Causes of holding your breath during sleep. Snore. Apnea. Causes of sleep disordered breathing

General practitioner, somnologist

Sleep is the time when a person can restore his strength. However, it often happens that people feel more “broken” in the morning than at the end of a busy day. The cause of poor health may be poor sleep, namely sleep disordered breathing. The inability of the lungs to saturate the body with oxygen in most cases is a consequence of apnea.

Apnea is a breathing disorder in which prolonged cessation of breathing occurs during sleep. Translated from ancient Greek, this term means lack of breathing or calmness. Doctors divide apnea into central and obstructive.

OSA (or obstructive sleep apnea) occurs due to narrowing of the upper airways. The patient's muscles relax, as a result of which the tongue sinks into the respiratory tract, preventing the flow of oxygen into the body. Often OSA is masked by snoring, to which most people have long become accustomed. However, snoring can be considered a signal and a reason to consult a doctor.

Stopping breathing during sleep can last no more than a minute, but repeated several times a night, they can last more than an hour in total. OSA typically results in severe hypoxia (the inability of oxygen to supply the body), but in three out of five cases it results in death.

Typical complaints with obstructive apnea syndrome:

• high blood pressure;
• uncontrolled weight gain;
• chronic fatigue and apathy;
• heart disorders and/or diabetes;

In some cases, apnea can be neurological in nature, and is called central sleep apnea syndrome. With this syndrome, respiratory arrest occurs due to disorders of the central nervous system. In this case, the airways, unlike the previous case, are completely free, and disturbances occur due to malfunctions in the part of the brain responsible for breathing. This syndrome is much less common than OSA, but doctors need to know exactly what causes the disorder. That is why sleep diagnostics are the only chance to make an accurate diagnosis.

The main symptoms of sleep disordered breathing are:

• Snore;
• Difficulty breathing (during sleep, in the first moments after waking up);
• Frequent awakenings during the night;
• Increased urination during sleep;
• Frequent nightmares;
• Headache or fainting in the morning, immediately after waking up;
• Sharp weight gain (over 1-2 years);
• High blood pressure;
• Daytime sleepiness, irritability, loss of alertness;
• Causeless depression;
• Shortness of breath and certain difficulties when performing physical exercises;

Apnea does not necessarily manifest itself by the presence of all of the above symptoms, so the presence of one or more of them should be a reason to immediately consult a doctor. Often a person does not even suspect that all these symptoms may be a manifestation of a serious illness.

It is important to remember that treatment for sleep disordered breathing begins with sleep assessment and an accurate diagnosis.

If you experience sleep-disordered breathing, get a consultation or make an appointment on the Clinical Brain Institute website. Our specialists will help you ensure healthy sleep and solve breathing problems.

Update: December 2018

During sleep, the body adapts to a completely different operating pattern than during wakefulness. Contrary to popular belief, he does not rest at all at this time - the brain controls a person’s well-being and creates dreams, and the internal organs support all vital functions: heartbeat, hormone production, breathing and others.

However, for some people, the normal functioning of the body may be disrupted during sleep. Due to a number of reasons, less air enters the lungs, and the body begins to experience “oxygen starvation.” Doctors call this condition sleep apnea syndrome. How dangerous the disease is, how to detect it and successfully treat it - you will find a competent and reasoned answer to all these questions in this article.

What is “night apnea”

This term means partial or complete cessation of breathing during sleep. These periods last no longer than a few minutes, so they are practically not capable of leading to sudden death. The brain manages to notice the lack of oxygen, after which it forces the person to wake up and restore normal breathing. The disease is hidden and some people may not notice it for several years or even decades.

However, breathing problems occur every night and cause chronic oxygen deficiency that continues even during the day. The patient experiences metabolic disorders, decreased functions of various organs, and hormonal changes. The result is the development of complications and the appearance of other diseases.

The following are the most common complications that occur with sleep apnea:

• Obesity;
• Arterial hypertension - an increase in blood pressure more than 140/90 mmHg;
• Diabetes and prediabetes (synonym – “impaired glucose tolerance”);
• Atherosclerosis is the deposition of plaques on the wall of arteries that supply blood to various organs;
• Coronary heart disease, including rhythm disturbances, angina pectoris (attacks of chest pain), heart attack;
• Cerebrovascular disease (abbreviated as CVD). This is a group of pathologies in which the nutrition of the brain and part of its functions are disrupted: memory, attention, control over emotions, etc.;
• Chronic heart failure is an irreversible damage to the heart muscle, in which blood begins to “stagnate” in various organs/tissues.

It should be noted that each of the above diseases reduces life expectancy and reduces its quality. About 500 thousand people die from these diseases every year. Of these, 40-70 thousand people suffered from apnea syndrome, which caused or aggravated the underlying disease. Getting rid of it and reducing the risk of developing the listed pathologies is the main task of the patient who wants to prolong his life.

Causes and variants of the disease

There are two groups of reasons why a person experiences this disease.

• The first is partial blockage of the airways. As a rule, obstruction occurs at the level of the nose or pharynx. It is associated with various anatomical defects or chronic diseases. Temporary apnea is often observed in patients with obesity, chronic rhinitis, deviated nasal septum, polypous rhinosinusitis, etc.
• The second group of reasons is disruption of the respiratory center of the brain. Since in a dream a person cannot consciously control the breathing process, this function falls entirely on the reflexes of the nervous system. With sleep apnea, the brain partially loses control over this process, which causes “interruptions” in the supply of oxygen to the blood.

