Signs of Sleep Apnea

Sleep apnea  is a common and potentially serious sleep disorder in which your breathing is repeatedly interrupted while you sleep. If left untreated, sleep apnea can contribute to  type 2 diabetes  and  heart disease  while increasing your likelihood of stroke  and  heart attack.  

Sleep apnea can affect toddlers, children, and adults, although some of the identifying symptoms are different depending on your age. 

Signs and Symptoms of Sleep Apnea in Adults 

Obstructive Sleep Apnea (OSA) is a syndrome, which manifests as a collection of signs and symptoms. Some may be apparent some not. Any of these may reflect an increased risk of OSA. 

Loud Snoring 

Despite it usually accompanying it, snoring can occur without Obstructive Sleep Apnea. This is called primary snoring. Advertisements abound exist with promises of cheap solutions where many of their proposed solutions are frankly potentially dangerous. Without testing, snoring could be treated successfully with these solutions but OSA will be left to wreak havoc on the body. Often, this apparent relief in symptoms will delay the OSA diagnosis until patients suffer long-lasting personal and medical effects of OSA. 

Loud snoring is not benign and has a very strong association with ischemic stroke 

Many studies report strong associations with snoring, both ischemic and silent stroke. 

Your bed partner says that you snore and sometimes stop breathing when you sleep 

One of the best indicators of OSA is observation by your bedpartner. With the advent of apps and new technology, such information will be available without an irritated bed partner. 

Awakening abruptly with shortness of breath 

Some people awaken either simply feeling out of breath or feeling like they’ve had a dream resulting in it. Since dreams occur during Rapid Eye Movement (REM) sleep when OSA and oxygen deficit at their worst, these may be related. 

Awakening choking or gasping 

The ‘gasping’ experienced is the brain jolting the body out of suffocation which would otherwise kill the individual. This ‘stress response’ (fight or flight) saves lives until it can no longer cope. 

Frequent awakening to use the bathroom 

This may be due to OSA’s effect on smooth muscle (OSA is also associated with erectile dysfunction), or simply deciding to go while awake due to fragmented sleep. 

A dry mouth or sore throat upon awakening 

Snoring often results in a sore, dry or irritated throat. Evidence now confirms that snoring also damages the very throat muscles that help to keep the airway open, thereby causing a vicious cycle that worsens snoring. 

A headache upon awakening 

During sleep and the body’s relative rest, the brain requires 20% of the body’s oxygen. Failure to supply the adequate level of oxygen to the brain damages tissue. The frontal lobes lose volume with chronic Sleep Disordered Breathing (OSA/Heavy Snoring), hence the frontal headache is sometimes experienced as a symptom. 

Insomnia (difficulty staying asleep) 

Sleep fragmentation is extreme in OSA. It also causes activation of the sympathetic nervous system due to the body’s awareness of the potential dangers of suffocation. 

Excessive Daytime Sleepiness (EDS) 

There are other causes of EDS and while EDS is not always present in OSA, it is often a symptom that appears as sleepiness, lack of energy or behaviours associated with tiredness. 

Attention, concentration, or memory problems while awake 

OSA affects attention and concentration hence the significant increase in accidents associated with untreated OSA. Deterioration of memory likely occurs due to the associated lack of oxygen, sleep fragmentation and stress that OSA imposes on the body. 

Tooth grinding (Bruxism) while asleep 

Although Bruxism may be a movement disorder or result of stress, it is frequently seen in association with OSA. Tooth wear on patients with airway problems is frequently seen on the front teeth. Look at your teeth in the bathroom mirror – posture your jaw forward – do they fit together without a space? It is my opinion that such grinding is frequently the result of posturing the lower jaw forward to open and improve the airway. This is why Dental Oral Appliances are successful. 

Heart burn (Gastro-esophageal reflux disease or GERD) 

Heartburn due to stomach acid in the throat is not uncommon. Upon the body’s desperate attempts to breathe in, the chest pressure drops and pulls stomach acids up into the food pipe (esophagus). Many physicians still refute this but there remains a very strong clinical association between the two dysfunctions. 

Night sweats and/or palpitations 

Despite general apathy toward OSA, it remains a potentially fatal disease. Its effects are far-reaching where the heart is affected both in speed and regularity. Adrenaline released in response to the impending suffocation often leads to the signs of ’stress’ (fight or flight) - clammy skin, fear, fast heart rate and sweating. 

Irritability and experiencing mood swings. 

This can affect both the OSA sufferer, who experiences oxygen deficiency and sleep deprivation, and the bedpartner who can experience extreme sleep deprivation and develop hyperawareness. In my opinion, often times your spouse will be unable to sleep whilst listening for a cessation of breathing. This emotional stress cannot be overestimated! The OSA sufferer can experience a stroke or heart attack during the night which can be a great cause of concern. 

If you have risk factors for sleep apnea, such as being overweight or obese, drinking alcohol, smoking tobacco, sleep deprivation or snoring, OSA can be seen more frequently. 

A decreased interest in sex or are experiencing sexual dysfunction. 

OSA has been shown to affect libido in both males and females, erectile dysfunction in men and depression in both sexes. 

Difficulties in pregnancy  

Difficulties in pregnancy and a greater risk of post-partum depression is present in female OSA sufferers. Despite unequivocal evidence, the management of OSA and snoring is still ignored in obstetric classes.  

Incidentally, and sadly, the dangers are also often ignored by heart and stroke foundations and some cardiologists who insist on using anti-coagulants instead of sleep testing following a heart attack. Anyone who has already had a heart attack, ischemic stroke, hypertension, type 2 diabetes, atrial fibrillation or kidney disease is recommended to request a sleep test. Home testing are commonly used to exclude or diagnose OSA. 

Prevalence 

Sleep apnea is more common than you might think. Estimated at 25% of Canadian Adults or 5.4 Million Canadians, less than 10% have been tested and diagnosed!  

If you have any concerns that you may have obstructive sleep apnea, you can call us for screening and assistance in resolving this so that you can get on with your life, the way it was meant to be!  

 For more Blogs - please see - www.abettersleep.net - Stephen Bray (2020)