OBSTRUCTIVE SLEEP APNEA (OSA)

Obstructive sleep apnea (OSA) is a common sleep apnea caused by obstruction of the airway. It is characterized by pauses in breathing during sleep. These episodes, called apneas (literally, "without breath"), each last long enough that one or more breaths are missed, and occur repeatedly throughout sleep. In obstructive sleep apnea, breathing is interrupted by a physical block to airflow, despite the effort to breathe.

What are the warning signs of OSA?

• Excessively loud snoring which can be heard rooms away (or even by neighbors)
  
  
• A pattern of snoring interrupted by pauses, then gaps, is a sign that breathing stops and restarts. Occasionally, patients will remember waking up short of breath or gasping, although the vast majority of episodes are not recalled.
  
  
• Falling asleep at the wrong times, such as work or while driving.
  
  
• Trouble concentrating, or becoming forgetful, irritable, anxious, or depressed.
  
  
• Morning headaches or nausea, frequent trips to the bathroom to urinate at night, and loss of interest in sex. Men may complain of impotence and women may have menstrual irregularities.

These problems usually appear slowly and progress over many years, so that the patient may not recognize the symptoms. Sometimes the patient thinks the symptoms are just from getting older or are not serious.

Family members, employers, or co-workers may be the first to recognize a pattern of excessive sleepiness and/or changes in mood or behavior, and should encourage a visit to a healthcare professional.

Some possible Consequences of untreated OSA

• High Blood Pressure
• Heart Attack
• Heart Failure
• Stroke
• Depression
• Diabetes

General Measures

Weight loss may help in the treatment of OSA if you are overweight. Even small amounts of weight loss – 20 pounds by a 200-pound man who should weight 165 – may improve breathing during sleep, making sleep more restful and lessening daytime sleepiness.

• Avoid alcohol within four hours of bedtime.


• Avoid sleeping pills.


• Sleep lying on one side or your stomach.


• Medications to relieve nasal stuffiness may be helpful in reducing snoring and may help OSA slightly.

Specific Treatments

Positive Airway Pressure (PAP):
In this highly effective therapy, a light mask is worn over the nose during sleep. A small, quiet air pump is attached to the mask with a long tube, so that air under pressure enters the throat through the nasal passages. The gentle air pressure holds the throat open and allows normal sleep and breathing.

Common Complaints of PAP Treatment

• Nasal stuffiness or congestion
  
  
• Dryness of the mouth or nose
  
  
• Mask air leaks
  
  
• Noise made by PAP machine
  
  
• Sore, dry, or red eyes
  
  
• Skin irritation from the mask and/or straps
  
  
• Sensation of too much air pressure

Oral Appliances: Some OSA patients are helped by oral appliances, devices that open the breathing passage by bringing the jaw or tongue forward or raising the soft palate. Patients with mild and moderate OSA may especially benefit by using an oral appliance, while severe OSA usually does not respond to this type of treatment.

These devices sometimes cause excessive salivation, jaw pain, gagging, or dental problems. Oral appliances should be fitted by qualified dental personnel.

Surgery: Physical problems that interfere with breathing during sleep can sometimes be corrected surgically. These problems include: enlarged tonsils or adenoids (common in children), nasal polyps or other growths, a deviated nasal septum, or certain sizes and/or shapes of the face, jaw, or soft palate.

Oxygen: Giving extra oxygen is not usually a good treatment for OSA. Oxygen may be added to the PAP system, however, to correct for low oxygen levels due to existing lung or heart disease.