OSA is a dangerous medical disorder in which your air passages temporarily collapse during sleep and you cannot breathe.
When you stop breathing for 10 seconds or more, that interruption is called an “apnea.” Apneas can occur dozens of times per hour and hundreds of times per night. Repeated apneas reduce the oxygen saturation in your blood stream, so that your body’s tissues and organs do not get the oxygen supply they need during sleep. Also, when the airway is blocked, carbon dioxide gets trapped in the lungs and CO2 levels increase in the blood. This leads to dilation of the blood vessels in the head, which can cause throbbing headaches – a common symptom of moderate or severe OSA.
Repeated apneas also cause the blood pressure to rise, as the heart works harder to try to supply the body’s needs, and this results in stress to your circulatory system. With sleep apnea, instead of feeling rested and revitalized after sleep, your body feels like it has run a marathon.
OSA causes harmful short-term and long-term effects to your mental and physical health, and can impact your mood, your memory, your alertness, your performance at work or school, your relationships, and your quality of life. Untreated OSA can cause troubling symptoms, such as migraine-like headaches and heartburn or acid reflux. More importantly, untreated OSA can cause or worsen other chronic diseases, like hypertension, heart disease, diabetes, depression, stroke, erectile dysfunction, obesity, and dementia or Alzheimer’s Disease.
Left untreated, OSA significantly increases the risk of having serious or fatal auto accidents, as the result of daytime sleepiness. Untreated OSA has also been shown to significantly increase your risk of early death.
The most common symptoms are:
- Loud, frequent snoring
- Choking or gasping for breath during sleep
- Interruptions in breathing while asleep
- Excessive daytime sleepiness
Other commonly reported symptoms include:
- Awaking in the morning with a dry mouth or sore throat
- Awaking in the morning with a headache
- Awaking in the morning already feeling tired – “like I ran a marathon in my sleep”
- Moodiness or irritability
- Waking up frequently during the night to urinate
- Decreased libido and/or impotence
- Difficulty concentrating or remembering
- Fibromyalgia or pain
- Gastroesophageal reflux disease (GERD)
Obstructive sleep apnea is caused by temporary and repeated closing of the upper airway. Normally when you breathe, the oxygen flows in from your nose or mouth through your airway to the lungs. Your airway is a flexible tube; with OSA, your tongue muscles relax in sleep to the point where the tongue collapses back against the airway, pressing it closed and blocking the flow of oxygen. (Illustrations here of open and closed airway)
Think of a garden hose with a kink in it, blocking the flow of water. If this ‘kink” in your airway were to persist, the event would be fatal. But your brain senses that it is not getting enough oxygen and sends an alarm signal, causing you to partially awaken to restart your breathing. Most people with OSA are never aware of the repeated awakenings throughout the night, although spouses or bed partners may hear the gasping or choking sound when these stirrings occur.
Normally the muscles in your throat help to keep the airway open. However, with aging and weight gain, those muscle fibers relax and nerve signals diminish, making it easier for the airway to collapse, particularly when lying flat on your back. Some people are more likely to have OSA because of the shape of their palate, or the size of their neck and/or tonsils. People who are overweight may also have fatty tissue built up around the airway, which can press it closed during sleep.
When you sleep, your breathing patterns are different than when you are awake, and the size of the airway gets smaller. Also, the muscles that support the tongue relax during sleep — if you are lying flat, it is more likely that your airway will close up. Several factors may contribute to the airway collapse, like age, weight gain, neck size, and your body type.
Snoring is caused by the soft palate vibrating as air is forced to pass through a narrowed airway. Think of snoring as being like the sound of rattling water pipes in an old building. The pipes build up mineral deposits over the years, which narrow the opening, and water being forced through the smaller opening causes the pipes to vibrate.
Snoring can be a warning sign for OSA, since nearly all people who have OSA also snore, often loudly and frequently. However, there are many people who snore who don’t have OSA.
A lot of people don’t know if they snore … or if they do, won’t know if their snoring is harmless (just snoring) or harmful and potentially dangerous (OSA).
Now, with DROWZLE, there is an easy way to record and analyze your sleep breathing patterns, like snoring, or the times that you stop breathing, or stir from sleep, gasping for breath. Analysis of the patterns can tell you whether your snoring is harmless or harmful.
Restful, uninterrupted sleep is vital to your health. In fact, recent studies in neuroscience have concluded that the single most important factor in maintaining a healthy brain and body, particularly as we age, is getting enough restful sleep.
Measuring your sleep breathing health can tell you a lot about how restful your sleep is, and how alert and productive you can expect to be during the day. Regular monitoring of your sleep breathing patterns can tell you if your sleep breathing is stable, getting better or getting worse.
Repeated airway collapses during sleep result in less oxygen reaching the blood stream. Your body reacts to the reduced oxygen by releasing adrenaline and other hormones into the blood to “jolt” you awake, for survival. As you start to awaken, you gasp to restore breath, and the airway opens up again.
