All You Need to Know About Sleep Apnea and Other Less Common Existing Sleep Disorders

Sleep Apnea

What is Sleep Apnea?

Sleep apnea is a common sleep disorder characterized by abnormal breathing during sleep. People suffering from sleep apnea repeatedly stop and start breathing while sleeping. This disrupts the body’s ability to obtain a sufficient supply of oxygen during the night. Consequently, this lowers the quality of sleep and often causes short-term sleep deprivation. The most common symptom of this sleep condition is loud snoring during the night. Over time, if left untreated, sleep apnea can lead to serious health consequences. Luckily, there are effective treatments available.

How Common is Sleep Apnea?

Sleep apnea is a common sleep disorder, affecting around 2-9% of the adult population. However, there are many cases which go undiagnosed. Sleep apnea can affect people from all ages but it is more common in older adults. Furthermore, people who are obese are more likely to suffer from this sleep condition. Studies indicate that about 3% of people who have an average weight are suffering from sleep apnea. Meanwhile, 20% of obese people are affected by this sleep disorder. Studies show that sleep apnea affects men more than women. However, the rate of women suffering from sleep apnea increases tremendously after menopause.

Types of Sleep Apnea

There are three types of sleep apnea. These are called obstructive, central and mixed sleep apnea.

1. Obstructive Sleep Apnea (OSA): The most common type of sleep apnea. It is characterized by a blockage of the airway during sleep caused by the relaxation of throat muscles. As a result the tongue collapses against the back of the throat, closing the airway and preventing optimal oxygen circulation.
2. Central Sleep Apnea (CSA): This type of sleep apnea is much rarer. It is characterized by the inability of the brain to send proper signals to the muscles that control respiration. This leads to slower and shallower breathing, but there is no airway blockage occurring.
3. Mixed Sleep Apnea also called Complex Sleep Apnea Syndrome: This type of sleep apnea is a combination of both OSA and CSA. 

Symptoms of Sleep Apnea

All three types of sleep apnea share the following symptoms:

• Episodes in which you stop breathing during sleep
• Excessive daytime sleepiness
• Morning headaches
• Irritability
• Difficulty maintaining focus or thinking clearly throughout the day

The following symptoms are limited to Obstructive Sleep Apnea (OSA):

• Loud Snoring which can involve gasping for air, choking or snorting which can cause brief awakenings
• A sore throat and/or dry mouth in the morning
• Increased frequency of nightly bathroom visits (called nocturia)

Risk Factors of Sleep Apnea

There is a wide variety of factors which can increase the risk of sleep apnea:

• Weight: Being overweight or obese significantly increases the risk of sleep apnea. This is because fat deposits around the upper airway can obstruct breathing. Studies indicate that a 10% increase in weight can result in a six-fold increase in obstructive sleep apnea (OSA).
• Age: Sleep apnea occurs significantly more often in older adults.
• Anatomy: Various anatomical characteristics can increase the risk of sleep apnea. Examples include the size and positioning of a person’s neck, jaw, mouth, tongue, tonsils, adenoids, etc.
• Family History: People who have one or more close relatives with sleep apnea are more likely to develop sleep apnea themselves. 
• Gender: Adult men are two to three times more likely to have sleep apnea compared to adult women. 
• Sleeping Position: Sleeping on your back increases the risk of sleep apnea as tissues surrounding the airway are more likely to block proper oxygen circulation.
• Use of Alcohol and Other Sedatives: Sedative medications, drugs and alcohol can cause tissue in the throat to relax, increasing the risk of sleep apnea.
• Smoking: Smokers are much more likely to suffer from obstructive sleep apnea compared to non-smokers. This is because smoking increases the amount of inflammation and fluid retention in the upper airway.
• Nasal Congestion: People who have difficulties breathing through their nose are more likely to develop obstructive sleep apnea. This nasal congestion can have numerous causes such as allergies, a cold or because of an anatomical problem.
• Medical Conditions: Numerous medical conditions may increase the risk of developing sleep apnea. Examples include congestive heart failures, high blood pressure, type 2 diabetes, Parkinson’s disease,  asthma etc.
• Hormonal Abnormalities: Certain hormone disorders may increase the risk of sleep apnea by causing swelling of tissue near the airway and/or contributing to a person’s risk of obesity. Examples include underactive thyroid or hypothyroidism and excess growth hormone or acromegaly. 

Health Risks of Sleep Apnea

If left untreated, sleep apnea can result in serious long-term health consequences. This is because sleep apnea causes regular and continuous nightly interruptions, therefore lowering overall quality of sleep. Over time this leads to severe sleep deprivation which affects a person physically, mentally and emotionally to a large extent. Examples of health problems caused by sleep apnea include heart disease, diabetes, high blood pressure, cancer, dementia, depression etc. More information can be found on the page focused on The Impact of Inadequate Sleep on Individuals.

