How does sleep apnea fit into dreams?

Health check: sleep apnea

Suddenly you can't breathe in your sleep, that sounds like a nightmare. For many people, however, this is a bitter reality that repeats itself several times night after night. The deep sleep, which is essential for health and well-being, usually falls by the wayside and so those affected often feel as if they are exhausted during the day.

1. What is sleep apnea?

The term apnea is derived from the Greek term “apnoia”, which can be translated as breathlessness or calm. Sleep apnea is a sleep disorder that manifests itself in the cessation of breathing for at least ten seconds (often longer than a minute up to two minutes). The paused breath causes the affected person to gasp for air, which triggers an alarm in the brain. This alarm causes a short-term waking phase, which is only long enough for the airways to open again and "gasping for air" is possible. Afterwards, the person concerned falls straight back into deep sleep. He is unaware of what was going on.

According to the definition, sleep apnea is when the episodes of paused breathing during sleep and waking phases with "gasping for breath" occur at least five times an hour. However, the majority of sleep apnea patients experience between 20 and 60 of these breathing pauses every hour, which is why they feel completely “worn out” in the morning. The reason for this, however, is completely unclear to most.

Another breathing disorder characterized by greatly decreased airflow is known in medicine as hypopnea. Sleep apnea sufferers can also suffer from hypopnea.

"Sleep apnea: when snoring becomes life-threatening" by focusonline

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The so-called Pickwick syndrome, which is a combination of extreme obesity, snoring and addiction to sleep (narcolepsy), has been known in medicine for many decades. The unusual name of this disease goes back to a novel by Charles Dickens: Dickens described in his work "The Pickwickier" published in 1836 a fat, snoring and constantly tired man who fell asleep in every situation. In the 1960s it was found that Pickwick syndrome is just an extreme form of sleep apnea syndrome.

Excursus: harmless snoring or sleep apnea?

With the support of the respiratory muscles, our lungs create a negative pressure when we breathe. The air flows passively through the nose, larynx and bronchi into the lungs. Our airways essentially consist of a muscle tube that would collapse if our complex airway control system did not counteract this with every breath.

During sleep, the muscle tube relaxes, which leads to a turbulent flow of air. The walls of the muscular tube approach each other, which can cause them to vibrate. It is these movements that we commonly perceive as snoring with the familiar sawing noises.

Snoring occurs primarily at three narrow points in the respiratory system: in the nasal cavity, on the soft palate with the uvula and in the mouth region, where the base of the tongue presses against the back of the throat, creating the grunting noises typical of snoring. It is not uncommon for all three areas to be affected by a constriction at the same time, so that unpleasant snoring melodies can be heard in the "triad".

The vibrations and thus the snoring become more pronounced depending on the looseness of the throat tissue and the narrowing of the airways.

"Normal" snoring is usually not harmful to health, but it can certainly become a burden for those affected and their companions. There are various aids and therapeutic approaches to reduce snoring or to stop it altogether.

Loud snoring is one of the main symptoms of sleep apnea, although it should be noted that there are some sleep apnea sufferers who do not snore. Sleep apnea syndrome can also be present without snoring.

With regard to sleep apnea, one can speak of dangerous snoring when the airways collapse completely after a period of loud snoring and breathing completely stops. This state lasts from ten seconds to over a minute before an unconscious awakening occurs with an almost explosive onset of breathing.

Sleep stages in sleep apnea

People affected by sleep apnea spend up to 80% of the night in a superficial sleep that offers little or no recreational value. Accordingly, only about 10-20% of the night remains that the apnea sufferer experiences in a required deep sleep stage or in a REM dream phase.

In comparison: sleep stages in healthy sleep

So that sleep is restful for the body, the sleeper must have gone through the five sleep stages (sleep stages 1-4 + REM) at least 4 times. The phase of deep sleep, which extends over sleep stages 3 and 4, is used to regenerate the body, while the REM phase, which is also known as the dream phase, is used to process daily events.

2. What happens in the body during sleep apnea

In sleep apnea, excessive tension loss in the upper airway muscles of the throat (pharynx) leads to a narrowing and a temporary collapse of the airways. In this way, breathing comes to a standstill, which lowers the level of oxygen in the blood. As soon as the brain registers the decrease in oxygen in the blood, it ensures that the person concerned wakes up to breathe again. This awakening is usually not perceived by the consciousness.

