raise your heart rate and increase your risk of high blood pressure, heart attack, stroke, and arrhythmias (irregular heartbeats). The hormones also raise the risk of heart failure.

Untreated sleep apnea also can lead to changes in how your body uses energy. These changes increase your risk of obesity and diabetes.

Sleep apnea can affect anyone at any age, even children. Risk factors for sleep apnea include:

• Male gender
• Being overweight
• Being over the age of forty
• Having a large neck size (17 inches or greater in men and 16 inches or greater in women)
• Having large tonsils, a large tongue, or a small jaw bone
• Having a family history of sleep apnea
• Gastroesophageal reflux, or GERD
• Nasal obstruction due to a deviated septum, allergies, or sinus problems

Self Help To Help Combat Obstructive Sleep Apnea

There are a few things you can do on your own to help aleviate OS Apnea. However these guidelines might not be suitable for everyone. Constult your qualified medical practitioner in all instances to find which would be most suitable for you.

• Lose weight. Losing even a little bit of weight can reduce fatty tissue in the back of the throat and decrease the symptoms of OS Apnea
• Exercise can also help. Working out to tone your arms, legs, and abs, for example, also leads to toning the muscles in your throat, which in turn can lead to less snoring.
• Quit smoking. Smoking causes airways to be blocked by irritating the membranes in the nose and throat.
• Avoid alcohol, sleeping pills, and sedatives, especially before bedtime, because they relax the muscles in the throat and interfere with breathing. Talk to your doctor about any prescription medications you’re taking, as some encourage a deeper level of sleep which can your symptoms much worse.
• Prolonged sitting during the day long periods of daytime sitting can cause fluids to shift from your legs when you recline at night, narrowing airway passages and possibly increasing the risk of obstructive sleep apnea.

Central Sleep Apnea (CSA)

While sleeping, a normal individual is "at rest" , breathing is regular in a healthy person during sleep, and oxygen levels and carbon dioxide levels in the bloodstream stay constant. Any sudden drop in oxygen or excess of carbon dioxide, even if tiny, strongly stimulates the brain's respiratory centers to breathe.

In central sleep apnea, the basic neurological controls for breathing rate malfunction and fail to give the signal to inhale, causing the individual to miss one or more cycles of breathing. If the pause in breathing is long enough, the percentage of oxygen in the circulation will drop to a lower than normal level (hypoxaemia) and the concentration of carbon dioxide will build to a higher than normal level (hypercapnia). In turn, these conditions of hypoxia and hypercapnia will trigger additional effects on the body.

The exact effects of the condition will depend on how severe the apnea is and on the individual characteristics of the person having the apnea. In any person, hypoxia and hypercapnia have certain common effects on the body. The heart rate will increase, unless there are such severe co-existing problems with the heart muscle itself or the autonomic nervous system that makes this compensatory increase impossible. The more translucent areas of the body will show a bluish or dusky cast from cyanosis, which is the change in hue that occurs owing to lack of oxygen in the blood ("turning blue"). Overdoses of drugs that are respiratory depressants (such as heroin, and other opiates) kill by damping the activity of the brain's respiratory control centers. In central sleep apnea, the effects of sleep alone can remove the brain's mandate for the body to breathe. Even in severe cases of central sleep apnea, the effects almost always result in pauses that make breathing irregular, rather than cause the total cessation of breathing.

Normal respiratory drive: after exhalation, the blood level of oxygen decreases and that of carbon dioxide increases. Exchange of gases with a lungful of fresh air is necessary to replenish oxygen and rid the bloodstream of built-up carbon dioxide. Oxygen and carbon dioxide receptors in the blood stream (called chemoreceptors) send nerve impulses to the brain, which then signals reflex opening of the larynx (so that the opening between the vocal cords enlarges) and movements of the rib cage muscles and diaphragm. These muscles expand the thorax (chest cavity) so that a partial vacuum is made within the lungs and air rushes in to fill it.

Physiologic effects of central apnea: During central apneas, the central respiratory drive is absent, and the brain does not respond to changing blood levels of the respiratory gases. No breath is taken despite the normal signals to inhale. The immediate effects of central sleep apnea on the body depend on how long the failure to breathe endures. At worst, central sleep apnea may cause sudden death. Short of death, drops in blood oxygen may trigger seizures, even in the absence of epilepsy. In people with epilepsy, the hypoxia caused by apnea may trigger seizures that had previously been well controlled by medications. In other words, a seizure disorder may become unstable in the presence of sleep apnea. In adults with coronary artery disease, a severe drop in blood oxygen level can cause angina, arrhythmias, or heart attacks (myocardial infarction). Longstanding recurrent episodes of apnea, over months and years, may cause an increase in carbon dioxide levels that can change the pH of the blood enough to cause a metabolic acidosis.

What Causes Central Sleep Apnea?

Central sleep apnea often occurs in people who have certain medical conditions. For example, it can develop in persons who have life-threatening problems with the brainstem, which controls breathing.