Obstructive apnea

Depending on the cause of apnea, there are three variants of the disease:

1. Obstructive – this form is associated with impaired air conduction;
2. Central - oxygen deficiency occurs due to improper functioning of the respiratory center;
3. Mixed - one person has two pathological factors simultaneously.

Determining the type of disease is important for selecting the right therapy that will eliminate the very cause of the disease and influence the mechanisms of its development. The table below summarizes all the necessary information that will help you understand this issue.

The mixed version is the most difficult in terms of treatment, as it combines two mechanisms of breathing problems. Therefore, to eliminate the symptoms, it is necessary to eliminate two causes simultaneously. Otherwise, the therapy will be ineffective.

Symptoms

Since this syndrome occurs only in a dream, it is quite difficult to detect the disease yourself. However, 100% of people suffering from apnea have characteristic breathing during sleep - periods of loud snoring alternate with interruptions in breathing. Others cannot help but notice this. If a person sleeps alone and does not know that he snores, then you should pay attention to other signs of the disease, which include:

• Frequent nightmares or restless sleep. A lack of oxygen flow to the brain leads to changes in its functioning and disruption of information processing. This process is manifested by a change in the nature of dreams. They become frightening, chaotic, tense. The process of sleep does not refresh the patient and does not allow him to rest, but on the contrary, it oppresses him and causes anxiety;
• Regular night awakenings. The production of stress hormones and the restoration of breathing are invariably accompanied by interruption of sleep. There can be a varying number of such attacks of apnea - from single episodes to several dozen times. If they occur continuously (over weeks or months), it is necessary to suspect the presence of hidden pathology;
• Daytime sleepiness. For normal performance, people need to sleep 6-9 hours daily. Otherwise, the natural biorhythm is disrupted and a feeling of constant lack of sleep appears;
• Decreased attention and performance. Over time, air deficiency begins to occur in patients not only at night - it continues to persist during wakefulness. Excess carbon dioxide in the blood has a negative effect on the brain, which causes disruption of its functioning;
• Decreased mental abilities;
• Emotional lability: unreasonable mood swings, constant irritability, anger, tendency to depression;
• Decreased libido in men and women.

We should also not forget about the objective signs of the disease. Constant pauses in breathing during apnea inevitably lead to the development of complications. They can be suspected based on the following criteria:

Diagnosis of the disease

There are two simple methods that can confirm the presence of the disease. The first is a survey - scientists have developed a series of questions that can be used to determine the degree of sleep deprivation of a person and indirectly assess the presence of “oxygen starvation.” This questionnaire is called the Epworth Sleepiness Scale (abbreviated ESS). If you wish, you can assess the likelihood of you having the disease yourself.

To do this, you need to answer several questions below that will assess your susceptibility to daytime sleepiness. For each of them there are three possible answers:

• I don’t fall asleep in this situation – 1 point;
• There is a low probability of dozing off – 2 points;
• I can easily fall asleep – 3 points.

Epworth scale questions:

With a score of more than 14 points and the presence of risk factors, there is a high probability of apnea in an adult. In this case, you need to consult a doctor who will choose the most appropriate treatment tactics.

The second method is called pulse oximetry. A pulse oximeter is a small device that is placed on a finger and detects the presence of oxygen deficiency. This study can be carried out in any hospital, it does not require preparation and takes no more than a minute. However, it has one drawback. Pulse oximetry can only detect long-term obstructive apnea. In other cases, the study will not show deviations from the norm.

"Gold standard" of diagnostics

According to European recommendations, the best method for diagnosing the disease is a polysomnographic study. However, in Russia this method is used extremely rarely, only in large research centers or private clinics.

The principle of performing polysomnography is quite simple:

1. The patient falls asleep or is put to sleep using hardware or medication methods;
2. During sleep, the patient undergoes the following studies: electroencephalography, electrocardiography, assessment of the blood coagulation system, chin electromyogram, pulse oximetry, assessment of air flow, counting respiratory movements of the chest and abdomen, electromyography of leg muscles;
3. The doctor evaluates the results obtained and compares them with the norms.

It is almost impossible to carry out such a comprehensive examination in the Russian Federation. Therefore, the diagnosis of this pathology is carried out on the basis of patient complaints, the presence of risk factors, questionnaire data and pulse oximetry.

Modern principles of treatment

To successfully get rid of the disease, you need to know its variant (obstructive, central or mixed) and the immediate cause of the pathology (deviated nasal septum, presence of adenoids, etc.). Only after this can you begin treatment for sleep apnea, the goal of which is to restore the patency of the respiratory tract.

Eliminating the cause of the pathology

In 85-90% of cases, the main factor in the occurrence of obstructive apnea syndrome is obesity. If your body mass index increases above 30, it is necessary to take weight loss measures. In most cases, after reducing BMI to 20-25, the symptoms of the disease disappear on their own.

At the moment, the pharmaceutical market is overflowing with “diet pills,” private clinics offer various options for operations, and strict diet plans bordering on starvation are ubiquitous on the Internet. For the vast majority of people, all these methods will not bring any benefit, but will only further harm their health.