In people with OSA, this series of events happens many times per hour, throughout the night. If you have severe OSA, it can occur hundreds of times per night. Unfortunately, the repeated release of these hormones has negative effects over time.
The partial awakenings triggered by adrenaline interrupt the normal sleep pattern, so that sleep is fragmented and restless. People with OSA wake up tired and are often sleepy throughout the day, having a tendency to fall asleep at work or in the car. The long term effects of non-restful sleep can cause irritability and can slow down thinking. People with OSA are more likely to be forgetful and/or depressed.
You may have heard about the “fight or flight” response for survival: when facing a predator, we must either run or prepare for battle. Adrenaline causes the heart to beat more rapidly and forcefully, to prepare for fight or flight. It also makes the blood more likely to clot, a good thing if injured, and stimulates the inflammatory cell response, in case there is a wound.
However, when the release of adrenaline is sustained over time, as it is in OSA, it can be detrimental. Adrenaline raises the heart rate and blood pressure; over time this increases the risk of a heart attack, stroke, or heart failure. The effect on clotting also increases the risk for heart attack and stroke. Inflammation can alter the lining of blood vessels and promote atherosclerosis, which leads to hardening and narrowing of the arteries, which can lead to blockage, again resulting in heart attack or stroke.
Adrenaline also causes an increase in another hormone — cortisol – a substance that increases the appetite and blood sugar, so excess adrenalin can make weight gain and diabetes more likely.
Studies have also shown that the repeated episodes of lowered blood oxygen that occur during OSA increase the risk of diabetes by altering the body’s response to its own natural insulin.
Exercise and weight reduction are important in preventing and treating type II diabetes – the form of diabetes that affects adults, especially those who are overweight. But it’s not always easy for people to exercise regularly and this becomes even more difficult in people with OSA, when they already feel tired or fatigued. Therefore people with OSA are prone to be less active and gain more weight, creating a vicious cycle of worsening disease.
In addition to the impact of OSA on high blood pressure, heart failure, diabetes, and weight gain, recent studies have shown that untreated OSA and poor sleep quality are linked to a greater risk of developing dementia and Alzheimer’s disease as people age.
Thus, OSA negatively impacts your quality of life and can cause or worsen other serious diseases. The good news is that if OSA is recognized and treated, this cycle can be broken or avoided.
Approximately 40 million American adults have symptoms of OSA, and it is estimated that about 25 million of those have moderate-to-severe OSA, needing treatment.
On average, OSA affects about 1 in 3 men and 1 in 6 women in the age range of 30 to 70. Moderate-to-severe OSA, which is the most important to detect and treat, affects about 15% of all men and 5% of all women, but those odds increase as we grow older and gain weight.
There is a high likelihood that people with the following chronic conditions will also have OSA:
• Hypertension (high blood pressure)
• Congestive Heart Failure
• Atrial fibrillation (cardiac arrhythmia)
• Erectile dysfunction
The DROWZLE app includes some simple questionnaires that can help you determine your risk for OSA and can help you keep track of your symptoms and their severity, and whether they are changing. This information can help to inform your doctor, along with a clinical examination.
Confirming a diagnosis of OSA used to require an overnight stay in a sleep lab, however new technologies now allow you to test in the privacy and comfort of your home, and in your natural sleeping environment.
The DROWZLE app provides the easiest, most comfortable and reassuring means of evaluating your sleep breathing patterns, to determine if you are at risk for OSA. Regular use of DROWZLE will help you monitor whether your risk of OSA is improving or getting worse over time, and it can alert you when you need to consult a physician.
Medical studies have shown that treatments for OSA can help you get restful sleep, stay awake and focused though out the day, increase your energy, improve your mood, help your heart work better, and lower your blood pressure. If you have diabetes, being treated for OSA can also lower your Hemoglobin A1c.
One of the most effective and widely-used treatments is Continuous Positive Airway Pressure or CPAP, which helps you breathe more easily during sleep by increasing air pressure in the throat, so the airway stays open. CPAP also reduces or eliminates snoring, so the bed partner gets more restful sleep as well. People who use CPAP report having more energy and ability to focus during the day, as well as a significant reduction in their symptoms.
People often have the misconception that CPAP requires a large, noisy machine that is uncomfortable to use. In reality, CPAP technology has made numerous advances in recent years, so that modern bedside machines are small, silent, unobtrusive devices with much more comfortable air delivery systems than in the past. There are even tiny, battery-powered, ultra- portable versions that can easily fit in your overnight bag for travel.
For people who cannot tolerate CPAP, or those who prefer other options, there are also oral appliances that can improve sleep breathing and reduce symptoms of OSA. Oral appliances are custom fitted by a dentist. Worn nightly, these devices work like a sports mouth guard or a retainer, to align and support the jaw and/or the tongue in a forward position that helps to keep the airway open during sleep.
For a few individuals whose OSA is caused by jaw size or position abnormalities, or irregularities in the facial bone structure, surgery has been found to provide a curative solution for OSA.