Conditions that can cause or lead to central sleep apnea include:

Arthritis and degenerative changes in the cervical spine or the base of the skull
Bulbar poliomyelitis
Complications of cervical spine surgery
Encephalitis affecting the brainstem
Neurodegenerative illnesses such as Parkinson's disease
Obesity
Radiation of the cervical spine
Stroke affecting the brainstem
Primary hypoventilation syndrome
Use of certain medications such as narcotic-containing painkillers
A form of central sleep apnea commonly occurs in people with congestive heart failure.

If the apnea is not associated with another disease, it is called idiopathic central sleep apnea.

Central sleep apnea is not the same as obstructive sleep apnea, which is due to a blockage in the airway.

A condition called Cheyne-Stokes respiration can mimic central sleep apnea. This involves breathing to a variable depth, usually while sleeping.

What Are The Health Risks Of Central Sleep Apnea?

Central Sleep Apnea is associated with or combined with other ailments. Complications may result from the underlying disease causing the central sleep apnea. Other symptoms may occur if the apnea is due to a neurological condition. Symptoms depend on the underlying disease and what parts of the nervous system it has affected, but may include:

Difficulty swallowing
Voice changes
Weakness or numbness throughout the body

Central Sleep Apnea Treatments

Oxygen, nasal CPAP, or bilevel positive airway pressure (BiPAP) may be used for some types of central sleep apnea. Some types of central sleep apnea are treated with drugs that stimulate breathing. Patients should avoid the use of any sedative medications.

What Is Complex Sleep Apnea (CompSA)

Complex sleep apnea patients have a combination of both types of Apnea(OSA and Central). When obstructive sleep apnea syndrome is severe and longstanding, episodes of central apnea sometimes develop.Complex sleep apnea (CompSA) is a form of sleep apnea in which the central apnea is most commonly noted while on CPAP therapy after the obstructive component has been eliminated.

Complex sleep apnea is a form of sleep-disordered breathing caused by the temporary absence of a signal from the brain’s respiratory center. Without this signal, there is no effort to breathe. Mixed sleep apnea is fairly common and consists of both central and obstructive components. On the other hand, CompSA consists of all or predominantly obstructive apneas which convert to all or predominantly central apneas when treated with a CPAP or bilevel devices.

CompSA is characterized by the following:

The persistence or emergence of central apneas or hypopneas upon exposure to CPAP or bilevel when obstructive events have disappeared.

What Causes Complex Sleep Apnea

Among the causes of hypopnea are:
Anatomical defects such as nasal septum deformation or congenital narrowness of nasal meati and the gullet.
Acute tonsillitis and/or adenoiditis
Obesity or being overweight
Neuromuscular disease or any condition that entails weakened respiratory muscles
Use of sedatives (sleeping pills, etc.)
Alcohol abuse
Smoking
Aging
Others, most of which are also typical causes of airway obstruction, snoring and sleep apnea.

What Are The Health Risks Of Hypopnea

Hypopnea is a disorder that may result in excessive daytime sleepiness and compromised quality of life, including traffic accidents, diminished productivity in the work place and emotional problems.
Cardiovascular consequences of hypopnea may include myocardial infarction, stroke, psychiatric problems, impotence, cognitive dysfunction, hypertension, coronary heart disease, and memory loss.

Complex Sleep Apnea Treatments

What Is Hypopnea

Hypopnea is a medical term for a disorder which involves episodes of overly shallow breathing or an abnormally low respiratory rate. This differs from apnea in that there remains some flow of air. Hypopnea events may happen while asleep or while awake.
During sleep - sleep is disturbed such that patients may get a full night's sleep but still not feel rested because they did not get the right kind of sleep. The disruption in breathing causes a drop in blood oxygen level, which may in turn disrupt the stages of sleep.
During Daytime -hypopnea events are mostly limited to those with severely compromised respiratory muscles, as occurs in certain neuromuscular diseases. Similarly, daytime hypopnea can also cause a drop in blood oxygen level.
What Causes Hypopnea?

Among the causes of hypopnea are:

Anatomical defects such as nasal septum deformation or congenital narrowness of nasal meati and the gullet
Acute tonsillitis and/or adenoiditis
Obesity or being overweight
Neuromuscular disease or any condition that entails weakened respiratory muscles
Use of sedatives (sleeping pills, etc.)
Alcohol abuse
Smoking
Aging
Others, most of which are also typical causes of airway obstruction, snoring and sleep apnea.

What Are The Health Risks Of Hypopnea

Hypopnea is a disorder that may result in excessive daytime sleepiness and compromised quality of life, including traffic accidents, diminished productivity in the work place and emotional problems.
Cardiovascular consequences of hypopnea may include myocardial infarction, stroke, psychiatric problems, impotence, cognitive dysfunction, hypertension, coronary heart disease, and memory loss.

Hypopnea Treatments

One treatment for hypopnea is continuous positive airway pressure (Cpap). Cpap is a treatment in which the patient wears a mask over the nose and/or mouth. An air blower forces air through the upper airway. The air pressure is adjusted so that it is just enough to maintain the oxygen saturation levels in the blood. For people with neuromuscular disorders, the most common treatment is the use of BPAP or other non-invasive ventilation.
Another treatment is a custom fitted oral appliance. Oral Appliances should be custom made by a dentist with training in dental sleep medicine.