Rational weight loss can be achieved by regularly observing the following conditions:

• Refusal to consume alcohol and nicotine (including cigarettes, smoking mixtures, vapes, etc.). A single consumption of strong alcoholic beverages of no more than 50 g is acceptable, no more than 2 times a week;
• The right diet. You should not give up all types of food and go hungry - these measures are only effective for a short period of time. To lose weight, just change your diet as follows:
  • Refuse any confectionery products, including chocolate, cookies, cakes, pastries and others. These products are sources of quickly digestible carbohydrates that the body does not have time to use for its needs. As a result, they are stored in fatty tissue throughout the body, including in internal organs (liver, pancreas, heart, blood vessels, etc.);
  • Avoid fatty foods: various foods cooked in butter/margarine; fatty meats (veal, lamb, pork, beef); sausages and others;
  • Give preference to protein foods - poultry and grain porridges;
  • Be sure to include fruits and vegetables in your diet as a source of plant fiber and activators of intestinal function.
• Adequate daily physical activity is a prerequisite for losing weight. This point does not mean that a person should go to the gym every day and work out for several hours. Light jogging, brisk walking, visiting the pool or doing exercises at home is enough. The main thing is regularity physical exercise.

For most patients, these recommendations are sufficient to gradually reduce BMI to acceptable values ​​over several years. The main thing is not to deviate from the listed principles and adhere to the described scheme. It is quite difficult to rebuild your lifestyle, so people often neglect simple methods, searching for a “magic pill” or other means. Unfortunately, at the moment there is no safe and effective means that would allow you to reduce weight without human effort.

Principles for eliminating other causes

If apnea is not associated with the development of obesity, it is necessary to discover the cause of the disease and try to eliminate it. In most cases, this can be done with special therapy or minor surgery.

Different diseases have their own treatment options. For each patient, the doctor individually determines the most optimal approach, depending on the condition of his body and the type of respiratory disorders. Below are general principles for eliminating pathologies that can cause apnea, and the specifics of a doctor’s tactics for various diseases.

Treatment of "oxygen starvation"

With a long course of the pathology, a lack of air can persist in the blood even after adequate therapy. Since the body “gets used” to a certain concentration of gas in cells and tissues, it continues to maintain its deficiency. As a result, the person continues to have symptoms despite excellent airway patency.

To saturate the body with oxygen, American scientists have developed a new technique called “non-invasive ventilation”. Its principle is extremely simple - a mask is put on a person’s face or breathing tubes are put on the nose, after which a special device begins to supply gas under a certain pressure. This procedure is performed during sleep, and all apnea treatment occurs at home.

The only drawback of this method is the price. Therapy requires special equipment necessary for daily use: a CPAP machine or a ViPAP machine. Their cost in Russia ranges from 40 thousand to 200 thousand, when ordering from American sites - half the price. Not every patient can afford such expensive equipment, which limits its use.

"The Curse of Ondine"

The article described many reasons that can cause sleep apnea. However, in some people the disease may occur without any reason. How does this happen? Against the background of complete health, a small child or adult develops snoring with episodes of respiratory arrest. These episodes can last significantly longer than in the classic course of the disease. In some cases, they end in death from strangulation.

This option is called Ondine's Curse syndrome or idiopathic hypoventilation. The exact cause of its occurrence is not known to this day. Scientists suggest that the syndrome is associated with congenital underdevelopment of the respiratory center or damage to the nerves that control the functioning of the respiratory muscles. Most often, it manifests itself in newborns or young children, but there are cases of late onset of the disease (at 30-40 years).

The Legend of Ondine.In German mythology, there is a story about the beautiful mermaid Ondine, who lived on the shore of a raging sea. A knight passing by her hut was amazed by the beauty and singing of the girl. Swearing to her with his morning breath, he won the heart of Ondine and married her. Over time, the knight forgot about his love and found a new object of desire. Seeing this, Ondine cursed her husband, depriving him of the ability to breathe during sleep, saving him only his “morning breath.”

The "Curse of Ondine" is a diagnosis of exclusion. It can only be determined after all other possible causes have been excluded. A distinctive feature of this pathology is the absence of any symptoms other than respiratory arrest and snoring. No diagnostic method can confirm its presence, so laboratory and hardware techniques are needed only to exclude other causes.

It is impossible to completely get rid of this disease. In severe cases, the patient has to fight for every breath all his life, since all respiratory movements are performed through an effort of will. Existing treatment methods do not affect the cause of hypoventilation syndrome and do not allow getting rid of it. The only way to maintain a decent quality of life for such patients is CPAP machines for BiPAP therapy.

Sleep apnea in children

The principles of treatment and diagnosis of this disease in a child are practically no different from those procedures in an adult. However, the causes and manifestations of the pathological process have certain characteristics at a young age that need to be known. This will allow you to suspect the disease earlier and begin to confirm the diagnosis in a timely manner.

Apnea in children rarely develops due to tumor processes, damage to the nervous system and obesity. In terms of frequency of occurrence, the following conditions come first in young patients:

• Entry of foreign bodies into the respiratory tract. Various options are possible - the object can pass from the larynx to the bronchial tree. In this case, a diagnosis can only be made using an X-ray examination;
• Adenoid growths (enlarged nasopharyngeal tonsils);
• Anomalies in the structure of the airways (deformation of the septum, choanal atresia, hypertelorism, etc.) or the upper jaw;
• Chronic rhinitis, often of an allergic nature;
• Acromegaly is the rarest option.

