Sleep Apnea Treatment in Delhi, India

There are three main types of sleep apnea:

Obstructive Sleep Apnea (OSA)

Obstructive sleep apnea (OSA) is the most common type of sleep apnea. It occurs when the airway becomes blocked during sleep, preventing air from flowing freely to the lungs. This can happen because the muscles in the throat relax and collapse, or because the tongue or other structures in the airway become enlarged or obstruct the passage of air. OSA is characterised by loud snoring, gasping for air during sleep, and daytime fatigue.

Central Sleep Apnea (CSA)

Central sleep apnea (CSA) occurs when the brain fails to send signals to the muscles that control breathing. This can happen because of problems with the brain's breathing control centre, or because of damage to the nerves that carry signals from the brain to the muscles. CSA is characterised by periods of interrupted breathing during sleep, without the loud snoring that is common in OSA.

Complex Sleep Apnea Syndrome

Complex sleep apnea syndrome is a combination of OSA and CSA. This means that the person experiences both types of breathing interruptions during sleep. Complex sleep apnea syndrome is often more severe than either OSA or CSA alone.

Understanding the risk factors for Obstructive Sleep Apnea (OSA) is crucial in identifying potential vulnerabilities. Here are some key factors that influence the likelihood of developing OSA.

Obstructive Sleep Apnea (Osa) Risk Factors:

• Age: The risk of OSA increases with age, particularly after age 40.
• Gender: Men are more likely to develop OSA than women.
• Weight: Increased body fat, particularly around the upper airway, can narrow the passageway and increase the risk of collapse during sleep.
• Large neck circumference: A larger neck circumference indicates more tissue around the airway, increasing the likelihood of obstruction.
• Narrow airway: Certain structural features like a small jaw, recessed chin, or enlarged tongue can contribute to airway narrowing during sleep.
• Family history of OSA: OSA tends to run in families, suggesting a genetic predisposition.
• Smoking: Smoking can irritate and inflame the upper airway, making it more prone to collapse during sleep.
• Excessive alcohol consumption: Excessive alcohol consumption can relax the muscles in the throat, increasing the risk of airway obstruction.
• Underlying medical conditions: Conditions such as congestive heart failure, high blood pressure, stroke, hypothyroidism, and acromegaly can increase the risk of OSA.

Central Sleep Apnea (Csa) Risk Factors:

• Neurological disorders: Conditions like Parkinson's disease, Alzheimer's disease, and multiple sclerosis can increase the risk of CSA.
• Heart failure: Congestive heart failure can disrupt the signals that control breathing during sleep, leading to CSA episodes.
• Stroke: A history of stroke, can damage the areas of the brain responsible for breathing control, increasing the risk of CSA.
• Medications: Certain medications, such as opioids, sedatives, and muscle relaxants, can suppress breathing and contribute to CSA.
• Altitude: Living at high altitudes can reduce oxygen levels in the blood, which can trigger CSA episodes.
• Weight: While not as common a risk factor for CSA as OSA, obesity can still increase the risk of CSA, particularly in individuals with other risk factors.

Obstructive and central sleep apneas share similar symptoms, making it challenging to distinguish between the two types. The most common symptoms of both obstructive and central sleep apneas include:

• Hypersomnia (Excessive daytime sleepiness): This is the most common symptom of sleep apnea. People with sleep apnea often feel tired even after getting a full night's sleep. They may have difficulty concentrating, staying awake, and remembering things.
• Loud snoring: Snoring is a common symptom of sleep apnea, but not everyone who snores has sleep apnea. However, loud snoring is a risk factor for sleep apnea.
• Observed episodes of stopped breathing during sleep: If you have sleep apnea, your partner or roommate may notice that you stop breathing for short periods of time during sleep.
• Waking up with a dry mouth: People with sleep apnea often wake up with a dry mouth or throat because they have been breathing through their mouth during sleep.
• Waking up with a headache: Some people with sleep apnea wake up with a headache that goes away later in the day.
• Irritability or mood changes: Sleep apnea can lead to irritability, mood swings, and depression.
• Reduced libido: Sleep apnea can also lead to a reduced libido and sexual function in both men and women.

If an individual is experiencing any of the symptoms of sleep apnea, it is important to see a sleep apnea doctor to get a diagnosis and treatment.

The complications of sleep apnea depend upon the type of sleep apnea. Here’s a quick overview of the complications of both obstructive and central sleep apnea.

