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Sleep Apnea
Sleep Apnea is a disease that must be treated. Although CPAP is considered the gold standard treatment, you still have other therapy options to treat your sleep apnea if you cannot accept or adhere to CPAP.
2-4 times higher risk of AFib in people with sleep apnea
2 times higher risk of stroke in people with severe, untreated sleep apnea
*So, if you are experiencing symptoms of sleep apnea and have tried but failed to adapt or accept CPAP treatment, you may consider trying other solutions to restore yourself to healthy sleep. Among them, oral appliance, or positional therapy, are also very worthy of consideration. If your sleep apnea is caused by a serious structural problem, you may need sleep apnea surgery.
2 times higher risk of dying from heart diseases for severe, untreated sleep apnea
01 | About Sleep Apnea
02 | Types of Sleep Apnea
03 | Is Sleep Apnea Common in HK?
04 | Symptoms of Sleep Apnea
05 | Risk Factors of Sleep Apnea
06 | How Sleep Apnea Affects Health?
07 | Causes of Sleep Apnea
08 | How to Diagnose Sleep Apnea?
09 | Sleep Apnea Treatment Options
10 | Lifestyle Changes to Improve OSA
About Sleep Apnea
Sleep apnea is a kind of sleep breathing disorders. If you don’t get proper treatment for a long time, the organs will increase the risk of failure due to not getting enough oxygen every night. It will also increase the risk of having fatal chronic diseases, such as hypertension, diabetes and stroke. Therefore, sleep apnea is a common sleep disorder that must be treated as soon as possible.
Patients with sleep apnea would repeatedly stop breathing during their sleep, the duration of each apnea can be as long as one minute, and the numbers of apnea can be as many as hundred times throughout the night! If you observe the sleep of a patient with sleep apnea, you will find that the patient making gasping, and the brain would also be awakened due to lack of oxygen. Until the patient's breathing returns to normal, he/she needs to slowly re-enter deep sleep from the light sleep that was almost awakened. When this happens every hour during sleep, it will seriously affect your health. This is because the deep sleep that helps the body repair is constantly being destroyed, and often return to light sleep shortly after entering deep sleep because of apnea, which cause the patient to have some symptoms, such as excessive daytime sleepiness, difficulty in concentration and poor memory.
According to the guideline of the American Academy of Sleep Medicine (AASM), apnea during sleep that lasts for 10 seconds or more is regarded as one apnea, and 5 or more apneas per hour are defined as sleep apnea. The severity of sleep apnea is based on the number of apnea hypopnea index (AHI). 5-10 times per hour is “mild”, 15-30 times per hour is “moderate”, and 30 times or above per hour is “severe”.
Types of Sleep Apnea
Obstructive Sleep Apnea
Up to 90% of patients with sleep apnea are obstructive sleep apnea. The cause of obstructive sleep apnea is that when the patient is sleeping, the muscles and soft tissues around the throat relax and collapse and block the airway, which narrows the airway and causes apnea.
Central Sleep Apnea
Different from obstructive sleep apnea, the airway of patients with central sleep apnea have not be blocked. Their apnea issue is caused by the damage of the brain due to the problems of stroke or head trauma, which causes the brain and the muscles that control breathing fail to function normally, and the brain is unable to give breathing instructions to the body, resulting in shortness of breath and/or apnea.
Mixed Sleep Apnea
As the name suggests, when a patient has both obstructive and central sleep apnea, it is called mixed sleep apnea.
Is Sleep Apnea
Common in Hong Kong?
According to the data from the Hong Kong Government, there are more than 200,000 people in Hong Kong suffering from sleep apnea. Among them, middle-aged men are more common, and people with obesity are also at high risk. In addition, a study conducted jointly by Australia and Hong Kong found that Asians are generally at higher risk of suffering from sleep apnea than whites, which is related to the facial bone structure of Asians. Even though the BMI of the patients participating in the study is similar, because the jawbone of Asian patients is relatively short, the symptoms of sleep apnea are more severe than whites.
Symptoms of Sleep Apnea
People with sleep apnea usually have some of the following symptoms.
During Sleep:
Loud and intermittent snoring.
Difficult to breathe, even necessary to use mouth to breathe.
Episodes of stop breathing have been observed by family.
Frequent need to wake up to urinate (Nocturia).
After Waking Up:
Dry mouth or headache.
Often feel tired, even have excessive sleepiness.
Often fall asleep unconsciously.
Slow reaction and find it hard to concentrate.
Irritability and have mood swings.
Cognitive decline.
Risk Factors of Sleep Apnea
Elderly
(50 years old or above)
Obesity or
Large Neck Circumference
Short
Chin or Jaw
Enlarged Tonsils
Suffer from
High Blood Pressure
How Sleep Apnea
Affects Your Health?
