Sleep apnea syndrome( nighttime apnea) - Causes, symptoms and treatment. MF.

Apnea in a dream - episodes of stops of breathing that appear in a dream. They are single, which is normal, if their frequency does not exceed five per hour. With several tens and even hundreds of stops of breathing per night, they talk about the syndrome of obstructive or central apnea in a dream. Differences between the two syndromes are in the types of apnea.

obstructive sleep sleeps are associated with changes in the airway to the level of the larynx. Sleep apnea of the central type is due to the operation of other organs and systems, including lungs.

Possible causes of sleep apnea

Possible causes of obstructive sleep apnea similar to those of snoring. They can be combined into two large groups.

1. Difficulty of air passing through the respiratory tract. This is possible, if available:
• Diseases of the nose( polyps, cyst Tornwald);
• allergy;
• Frequent sore throats or adenoids;
• pharyngeal neoplasm;
• congenital narrowing of the airway lumen;
• small and posterior lower jaw;

• acromegaly or Down's disease, in which the tongue is enlarged;
• obesity with the deposition of fat cells around the lumen of the pharynx.

2. Reducing the tone of the muscles of the pharynx :
• on the background of taking alcohol or medications that relax the muscles( tranquilizers, part of sleeping pills, drugs, muscle relaxants).This is also possible when performing operations where it is required to relax a person, use artificial ventilation of the lungs or relieve severe pain. This is the risk of apnea before coming to consciousness;
• with a decrease in thyroid function, in which all tissues become more friable, and muscles are flaccid;
• if there is a violation of the supply of nerve impulses from the brain responsible for muscle tone( myodystrophy, myasthenia gravis and other neuromuscular diseases);
• if peripheral nerves are damaged during surgery or injury;
• in case of inhibition of consciousness, which can be observed with diseases of the brain or lesions of the cranial nerves. If this happens, you should immediately seek medical help!

Possible causes of central apnea in a dream can also be divided into several groups.

1. Decreased activity of the respiratory center in the brain of .This center regulates the frequency and depth of breathing, sending impulses to the respiratory muscles. If such signals do not arrive or are rarely given, breathing in sleep can be interrupted. This happens in the following conditions:
• Undine's syndrome
• damage to the brainstem( trauma, neoplasm or bleeding, cyst)
• pharyngeal collapse( throwing acidic stomach contents into the respiratory tract)

2. Disruption of blood supply or gas exchange of organs and systems .Normally, if there is a lot of oxygen, the respiratory center "turns off" for a time when the concentration decreases - actively imparts impulses for breathing. With cardiovascular disease or impaired lung function, the time of transmission of information about the oxygen content in the blood is disturbed. As a result, the respiratory center "recycles", it is too depressing to breathe when there are stops, it is too dispersed when hyperventilation develops. This is possible, if there is:
• lung disease
• hypoxemia( decrease in oxygen in the blood)
• altitude sickness
• heart failure

3. Changes in breath research data .Central apnea can be found during a sleep study( when falling asleep, in deep sleep, overweight, when the sensors move insufficiently relative to each other).In this case it will be a mistake to talk about the syndrome of central apnea. But with neuro-muscular diseases and weakness of the respiratory muscles this is a pathology. The border with the norm will be the frequency of stopping breathing and concomitant diagnosis.

Possible symptoms of sleep apnea

Sleep apnea - breath stops that are not audible( especially central character) and it is difficult to recognize if a person sleeps alone. The only sign of obstructive sleep apnea in the early stages may be snoring, which occurs when breathing is restored and the airway wall vibrates.

The appearance of other symptoms indicates the progression of sleep apnea syndrome and the need for urgent treatment to a doctor-somnologist who deals with breathing disorders in a dream. The most common manifestations of apnea are:

• Daytime drowsiness
• Frequent awakenings
• Superficial and restless sleep
• Morning headache
• Morning hypertension that passes without taking medication
• No blood pressure lowering at night
• Nocturnal arrhythmias and blockages of
• Night sweating
•Nauseous burp or heartburn
• Getting into the toilet for urinating more than 2 times a night
• Impotence
• Infertility
• Weight gain
• Inability to reduce weight permanently
• Increased sugar levels and development of diabetes mellitus
• Early morning early morning
• Morning strokes

All these symptoms are associated with a lack of oxygen against the background of stopping breathing in sleep, increasing the load on the cardiovascular system and the development of hormonal disorders.

Diagnosis of nocturnal sleep apnea

The main method of diagnosing apnea is the study of breathing during night sleep, when the flow of air, snoring and oxygen content in the blood are measured. To do this, use respiratory monitoring, cardio-respiratory monitoring and polysomnography.

To assess lung function, lung radiography( if necessary, computed tomography or magnetic resonance imaging), functional tests and determination of vital capacity of lungs, maximum expiratory flow and blood gases will be needed.

