Understanding Sleep Apnea

Are you struggling with excessive daytime sleepiness or disrupted sleep and can’t figure out why? You might be one of the 39 million in the US and 936 million globally affected by a sleep-related breathing disorder known as Obstructive Sleep Apnea (OSA). OSA is a condition marked by a reduction or complete stoppage of airflow due to the relaxation of throat muscles during sleep, leading to the soft tissue at the back of the throat collapsing and obstructing the upper airway. This obstruction results in brief interruptions of breathing known as hypopneas (partial blockages) and apneas (complete blockages)—that last for at least 10 seconds, often waking up the sleeper just enough to resume breathing, a process that can repeat itself hundreds of times throughout the night, severely disrupting sleep quality and leading to considerable daytime fatigue and brain fog. Individuals with OSA typically experience loud and persistent snoring, punctuated by quiet spells during breath interruptions, followed by choking, snorting, or gasping sounds as breathing restarts.

OSA doesn’t just steal your good night’s sleep; it can sneak into your daily life in ways you might not expect and can strain personal relationships. Moreover, OSA contributes to emotional disturbances, such as irritability, depression, and anxiety, stemming from chronic sleep deprivation.

Risk Factors

Could You Be At Risk? Identifying OSA early is key, and for that, awareness of risk factors is crucial as is understanding gender differences in presentation. In men, risk factors such as higher body mass index (BMI), larger neck circumference, and the overall structure of the upper airway contribute to a higher predisposition to OSA. Men are more likely to exhibit classic symptoms such as loud snoring, observed apneas, and daytime sleepiness.

On the other hand, women may present with more subtle or atypical symptoms such as fatigue, insomnia, mood disturbances, and unrefreshing sleep, which can sometimes lead to underdiagnosis. Hormonal factors and differences in fat distribution also play a role in the risk and presentation of sleep apnea in women. Pre-menopause, women are somewhat protected against OSA, but the risk increases with menopause, aligning with changes in hormone levels that affect the airway and fat distribution. Additionally, the clinical presentation in women may be less severe in terms of the number of respiratory events per hour, yet the impact on daytime functioning and cardiovascular health remains significant. These gender-related differences highlight the need for gender-specific approaches in the diagnosis and treatment of sleep apnea.

Untreated OSA doesn’t just affect sleep and daily functioning; it’s a gateway to more severe health issues like hypertension, heart disease, stroke, diabetes, dementia, and erectile dysfunction. The risk of metabolic and cardiovascular comorbidities, and even death, is notably higher in people with untreated OSA. Some studies suggest untreated apnea can reduce your life expectancy by 7 years.

Diagnostic Process

The diagnostic process for OSA typically involves a detailed review of medical history, and a clinical examination and assessment that focuses on the oral cavity, throat and nasal passages to look for anatomical factors such as enlarged tonsils, a deviated nasal septum, malformed lower jaw structure, or signs of dental occlusion issues.

This is then potentially followed by either home sleep apnea tests (HSATs) or in-lab polysomnography (PSG). HSATs can be as simple as wearing a ring for two nights sleep and offer the advantages of convenience, speed, and lower cost, allowing patients to undergo testing in the familiar comfort of their own homes.

OSA Treatment

If you are experiencing symptoms of sleep apnea, I strongly urge you to schedule a consultation with me. I have the clinical education and training to provide the most appropriate treatment customized specifically for you. I will help you discover how a combination of CPAP, myofunctional therapy and FDA-approved oral appliances (mandibular advancement devices or MAD) can treat your OSA, improve your quality of life and reduce the risk to your health.