Complications of Obstructive Sleep Apnea 

• Fatigue: OSA disrupts normal sleep, leading to insufficient rest and persistent fatigue during waking hours.
• Difficulty in concentrating: Sleep interruptions hinder cognitive function, resulting in challenges with concentration and focus.
• High blood pressure or cardiac issues: Irregular breathing patterns strain the cardiovascular system, leading to increased blood pressure and cardiac concerns.
• High risk of heart attack, stroke, and irregular heartbeats: OSA contributes to oxygen deprivation, elevating the risk of severe cardiovascular events.
• Type 2 diabetes susceptibility: Sleep apnea is linked to insulin resistance, increasing the likelihood of developing Type 2 diabetes.
• Metabolic syndrome implications: OSA is associated with metabolic disturbances, contributing to the development of metabolic syndrome.
• Issues arising from medications and surgical procedures: Breathing problems associated with OSA may complicate the use of certain medications and pose risks during surgery.
• Liver problems: OSA is linked to abnormal liver function and signs of nonalcoholic fatty liver disease.
• Sleep-deprivation of partner: Loud snoring, a common OSA symptom, can disrupt the sleep of the affected individual’s partner.

Complications of Central Sleep Apnea 

• Fatigue: CSA disrupts the normal sleep cycle, causing ongoing fatigue and daytime drowsiness.
• Concentration issues: Sleep interruptions in CSA can result in difficulty concentrating and impaired cognitive function.
• Heart problems: Sudden drops in blood oxygen levels during CSA episodes can adversely affect heart health.
• Increased risk of irregular heartbeats: Multiple episodes of low blood oxygen, known as hypoxia, worsen prognosis and heighten the risk of irregular heart rhythms.

Diagnosing sleep apnea involves a comprehensive evaluation of sleep patterns, symptoms, and often requires specialised testing. Here's an overview of the key steps in the diagnostic process:

Clinical Assessment

• Medical history: Healthcare providers review the patient's medical history, focusing on sleep-related symptoms, daytime fatigue, and observed breathing irregularities.
• Symptom evaluation: Common signs, such as loud snoring, choking, or gasping during sleep, are assessed to identify potential indicators of sleep apnea.

Sleep Studies

• Polysomnography (PSG): A sleep study conducted in a sleep centre monitors various parameters, including brain activity, eye movement, heart rate, respiratory effort, air flow, and oxygen levels, providing a comprehensive analysis of sleep patterns.
• Home sleep apnea testing (HSAT): In some cases, portable devices allow for sleep apnea assessment in the comfort of one's home, focusing on key indicators like airflow, breathing effort, and blood oxygen levels.

Assessment of Daytime Functioning

Epworth sleepiness scale: Patients may be asked to self-assess their daytime sleepiness using a standardised scale, providing additional insights into the impact of sleep disturbances on daily life.

Physical Examination

Upper Airway Evaluation: An examination of the upper airway helps identify anatomical factors contributing to sleep apnea, such as enlarged tonsils, nasal congestion, or a deviated septum.

Screening Tools

Questionnaires: Specific questionnaires may be employed to gather information about sleep habits, lifestyle factors, and the severity of symptoms.

Obstructive Sleep Apnea Treatment

Effective management of Obstructive Sleep Apnea (OSA) often involves a combination of lifestyle modifications, medical interventions, and, in certain cases, surgical procedures. Here's an overview of the treatment options available:

Lifestyle Modifications

• Weight management: Losing excess weight can significantly reduce the severity of OSA, as it decreases the pressure on the airway.
• Positional therapy: Sleeping in certain positions may help minimise airway obstruction. Avoiding sleeping on the back is commonly recommended.

Continuous Positive Airway Pressure (Cpap)

CPAP Therapy: The gold standard for OSA treatment, CPAP involves using a machine that delivers a continuous stream of air through a mask, preventing airway collapse during sleep.

Oral Appliances

Mandibular advancement devices (MADs): These dental appliances help reposition the lower jaw and tongue to keep the airway open.

Surgery

• Uvulopalatopharyngoplasty (UPPP): Surgical removal of excess tissue from the throat may be recommended.
• Genioglossus advancement (GA): Repositioning the tongue attachment to prevent airway collapse.

Inspire Therapy

Hypoglossal nerve stimulation: A surgically implanted device stimulates the hypoglossal nerve to prevent airway obstruction during sleep.