When suffering from sleep apnea, the “cumulative effect” will occur. If the patient does not receive proper treatment for a long time, the risk of suffering from other serious and fetal diseases will increase, and even worsen the original health problems.
30-40%
Hypertension
Patients have
Obstructive Sleep Apnea
85%
Resistant
Hypertension
Patients have Sleep Apnea
7 out of 10 patients with
Type 2 Diabetes
have Obstructive Sleep Apnea
2X higher risk of
Stroke
2X higher risk of dying from
Heart Diseases
2-4X higher risk of
Atrial Fibrillation
Did You Know
Since one of the symptoms of Sleep Apnea is excessive daytime sleepiness, studies have found:
2.5 times
as likely to be
the driver in a
Motor Vehicle
Accident
When CPAP
Treatment
was used, the risk
was reduced by
70%
Causes of Sleep Apnea
Sleep apnea is caused by abnormalities in the upper airway such as the nose and throat, or the muscles or soft tissues that support the upper airway become loose, causing them to collapse under the influence of gravity when lying down, blocking the airway and causing brief pauses in breathing. If you are detail-oriented, you will understand why people with sleep apnea almost all have serious snoring problems. It is because the obstructed airway is also one of the causes of snoring. When the inhaled air hits the collapsed throat muscles or soft tissues and vibrates, snoring will occur. Therefore, the more severe the obstruction of the airway, the greater the volume of snoring, and the more severe of apnea. This also explains why snoring is one of the symptoms of sleep apnea.
Normal Breathing
Air can smoothly pass through the airway into the lungs.
Normal People Sleeping
Just like normal breathing, the inhaled air will pass through the turbinates, uvula, and tongue. Even though the muscles will relax during sleep and be affected by gravity, there is still enough space for the inhaled air enter the lungs through the airway.
Sleep Apnea Patients Sleeping
Due to the relaxation of the soft tissues and muscles in the airway and the influence of gravity, the inhaled air cannot pass through smoothly. At least one part of the upper airway is blocked (the green dot), causing apnea and/or hypopnea.
How to Diagnose Sleep Apnea?
Doctors will generally evaluate your sleep through interview, and may ask you to complete two self-assessments: STOP BANG and ESS. The questions in the assessments are all designed for the symptoms of sleep apnea, which is helpful for the doctor’s initial evaluation about your risk of sleep apnea. If the initial evaluation is medium to high risk, the doctor will generally recommend you to take a sleep test, which will keep measuring and recording your sleep throughout the night. You can get objective data, including: Apnea-Hypopnea Index (AHI), the duration of each apnea, blood oxygen level, heart rate, etc., in order to know whether you are suffering from sleep apnea, and to provide you with suitable treatment.
Sleep Apnea Treatment Options
At present, there is no treatment that can completely cure sleep apnea, the situation is the same as the treatment of myopia. Patients with myopia must wear glasses, while patients with sleep apnea must wear CPAP or oral appliance. In addition, even if you choose the surgical treatment, it is not once and for all, the soft tissues in the airway will still have a chance to regenerate or/and relax again in the future, causing relapse of sleep apnea.
Then, everyone may have the same question, if I undergo surgery for sleep apnea, will it be completely cured? The answer is the same as vision correction surgery. Even after vision correction surgery, when the corneal aberration changes again after the surgery, you may relapse into problems such as myopia, astigmatism, or hyperopia; therefore, even if you choose sleep apnea surgery, It is not a once and for all solution. It may still recur in the future due to the relaxation or proliferation of the tissues in the respiratory tract, reappearing the same causes of sleep apnea before the surgery.
No matter which sleep apnea treatment option you end up choosing, remember that this is a sleep disorder that must be treated. Receiving treatment is definitely better than having no treatment at all. Even if the solution you choose can only achieve a mild improvement in sleep apnea, it is still better than receiving no treatment at all. Sleep apnea treatment has huge benefits for your health and daily life with no harm. Moreover, medicine continues to advance with the times. There are now many effective sleep apnea improvement options, which are no longer limited to CPAP or sleep apnea surgery. Therefore, do not give up treatment easily just because one of the sleep apnea improvement options you have tried is not suit you well. If the symptoms of sleep apnea are not detected early and have not received any treatment or preformed any sleep apnea surgery, the risk of high blood pressure, fatal cardiovascular and chronic diseases will increase in the long run, so it should never be taken lightly.
(A) CPAP Therapy
CPAP is the gold standard treatment suitable for patients with mild to severe sleep apnea. It can effectively treat the problem of airway obstruction. For some patients, it can significantly improve the symptoms of sleep apnea, such as frequent nocturia and daytime sleepiness. The principle is based on the root cause of sleep apnea, using air pressure to open the obstructed airway, so that the patient’s breathing can be restored, so as to achieve the goal of improving the symptoms of sleep apnea.
