Diseases that arise and develop imperceptibly for the patient are the most dangerous. When a person cannot recognize them in time, he is not able to help himself in a timely manner … Obstructive sleep apnea – frequent cessation of breathing during sleep against the background of snoring – also belongs to such diseases.

What is Obstructive Sleep Apnea Syndrome (OSAS)? How does it threaten and why is it necessary to treat it?

Sleep apnea and its danger

Apnea syndrome causes nighttime choking. This disease affects 4-7% of people (and according to recent studies – up to 13% of the population over 30 years old!). Respiratory arrest in mild cases occurs 5-15 times per hour, and in severe cases occurs hundreds of times per night, leading to severe oxygen starvation of the brain, heart and other organs.    

Sleep apnea disrupts sleep. Each stop triggers a powerful stress response that partially wakes up the brain and forces it to take control of breathing. Breathing is restored, but the person goes back to sleep, after which the whole cycle repeats. In the morning, the patient usually does not remember these numerous awakenings, but he feels bad: overwhelmed, lethargic, tired, sleepy. Because sleep apnea is a chronic condition, feeling unwell becomes permanent. 

Stopping breathing during sleep is an increased risk of disability and death. Just think: in 8 hours of sleep, breathing can stop up to 500 times! The brain and heart constantly receive less oxygen, this increases the risk of heart attack and stroke, this also explains the appearance of angina attacks and rhythm disturbances during sleep. Almost half (43%) of patients with coronary heart disease have obstructive sleep apnea syndrome – there is something to think about!   

At the Center for Sleep Medicine, we observed patients who had more than 3 minutes of respiratory arrest during sleep! Needless to say, in such situations , apnea syndrome can provoke not only a cardiovascular catastrophe, but also death in sleep caused by respiratory arrest. 

Why Sleep Apnea Syndrome Occurs

Understanding the causes of the disease is very important, because their elimination is a prerequisite for successful treatment.

In a healthy person, air circulates freely through the respiratory tract during sleep, so breathing and gas exchange are normal. But in a patient with OSAS, obstruction occurs during sleep – a collapse of the walls of the airways at the level of the pharynx, closing its lumen. This occurs in people with an initial narrowing of the pharynx with muscle relaxation during sleep.

Causes of narrowing of the pharynx leading to sleep apnea:

• Obesity. With overweight, adipose tissue is deposited everywhere, including around the pharynx, squeezing it from the outside and causing its lumen to narrow.
• Enlargement of the tonsils and excess tissue of the soft palate (elongated uvula, low location of the soft palate).
• Age. With age, the elasticity of tissues decreases, this provokes and aggravates breathing disorders during sleep.
• Allergic rhinitis, smoking causes inflammation and swelling of the upper respiratory tract, which interferes with their patency.
• Drinking alcohol and sleeping pills provokes snoring and apnea, as it enhances muscle relaxation at night.
• Curvature of the nasal septum, polyps in the nose can also cause sleep apnea.
• A small and displaced lower jaw is a structural feature in which a person’s pharynx is anatomically narrowed (this is conducive to the appearance of sleep apnea).

Sometimes a patient has multiple causes of sleep apnea at the same time. This complicates treatment and makes it impossible without the participation of a doctor.

Apnea symptoms

• Snore

Almost always, apnea syndrome does not appear suddenly, but after a fairly long period of snoring. This is his harbinger, and then a direct symptom. With “normal” snoring, the walls of the pharynx come together, vibrate when breathing, touch, but do not completely collapse, while during sleep apnea, the lumen of the pharynx occasionally closes.

• Respiratory arrest

If a person snores during sleep and the snoring is interrupted by pauses in breathing for more than 10 seconds (at least some of them), we can most likely talk about the presence of sleep apnea.

• Restless night sleep and daytime sleepiness

Sometimes the patient notices that he often wakes up at night. In this case, awakenings can be accompanied by a feeling of suffocation, shortness of breath, and coughing. Very often a person does not remember nighttime awakenings, but wakes up in the morning with a feeling of “sleepiness”, although he spent a lot of time in bed. Sleep does not bring vigor, during the day the patient feels sleepy, broken, irritated, he may have a headache.

• High blood pressure

Blood pressure at night and immediately after waking up is increased (although in people with hypertension, but without sleep apnea in the morning, it is just minimal).

• Other symptoms

We advise people with snoring to pay attention to the following signs of apnea: frequent urge to use the toilet at night (patients with OSAS can urinate up to 4-7 times per night), night sweats. They are very common with this disease.

Watch the video: the patient talks about the symptoms they experienced before the treatment for apnea syndrome. Do you have similar signs?

How to Diagnose Sleep Apnea

Polysomnography is done to confirm the presence of the disease and to determine its severity. It is performed in a sleep center or at the patient’s home.

During the night, the physiological parameters of the body are examined in a person. For this, several sensors are fixed to his body, which do not interfere with sleep and do not disturb the quality of sleep.

In the morning after the examination, the data obtained are deciphered, and a conclusion is drawn from them on whether a person has sleep apnea and what degree of severity he has. Today, polysomnography is the most accurate method for diagnosing any sleep disorder. 

How to treat apnea

Doctor’s prescriptions depend on many factors, primarily the severity of the breathing problem. For moderate to severe forms (a person has 15 or more respiratory stops per hour), the “gold standard” of treatment is CPAP therapy.

This is a hardware technique. It consists in the fact that during sleep a person breathes through a mask using a special device. A low pressure stream of air is supplied to the patient’s airways during the night. It is sufficient to prevent the walls of the airways from collapsing (creates an “air wedge”), but at the same time subjectively does not interfere with a person’s breathing.

Currently, improved CPAP devices Prisma Line from the new line of Loewenstein Medical (Weinmann), Germany have been developed . Their use allows the most effective and comfortable treatment of the entire spectrum of breathing disorders in patients during sleep.  

In this video, our patient talks about his feelings during CPAP therapy. How has the state of health changed? Was it difficult to get used to the CPAP machine? How did your loved ones react to the treatment? Is the patient satisfied with the treatment and will continue with it? 

Feedback from a patient at the Sleep Medicine Center based at the Rehabilitation Clinic in Khamovniki on the effectiveness of CPAP therapy for obstructive sleep apnea syndrome.

Other treatments are possible for mild sleep disorders.

Apnea prevention

Normalize or at least slightly (by 7-10%) reduce weight – and this may be enough to prevent the disease from developing. Give up smoking, do not drink alcohol. If you are experiencing insomnia, see a specialist to restore sleep without medication or to select sleeping pills that do not provoke sleep apnea. If you know or suspect you have tonsillitis or adenoids, visit your ENT doctor to help resolve the problem. 

If all these preventive measures have not helped you to avoid sleep apnea, do not postpone the visit to the doctor. Experienced somnologists work at the Center for Sleep Medicine on the basis of the Rehabilitation Clinic in Khamovniki in Moscow. They will diagnose apnea and prescribe treatment in the best traditions of Kremlin medicine. 

We also offer participation in the unique program “Life with CPAP 30-60-90”, developed by the head of our Center for Sleep Medicine, Dr. Buzunov. It will provide a more comfortable adaptation to CPAP therapy and the most effective treatment with this method.