Central Sleep Apnea Treatment

The treatment approach for Central Sleep Apnea (CSA) targets the underlying causes and aims to restore normal respiratory patterns. Here are key components of CSA management:

Positive Airway Pressure

Adaptive servo-ventilation (ASV): A specialised form of positive airway pressure that adjusts ventilation to the patient's needs, providing support during both inhalation and exhalation.

Oxygen Therapy

Supplemental oxygen: Administering additional oxygen can help alleviate CSA symptoms, particularly in cases associated with chronic lung diseases.

Treating Underlying Conditions

Cardiac treatment: Managing heart conditions contributing to CSA, such as congestive heart failure, can be crucial in improving respiratory function.

Medications

Acetazolamide: A diuretic that can stimulate breathing and improve respiratory control.

Adaptive Support Ventilation (ASV)

Bi-Level Positive Airway Pressure (BiPAP): Providing varying levels of pressure support to assist with breathing.

Lifestyle Modifications

Avoiding exacerbating factors: Identifying and addressing lifestyle factors or medications that may worsen CSA.

If you have any of the symptoms of sleep apnea, it is important to see a doctor to get diagnosed and treated.

Q. Is sleep apnea a serious condition?

Yes, sleep apnea is a serious condition that can have a number of negative health consequences if left untreated. These include:

• High blood pressure: Sleep apnea can increase your risk of developing high blood pressure, which can lead to heart disease, stroke, and kidney problems.
• Heart disease: Sleep apnea can increase your risk of developing heart disease, including heart attack and congestive heart failure.
• Stroke: Sleep apnea can increase your risk of stroke, which is a serious condition that can cause permanent disability or death.
• Type 2 diabetes: Sleep apnea can increase your risk of developing type 2 diabetes, a chronic condition that affects how your body regulates blood sugar.
• Other health problems: Sleep apnea can also increase your risk of developing other health problems, such as obesity, depression, and cognitive impairment.

Q. Is there a cure for sleep apnea?

There is no cure for sleep apnea, but there are a number of effective treatments available. These include:

• Lifestyle changes: Making lifestyle changes, such as losing weight, quitting smoking, and avoiding alcohol before bed, can help to improve sleep apnea symptoms.
• Continuous positive airway pressure (CPAP): CPAP is a machine that delivers a continuous flow of air through your nose or mouth while you sleep to keep your airway open.
• Oral appliances: Oral appliances are devices that fit in your mouth and help to keep your airway open while you sleep.
• Surgery: Surgery may be an option for people with severe sleep apnea that does not respond to other treatments.

Q. What triggers sleep apnea?

A: Sleep apnea is triggered by a collapse of the airway during sleep. This can be caused by a number of factors, including:

• Excess weight: Obesity is a major risk factor for sleep apnea because it can cause fat to accumulate around the upper airway.
• Narrow airway: People with a narrow airway are more likely to develop sleep apnea because there is less space for air to flow during sleep.
• Enlarged tonsils or adenoids: Enlarged tonsils or adenoids can block the airway and increase the risk of sleep apnea.
• Smoking: Smoking can irritate and inflame the airway, making it more likely to collapse during sleep.
• Alcohol: Alcohol can relax the muscles in the throat, making it more likely to collapse during sleep.

Q. How does sleep apnea disrupt the sleep cycle?

Sleep apnea disrupts the sleep cycle by repeatedly interrupting the flow of air to the lungs. This can cause you to wake up frequently throughout the night, making it difficult to get a good night's sleep.

Q. What is a good alternative to a CPAP?

There are a number of alternative treatments to CPAP available, including:

• Oral appliances: Oral appliances are devices that fit in your mouth and help to keep your airway open while you sleep.

Surgery: Surgery may be an option for people with severe sleep apnea that does not respond to other treatments.

Q. How can I reduce my risk or prevent sleep apnea?

There are a number of things you can do to reduce your risk of developing sleep apnea or prevent it from getting worse, including:

• Losing weight: Losing weight can help to reduce the amount of fat around your upper airway.
• Quitting smoking: Smoking irritates and inflames the airway, making it more likely to collapse during sleep.
• Avoiding alcohol: Alcohol can relax the muscles in the throat, making it more likely to collapse during sleep.
• Getting regular exercise: Regular exercise can help to improve sleep quality and reduce the risk of sleep apnea.
• Sleeping on the side: Sleeping on the side can help to keep your airway open.

