Sleep Apnea - 3 Different Types

Obstructive, Central, and Mixed

Woman suffering from nocturnal asthma.
Woman suffering from nocturnal asthma. GARO/PHANIE/Getty Images

Sleep apnea is a common disorder in which you briefly stop breathing while you are asleep. According to the American Sleep Apnea Association, more than 12 million Americans suffer from sleep apnea. Being overweight is often the cause of sleep apnea. However, anyone can get sleep apnea — even children.

If you have sleep apnea, then every night, you repeatedly stop breathing in your sleep. You will know whether or not you likely have this problem by reviewing the signs and symptoms listed in this article.

This causes harmful effects to your brain and heart and can cause other problems like depression and weight gain. Let's review the three different types of sleep apnea that may be affecting your quality of sleep.

Obstructive Sleep Apnea

Obstructive sleep apnea (OSA) occurs when something is blocking the airway. In the case of overweight people, it can mean that there is too much tissue around the neck and back of the throat. It can also occur when structures inside the nose and throat such as the tonsils or adenoids are enlarged. The most common causes of OSA include:

  • Being overweight
  • Enlarged tonsils
  • Enlarged adenoids (adenoids shrink the older you get so this is usually a problem unique to children)
  • Genetic causes such as an inherited narrow airway or a large tongue. There are also certain genetic syndromes that make it more likely to get OSA such as Patau Syndrome (trisomy 13)
  • Taking sedatives before bedtime

Central Sleep Apnea

Central sleep apnea is different from OSA because there is no obstruction making it difficult to breathe. Instead your brain fails to send out the message to breathe at certain times when you are asleep.

Central sleep apnea can further be classified as two different types related to carbon dioxide levels in your blood: decreased respiratory drive and increased respiratory drive.

You will have increased levels of carbon dioxide in your blood if your central sleep apnea is related to a decrease in your bodies respiratory drive. Some cause of include:

  • myasthenia gravis
  • brainstem tumor
  • muscular dystrophy
  • postpolio syndrome
  • paralysis of your diaphragm
  • amyotrophic lateral sclerosis (ALS)

When the carbon dioxide levels are normal in your blood, your respiratory drive is considered normal and the cause of central sleep apnea may be related to:

  • congestive heart failure
  • atrial fibrillation
  • stroke or other cerebrovascular diseases
  • opioid
  • kidney failure

Mixed Sleep Apnea

As you might guess from the name mixed sleep apnea is a combination of obstructive and central sleep apnea. Treatment of this type of apnea is the same as treatment for the central and obstructive causes for your sleep apnea.

Signs and Symptoms of Sleep Apnea

There are many possible signs and symptoms of sleep apnea.

You may have some or all of them. Since you are asleep when signs of sleep apnea occur they are often reported by a spouse or other bedroom partner.

  • Long periods or pauses in which you do not breathe while sleeping
  • Snoring (learn how you can stop snoring)
  • Gasping during sleep
  • Restlessness during sleep
  • Difficulty staying awake or being tired during the day
  • Depression or mood swings
  • Difficulty concentrating
  • Memory loss
  • Frequent headaches

Diagnosing Sleep Apnea

A polysomnogram (sleep study) can help diagnose sleep apnea. To undergo this test, you must go to a sleep center. When undergoing this test, you will have the following things done:

  1. Monitors will be put on you before you fall asleep including an oximeter (a monitor which is usually placed on your finger and measures the amount of oxygen in your blood)
  2. Electrodes will be placed on your head which record your brain waves (EEG)
  3. Electrodes placed on your chest which record the activity of your heart (EKG)
  4. Electrodes placed on your jaw to record jaw clenching or teeth grinding
  5. Electrodes placed on your legs which record the movement of your legs while sleeping (this is helpful in diagnosing restless leg syndrome).
  6. You will likely be asked to fall asleep on your back since this is the most likely position in which apnea will occur. It can be difficult to fall asleep during a sleep study, but this usually doesn't stop most people from being able to fall asleep.

Your test results will be used to determine an apnea-hypopnea index (AHI) to rate your severity of apnea.

  • less than 5 means that you do not have significant sleep apnea
  • 5 to 15 means that you have mild sleep apnea
  • 15 to 30 means that you have moderate sleep apnea
  • greater than 30 means that you have severe sleep apnea

Treating Sleep Apnea Without Surgery

Non-surgical treatment often begins with losing weight. Discontinuing sedative medications can prove helpful in treating sleep apnea as can the use of a CPAP, which stands for continuous positive airway pressure. It involves wearing a mask. There are many different types of masks but they all blow air into the nose or mouth to keep the airway open. If the patient has difficulty keeping their oximetry (blood oxygen levels) above 90 percent, supplemental oxygen can be added to their CPAP. Humidification is often used because plain air can dry out the nose and mouth.

Besides CPAP, there are other devices that your sleep doctor may prescribe to improve your sleep apnea, like BiPAP and EPAP. If you have difficulty tolerating your device, you can try a different mask type or size to make it more comfortable to sleep. While these devices may be beneficial in treating sleep apnea, in general the best treatment is to find and treat the underlying cause.

Surgical Treatment of Sleep Apnea

There are few surgical treatments for central sleep apnea. If the cause of your sleep apnea is related to a brain tumor, then surgical removal may eliminate your central apnea. However for other causes, there are not currently any surgical treatments available. You would most like be placed on CPAP or another device.

There are several surgeries that may be able to help reduce or eliminate your sleep apnea if your problem is ENT (ears, nose, and throat) related. If you or your child have severe tonsillitis or enlarged adenoids, a tonsillectomy or an adenoidectomy may be beneficial. There are other surgical procedures that can be helpful in treating OSA like Uvulopalatopharyngoplasty (UPPP). In this procedure the uvula is removed as well as part of the soft palate. This gives more room for air to get to the lungs. Surgery to treat nasal obstruction may include reducing the size of enlarged turbinates or nasal sinus surgery.

Complications of Sleep Apnea

Many people have difficulty complying with non-surgical treatments for sleep apnea but it should be noted that sleep apnea is a deadly disease. The lack of oxygen flow to the blood and brain can cause important cells to die, which can limit the ability of your major organs to function appropriately. Sleep apnea can therefore lead to heart disease including heart attacks and heart failure. There is some evidence that sleep apnea can also cause strokes due to the lack of oxygen and tissue death in the brain.

Despite the problems that can arise from sleep apnea, with treatment the likelihood of recovering can be very good. Most people feel more rested and symptoms of depression and mood changes are relieved. With appropriate treatment some heart disease may be reversed.

Source:

American Family Physician. Obstructive Sleep Apnea. Accessed: November 28, 2009 from http://www.aafp.org/afp/991115ap/2279.html

American Sleep Apnea Association. Sleep Apnea. Accessed: November 28, 2009 from http://www.sleepapnea.org/learn/sleep-apnea.html

Medline Plus. Central Sleep Apnea. Accessed: November 28, 2009 from http://www.nlm.nih.gov/medlineplus/ency/article/003997.htm

Ryan, CM & Bradley, TD. (2016). Murray and Nadel's Textbook of Respiratory Medicine: Central Sleep Apnea. 6th edition. Accessed on August 21, 2016 from https://www.clinicalkey.com (Subscription Required)

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