Sleep Apnea

What is sleep apnea?
Apnea is the stoppage of breathing while sleeping, for at least 10 seconds. When sleep apnea is accompanied by symptoms during the day or night, then we are talking about Sleep Apnea Syndrome (SAS). The most common symptoms of Sleep apnea are listed below.

Types of sleep apnea
Sleep apnea is divided into two types: obstructive and central.

• Obstructive apnea. It is due to narrowing or obstruction of the pharynx due to muscle relaxation during sleep. It is accompanied by snoring and is the most common type of apnea.

• Central apnea. It’s because the brain is unable to drive the breathing muscles to function. It is usually observed in people suffering from severe heart failure, neurological diseases, etc.

What’s the cause of the apnea?

Sleep is a process in which the human body relaxes and rests. The muscles in the pharynx area, as in the whole body, relax. This is a normal situation that does not cause any problems in most people. But in a percentage of people (especially older people), the relaxation of the throat muscles is greater than normal, thus preventing breathing and causing apnea.

Also, apnea may be due to the fact that the pharynx is narrower than normal, due to various anatomical factors such as:
a) hypognathism (smaller mandible than normal),
b) larger tongue size than normal,
c) enlarged tonsils and grape size,
d) increased fat deposition in the pharynx, especially in obese individuals

In other cases, the problem is localized in the part of the brain that controls breathing during sleep. The brain seems to “forget” to send an order for breathing.

What are the symptoms?
• Snoring
• Feeling tired during the day
• Feeling unsatisfactory sleep (lack of a feeling of rest from sleep)
• Sleepiness
• Awakenings with a feeling of lack of air
• Restless sleep
• Frequent urination awakenings
• Night sweats
• Morning dry mouth
• Frequent morning headaches
• Lack of concentration
• Reduced memory
• Personality changes (nervousness, anxiety, depressed mood)
• Nightmares
• Decreased libido and erection disorders

Sleep apnea does not presuppose the existence of all the above symptoms at the same time. Thus, people who experience daily and intense snoring should visit a specialist in sleep disorders to investigate the possibility of the presence of sleep apnea.

What are the complications of sleep apnea?
By stopping to breathe, the amount of oxygen in the blood decreases and the heart works more intensively to meet the needs of the body. This results in an increased likelihood of developing the following:

• Arterial hypertension (αυξημένη πίεση)
• Cardiac arrhythmias
• Sudden death in people without obvious health problems
• Coronary heart disease
• Myocardial infarction
• Heart failure
• Vascular strokes
• Diabetes mellitus, etc.

Therefore, an early diagnosis and treatment of sleep apnea syndrome prevents serious health problems.
Also, patients with sleep apnea, due to poor sleep quality, often experience decreased concentration, feeling tired, as well as drowsiness.
Thus, they have an increased risk of getting involved in traffic accidents, as well as other types of accidents. In addition, the disturbance of sleep stages in people with sleep apnea has a negative impact on their metabolism, resulting in difficulty losing weight and obesity.

How is sleep apnea diagnosed?
If one of the above symptoms is present, the person concerned should visit a qualified physician in matters of sleep disorders. By taking a detailed medical history, completing special questionnaires and clinical examination, the doctor will determine whether there is a possibility of sleep apnea.
In such a case, the person concerned should undertake a relevant examination, to confirm the existence, as well as the severity of sleep apnea. This test is called a “sleep study”.
The sleep study is a painless and non-invasive examination, in which various cables and sensors are placed on the patient’s body, to record various functions of the body during sleep. Sleep study can be done either in a specialized sleep study laboratory or at the patient’s home (portable study).

What is the treatment?
The type of treatment of sleep apnea depends on the severity of the disorder.
In mild cases it is possible to suggest weight loss, avoidance of supine position during sleep (if sleep apnea is recorded), avoidance of alcohol, and sedative drugs and use of mouth devices. The latter, mechanically keep the airways open.
In moderate and severe situations, the most active treatment for sleep apnea is the use of air delivery devices with positive pressure, to keep the airways open during sleep and thus, not interrupt breathing. These devices are called CPAP (Continuous Positive Airway Pressure).
Surgical intervention is not the first choice in the treatment of sleep apnea, because it certainly has no results or in cases of possible initial improvement, there may be a subsequent recurrence. For this reason, surgical procedures consist only of the few cases where the use of CPAP is not acceptable to the patient.