Test: How sleep apnea feels to those affected

In order to get an idea of ​​how sleep apnea sufferers feel, you can carry out a small experiment: To do this, hold your breath at unanimous intervals for 30 to 45 seconds at a time. Find out how long you can hold this type of breathing.

3. What types of sleep apnea are differentiated

The breathing disorder sleep apnea, which only occurs during sleep, is divided into three different forms: obstructive, central and mixed sleep apnea.

Obstructive Sleep Apnea (OSA)

Instead of obstructive sleep apnea, there is often talk of obstructive sleep apnea syndrome, which is abbreviated to OSAS. This is the most common type of sleep apnea. People with obstructive sleep apnea try to breathe but are unable to breathe due to an upper airway blockage. When trying to inhale, the airways collapse. In order for the airways to be reopened, the sleeper must wake up. Obstructive sleep apnea is often associated with loud snoring and daytime sleepiness.

Central sleep apnea (CSA)

Central sleep apnea is less common. The airways are free in central sleep apnea. The interruptions in breathing are based on a disturbed brain function. The brain ceases to breathe for a few seconds, stopping the diaphragm from moving and stopping breathing. Central sleep apnea is common for people with neurological disorders, serious heart disease, or metabolic disorders, and people who have had a stroke.

Mixed sleep apnea (MSA)

Mixed sleep apnea is when a sleep apnea sufferer exhibits features of both obstructive and central sleep apnea. Primarily, apnea in mixed sleep apnea is caused by blocked airways.

4. Who suffers from sleep apnea

Sleep apnea is comparatively common. It is assumed that around two to four percent of the middle-aged population in Germany is affected by it. The risk of developing sleep apnea syndrome generally increases with age. In principle, however, everyone - from babies to very old people - can get sleep apnea!

Sleep apnea is most commonly found in middle-aged, overweight men (around 45 years of age). In general, men (9 to 24%) are more likely to suffer from sleep apnea than women (4 to 15%).

Sleep apnea in babies and young children

Sleep apnea syndrome is very rare in infants and young children. If the sleep apnea syndrome or a break in breathing occurs in small children, this can lead to a life-threatening situation even with a single occurrence. Emergency measures should be initiated directly here.

Sleep apnea seems most likely to affect premature babies or nine-month-old babies born under difficult conditions. It is believed to be related to the fact that the brain cannot yet fully transmit its signals to the lungs.

It should be noted that so-called "periodic breathing" is a completely normal phenomenon in infants and a distinction must be made here from sleep apnea syndrome. As part of periodic breathing, the infant may stop breathing for about ten seconds before resuming it regularly.

If in doubt, the pediatrician should always be consulted if the infant's breathing is a cause for concern. If an apnea attack is detected in the baby, the infant's breathing can be recorded with an apnea monitor. The device detects every breathing pause that is too long and can damage the baby's brain. As a result, an alarm is triggered so that the parents can take action.

The emergency doctor should be informed immediately if the breathing pause lasts longer than 15 seconds, the baby's skin has turned bluish or the child is no longer moving. There is always a risk of sudden infant death.

Sleep apnea in children

Many older children experience irregular breathing during sleep. The pauses in breathing, which can occur several times in one night and over months or years, are usually only very brief and not life-threatening. Depending on the child's health and behavior, normal phases of sleep alternate with periods of heavy breathing and even breathlessness. The blocked airways in the nose and throat can usually be traced back to medical causes. Polyps or enlarged tonsils are particularly responsible for snoring and apnea-like sleep conditions in older children.

5. How to recognize sleep apnea

The symptoms that indicate sleep apnea can generally be distinguished between signs perceived during the day and during the night.

Sleep apnea sufferers usually suffer most from extreme sleepiness during the day. More than 80% of those affected feel unimaginably tired during the day, which affects all areas of life. The daytime sleepiness of sleep apnea sufferers can massively impair their ability to drive and their performance. Further consequences are a disturbed libido up to impotence and a deterioration of the general quality of life. It can also lead to changes in personality, mood swings, irritability and interpersonal relationship problems.