Diagnosis of Sleep Apnea

People who have symptoms of sleep apnea should take action urgently. The first step to take would be to contact your doctor and schedule an appointment. Only a trained medical professional will be able to do a proper diagnosis. Most of the time a proper evaluation or sleep study will need to be conducted to truly determine if someone has sleep apnea or not. Typically, this sleep study is performed at a sleep clinic where breathing, blood oxygen levels and brain wave activity are closely monitored. These key indicators help determine whether the patient is suffering from sleep apnea as well as the severity of the condition.

In some circumstances this sleep study can be done at home by providing all of the necessary equipment to the patient. This method of home study has become more common nowadays due to the pandemic. However, based on the results of your home test, you doctor may still recommend an in-clinic sleep study for further testing or a visit to a specialized doctor.

Treatments For Sleep Apnea

There exist different treatment methods for sleep apnea depending on the severity of the condition and the type of sleep apnea. For milder cases your doctor will recommend certain lifestyle and behavioral changes. Examples include losing weight, quitting smoking, reducing use of sedatives and alcohol as well as sleeping on your side instead of your back. Other recommendations would be to undergo treatment for your nasal allergies to prevent mild sleep apnea from occurring.

If these measures do not prove to be effective or you are suffering from moderate to severe sleep apnea there are other treatments available:

• Continuous Positive Airway Pressure (CPAP): This is the most common and most effective treatment for moderate to severe sleep apnea. This is a machine that sits beside your bed and is connected to a mask which you wear on your face. The machine pushes pressurized air into your airway while you sleep and prevent them from closing.
• Other Airway Pressure Devices: If using a CPAP machine is too uncomfortable there are also other types of airway pressure devices available. These include auto-CAP devices which automatically adjust the pressure provided while sleeping. Additionally, bilevel positive airway pressure (BPAP) devices are available. These devices provide more pressure when inhaling and less when exhaling.
• Adaptive Servo-Ventilation (ASV): This is a newer type of positive airway pressure device which appears to be more effective at treating complex sleep apnea. This airflow device automatically learns and stores your normal breathing pattern at night. Once asleep, the machine uses pressure to normalize your breathing pattern and prevent pauses in your breathing.
• Oral Appliances and Mouthpieces: Another treatment for mild to moderate sleep apnea involves a dental appliance that people wear while they sleep. These mouthpieces are designed to open your throat by bringing your jaw forward. They can be effective for mild to moderate sleep apnea and might be easier to use than CPAP devices. 
• Oxygen Supplementation Devices: Supplemental oxygen is mostly used for people suffering from central sleep apnea (CSA). There exist various types of oxygen delivery devices.
• Surgery: If all other treatment have proven to be unsuccessful surgery is considered as the final option. However, in rare cases where people have certain jaw structure problems it may be recommended as a good first option. There are different types of surgical options available to resolve severe sleep apnea. These include surgery to remove certain tissues in the back of the throat such as tonsils and/or adenoids. Another procedure is surgery to alter and reposition the structure of the mouth, nose and jaw. A final procedure which can be done is a surgery that stimulates the nerve that controls tongue movement. This helps to keep the tongue in a position that keeps the airway open.

Somnambulism

Description of the Sleep Condition

The sleep condition called somnambulism encompasses all different sleep (somnus) disorders that involve some type of movement (ambulation). Examples include sleep talking, sleep walking, sleep eating, sleep texting etc. Contrary to popular belief, all of these events do not arise from dream REM sleep but occur during the deepest stage of non-dreaming NREM sleep. An overview of the difference between REM sleep and NREM sleep can be found on the page focused on Sleep Architecture.

Cause of Somnambulism

It is still largely unclear what the cause is of somnambulism. However, evidence suggests it is triggered by an unexpected spike in nervous system activity during deep sleep. An electrical jolt removes the brain from the basement of deep NREM sleep all the way into wakefulness. However, it gets stuck somewhere in between.

The individual is trapped in a state of mixed consciousness, neither awake nor asleep. Operating in this confused state causes the brain to perform basic well-rehearsed actions. Examples include sitting up on the edge of the bed and uttering a few words or sentences, walking over to a closet and opening it, attempting to put on clothes and walking out of the room, etc. These people seem awake, but the brainwave activity clearly indicates their brain is sound asleep.

How Common is Somnambulism? 

Studies indicate that sleepwalking and/or sleep talking are common in the adult population and very common in children. It is unclear why children experience somnambulism more than adults nor why some children grow out of having these nighttime events, while others don’t. A logical explanation would be that children generally have more deep NREM sleep compared to adults. Therefore, they have a higher statistical likelihood of sleepwalking or sleep talking at night. Luckily, most somnambulism episodes are harmless and do not require intervention. In very rare cases when the afflicted patient, his partner or parent feels that the condition is compromising health or poses a risk, there are effective treatments available.

Narcolepsy

Description of the Condition

Narcolepsy is a sleep condition which is incredibly debilitating and has serious consequences on the health and the overall way of life of the patient. Narcolepsy is a neurological disorder originating within the central nervous system, specifically in the brain. This is a very rare condition affecting about one in two thousand people. Narcolepsy usually emerges between ten and twenty years of age.

Symptoms of Narcolepsy

The disorder is characterized by three core symptoms.