In addition to the classic symptoms, apnea in newborns and young children (up to 14 years of age) is manifested by a number of additional disorders. All of them are associated with a deficiency of tissue nutrition and a constant lack of air. These include:

1. Delayed growth and physical development. Apnea in newborns may be manifested by slower weight gain compared to normal values. With a long course of the pathology, characteristic signs for young patients are short stature, muscle weakness and fatigue;
2. Decreased thinking and cognitive functions. In preschool age, it manifests itself as absent-mindedness and difficulties with learning the skills of reading, counting, time orientation, etc. In schoolchildren, this disease can cause poor performance and discipline in the classroom;
3. Daytime lethargy/hyperactivity.

A separate group of patients consists of children born ahead of schedule. With a slight deviation from the norm (for 1-2 weeks), the child may not have respiratory problems. However, premature birth at an earlier stage often causes apnea in premature babies.

Making a diagnosis in this situation rarely causes difficulties. Since the child is not discharged from the perinatal center until his condition normalizes, airway obstruction is promptly detected by a neonatologist and successfully treated in a medical facility. With a late “debut” of the pathology, it is also not difficult to detect it - the mother quickly detects periods of lack of breathing that occur during sleep and turns to the pediatrician for medical help.

TOP 5 misconceptions about sleep apnea

There are many articles on the Internet describing this problem. It must be remembered that when reading any information, you need to treat it critically and, first of all, consult your doctor. When analyzing various resources and medical portals, the most common misconceptions of the authors were identified.

Here are our TOP 5 misconceptions about sleep apnea:

1. Menopause is a risk factor for sleep apnea. Until now, scientists have not discovered a connection between the amount of female sex hormones and the tone of the pharyngeal muscles. There are no studies or clinical recommendations that would confirm this risk factor. Otherwise, the main contingent of patients with this disease would be women over 50 years of age. However, almost 90% of patients are men 30-40 years old;
2. ARVI can cause illness. No acute illness causes sleep apnea in children. Of course, they can lead to difficulty in nasal breathing, but this disorder persists in daytime. This pathology is a consequence of chronic respiratory failure lasting more than 2 months;
3. Mandibular splints are an effective treatment method. At the moment, European and domestic doctors recommend treating sleep apnea without using the above methods. Since splints do not affect the tone of the pharynx, cannot improve nasal breathing or the functioning of the respiratory center, their use is not justified;
4. Tracheostomy and bariatric surgery are good methods of eliminating the disease. Tracheostomy (making an incision in the larynx and inserting a tube into it) has only one indication - a threat to life due to complete blockage of the upper respiratory tract. This method is never used to treat sleep apnea.
   Bariatric surgery (for weight loss) is also a last resort in the treatment of obesity and should not be widely used. Patients with apnea, for the most part, are people who have practically no worries. In this case, the risk/benefit ratio of surgical intervention is incomparable - the consequences of such operations can be hospital infection, adhesive disease, laryngeal stenosis, etc. Preference should be given to conservative therapy;
5. Bronchodilators and sedatives can be used to treat sleep apnea. These groups of drugs are not used in therapy. Bronchodilators are substances that dilate the bronchi and improve air circulation. lower parts of the respiratory tract. They do not affect the condition of the nasal cavity and pharynx. The main indications for their use: bronchial asthma, COPD, bronchospasm attack. With these diseases, breathing may be impaired not only at night, but also during the day.

Sedative medications also do not have a positive effect on the course of the disease. On the contrary, some of them increase the symptoms of central apnea and increase the risk of complications. This fact can be found in the “contraindications” section if you carefully read the instructions.

FAQ

Question:
How to determine the severity of apnea?

Question:
What is hypopnea?

Decreased depth or frequency of breathing movements, leading to the accumulation of carbon dioxide in the blood. It is quite difficult to detect hypopnea during a routine examination, so this sign is rarely used in making a diagnosis.

Question:
Can breathing problems occur while falling asleep rather than during sleep?

Yes, since relaxation of the pharyngeal muscles begins to occur already at the stage of falling asleep. In this case, further examination is necessary to identify pathology.

Question:
Can the disease develop due to allergies, vaccinations, ARVI, etc.?

This pathology occurs with prolonged respiratory failure, only during sleep. Therefore, acute conditions, such as acute respiratory viral infections or the body’s reaction to a vaccine, cannot cause sleep apnea.

Question:
How to treat apnea in young children?

The principles of therapy do not differ from those in the adult population. The main thing is to determine the cause of the violations, after which you can begin to eliminate it and combat air deficiency.

Question:
Which doctor should you consult with this pathology?

Making this diagnosis is the responsibility of a therapist/pediatrician. Any competent specialist will be able to suspect a violation, prescribe further examination and, if necessary, consultation with other specialists.

There are things that a modern person should not be unaware of - for example, SLEEP APNEA (apnea - cessation of breathing). The term is slightly shocking, which is not difficult to understand: sleep apnea is serious cessation of breathing when a person is in the power of Morpheus. For those who are not yet scared - about the impact of respiratory arrests on the body and human health in general.

Are pauses in breathing (apnea) beneficial or harmful to the body? In reality the question is rhetorical, but in a dream... no one asks such a question and no one asks such a question. However, during sleep a person stops breathing. It is difficult to say why nature came up with such a sophisticated thing - sleep apnea, but the fact remains: during sleep, breathing stops and then resumes (this is easy to register with the help of instruments).