During the night, sleep apnea can manifest itself in the following ways:

  • Pronounced snoring - the partner usually becomes aware of this symptom
  • Breathing stops
  • Dry mouth on waking
  • increased, excessive sweating (caused by exertion in breathing)
  • Attacks of suffocation
  • nocturnal urge to urinate
  • nocturnal heartburn
  • choke

Overview: Possible Symptoms of Sleep Apnea

The side effects and sequelae that can be associated with sleep apnea syndrome are diverse and are not present to the same extent and to the same extent in every person affected. Typical symptoms of sleep apnea include:

  • ✓ Loud, irregular snoring
  • ✓ persistent fatigue
  • ✓ Obligation to fall asleep during the day
  • ✓ reduced performance (physical and mental)
  • ✓ Difficulty concentrating
  • ✓ irritability, nervousness
  • ✓ headache
  • ✓ depression
  • ✓ nightmares
  • ✓ Spells of dizziness
  • ✓ sexual disorders, impotence
  • ✓ Night sweats
  • ✓ Changes in personality
  • ✓ In children: bed-wetting

Questionnaire: Do you suffer from sleep apnea syndrome?

To help you identify sleep apnea, we have put together a questionnaire that you can download as a printable .pdf file. Some typical symptoms are asked about in the questionnaire. At the end you will receive an evaluation result in numbers, which gives you information about how high the probability is that you suffer from sleep apnea syndrome.

6. What causes and promotes sleep apnea

Sleep apnea can be attributed to various causes. In addition, there are a number of factors that increase the risk of falling ill or worsen the overall clinical picture.

Sleep apnea syndrome can be inherited, which is why experts believe that the risk of sleep apnea is 2 to 4 times higher if a relative is already suffering from it.

What can cause and / or promote sleep apnea

  • ✓ massive overweight
  • ✓ extensive evening meals
  • ✓ Alcohol consumption (especially in the evening)
  • ✓ Smoking (40% higher risk for heavy smokers)
  • ✓ Taking sleeping pills and sedatives
  • ✓ irregular sleeping times (e.g. as a result of shift work)
  • ✓ known cases of sleep apnea in the family
  • ✓ male gender
  • ✓ Bottlenecks in the nose / throat (e.g. due to enlarged tonsils)
  • ✓ chronic respiratory diseases such as bronchitis or asthma

As mentioned elsewhere, middle-aged men who are overweight are particularly likely to develop sleep apnea.

Determine body mass index

The risk of developing sleep apnea syndrome is significantly higher in overweight people than in people of normal weight.

If you are unsure whether you are still classified as normal weight or already overweight, you can calculate your body mass index to get an answer.

The body mass index - BMI for short - is calculated using the following formula:
BMI = weight in kg / (height in m) ²

Example for a height of 175 cm and a weight of 70 kg:
BMI = 70 / (1.75 * 1.75) = 22.86

The result is a value that can be anywhere in the range from 18 to over 30. The following can be roughly derived from the BMI:

BMI under 20:Underweight
BMI from 20 to 24.9:Normal weight
BMI from 25 to 29.9:Obesity
BMI 30 or higher:obesity

The fat distribution can also have a positive effect on the development of sleep apnea syndrome. People in whom the fat is primarily attached to the trunk (so-called apple type) have a higher risk of getting sick. If the waist / hip circumference ratio is lower than with the so-called pear type, in which the fat is primarily deposited on the hips and thighs, the risk is lower.

In principle, however, it must also be stated that not all sleep apnea sufferers are overweight or obese. About 30 to 50 percent of those affected are not overweight.

In addition to the risk factors that can be traced back to living conditions (such as obesity or smoking), it is primarily anatomical factors that can cause or promote sleep apnea. These include slight misalignments of the jaw (e.g. an overbite) as well as a special structure of the middle facial bones or the hard palate. In addition, blockages in the nose, polyps, enlarged tonsils or a large tongue can also be responsible for the occurrence of sleep apnea syndrome.

Notes on the reinforcing factors

In the case of sleep apnea, the consumption of alcohol has an intensifying effect because it slows down the activity of the upper respiratory tract and relaxes the muscles that are responsible for keeping the windpipe open. Taking tranquilizers has a similar effect, although it can also lead to shallower breathing.

