Breathing & Sleep

Sleep Disordered Breathing

According to the Sleep Foundation, sleep-related breathing disorders are conditions of abnormal and difficult respiration during sleep, including chronic snoring and sleep apnea. Some sleep-related breathing disorders have limited health impact, but others can have serious consequences because of their potential effects on sleep and the balance of oxygen and carbon dioxide in the blood.

(Source: https://www.sleepfoundation.org/sleep-related-breathing-disorders)

The American Academy of Sleep Medicine identifies several types and subtypes of sleep-related breathing disorders. The symptoms, severity, causes, and treatment of sleep-disordered breathing varies based on the type. In complex cases, a person may be diagnosed with more than one type. Several types are described below.

(Source: https://pubmed.ncbi.nlm.nih.gov/25367475/)

Obstructive sleep apnea

Obstructive sleep apnea (OSA) is one of the most common and serious sleep-related breathing disorders. In OSA, the airway repeatedly collapses during sleep, causing lapses in breathing that both fragment sleep and affect the body’s oxygen levels.

Symptoms:

Loud snoring
Nocturnal restlessness
Insomnia with frequent awakenings
Awakening with choking or gasping
Vivid or threatening dreams
Daytime sleepiness
Lack of concentration
Morning headaches
Cognitive deficits
Changes in mood

(Source: https://www.mayoclinic.org/diseases-conditions/pediatric-sleep-apnea/symptoms-causes/syc-20376196)

Upper Airway Resistance Syndrome

Upper Airway Resistance Syndrome (UARS) is a milder form of OSA in which sleep is disrupted but oxygen levels are not affected to the same degree. It is similar to OSA in that the soft tissue of the throat relaxes, reduces the size of the airway, and results in disturbed sleep. Although the increase in upper airway resistance is not enough to meet criteria of the sleep disordered breathing that define OSA, the resulting increase in breathing effort does cause a brief awakening from sleep that is often undetected by the affected individual. When this scenario repeats throughout the night, sleep is impaired, just like in obstructive sleep apnea.

Symptoms:

People with UARS usually complain of snoring, daytime sleepiness, cognitive impairment, un-refreshing sleep, and frequent arousals from sleep.

(Source: https://stanfordhealthcare.org/medical-conditions/sleep/upper-airway-resistance-syndrome.html)

See the chart below for a comparison between OSA and UARS.

Pediatric obstructive sleep apnea

Pediatric obstructive sleep apnea is a sleep disorder in which a child's breathing is partially or completely blocked repeatedly during sleep. The condition is due to narrowing or blockage of the upper airway (e.g., by enlargement of the tonsils and adenoids) during sleep. Obstructive sleep apnea is estimated to affect 1-5% of children of all ages.

Symptoms

During sleep, signs and symptoms of pediatric sleep apnea might include:

Snoring
Pauses in breathing
Restless sleep
Snorting, coughing or choking
Mouth breathing
Nighttime sweating
Bed-wetting
Sleep terrors

During the day, children with sleep apnea might:

Perform poorly in school
Have difficulty paying attention
Have learning problems
Have behavioral problems
Have poor weight gain
Be hyperactive

(Sources: https://www.sleepfoundation.org/sleep-related-breathing-disorders; https://www.mayoclinic.org/diseases-conditions/pediatric-sleep-apnea/symptoms-causes/syc-20376196)

Importance of seeking out diagnosis and treatment for sleep apnea

It’s important to treat sleep apnea because it can have long-term consequences for your health. Several studies have shown an association between sleep apnea and problems like type 2 diabetes, stroke, heart attacks, and even a shortened lifespan.

(Source: https://www.hopkinsmedicine.org/health/wellness-and-prevention/the-dangers-of-uncontrolled-sleep-apnea)

What to do if you think you may be suffering from a sleep disorder:

First, follow up with your family doctor. Your doctor may make an evaluation based on your signs and symptoms and a sleep history (which you can provide with help from someone who shares your bed or your household, if possible).

You will then likely be referred to a sleep disorder center where a sleep specialist can help you determine your need for further evaluation.

An evaluation often involves a home sleep assessment with a testing kit. Overnight monitoring of your breathing and other body functions during a formal sleep study at a sleep disorder centre might also be an option.

Please note: Upper Airway Resistance Syndrome (UARS) is unable to be picked up on a home sleep test, since they are not sensitive enough to pick up this subtle breathing disorder. Therefore, if you are concerned about UARS, the only way to truly confirm the diagnosis is to perform a formal sleep study in a sleep lab.

(Source: https://www.mayoclinic.org/diseases-conditions/sleep-apnea/diagnosis-treatment/drc-20377636)

Treatment options

For milder cases of sleep apnea, your doctor may recommend only lifestyle changes, such as losing weight or quitting smoking. If you have nasal allergies, your doctor will likely recommend allergy treatment.

If these measures don't improve your signs and symptoms or if your apnea is moderate to severe, other treatments are available. For example, certain devices can help open up a blocked airway (e.g., continuous positive airway pressure machines, oral appliances). In other cases, surgery might be necessary.