How does apnea differ from normal snoring?
Snoring is the sound of the soft tissues of the throat vibrating in the air flow. By itself, it only means that the airways are narrowed, and for many people it remains an unpleasant but safe feature. Apnea is a complete or almost complete blockage of the lumen: air does not pass for ten seconds or longer, oxygen in the blood decreases, and the brain gives an emergency signal. A person comes out of deep sleep for a moment, the muscles of the throat tense, the passage opens - and this is accompanied by the same sharp snore that family members hear. Then the cycle repeats.
Simple mechanics help to understand why this happens. During sleep, the muscles of the pharynx relax, and inhalation creates negative pressure in the airways, which tends to collapse their walls, like the walls of a soft tube. In a healthy person, there is enough muscle tone to keep the lumen open. If the airways are initially narrowed - due to fat deposits in the neck, large tonsils, massive root of the tongue, structural features of the lower jaw or a stuffy nose - there is not enough tone, and the pharynx collapses. Hence the typical portrait of the patient: a middle-aged, overweight man with a short, full neck, although apnea occurs in both thin people and women, especially after menopause.
- Even snoring without pauses is most often not dangerous to health, although it disturbs others
- Snoring, interrupted by silence and then loud snoring, is a typical picture of apnea.
- With apnea, sleep formally lasts eight hours, but there are almost no deep stages in it
- There is also central apnea - when the brain itself stops sending the command to breathe; it is less common and is associated with heart and nervous system diseases
- Not every person who snores has apnea, but the vast majority of people with apnea do snore.
What it looks like: night and day signs
The problem with apnea is that a person is not aware of almost all nighttime symptoms, and usually explains daytime symptoms by fatigue, age or work. Therefore, the diagnosis is often made 5-10 years after the onset of the disease, and the reason for contacting is the insistence of the spouse or hypertension accidentally discovered during an examination.
- At night: loud intermittent snoring, pauses in breathing, snoring, restless sleep, sweating
- At night: frequent trips to the toilet - apnea produces a hormone that increases urine production, and this nocturia is often mistakenly attributed to the prostate
- In the morning: fatigue, feeling that sleep did not bring rest, dry mouth, headache
- During the day: drowsiness, need to take a nap, falling asleep in transport, cinema, at meetings
- During the day: decreased attention and memory, irritability, depressed mood
- Decreased libido and erectile dysfunction in men
- Poorly controlled blood pressure, especially high in the morning
Why is it dangerous?
Each stop in breathing is a jump in blood pressure, a release of stress hormones and a strain on the heart. There are hundreds of such episodes per night, and the body lives for years without normal night recovery. Hence the consequences, which at first glance have nothing to do with sleep.
- Treatment-resistant arterial hypertension: pressure does not normalize even with several medications, and does not decrease at night as it should
- Heart rhythm disturbances, primarily atrial fibrillation and night pauses
- Increased risk of myocardial infarction and stroke
- Insulin resistance and type 2 diabetes mellitus, worsening control of existing diabetes
- Progression of heart failure
- Road traffic accidents due to micro-sleeping while driving
- Depression, anxiety, decreased performance
Separately, it is worth mentioning about drivers and people working with machinery. Microsleep lasts only a few seconds, the person does not notice it and is sure that he just “blinked”. At a speed of 90 kilometers per hour, the car travels 75 meters blindly in three seconds. That is why daytime sleepiness with apnea is not a complaint about well-being, but a safety issue, and it should be solved not with strong coffee, but with an examination.
Examination: how severity is measured
- Беседа и опросники: оценивают выраженность дневной сонливости, храп, паузы в дыхании, сопутствующие болезни. Опросник — это отбор, а не диагноз.
- Осмотр: измеряют вес, рост, индекс массы тела и окружность шеи; оценивают строение глотки, миндалины, нижнюю челюсть, носовое дыхание.
- Осмотр оториноларинголога — искривление перегородки носа, полипы, увеличенные миндалины, аденоиды у детей.
- Компьютерная пульсоксиметрия во сне — простой скрининг: прибор всю ночь пишет насыщение крови кислородом и пульс.
- Респираторная полиграфия — регистрирует поток воздуха, храп, движения грудной клетки и живота, кислород, положение тела; во многих случаях этого достаточно для диагноза.
- Полисомнография — самый полный метод, дополнительно фиксирует стадии сна по активности мозга, движения глаз и мышц; нужна в сложных и спорных случаях.
- Дополнительно по показаниям: ТТГ, гликированный гемоглобин, суточное мониторирование давления, ЭхоКГ.
CPAP therapy and other methods
The main treatment for moderate to severe forms is continuous positive airway pressure therapy, known as CPAP (in international sources - CPAP). The device delivers a low-pressure air stream through the mask, and this air acts like a pneumatic tire, preventing the walls of the throat from collapsing. This is not oxygen or medicine: the device simply mechanically holds the airways open. The pressure is selected individually, based on the results of the study or using the automatic mode.
- CPAP therapy - eliminates respiratory arrest almost completely on the first night; Daytime sleepiness usually goes away within a few days, and blood pressure begins to be better controlled within weeks.
- The device must be used every night: the effect lasts only as long as the therapy lasts and does not accumulate for future use
- Intraoral appliances that push the lower jaw forward are an alternative for mild to moderate cases of mask intolerance; made by a dentist
- ENT surgeries are effective when there is a clear anatomical cause: a deviated nasal septum, large tonsils, adenoids in a child. In children, removal of enlarged tonsils and adenoids often solves the problem completely
- Positional therapy - for apnea that occurs only on the back; use devices that prevent you from sleeping in this position
- Bariatric surgery - discussed in cases of severe obesity, when weight loss by other methods is not possible
Getting used to the mask deserves a separate discussion. The first nights are almost always difficult: air flow is disrupted, the feeling of a foreign object on the face, and sometimes dry nose. Most difficulties can be solved technically - by selecting the appropriate type of mask according to the size and shape of the face, adjusting the rate of pressure increase, and connecting a humidifier. Quitting therapy after two nights because of an uncomfortable mask is the most common and most offensive reason for failure, because the technique itself works. It makes more sense to return to the doctor and select the equipment again.
What depends on the person himself
- Снижение веса. Это единственный фактор, который человек может изменить с большим эффектом: уменьшение массы тела примерно на десять процентов снижает индекс апноэ в среднем на четверть, а при лёгкой форме иногда убирает проблему совсем.
- Отказ от алкоголя за 3-4 часа до сна: он расслабляет мышцы глотки и заметно удлиняет остановки дыхания.
- Отказ от курения — оно поддерживает отёк и воспаление слизистой глотки и носа.
- Сон на боку вместо спины, приподнятое изголовье.
- Регулярный режим сна и достаточная его продолжительность.
- Восстановление носового дыхания: при заложенности нос не пропускает воздух, человек дышит ртом, и глотка спадается легче.
- Контроль сопутствующих diseases — гипотиреоза, диабета, гипертонии.
- Обязательное предупреждение анестезиолога перед любой операцией: при апноэ меняются подходы к наркозу, обезболиванию и наблюдению после вмешательства.
- Отказ от вождения в состоянии выраженной сонливости — до тех пор, пока лечение не начато и не даёт эффекта.