The following tests are needed to assess the general condition of the body, cardiovascular risks and to determine possible causes of apnea:

• general blood test,
• blood sugar test,
• glycated hemoglobin,
• biochemical blood test for total protein, urea,creatinine,
• blood test for thyroid hormones( TSH, T4 free, AT-TPO),
• lipid spectrum of blood( total cholesterol, high-density lipoprotein( HDL), low-density lipoprotein( LDL), triglycerides, indexatherogenic)
• urinalysis: Rehberg test, urine test for albumin

Possible complications of apnea

One in five road accidents associated with sleepiness. With pronounced sleep apnea, when memory and concentration decrease, industrial injuries increase at times. About 33% of all arrhythmias leading to cardiac arrest are caused by sleep apnea. It is no coincidence that most of the heart attacks and ischemic strokes occur between 3 and 4 o'clock in the morning. All this is the result of undiagnosed and untreated sleep apnea. Such people are 5.2 times more likely to die compared with those who do not have apnea, or it is effectively treated.

Take a survey on time and save your life for yourself and loved ones!

Treatment of apnea

In those cases when the apnea has already developed, and there are daily symptoms or characteristic diseases, the full and immediate assistance of a doctor-somnologist is required.

In the treatment of apnea, an active tactic is used to eliminate the cause of the disease.
First of all, you need to change the way of life :

- Discarding bad habits.
- Compliance with diet( low carbohydrate high protein).
- Regular aerobic exercise.
- Weight reduction of at least 10% of the original, if there is an excess of mass.
- Positional treatment( sleep on the side, if the apnea is observed only on the back).

These measures can be applied alone for mild sleep apnea or combined with other treatments if breathing stops are more pronounced.

Medication for apnea.

The approach to taking medication depends on the type of apnea. With central stops of respiration , the emphasis is on correcting lung and heart function. Accordingly, the drugs will be prescribed by the doctor, based on the state of health. Directly on the central apnea affects the reception of diacarb, which is also prescribed by the doctor.

Treatment of obstructive sleep apnea with medications is ineffective. There are no magic pills, and those that are offered will not be able to heal you from the pauses of breathing. Even numerous folk remedies that strengthen the mucous, reduce swelling or deprive you of sleep, will not give the proper result. First, with apnea, the situation is serious, associated with the adhesion of the walls of the airways, which is not eliminated medically. Secondly, many drugs and folk remedies can even worsen the picture, causing allergies and swelling of the pharynx. Pay attention to the composition( Doctor Snoring, Silence, Snorstop).Typically, this is a combination of several plant components that can cause unpredictable reactions. This is worth remembering, especially given that allergic rhinitis occurs in a third of people with apnea. In this case, it is possible to use only local corticosteroids( mometasone), which reduce inflammation and swelling of the mucosa of the respiratory tract in case of an exacerbation of allergies. There is evidence that in 17% of cases, the volume of tonsils decreases, expanding the lumen of the pharynx.

Surgical treatment of apnea.

Only is used for obstructive sleep apnea , with central respiratory stops impractical, since there is no target object.

The aim of the surgical intervention is to increase the airway clearance and eliminate obstructions in the air flow path. It can be the removal of enlarged tonsils, adenoids, polyps or other neoplasms and developmental abnormalities. Surgery is very effective and can eliminate the cause of apnea, however only if there are no other conditions that affect breathing in the dream and there are no contraindications for performing surgical intervention, for example, obesity. The main error in the surgical treatment of apnea is operations in the soft palate( removal of the tongue), especially with the help of a laser. They can not be conducted! This is associated with low efficacy and high risks of complications right up to the lethal outcome immediately after surgery.

Intraoral devices( kapy).

Are a good alternative to surgery and PAD-therapy in obstructive apnea .With central disorders of breathing is not applied.

The capes push the lower jaw forward for the time of sleep, thereby increasing the airway clearance, do not let the walls come in contact with each other. The effectiveness of this method is quite high, and the inconvenience of wearing a kapa in a dream is insignificant and passes with time.

Kapi for the treatment of snoring and sleep apnea

Unfortunately, this method will only give results with mild to moderate obstructive sleep apnea. More serious breathing disorders in sleep require PAP therapy.

PAP-therapy for the treatment of apnea.

This is the method for treating respiratory stops both obstructive and central type .The main principle of the method is the supply of air under pressure in the respiratory tract, so as not to let the walls of the pharynx stick together. The device can work in different modes depending on the severity of the condition and the nature of the disturbances( CIPAP mode, BIPAP, TriLevel, servoventilation).This method is safe and has no absolute contraindications. The result is visible in the first days of use: breathing stops, snoring, daytime drowsiness and other manifestations of sleep apnea disappear. Efficacy can reach 100%, even with a combination of several causes of apnea, which allows you to abandon other methods, in particular operations on the throat. PAP-therapy is appointed by a doctor-somnologist and conducted at home.

PAP-therapy for apnea

Effective treatment of sleep apnea without harm to health is possible. And correct timely prevention will prolong your life.

Prophylaxis of sleep apnea

To prevent sleep apnea, it is necessary to remember the main factors of its appearance and not allow them to develop:
1. Timely examination and treatment of somatic diseases( especially the brain, thyroid, ENT organs, heart andlungs).Monitoring the level of thyroid hormones, sugar, blood pressure.
2. Weight control and its reduction when typing more than 10% of the original.
3. Refusal from bad habits: smoking, alcohol, night work, stress.
4. Regular aerobic exercise( walking, swimming, bicycle, game sports).

These simple rules not only protect you from apnea, but also save your life and health.

Elena Tsareva, doctor-somnologist,
"Unison-clinic",
www.clinic.unisongroup.en