(B) Oral Appliance Therapy
In general, oral appliance therapy is only suitable for patients with mild sleep apnea. For patients with moderate to severe sleep apnea, the therapeutic effect is usually not significant. In terms of use, the oral appliance therapy is relatively simple and convenient. You only need to correctly place the mouthpiece on the upper and lower teeth, which will pull the lower jaw slightly and effectively maintain the airway open, in order to improve the symptoms of sleep apnea.
(C) Positional Therapy
Due to gravity, the tongue, uvula and soft palate will slide back to the back of the throat when we sleeping on our backs, the airway may be blocked and increasing the chance of apnea. Therefore, by using the sleep apnea treatment products, such as body pillow and vibro-tactile sleep belt, they will help patients maintain an ideal side sleeping position throughout the night and reduce apnea caused by sleeping on their backs.
(D) Surgical Treatments
In some patients, sleep apnea is caused by structural abnormalities in the nose or throat. In this case, you can choose to receive related sleep apnea surgery as one of your treatment methods. Sleep apnea surgery will mainly remove or correct the tissues or facial bones that obstructed the airway, so that the airway can be restored to unblock, so as to improve the symptoms of sleep apnea. However, the removed tissue may be at risk of regeneration in the future, and sleep apnea will return again.
Lifestyle Changes
To Improve Sleep Apnea
(A) Lose Excess Weight
The fat accumulated around the neck of obese people narrows the airway. Also, when lying down and sleeping, the body muscles will relax, the fat and the relaxed muscles would be affected by the force of gravity, causing the airway to be blocked and increase the risk of sleep apnea. Therefore, weight loss is definitely helpful for improving the symptoms of sleep apnea. A study has pointed out that a 10% weight loss predicted a 26% decrease in AHI. For CPAP users, it means that the air pressure of the CPAP may also be reduced due to successful weight loss, which means CPAP treatment will become relatively comfortable.
(B) Alter Your Sleep Position
When sleeping on the back, the soft tissues of the airway will collapse under the influence of gravity. The more severe the obstruction of the airway, the more severe the symptoms of sleep apnea. Therefore, replacing sleeping on the back with side sleeping will help achieve the goal of improving sleep apnea. However, it is not easy to rely on personal will to maintain side sleeping during sleep, so many people will choose a body pillow as an aid to reduce the chance of sleeping on the back.
(C) Avoid Alcohol & Smoking
Alcohol will relax the throat muscles, and smoking will cause the soft tissues in the airway become swollen due to irritation. Therefore, the habit of drinking and smoking can make the symptoms of sleep apnea worse. For the sake of health, we should quit drinking and smoking as soon as possible. If you really want to have a drink with family and friends, you should also try to avoid drinking within 3 hours before going to bed to reduce the chance of apnea.
(D) Avoid Certain Medications
Many medicines, such as sleeping pills, can relax the muscles. Therefore, after the diagnosis of sleep apnea, patients should communicate with their doctors to find out if any of the medicines taken daily in the past will exacerbate the problem of sleep apnea, and check if you need to stop taking or use other medicines instead.
Learn more about the symptoms, impacts & treatment of sleep apnea
The information above is for reference only, you should consult your doctor if you have any health concern.
References: [1] Sleep Apnea Hurts Hearts Infographic. American Academy of Sleep Medicine. http://www.sleepeducation.org/docs/infographics/sleep-apnea-hurts-hearts.pdf?sfvrsn=2. Published 2017. [2] Tung P, Anter E. Atrial Fibrillation And Sleep Apnea: Considerations For A Dual Epidemic. J Atr Fibrillation. 2016;8(6):1283. Published 2016 Apr 30. [3] Wang X, Ouyang Y, Wang Z, Zhao G, Liu L, Bi Y. Obstructive sleep apnea and risk of cardiovascular disease and all-cause mortality: a meta-analysis of prospective cohort studies. Int J Cardiol. 2013;169(3):207-214. [4] Fu Y, Xia Y, Yi H, Xu H, Guan J, Yin S. Meta-analysis of all-cause and cardiovascular mortality in obstructive sleep apnea with or without continuous positive airway pressure treatment. Sleep Breath. 2017;21(1):181-189. [5] 消費者委員會：〈睡眠窒息症不容忽視 嚴選呼吸機助改善睡眠質素〉，2016年1月14日。取自https://www.consumer.org.hk/ws_chi/news/press/471/sleep-apnea-breathing-machines.html，2021年3月29日擷取。[6] 青山醫院精神健康學院：〈睡眠窒息症〉，2011年4月第3版。取自https://www3.ha.org.hk/cph/imh/doc/information/publications/1_10.pdf。
About Sleep Apnea - FAQs
1）Can weight loss cure sleep apnea?