Everyone knows that human organs need a continuous supply of oxygen. Oxygen is supplied by blood. As soon as this process is slowed down or stopped, the work of the cells is suspended or stopped; no energy is generated and they die. The dependence of tissues on the delivery of oxygen to them is different, but in any case, the minimum survival time is scanty: for example, the cerebral cortex will last no more than 5 minutes without the supply of oxygen. You will have to focus specifically on this micronumber. During periods of time when a person does not breathe, except for the brain, the heart suffers greatly. Serious heart rhythm disturbances are especially characteristic. They make the situation even worse.

During periods of apnea, sleep is interrupted. As a result, the structure of sleep changes dramatically, and the person does not rest. There is no freshness in the morning, and during the day I suffer from drowsiness. Performance and mood decline.

Most often, so-called obstructive apnea occurs when the air path is temporarily blocked. The body simply “forgets” to control the tone of the muscles that support the tongue, palate, and other anatomical structures that form the lumen of the upper respiratory tract. In other cases, the body “forgets” not to control the state of the airway lumen, but to breathe in general: the respiratory center temporarily does not send the appropriate signals. However, this is a rarer situation (occurs more than 20 times less often, in special situations). Let's leave it out for now.

Obstructive sleep apnea is common to everyone, but normally, pauses in breathing are not frequent, long-lasting, or dangerous. The paradox is that in pathology they are frequent, prolonged and dangerous, but the patient is not able to feel them. For the patient, apnea does not exist, even when he does not breathe for more than one minute ten times an hour throughout the night, and the blood oxygen saturation at the end of each period of apnea falls below a level compatible with life (these are the numbers sometimes recorded by devices) . If you ask a person with severe sleep apnea in the morning, “How many times during the night did you dive for pearls?” - he will answer: “I didn’t dive for pearls,” and he will be only half frank, because he really didn’t get a single pearl, but the fact that he didn’t dive does not correspond to reality... He dived incessantly, and each time he didn’t breathe as much time, as much as only a pearl hunter, and not a simple snorkeler, can afford.

Obstructive sleep apnea is a condition that has several characteristics. Snoring is one of them. In addition, the upper respiratory tract periodically completely collapses at the level of the pharynx, ventilation of the lungs stops while respiratory efforts remain, the concentration of oxygen in the blood decreases, sleep is roughly fragmented (during apnea, a person partially awakens, sleep is broken into pieces, i.e. fragmented) and severe daytime sleepiness is noted. Severe suffering occurs when a person has 30 or more pauses in breathing per hour. Unfortunately, this is often observed, especially in older overweight people with short necks.

Establishing a diagnosis of obstructive sleep apnea syndrome is not very simple, since there are no direct symptoms - there are only (A) indirect signs and (B) the possibility of direct recording of respiratory arrests in a specialized medical institution. An additional indirect criterion is blood oxygen saturation: during periods of respiratory arrest, blood oxygen saturation drops. Objective indicators are recorded only instrumentally.

The prevalence of obstructive sleep apnea is 5–7% among 30-year-olds. After 60 years, the frequency increases significantly. Among cardiac patients, the prevalence is even higher: of those suffering from hypertension, sleep apnea is observed in 30% (for treatment-resistant arterial hypertension, figures are about 80%).

Since all clinical signs of the disease are nonspecific, we begin to think that a person has obstructive sleep apnea when a complex of several risk factors for such a disorder is detected, that is, if in relation to the patient we find out the following:

Mature and old age;
- overweight and obesity;
- heavy snoring during sleep (usually from the words of the spouse);
- severe daytime sleepiness;
- frequent awakenings and unrefreshing sleep;
- dissatisfaction with night sleep, weakness in the morning;
- increased blood pressure, especially at night and in the morning;
- frequent urination at night;
- morning headaches;
- decreased memory and attention;
- deterioration of background mood.

Indeed, initially one can only speculate about sleep apnea. Next, there is a need for instrumental examination. The latter, to the maximum extent, is a full-fledged somnological study (i.e. monitoring a person’s condition during sleep), when in parallel not only the amount and duration of apnea is recorded, but also an electroencephalogram, eye movements, an electrocardiogram, blood pressure, severity of snoring, breathing amplitude , intermittency of sleep, limb movements and other parameters.

A sleep examination can determine the severity of breathing disorders. It is clear that with moderate severity (from 15 to 30 apneas per hour) and severe severity (more than 30 apneas per hour), medical intervention is indicated.

It is worth treating (!), especially moderate and severe forms of sleep apnea, in which the body remains in a state of oxygen starvation too often and for a long time. It is no coincidence that they say that myocardial infarctions, as a rule, occur at night, and patients with strokes most often wake up in the morning. Not all, but many of these events are directly or indirectly related to obstructive sleep apnea. Prolonged pauses in breathing are accompanied by disruptions in the regulation of internal organs and stressful changes in metabolism.

The most unpleasant consequence of chronic interruptions in the body's oxygen supply is the suffering of the brain. At first it is increased fatigue and decreased memory. In advanced cases - so-called cognitive impairment, that is, in Russian - a slowly progressive decline in intelligence.

Before talking about the main treatment approach for obstructive sleep apnea, one cannot fail to mention preventive and general therapeutic measures to reduce the severity of this pathology.

