Sleep apnea is a chronic sleep disorder that seriously disturbs your sleep. Apnea often causes patients to change from deep sleep to shallow sleep, which makes the quality of sleep worse and makes them sleepy during the day, which is easy to cause complications such as cardiovascular disease and mental illness.
Definition of sleep apnea
Respiratory diseases can be divided into two types:
1) Temporarily stop breathing: the mouth and nose airflow stops flowing for more than 10 seconds.
2) Hypopnea: the ventilation rate is reduced to 50% or less for more than 10 second. The number of apnea or hypopnea can occur 5-30 times or more in an hour; And under normal circumstances, there will be loud snoring or choking, and then return to normal breathing. There are many diagnostic criteria for sleep apnea in adults, one of which is that there is no breathing and the AHI is higher than 5.
Classification of sleep apnea
Obstructive sleep apnea: during sleep, the upper respiratory tract from nose to lungs is blocked for some reason, resulting in respiratory interruption. This kind of patients are more common, but also have problems such as obesity or abnormal metabolism. Generally, when sleeping, the muscles of the whole body will relax, and the muscles that originally fixed and opened the throat will continue to operate, keeping the respiratory tract unblocked, so that people can still breathe smoothly during sleep to send enough oxygen. However, when some people sleep, their throats will be slightly slack, such as the drooping of the upper jaw or the relaxation of muscles around the trachea, which will cause a slight stenosis of the respiratory tract and lead to snoring. For some reasons, patients with obstructive sleep apnea syndrome aggravate the condition of respiratory tract stenosis, cause dyspnea, make the brain feel hypoxia, order the body to breathe hard, cause short-term awakening, disrupt the sleep cycle, or make the sleep cycle lack deep sleep, and the body can't get enough rest, so that it is depressed during the day and often dozes off. Because it may only take a few seconds, most people don't know that they have the disease even if they wake up dozens of times during the whole sleep.
Central sleep apnea: due to problems in the muscles and nerves that control breathing, the body cannot breathe automatically and the breathing is interrupted. This kind of patients is quite rare, more common in nervous system diseases.
Obstructive and central mixed: Obstructive and central have symptoms of sleep apnea, and the proportion of patients accounts for about 15% of the total number of patients with sleep apnea.
Risk factors of sleep apnea
Sleep apnea may occur in men and women of all ages, but some specific factors increase the risk of this disease.
Obstructive sleep apnea:
Overweight: If there is fat accumulation around the upper respiratory tract, it may hinder breathing, but not all obese people have symptoms of sleep apnea.
Excessive neck circumference: A neck circumference greater than 43 cm will increase the risk of obstructive sleep apnea.
Hypertension: Sleep apnea is very common in patients with hypertension.
Respiratory tract stenosis: congenital respiratory tract stenosis, tonsil or adenoid enlargement, etc. , will narrow the respiratory tract.
Male: Men pause twice as often as women. However, if women are overweight and in menopause, their risk of sleep apnea will also increase.
Age: The probability of sleep apnea in the elderly over 65 years old is 2-3 times that of adults.
Family history: if family members have this disease, the risk will increase.
Alcoholics and sedatives: It is easy to relax the throat muscles and increase the risk.
Smokers: The risk of sleep apnea is three times higher than that of non-smokers, and smokers are also prone to inflammation or tissue residue in the upper respiratory tract.
A sedentary person
Central sleep apnea:
M: It is easier to get central sleep apnea.
Age: People over 65 are at higher risk.
Heart disease: People with atrial fibrillation or congestive heart failure are more likely to have central sleep apnea.
Stroke or brain tumor: It may damage the brain's ability to regulate breathing.
The mixture of blocking type and central type: the risk factors are the same as the above two types. In addition, mixed sleep apnea is often associated with heart disease.
Complications of sleep apnea
Cardiovascular problems: The risk of hypertension in patients with sleep apnea is 2-3 times that of normal people, which will also increase the risk of stroke. Due to apnea and hypoventilation, multiple episodes of unstable blood oxygen value (hypoxia or hypoxemia) may also lead to sudden death. In addition, studies have shown that obstructive sleep apnea is related to atrial fibrillation, congestive heart failure and other vascular diseases. In contrast, people with cardiovascular problems are also prone to central sleep apnea.