Losing weight can improve sleep apnea, but it may not completely cure sleep apnea. Since the cause of sleep apnea is not only because of obesity, therefore, when a patient with sleep apnea loses weight, even if the weight drops significantly, it is difficult for the relaxed muscles and soft tissues in the upper airway to regain firmness. This means they are still at risk of collapsing down and blocking the airway when lying down to sleep. Therefore, medical professionals generally recommend that patients continue to use CPAP after losing weight. However, sleep apnea patients who intend to lose weight should not be giving up. Since losing weight and weight management are always helpful for sleep apnea, and even make the treatment more comfortable, because the air pressure level of CPAP may be reduced after losing weight. When the air pressure is no longer maintain at a high-level during sleep, the CPAP treatment should be more comfortable.
If you are using Fixed CPAP, it is recommended to do a titration and sleep test again after successful weight loss, in order to re-evaluate the severity of your sleep apnea and the CPAP air pressure you need after weight loss. If the test results show that the air pressure you need can be reduced, you need to adjust the setting, and your CPAP therapy will be much more comfortable after lowering the air pressure level.
If you are using Auto CPAP, the air pressure will be automatically adjusted according to your needs, you don’t need to reset the air pressure manually. If you want to know whether the air pressure has been lowered, you will not only feel more comfortable when using CPAP, it will also be shown on the CPAP usage report. Therefore, checking the CPAP usage report regularly will help you better understand your health condition and the treatment effectiveness.
On the other hand, if you gain weight, it is also recommended to do a titration and sleep test again, in order to ensure you are properly treated to improve the symptoms of sleep apnea, such as fatigue, daytime sleepiness and high blood pressure. Of course, it would be great if the weight does not rebound after successful weight loss. As everyone know, keeping your weight under control at all times is good for your health.
2）Can sleep apnea go untreated?
Sleep apnea is a chronic disease that must be treated. If it is not treated, it will not only affect the quality of sleep due to continuous interruption of sleep, but also cause insufficient oxygen to be supplied to various organs of the body. Under the accumulative effect, the load on each organ will continue to increase, and the function of each organ may decline and weaken, increasing the risk of fatal cardiovascular diseases, such as high blood pressure, stroke, diabetes and heart disease, etc. If you already have cardiovascular disease, you are more likely to exacerbate pre-existing health problems. Therefore, sleep apnea must be treated. If you have any doubts about your health, you should consult the healthcare professionals and make an appointment for a sleep test as soon as possible.
3）Can you have sleep apnea without snoring?
Most people with sleep apnea suffer from snoring, which is caused by the collapse of loose muscles or soft tissues in the airway when lying down, narrowing the airway and even causing obstruction. Snoring occurs when the inhaled air hits the muscles or soft tissues that block the airway, which is why most people with sleep apnea have snoring at the same time. But of course, there are exceptions. We have also met many sleep apnea patients who do not have snoring. They may be born with a narrow airway, or because of the facial bone structural problems, such as short chin, deviated nasal septum, etc. These can cause breathing disorders and lead to sleep apnea. However, these conditions do not involve loose muscles or soft tissues, which means no vibration will occur, and snoring will not be caused.
4）Do patients with sleep apnea die in their sleep?
It is extremely rare for patients with sleep apnea to experience sudden death, since patients with sleep apnea are not completely unable to breathe during sleep. Also, our body has a protective mechanism, it will wake up the brain to restore consciousness when it detected there is not enough oxygen in the body, thereby informing the respiratory system to inhale air to ensure all of our organs are well-functioning. However, if sleep apnea patients do not receive any treatment, and the oxygen level of the body is always low, which would greatly increase the load of our heart and cause high blood pressure, even increase the risk of sudden death from stroke or heart disease.
5）Can young and skinny people have sleep apnea?
Sleep apnea is not only associated with individuals who are old and overweight. Even though obese people and men over 50 are generally at higher risk for sleep apnea, it doesn’t mean young people, women or skinny people would not suffer from sleep apnea. First of all, the causes of sleep apnea are not only related to gender, age and weight, which may also be related to the structural problems of our nasal, throat and facial bone. Therefore, if you have deviated nasal septum, enlarged tonsils, large tongue, or short chin, you may also at risk for sleep apnea even you’re young or thin.
6）Is sleep apnea hereditary?
If your sleep apnea is caused by the structural problems such as short chin, large tongue, or enlarged tonsils, and your family members have similar congenital problems, there may be genetic factors involved. In addition to the gold standard treatment – CPAP, patients with mild sleep apnea who are born with a short chin can also try oral appliance to pull the lower jaw forward to open the narrow airway. Besides, if you have large tongue or enlarged tonsils, you can consult medical professional whether surgery is an appropriate sleep apnea treatment option for you.