These include:
- reduction in body weight (obesity is an important factor that aggravates breathing disorders during sleep; with obesity, fat accumulates, including in the soft tissues of the pharynx and nasopharynx, leading to a narrowing of the lumen);
- quitting smoking (smoking maintains chronic inflammation in the airways and reduces muscle tone);
- abstaining from alcohol, at least from drinking alcoholic beverages shortly before bedtime (exposure to alcohol increases the severity of sleep apnea by 50-70%);
- excluding the use of certain sedatives and sleeping pills (in case of emergency, it is permissible to use only certain modern medications of this type);
- positional treatment (sleep apnea is less pronounced or not observed at all, especially with not too severe forms, if a person sleeps on his side and not on his back) (a pocket is sewn on the back of the underwear in which the person sleeps and a ball from a large tennis: the ball will not let you lie on your back in a dream);
- training the muscles of the tongue and lower jaw (there are a number of exercises for this).

An extremely important aspect is the condition of the ENT organs. If the question of sleep apnea arises, you cannot do without consulting an otolaryngologist. Sometimes there is a need for surgical treatment, since it is impossible to talk about optimizing breathing during sleep if, even while awake, the nose breathes poorly or huge tonsils block ¾ of the lumen of the pharynx.

Among the measures that are used to combat snoring and associated cessation of breathing during sleep, intraoral devices can also be mentioned; snoring wake-up devices and even some nutritional supplements. However, they are tolerated differently, have disadvantages and are not always effective.

Treatment aimed at directly eliminating sleep apnea is the use of a special device in the form of a compressor with a mask, designed to provide constant positive pressure in the airways (only this method allows you to maintain the lumen of the airways open, thereby eliminating episodes of air flow obstruction). The method is extremely effective. Condition of a person who sleeps with a device CPAP(from the English term ConstantlyPositiveAirwayPressure– constantly positive airway pressure) changes radically. In addition to the fact that he begins to get enough sleep, many very unpleasant moments go away, in particular, blood pressure decreases and the risk of cardiovascular accidents in the form of myocardial infarction and strokes generally decreases, which not only improves the quality of life, but also prolongs life.

As with any other treatment method, CPAP-therapy has contraindications and side effects. The latter, by the way, are short-term and surmountable. It's more difficult with the characteristic CPAP- therapy has a disadvantage, namely the high cost of the device. However, here it is appropriate to point out two points: on the one hand, everything in this world is relative, including the numbers on the price tag, especially when the price of the issue is health and life; secondly, the device CPAP- this is not just a “bottle with a tube”, it is a complex device with mechanical and electronic filling, and it cannot be cheap. In this case, on one side of the scale there is a large amount of money, on the other - a radical improvement in health and prolongation of life.

If the money issue is resolved, then the only thing left to do is find a medical institution that specializes in sleep medicine; be examined under the guidance of specialists; if there are no contraindications, get the device and learn how to use it (also under the supervision of a specialist).

Everything related to the diagnosis and treatment of sleep apnea is a piece of medicine of the future. If communism came, and medicine reached incredible heights, then half of adults and elderly people would sleep with devices CPAP, and as a result, the life expectancy of the population would go through the roof...

Apnea syndrome is a short-term (up to three minutes) cessation of breathing during sleep. Breath-holds can be either single or few, or in large numbers - hundreds of breath-holds per night. The main danger of apnea is that in the worst possible situation you can die while sleeping. Why does breathing stop during sleep and how to protect yourself from apnea syndrome?

When we talk about stopping breathing during sleep, we mean obstructive sleep apnea syndrome (OSA), which can be of two types:

• Apnea - During sleep, the throat muscles relax so much that they block the airway. In this case, breathing may be interrupted for 10 seconds or more.
• Hypopnea is when the airways are partially blocked and only 50% or less of the oxygen reaches the lungs. Breathing also stops for 10 seconds or longer.

In addition to OSA, there is another type of sleep apnea called central sleep apnea. The difference between these two types of apnea is that with OSA, breathing stops due to the tissues of the pharynx blocking oxygen, and with central night apnea, breathing stops due to improper functioning of the brain. The brain does not control the respiratory process and seems to “forget” to send a signal to the airways to open. This causes respiratory arrest, which can be fatal.

Due to frequent episodes of apnea, a person may experience problems with the quality and duration of sleep. The fact is that when breathing stops due to insufficient oxygen in the lungs, the body can move from the stage of deep sleep to the stage of superficial sleep, or even cause awakening. The person may wake up and sit on the bed to catch their breath. Often people don't even remember it, but in the morning they may feel tired and sleep-deprived.

Symptoms of sleep apnea

The main symptom of sleep apnea is stopping breathing during sleep for more than 10 seconds (stopping breathing for less than 10 seconds can simply be a deep exhalation). It is almost impossible to notice the symptoms of apnea on your own - for this you need another person to monitor how you breathe in your sleep. However, you can guess that a person may be experiencing episodes of sleep apnea by hearing heavy snoring and loud, intermittent breathing during sleep. Other symptoms of apnea that a person may detect in himself:

• Excessive fatigue during the day: a person does not understand why he did not get enough sleep, although he slept a sufficient amount of time. He simply does not remember that he woke up several times due to respiratory arrests.
• Feeling of dry mouth after waking up, possible sore throat.
• Headaches, especially in the morning.
• Memory impairment.
• Anxious state.
• Irritability.
• Depression.
• Decreased libido.
• Decreased mental abilities.
• Urge to urinate more than twice a night.
• Impotence.
• Weight gain.
• Increased blood sugar levels.
• High blood pressure in the morning.

Sleep apnea is twice as common in men as in women. This is explained by the fact that men have more developed abdominal breathing, as well as the structure of the diaphragm and oropharynx and larynx. Men snore more often and more heavily, which may be a symptom of sleep apnea. Alcohol intake contributes to the appearance of apnea syndrome. This also explains why men are more likely to experience sleep apnea - they drink alcohol more often than women.