Daytime fatigue: Because sleep apnea can reduce blood oxygen concentration for many times, it will lead to poor sleep quality or interruption of sleep cycle, which will make patients unable to rest reliably, leading to daytime sleepiness, fatigue, irritability, inability to concentrate at work or sudden sleep; If children or teenagers suffer from this disease, they may not perform well in school or have behavior problems.
Drug or surgical complications: people with obstructive sleep apnea should be especially careful about the accident of respiratory arrest if they use some sedatives, sleeping pills or general anesthesia; There may be a risk of dyspnea during anesthesia after major surgery.
Deprive your partner of sleep: people with sleep apnea may snore like thunder, making people around you unable to have a good rest; Or because the patient often stops breathing suddenly, which makes the partner nervous and unable to relax.
Symptoms of sleep apnea
Snoring like thunder: common in patients with obstructive sleep apnea.
Difficult to maintain sleep (insomnia): common in central and mixed patients.
Wake up with a dry throat or pain.
Have a headache in the morning
Excessive fatigue (drowsiness) during the day.
Breathing stops or pauses while sleeping.
Frequent nocturia
Memory or learning disabilities, unable to concentrate: often lead to children being misdiagnosed as attention deficit hyperactivity disorder (ADHD).
Irritability, depression, mood swings, or personality changes.
Diagnosis of sleep apnea
If there are: people who snore during the day are often depressed and have the above symptoms of apnea, they can go to the sleep centers of various hospitals for night sleep examination and find out the best treatment. The sleep center will carry out a variety of physiological tests (polysomnography) on night sleep, including electrocardiogram, electroencephalogram, electromyography, electrooculogram, respiratory airflow record, snoring volume and frequency, chest and abdomen fluctuation during breathing, oxygen concentration in blood, posture changes during sleep, etc. , record the physiological state and sleep cycle of patients sleeping all night; You can check whether the patient has sleep apnea and judge whether his sleep apnea is obstructive, central or mixed.
Treatment of sleep apnea
The treatment of sleep apnea depends on the main causes of apnea:
Obstructive sleep apnea: in the case of obstruction, the goal of treatment is how to keep the respiratory tract open during sleep. If the symptoms are mild, the doctor may ask the patient to lose weight or quit smoking; When the symptoms are severe, CPAP (continuous positive airway pressure ventilation) will be suggested to keep the throat clear and prevent obstruction. Sometimes surgery is also used to improve the respiratory structure, such as tonsillectomy or adenoidal hyperplasia (often used in children), or uvulopalatopharyngoplasty.
Central sleep apnea: central treatment should be able to maintain the regularity of breathing during sleep, and first find out the causes of apnea, which are neuromuscular problems, hypertension, heart disease and so on; Then symptomatic treatment. Maintaining a regular breathing pattern can be assisted by supplementing oxygen and various machines, such as CPAP, BPAP (positive bi-level airway pressure) and ASV (adaptive serum ventilation).
Obstructive and central type mixing: CPAP ventilator is the most commonly used, and it is used to treat lifestyle changes (such as losing weight and quitting smoking) and root causes (such as hypertension and heart disease).
At present, no research shows that herbs or vitamins can effectively treat sleep apnea, and acupuncture has been proved to be beneficial. About 6-8% of men over the age of 50 suffer from sleep apnea, and most of them are unaware of it and have not been treated. If your partner is found to have severe snoring, frequent nocturia and poor spirits during the day, you should first think of the possibility of sleep apnea and encourage him to consult a doctor to avoid further serious complications.
Life habit change and family nursing
In many cases, self-care may be one of the most effective ways to improve sleep apnea. Patients can try the following methods:
Lose excess weight: Even a slight weight change can help relieve throat contraction, and even completely cure your sleep apnea symptoms in some cases, and avoid drinking alcohol and taking certain drugs, such as sedatives and sleeping pills. These items will relax your posterior pharyngeal muscles and interfere with your breathing.
Sleeping on your side: Lying upright may cause the tongue and soft palate to fall to the posterior pharynx and block the respiratory tract. In order to prevent lying upright, you can try sewing some tennis balls on the back of pajamas to keep the nasal cavity unblocked at night: you can use normal saline nasal spray, or discuss with your doctor the short-term use of antihistamines to keep the nasal cavity unblocked.