• Excessive Daytime Sleepiness

The first symptom is excessive daytime sleepiness. Narcoleptic patients experience random overwhelming and irresistible urges to sleep at times when they want to be awake. These bouts of sleepiness are usually the first symptoms to emerge. The characterizing sensation is equivalent to feeling as tired as being awake for three to four days straight.

• Sleep Paralysis

The second symptom of narcolepsy is sleep paralysis. Sleep paralysis is the frightening loss of the ability to talk or move when waking up from sleep. Normally, during REM sleep, the brain paralyzes the body to prevent you from acting out your dreams. This is called muscle atonia. Usually, when waking up, the brain releases the body from this paralysis right at the moment when waking consciousness returns. For narcoleptic patients this state of paralysis lingers on longer than usual despite having terminated sleep. Consequently, sometimes when these individuals begin to wake up, they are unable to lift their eyelids or move their limbs. They are effectively locked in their body.

Sleep paralysis is not unique to people suffering from narcolepsy. It is much more common, with around one in four people experiencing sleep paralysis from time to time. However, narcoleptic patients experience sleep paralysis far more frequently and severely than healthy individuals.

• Cataplexy

The third symptom is the most debilitating for a narcoleptic patient’s life. It is called cataplexy which is characterized by a sudden loss of muscle control. The episodes of cataplexy can vary in intensity. Minor episodes include slight weakness causing the head to drop, face to sag, jaw to drop and speech to become slurred. However, major episodes include significant weakness causing an immediate loss of all muscle tone resulting in a total collapse.

These sleep attacks don’t occur randomly. Instead they are triggered by moderate or strong emotions which can either be positive or negative. Examples include listening to a funny joke, getting surprised by a loud noise, feeling strong emotions, having sex, and even taking a nice warm shower. All these events may cause the patient to collapse into the immobilized prison of his or her own body. While under the influence of cataplexy, patients are still awake and continue to perceive the outside world around them. Cataplexy is an abnormal functioning of the REM-sleep circuits in the brain. This causes muscle atonia to inappropriately be deployed while the individual is awake, rather than asleep and dreaming.

Narcolepsy truly devastates the patient’s quality of life. Patients are forced to abandon all hope of an emotionally fulfilling life as they are banished to a monotonic existence of emotional neutrality.

Cause of Narcolepsy

The underlying cause of narcolepsy is related to the malfunctioning of the sleep-wake switch within the hypothalamus. This sleep-wake switch is responsible for providing a signal to the brain when it is time to wake up or go to sleep. Like an electrical light switch it can flip the power on (wake) or off (sleep) by using a neurotransmitter called orexin. Orexin can be thought of as the chemical finger that flips the switch. Once orexin is released onto the brain the switch has been flipped on. This will power up the wakefulness-generating centers of the brain transitioning our body to full and stable wakefulness.

At night the sleep-wake switch stops releasing orexin to the brain signaling it’s time to sleep. This causes the individual to lose perceptual contact with the outside world. Narcoleptic patients suffer from its horrendous symptoms because they produce up to 90 percent less orexin compared to a healthy people. Additionally, they have a reduced number of orexin receptors in the brain to receive what little orexin is produced. Consequently, their sleep-wake switch does not work properly. The switch is never definitely on or off causing the patient to alternate constantly between sleep and wakefulness. This causes narcoleptic patients to be unable to sustain wakefulness throughout the day and have terrible sleep at night.

Narcolepsy is a horrible condition and unfortunately the treatment outlook at the present time is very limited. Additionally, there does not seem to be a cure in sight. A big reason for this is because it is such a rare condition that it is not profitable for pharmaceutical companies to invest in research.

Fatal Familial Insomnia

Description of the Condition

Fatal familial insomnia is a very rare genetic disorder that starts with insomnia emerging in midlife. After several months into the disease, the patient stops sleeping altogether and starts to lose basic brain and bodily functions. This leads to significant cognitive decline, compromised motor skills and overall deterioration of the body. By the end, the patient’s neurological condition resembles that of an elderly person at the end stages of dementia. The patient can no longer walk or talk neither bathe or cloth himself and is disturbed by regular hallucinations and delusions. There is no cure for this condition and most patients die within ten months of diagnosis.

Cause of Fatal Familial Insomnia

The underlying cause of the condition is an anomaly of a gene responsible for creating prion proteins. These prion proteins usually perform useful functions in the body. However, this condition causes the production of a rogue mutated version of the protein triggered by a genetic defect. This hostile protein spreads like a virus and destroys certain parts of the brain causing rapidly accelerating brain degeneration. The main target is the thalamus which is the sensory gate within the brain that must be closed for wakefulness to end and sleep to begin.

The mutated prion proteins eat away at the thalamus, utterly degrading its structural integrity. This causes the sensory gate of the thalamus to be stuck in a permanently open position. As a result, patients can never switch off their conscious perception of the outside world making it impossible to sleep. Luckily this condition is extremely rare, but it illustrates the fact that a lack of sleep will kill a human being.