The risk of sleep apnea increases with age; 60% of people over 65 years of age suffer from this disease. However, this syndrome can also occur in young people and even children; 60% of newborns also experience breath-holding during sleep. Many people do not even realize that they have sleep apnea - about 7% of people do not notice this disease and are at risk.

Main causes of sleep apnea

Stopping breathing during sleep can occur for many reasons. It is necessary to distinguish between obstructive sleep apnea syndrome and central sleep apnea syndrome, as well as apnea in children.

Causes of obstructive sleep apnea syndrome

Factors contributing to sleep apnea in OSA:

• Disorders of the jaw structure. If the jaw is not large enough, the person’s tongue falls back during sleep, blocking the airways.
• Too big tongue.
• Small or short neck.
• Overweight or obesity - in this case, a fatty “muff” surrounds the pharynx, squeezing it.
• Enlarged tonsils or adenoids create a mechanical obstacle to the flow of air.
• Drinking alcohol or sleeping pills - they relax the muscles of the pharynx to such a state that they practically stick together, preventing a person from breathing during sleep.
• Recent upper respiratory tract surgery.
• Chronic diseases of the upper respiratory tract - sinusitis or vasomotor rhinitis.

When breathing stops due to OSA, a person experiences severe oxygen starvation, since oxygen retention lasts for quite a long time. To finally get the necessary oxygen, the brain suddenly awakens and sends a signal to the lungs, which forces the person to take a sharp, noisy breath. After this, the person may snore quite loudly until the muscles relax again and another episode of apnea occurs.

Causes of central sleep apnea syndrome

SCAS can be caused by a number of reasons related to brain function:

• Opioid drug use - heroin, morphine, methadone.
• Heart or kidney failure.
• Being high in the mountains.
• Undergoing CPAP therapy. During this therapy, SCAS is a side effect that goes away after the therapy ends.

Causes of apnea in children

In newborns, sleep apnea is a fairly common occurrence. This is because the respiratory system has not yet fully developed. As a rule, a few weeks or months after birth, sleep apnea in infants goes away on its own. Many parents fear that this disease could lead to sudden infant death syndrome. However, there is no scientific evidence that these things are connected.

Causes of OSA in newborns:

• congenital narrowed airways;
• improperly developed laryngeal muscles;
• upper respiratory tract obstruction;
• improper development of the jaw, recessed tongue, cleft palate.

The causes of SCAS in newborns can be:

• traumatic brain injury during childbirth;
• increased levels of oxygen in the blood immediately after birth;
• hemorrhages in the skull, brain hematomas;
• improper brain development.

If the child’s fingers or face turn blue, the pulse slows to 90 beats per minute, when picked up, the baby’s body feels without tone, the arms and legs sag, the baby refuses to breastfeed, you should immediately call an ambulance.

At an older age, the causes of apnea in children may be adenoids, enlarged tonsils, or problems with nasal breathing: allergies or rhinitis. Also, the child may have a disorder of the structure of the facial skeleton or obesity, which interferes with normal air circulation during sleep. If you suspect apnea, be sure to visit a pediatrician or otolaryngologist.

Children with sleep apnea will benefit from CPAP therapy.

Diagnosis and treatment of sleep apnea

In order to identify apnea, you should monitor the patient's sleep. The first symptoms will be recognized by relatives, subsequent diagnostics will be carried out in a hospital: the air flow during exhalation, the level of oxygen in the blood and snoring will be checked. The patient is also given an X-ray of the lungs, a complete blood count, a blood sugar test, and a urine test. Correct diagnosis is the main key to the success of apnea treatment, since this disease cannot be eliminated by surgery - the patient needs to choose individual treatment that will help the person breathe fully during sleep.

Several different techniques are used to treat OSA. Almost all patients are prescribed CPAP therapy. It allows you to saturate the lungs with oxygen, straightening the walls of the airways. After this therapy, sleep apnea stops. This procedure is not recommended for patients with central sleep apnea syndrome, as it is not effective.

Snoring and sleep apnea are common sleep disordered breathing (SDB) problems that can affect your sleep, health, and quality of life. Snoring and sleep apnea often occur simultaneously.

Apnea - stopping breathing during sleep - is a very dangerous disease that can lead to hypertension, heart attack or stroke.

Sleep helps the body to rest and reload, relieves mental stress and “turns on” recovery processes in the body. But if your sleep is inadequate, you sleep little and poorly, then this threatens disruptions in the functioning of the body and the occurrence of various diseases. Sleep apnea is one of the serious disorders that interferes with the sleep process and can trigger other even more serious problems. Snoring is often a warning sign of sleep apnea. After all, many of us snore in our sleep, but do not attach much importance to it, considering snoring a slightly unpleasant, but fairly harmless little thing. In fact, snoring may be a signal that you are developing a physiological disorder that can lead to stopping breathing during sleep - sleep apnea.

What is apnea?

Apnea is a cessation of breathing that can occur for a variety of reasons. Stopping ventilation for more than 10 seconds is considered apnea. For those who suffer from sleep apnea, such stops can last several minutes and occur 10-15 times within an hour.

