What Triggers Sleep Apnea

• Central
• Obstructive

With central sleep apnea (CSA) the wiring in the brain has become faulty. The brain fails to properly send signals to the muscles that control your breathing. Unlike obstructive sleep apnea, in CSA all breathing functions stop. It is not until oxygen levels drop enough that the brain is able to trigger you to wake up abruptly. This form of sleep apnea is less common.

Obstructive sleep apnea (OSA) is by far the most common. It is the result of the soft tissues of the mouth and throat relaxing too much during sleep. These structures collapse inward, either partially or completely blocking the airway. During an episode of OSA the brain continues sending signals to breathe. With a partial obstruction the added effort causes the soft tissues to vibrate. This results in the loud, chainsaw-like snoring associated with OSA. A complete obstruction results in observable periods where breathing stops. Either type of episode usually ends with a fit of gasping or choking before normal breathing resumes.

While it is possible to have both forms of SA, it is not as common. Doctors refer to this as complex sleep apnea. Patients will have alternating periods of apnea due either to failed signals or obstruction.

• Age – As you age your risk of developing CSA increases. The groups most at risk are individuals over the age of 45 are at the greatest risk.
• Biological Sex – CSA is more common among men than it is among women.
• Heart Health – Heart health can have a tremendous impact on your risk factors. Conditions such as congestive heart failure or an irregular heartbeat are significant risk factors for CSA.
• Medications – Certain medications, particularly sedatives, opioids, and methadone can increase your risk.
• Stroke – Around 75% of patients who need physical therapy after a stroke are also diagnosed with sleep-disordered breathing. CSA is the most common diagnosis.
• Other Brain Abnormalities – Brain tumors and lesions on the brain stem can impair its ability to properly relay messages to the body.
• CPAP Use – Studies show that patients who use a CPAP machine to create positive pressure in their airway are more likely to develop CSA. Continued use of a CPAP often resolves this issue.

Obstructive sleep apnea is most greatly influenced by physical factors. Factors that increase your risk of developing OSA include:

• Weight – Obesity and excessive weight greatly increases the risk of sleep apnea. Fat deposits in the tongue and neck can obstruct breathing.
• Narrow Airway – Some people naturally have a narrow airway. Others may have enlarged tonsils or adenoids. While this can be an issue in adults, it is often identified and addressed in childhood. Having a thick neck can also cause a narrowing of the airway.
• Biological Sex – As with CSA, obstructive sleep apnea is more common in men than in women. Men are as much as 3 times more likely to develop the condition. Men tend to put on more weight in their midsection than women. Increased abdominal circumference is directly linked to OSA. Women have an increased risk of OSA if they are overweight or are post-menopause.
• Age – OSA is more common in adults over the age of 40.
• Family History – Many risk factors for OSA are hereditary.
• Substance and Drug Use – Alcohol, sedatives, and tranquilizers relax the muscles of the throat and slow your breathing.
• Smoking – Smoking causes inflammation and fluid retention in the upper respiratory tract. This narrows the airway and increases a smokers risk three times more than people who have never smoked.
• Nasal Congestion – Swelling in the nasal passages can cause the airway to become blocked or narrowed, especially when lying down. This may be due to allergies or illness. Anatomical abnormalities such as a deviated septum can also compound this issue.

Ways you can reduce your risks include:

• Weight Management – Doctors recommend that most patients with sleep apnea lose weight. Maintaining a healthy weight can reduce many key risk factors.
• Exercise – A moderate exercise routine can strengthen your heart and improve circulation. Regular exercise can also improve lung capacity. This helps to reduce how often you wake due to poor oxygenation.
• Reduce Medication and Drug Use – Reducing the use of opioids, sedatives, and tranquilizers will lower your risks.
• Avoid Smoking and Drinking – Quitting smoking is a great way to reduce your sleep apnea risk factors. As your lungs recover, airway irritation will reduce and allow for clearer breathing. Avoiding alcohol use before bed, or cutting it out altogether will also help.
• Humidifier – Some airway obstruction is the result of inflammation. Using a humidifier helps to sooth and open the airway for clearer breathing.
• Sleep Position – Depending on the cause of your obstruction, changing your sleep position may provide relief. Studies show that adults with OSA may benefit from side sleeping. Oddly, the same is not true of children with OSA. The same study showed that back sleeping reduces symptoms in children.
• Oral Appliances – An oral appliance is a mouthpiece very similar in design to a sport mouthguard. This custom fitted mouthpiece helps to angle the jaw and tongue forward to prevent soft palate collapse. Patients report faster relief from symptoms and a better rate of compliance than with a CPAP.