In addition, nasal congestion, lack of sleep, and sleeping on your back can worsen sleep apnea.

7. How dangerous sleep apnea is

Sleep apnea syndrome can have a number of negative effects on health. Other existing diseases such as hypertension (high blood pressure) can be exacerbated by the apnea. Apnea can also increase the risk of a stroke or heart attack.

During operations under general anesthesia, sleep apnea syndrome can lead to breathing problems.

Possible consequences of sleep apnea

  • ✓ Hypertension diseases
  • ✓ abnormal increase in red blood cells
  • ✓ Cardiac arrhythmias
  • ✓ heart attack
  • ✓ heart failure
  • ✓ coronary artery disease (CHD)
  • ✓ sudden cardiac death
  • ✓ stroke
  • ✓ sexual dysfunction (decreased libido, decreased ability to orgasm, impotence)
  • ✓ Nocturnal nosebleeds
  • ✓ Depression, anxiety
  • ✓ Forgetfulness, absent-mindedness
  • ✓ increased risk of accidents

Can someone with sleep apnea syndrome drive a car?

Due to the high level of daytime sleepiness, along with poor concentration, absent-mindedness and other restrictions, it is assumed that a sleep apnea sufferer has a seven-fold increased risk of accidents.

However, if sleep apnea syndrome is treated so that daytime sleepiness is reduced or even completely eliminated, there is nothing to prevent an affected person from driving a car. In advance, however, the responsible driver's license office and the insurance company should be informed about sleep apnea.

8. How sleep apnea is diagnosed and treated

In addition to loud snoring, it is usually daytime sleepiness that leads affected people to the doctor's office. Further examinations will then be carried out to clarify whether an apnea is present. For this purpose, the patient can be referred to a sleep laboratory in order to monitor his night sleep and detect breathing pauses. Breathing pauses can be measured, for example, using comprehensive polysomnography (PSG) or other methods that are less complex. Sometimes putting an oximeter on your finger is enough to check the nightly breathing pattern and the oxygen saturation in the blood. Following this, the measurement results are evaluated by a sleep doctor.

“Sleep apnea - finally sleep well again!” By Regio TV

It is not absolutely necessary to spend the night in a sleep laboratory in order to obtain the necessary measured values. Alternatively, there are also compact measuring devices that are issued on an outpatient basis by the family doctor. With such a device, the patient can spend the night in his familiar surroundings. The family doctor then evaluates the results and, if necessary, refers the patient to an experienced sleep specialist for further treatment.

"Sleep apnea - how dangerous is that?" By arztwissen

How severe is sleep apnea syndrome?

There is a rough subdivision into three groups for assessing the severity of sleep apnea, with the number of breath pauses as a benchmark:

  • - Mild sleep apnea with 10-20 pauses in breathing in one hour
  • - Moderate sleep apnea with 20-30 pauses in breathing in one hour
  • - Severe sleep apnea with more than 30 pauses in breathing in one hour

The distribution of the breathing pauses must be taken into account when making the assessment. If a patient has 30 respiratory pauses in the first two hours of the count - a total of 60 - but not a single breath pauses in the four following hours of sleep, the average is ten respiratory pauses per hour. The patient would then “scratch” the threshold of mild sleep apnea. The two very restless hours of his sleep can certainly lead to daytime sleepiness and other sequelae, which is why treatment may be appropriate here.

Furthermore, the length of the respiratory arrest should also be measured. If the breath stops 15 times for ten seconds in an hour, this is of course to be assessed differently than ten respiratory arrests in an hour, each of which extends over a minute.

Another important criterion in assessing the severity of sleep apnea syndrome is oxygen saturation in the blood. For example, 20 pauses in breathing in one hour can be much safer than 15 pauses in breath in an hour if the oxygen saturation is reduced by 50 percent in the second case, while in the first case there is virtually no decrease in saturation.

In addition, individually different factors such as the extent of the impairment caused by the disease play an important role in the assessment.

Treatment of sleep apnea

The type of therapy used to treat sleep apnea depends on the severity of the condition. CPAP therapy is mostly used for moderate to severe sleep apnea syndromes (for details see below).