Q. Is sleep apnea an ENT problem?

Sleep apnea is not an ENT problem in the traditional sense, but ENT doctors may be involved in the diagnosis and treatment of sleep apnea. This is because sleep apnea can be caused by structural abnormalities in the nose, throat, and mouth. ENT doctors can also provide treatment for sleep apnea, such as oral appliances and surgery.

Q. Is sleep apnea a neurological problem?

Sleep apnea is not primarily a neurological problem, but neurologists may be involved in the diagnosis and treatment of sleep apnea. This is because sleep apnea can have neurological consequences, such as cognitive impairment and depression. Neurologists can also help to rule out other neurological conditions that may be causing sleep problems.

Q. How much alcohol is it safe to drink before bed if I have sleep apnea?

It is best to avoid alcohol altogether if you have sleep apnea. Alcohol can relax the muscles in your throat, making it more likely for your airway to collapse during sleep. This can worsen your sleep apnea symptoms and make it more difficult to breathe at night.

Even small amounts of alcohol can have a significant impact on sleep apnea. A study published in the journal "Chest" found that even one drink can increase the number of apneas per hour by up to 50%.

If you absolutely must drink alcohol, do so in moderation and avoid drinking within three hours of bedtime. This will give your body time to metabolise the alcohol and reduce the risk of it worsening your sleep apnea symptoms.

Q. Is using a CPAP machine uncomfortable? Are there any tips for making it more tolerable?

CPAP machines can be uncomfortable at first, but there are a number of things you can do to make them more tolerable. Here are a few tips:

• Start slowly: Don't try to wear your CPAP machine for the whole night right away. Start by wearing it for a few hours each night and gradually increase the amount of time you wear it until you can wear it for the whole night.
• Adjust the CPAP mask: Make sure your CPAP mask is fitted properly. A well-fitting mask will be more comfortable and less likely to leak.
• Use a humidifier: A humidifier can add moisture to the air and make it more comfortable to breathe.
• Try different types of masks: There are many different types of CPAP masks available. Experiment with different types to find one that is comfortable for you.
• Use a chin strap: A chin strap can help to keep your mouth closed while you sleep and prevent you from breathing through your mouth.
• Be patient: It takes time to get used to wearing a CPAP machine. Be patient and give yourself time to adjust.

Q. I'm worried about snoring and sleep apnea affecting my partner's sleep. What can I do to minimise the disruption?

Snoring and sleep apnea can be very disruptive to your partner's sleep. Here are a few things you can do to minimise the disruption:

• Talk to your partner: Let your partner know that you are concerned about your snoring and sleep apnea and that you are taking steps to address it.
• Sleep in separate rooms: If your snoring or sleep apnea is severely disrupting your partner's sleep, consider sleeping in separate rooms.
• Use a white noise machine: A white noise machine can help to block out the sound of snoring.
• Encourage your partner to wear earplugs: Earplugs can also help to block out the sound of snoring.
• Seek treatment: If your snoring or sleep apnea is severe, seek treatment from a doctor. Treatment can help to reduce the severity of your snoring and sleep apnea and improve your partner's sleep.

Q. How can I manage my energy levels and daytime fatigue if I have sleep apnea?

Sleep apnea can make it difficult to get a good night's sleep, which can lead to daytime fatigue. Here are a few things you can do to manage your energy levels and daytime fatigue:

• Stick to a regular sleep schedule: Go to bed and wake up at the same time each day, even on weekends.
• Get enough sleep: Aim for 7-8 hours of sleep each night.
• Avoid caffeine and alcohol: Caffeine and alcohol can interfere with sleep.
• Get regular exercise: Regular exercise can help to improve sleep quality.
• Take naps: If you feel tired during the day, take a short nap.
• Talk to your doctor: If you are experiencing excessive daytime fatigue, talk to your doctor. They can help you rule out other medical conditions that may be causing your fatigue.

Q. What are the risks of pregnant women developing sleep apnea and what can they do to prevent it?

Pregnant women face an increased risk of developing sleep apnea due to hormonal changes and weight gain. To help prevent it, maintaining a healthy weight, sleeping on the left side, and using pillows for support can be beneficial. Regular prenatal check-ups and discussing sleep concerns with healthcare providers are crucial for monitoring and addressing any potential issues.

Reviewed by Dr. Ravinder Gera, Senior Director and Head of Department, Department of ENT on 30-Jan-2024.