Understanding and Treating Different Types of Sleep Apnea

Quick answer: Use this guide for education and for preparing questions for your clinician. Sleep-apnea symptoms, diagnosis, PAP settings, and treatment decisions should be reviewed with a qualified healthcare professional.

I. Introduction to Sleep Apnea

Sleep apnea causes repeated breathing interruptions during sleep and can affect daytime alertness and health. This guide explains obstructive, central, and treatment-emergent sleep apnea, along with questions to discuss with your sleep clinician.

It will also cover their causes, symptoms, and treatment options.

II. Obstructive Sleep Apnea (OSA)

1. Definition

• OSA is the most prevalent type of sleep apnea. It occurs when the soft tissues in the mouth and throat relax and expand during sleep, blocking the airway. This blockage stops air from getting into the lungs. Then, the blood oxygen levels go down. As a result, the person wakes up for a short time, often gasping or choking for air.

This cycle repeats throughout the night, disrupting normal sleep patterns and preventing restful sleep.

2. Symptoms

• Daytime sleepiness and fatigue
• Loud snoring that can be heard in adjacent rooms
• Episodes of falling asleep during quiet activities like watching TV or reading

3. Risk Factors

• Obesity: Excess weight can put pressure on the airway, increasing the likelihood of blockage.
• Some people are born with a naturally narrow throat, which predisposes them to obstructive sleep apnea (OSA).
• Enlarged tonsils or adenoids: These can obstruct the airway, especially in children.

4. Classification and Measurement

For adults, commonly used AHI categories are mild (5 to fewer than 15 events per hour), moderate (15 to fewer than 30), and severe (30 or more). A clinician interprets these numbers alongside symptoms and other findings; a machine-reported AHI is not a complete measure of sleep quality.

5. Treatment

• CPAP Therapy: The most common treatment is using a continuous positive airway pressure (CPAP) machine. It delivers a constant stream of air through a mask, keeping the airway open and allowing for normal breathing during sleep.
• Surgery: In severe cases or when other treatments are ineffective, surgical options may be considered. Procedures such as uvulopalatopharyngoplasty (UPPP), tonsillectomy, maxillomandibular advancement (MMA), and radiofrequency ablation (RFA) can be performed to correct the anatomical issues contributing to OSA.

III. Central Sleep Apnea (CSA)

1. Definition

CSA is less common than OSA and is caused by problems related to the brain's control of breathing. In CSA, the brain fails to send the appropriate signals to initiate breathing, resulting in pauses in respiration.

2. Symptoms

• Sudden stoppage of breathing during sleep
• Shortness of breath that improves when sitting up
• Nighttime chest pain — chest pain with sudden or severe breathing difficulty needs emergency assessment, not only a routine sleep-apnea appointment
• Difficulty concentrating during the day
• Mood changes

3. Causes

• Cheyne–Stokes breathing: a repeating pattern in which breathing deepens and then becomes shallower, sometimes with central pauses; it can occur with conditions such as heart failure.
• Neurological disorders: Conditions like Parkinson's disease or the use of certain narcotics can disrupt the brain's breathing signals.
• High altitudes: The thinner air at higher elevations can cause shallow breathing and trigger CSA in some individuals.

4. Treatment

• PAP therapy: Treatment depends on the cause of central sleep apnea. A sleep specialist may consider CPAP or other therapies; when bilevel PAP is used for selected forms of CSA, a backup breathing rate may be needed. Ordinary bilevel PAP without a backup rate is not interchangeable with those treatments.
• Medication: In some cases, doctors may prescribe medications to stimulate breathing, although they do this less commonly.

IV. Treatment-Emergent Central Sleep Apnea

1. Definition

Treatment-emergent central sleep apnea describes central breathing pauses that emerge or persist when PAP treatment is started for obstructive sleep apnea. It is not simply a case of CPAP failing to work. The sleep specialist reviews the breathing pattern and may monitor it over time or adjust the treatment plan.

2. Treatment

• Individualized PAP treatment: Do not lower CPAP or bilevel pressure on your own to address central events. The clinician decides whether continued CPAP, a device with a backup rate, or another treatment is appropriate.
• Adaptive servo-ventilation (ASV): ASV adjusts support in response to breathing changes and may be considered for selected patients. Heart-failure history and the exact device indication require specialist review before this therapy is prescribed.

V. Conclusion

Sleep apnea is a complex disorder. However, with proper diagnosis and treatment, it can be managed effectively.

If you suspect that you or someone you know might have sleep apnea, it's crucial to consult a physician. The doctor can carry out a proper evaluation. This evaluation may involve a sleep study. Through this, they can figure out the type and severity of the sleep apnea. Then, they are able to recommend the most suitable treatment.

Early detection and intervention play a significant role. They can greatly enhance the quality of life and overall health of those with sleep apnea. This ensures a peaceful night's sleep and better daytime performance.

When to involve your care team

Contact your sleep clinician or equipment provider if symptoms continue, your mask leaks, treatment feels uncomfortable, or you are considering pressure or therapy changes. Do not use a blog post as a substitute for diagnosis or individualized medical advice.

Continue learning

Review the sleep-apnea library and the CPAP-therapy library for related education and practical questions to discuss with your care team.