Treatment of mild sleep apnea
In the case of light sleep apnea, the same measures that are used to treat snoring are usually sufficient: The treatment with a mouth splint (mandibular protrusion splint, snoring splint) should be mentioned in particular. This splint is adjusted by the specialist. It is worn during the night, where it pulls the patient's lower jaw forward a little. This keeps the airway at the back of the throat open.

To support any therapeutic measure, one's own living conditions should also be viewed critically. Through targeted changes, each person affected can make a contribution to alleviating their suffering. These include weight reduction if you are overweight or obese, abstaining from alcohol (especially in the evening), sleeping on your side (lying on your back promotes snoring and breathing pauses), not taking sleeping pills or sedatives, and for smokers not consuming nicotine. A balanced diet and regular exercise also have a positive effect.

CPAP therapy for sleep apnea

A so-called CPAP device is used particularly frequently in the treatment of sleep apnea. CPAP is an abbreviation of the English expression "continuous positive airway pressure". CPAP devices are available in many different designs and from various manufacturers. The devices ensure a continuous positive pressure during night sleep, which ensures that the airways remain open. In general, around 80% of all those affected get along well with CPAP therapy.

The breathing mask is an important part of the CPAP device. Anyone who starts CPAP therapy to treat their sleep apnea will have to get used to it first. The large variety of models, however, allows experiments so that every patient can find a suitable and comfortable mask for themselves. A basic distinction is made between the following types of breathing masks for CPAP devices:

Nasal masks
The nasal masks are the most common. They are fixed to the head with straps and only sit above the nose.
Face masks
The face masks, like the nasal masks, are held in place by head straps. They cover the mouth and nose, which is why they are particularly recommended for people who breathe almost exclusively through the mouth or alternately through the mouth and nose.
Nasal pads
The nasal pads are not actually masks, as they are just two small pads that are inserted directly into the nose. Here, too, there is a fixation by head straps. Nasal pads are an alternative to the classic masks, which are particularly recommended for people who are prone to claustrophobia under masks or who have problems with the fit of the other masks.

With the CPAP device, sleep apnea patients can finally enjoy restful sleep again. The continuous flow of air generated by the device ensures that the airways remain open and there are no pauses in breathing. Snoring is also largely suppressed by using the device.

In addition to the devices that generate constant air pressure, there are also devices with variable air pressure. A distinction is made between auto-crap devices and bilevel devices:

  • Auto crap machines
    With the Auto-Crap devices, a sensor measurement of the air flow takes place, which is why the device can adjust the pressure with each breath to the personal requirements of the patient throughout the night. The lowest pressure required to keep the airways open is always used, which makes them very comfortable. These devices are usually a little more expensive to buy than conventional CPAP devices.
  • Bilevel devices
    Therapy with bilevel devices, also known as two-phase devices (BIPAP), is often used in people who suffer from pulmonary dysfunction (with or without obstructive sleep apnea syndrome). Bilevel devices produce lower pressure when you exhale and higher pressure when you inhale. The bilevel devices also usually have a higher purchase price. However, they are indispensable when the airways are extremely unstable and require very high ventilation pressure.

Who pays for CPAP therapy?
The CPAP therapy is paid for by health insurance companies. In the beginning, very close checks (about every two to four months) are required. After a certain period of time, an annual check is sufficient, in which the attending physician determines whether the device and its settings are still optimally suited to the patient's needs.

The decision for therapeutic treatment of sleep apnea syndrome does not always depend solely on its severity. Rather, other existing illnesses and concomitant illnesses must also be taken into account. In medical practice it has been shown, for example, that in the case of nocturnal breathing disorders which have occurred after a stroke, simultaneous treatment of the sleep apnea syndrome has a positive effect on the restoration of the bodily functions damaged by the stroke. This is then much faster. It has also been shown in the presence of cardiac insufficiency that this can be significantly improved if not only a therapy to treat the weakness of the heart but also something to alleviate the sleep apnea syndrome is undertaken.

Surgery for sleep apnea?

Surgery to treat sleep apnea is also performed very rarely. Surgery is usually only chosen if there are anatomical causes for the sleep apnea syndrome that can be remedied or corrected by surgery. This includes polyps and large tonsils that can be removed. If the uvula and soft palate are too large, they can be brought to a suitable size using a laser. Jaw misalignments can also be partially corrected with an operation.