The main risk factors and causes of sleep apnea syndrome:

The shape of the head and neck affects the shape of the airway lumen

Enlarged tonsils or adenoids or other anatomical abnormalities (deviated nasal septum, enlarged tongue, receding chin)

Obesity (about 50% of patients with sleep apnea suffer from this disease)

The muscles of the tongue and larynx relax excessively during sleep (this can be caused, for example, by drinking alcohol or sedatives before bed)

Snoring – Snoring can cause the roof of your mouth to elongate, which in turn causes airway obstruction.

Smoking (including passive inhalation of tobacco smoke)

Congestion in the nasal cavity

Family predisposition to sleep apnea syndrome. A specific gene responsible for this pathology has not been found, but a tendency towards hereditary predisposition has been discovered

Disorders and diseases - decreased thyroid function (hypothyroidism), acromegaly, amyloidosis, vocal cord paralysis, neuromuscular disorders, post-polio syndrome, Marfan syndrome, Down syndrome and some other diseases

Pathology of the body, such as abnormalities of the immune system, severe heartburn, backflow of acidic contents from the stomach into the esophagus, high blood pressure

• Obstructive apnea occurs when the airway is obstructed

The most common cause of sleep apnea is mechanical collapse of the walls of the airways, and snoring is a harbinger of this. In addition to snorers, overweight people are also at risk. It should be noted that apnea is more common in men than in women.

Symptoms

Patients suffering from this disease, as a rule, have a very characteristic appearance: outwardly, they are plump people with a short neck and a red face...
There are quite simple schemes with which you can suspect the disease and prescribe additional examination. If three or more of these signs are present (or only the first sign), an in-depth study is necessary:

What to pay attention to

• Loud or intermittent (with snoring) nighttime snoring
• Frequent urination at night
• Long-term disturbance of night sleep (more than 6 months)
• Increased daytime sleepiness
• Obesity
• Arterial hypertension (especially night and morning)

The easiest way to identify sleep apnea is to observe a sleeping person. Usually, immediately after falling asleep, a person begins to snore. Soon the patient suddenly stops breathing. At this time, no breathing sounds are heard, and snoring stops. However, the patient is trying to breathe, as can be seen from the movements of the chest and abdominal wall. After about 15-30 seconds, the person snores loudly and takes several deep breaths. As a rule, the patient's sleep is very restless: he turns around in bed, moves his arms and legs, and sometimes says something.

The frequency and duration of respiratory arrest depends on the severity of the disease. In severe forms of the disease, cyclic breathing stops occur almost immediately after falling asleep and in any body position. In less severe forms, this occurs only in the deep stages of sleep or when the patient sleeps on his back. Breathing problems are often associated with alcohol intake. Sometimes snoring and stopping breathing occur only after a significant dose of alcohol taken shortly before bedtime.

The above symptoms in themselves are not very pleasant and make it clear that apnea is not a harmless anomaly, but a serious disorder in the functioning of the respiratory system. Constant drowsiness, fatigue and lethargy can trigger the development of depression, disruption of the immune system and a shift in metabolism. But sleep apnea can lead to other serious problems. With frequent sleep apnea, the risk of developing hypertension, heart attack and stroke increases sharply, which in turn can cause death. Therefore, if you experience symptoms characteristic of sleep apnea, you should definitely consult a sleep specialist.

Sleep only on your side. Breathing disorders are significantly aggravated in the supine position due to the retraction of the tongue. There is a simple and effective way to get a person not to sleep on their back. On night pajamas or a special vest, a pocket is sewn between the shoulder blades in which a shady ball is placed. In this case, every time a person tries to lie on his back, he wakes up. As practice shows, after 3-4 weeks a strong reflex is developed not to sleep on your back

• Ensure an elevated head position. This also prevents tongue retraction and increased snoring. You can tilt the entire bed by placing 10-15 cm thick bars under the legs from the side of the head, or place a sheet of plywood under the mattress from the pelvis level (similar to a functional medical bed). In this case, it is advisable to use special contour pillows that provide the most optimal position of the head relative to the body. These methods help not only with snoring, but also with belching of gastric contents, which is often observed in overweight people who snore
• Avoid taking sedatives/hypnotics. Sedatives and hypnotics tend to reduce muscle tone and promote relaxation of the pharyngeal muscles, which, in turn, can provoke collapse of the airways. These medications are absolutely contraindicated in patients with moderate and severe forms of the disease. In mild cases, the question of their appointment should be decided individually
• Don't drink alcohol at night. Alcohol also relaxes the pharyngeal muscles and causes snoring and sleep apnea. The human liver processes 10 ml of pure alcohol per hour, so you can calculate what dose and how long before bedtime you can drink without health consequences. For example, 100 ml of vodka contains 40 ml of pure alcohol, so the negative effect of this dose will last about 4 hours
• Lose weight. It has been statistically proven that reducing body weight by 10% of the original can improve breathing parameters during sleep by 50%
• Quit smoking. Smoking often causes chronic inflammation of the pharynx and trachea, accompanied by swelling of their walls. This in turn can lead to a narrowing of the airways and an increased risk of sleep apnea.
• Ensure maximum free nasal breathing. Difficulty in nasal breathing can significantly increase snoring and cause sleep apnea. If this is a temporary phenomenon, then try using any vasoconstrictor medications for a runny nose (Glazolin, Otrivin, etc.). In case of chronic nasal congestion (polyps, deviated nasal septum, hypertrophy of the mucous membrane), it is necessary to consult an ENT doctor and decide on surgical treatment
• Healthy sleep is necessary for each of us, so it is worth trying to prevent disturbances in the sleep process and take care of comfortable conditions for