Sleep apnea (pronounced "AP-knee-uh"), literally means "without breath" and is a common problem that appears as pauses in breathing or excessively shallow breathing during sleep. These pauses in breathing can last from a few seconds to a few minutes at a time, and can occur anywhere from 5 to 30 or more times in a single hour. Often, these episodes are followed by a loud snort or choking sound, after which normal breathing resumes. This condition can be associated with significant sleep disturbance, and can cause daytime sleepiness and fatigue. Some signs and symptoms are: morning headaches, irritability, mood-swings, depression, sexual dysfunction, and learning or memory difficulties.

Diagnosis
Unfortunately, most people with sleep apnea go undiagnosed until a family member or sleep partner notices the condition. There is no physical examination or blood test that a doctor can perform to routinely screen for sleep apnea, although testing in a sleep clinic will reveal any problems. Most sufferers do not have any obvious symptoms, and are not aware of having difficulty breathing, even upon waking. If you are concerned about having sleep apnea, and do not have a sleep partner who can monitor you or a sleep centre nearby, you can use a recording device to record your breathing patterns during sleep, and play it back to hear if you have long pauses in your breathing or snoring. Should you hear a problem, following up with your healthcare provider is important.

Types of Sleep Apnea
There are two main types of sleep apnea, each of which has different symptoms and health ramifications.

Obstructive sleep apnea is the most common type and occurs most frequently in overweight individuals. This type of apnea is caused by the blocking of the airway by soft tissue in the throat, as the muscles in the body relax with sleep. This type is frequently associated with loud snoring as well. When the airway is only partially blocked, the air passing through the narrowed passage creates the loud "snoring" sound, and when the passage is completely blocked, apnea results. This type of apnea is marked by the chest rising as the body struggles to breathe during sleep.

Central sleep apnea is less common than obstructive sleep apnea, although they may both occur together. Central sleep apnea is a condition, also called Cheyne-Stokes respiration, and is caused by the brain failing to properly guage blood oxygen and carbon dioxide levels. Because of delayed response, the brain does not send the correct signals to the muscles that control breathing when oxygen levels drop and carbon dioxide levels rise in the blood. During pauses in breathing, there is no effort to breathe, no chest movements and no struggling. This type of apnea is not associated with snoring, but may be associated with certain medications such as muscle relaxants and sleeping pills.

Health Risks
Sleep apnea that is not treated properly can result in an increased risk of a number of different health concerns. Because the body is not taking in enough air during pauses in breathing, the blood oxygen levels drop, which begins to starve the body's tissues. Some conditions that have higher rates of occurrence in sleep apnea sufferers are:

• Cardiovascular disease
• Stroke
• Heart attack in men
• High blood pressure
• Heart arrhythmias
• Diabetes
• Car accidents
• Female dementia
• Mental function decline

Beneficial Lifestyle Changes
Risk for sleep apnea increases with smoking, drinking alcohol, being overweight, and medications that relax muscles such as ibuprofen and sleeping pills. For information on alternative sleep aid supplements, please read our insomnia article here. Some people with sleep apnea can reduce their symptoms by avoiding alcohol, and muscle relaxants. Losing weight and quitting smoking can also significantly reduce or eliminate sleep apnea. Changing the body position during sleep can also help to open the airway. For example, elevating the upper body by 30-degrees, or side-sleeping can help to move any soft-tissue away, and prevent it from obstructing the airway during sleep. These simple interventions have been found to significantly improve both obstructive and central sleep apnea. There are also machines that fit over the nose and mouth that provide continuous positive airway pressure (CPAP) to prevent soft tissues from collapsing into the airway.

Strengthening the Muscles of the Upper Airway
Learning and practicing musical instruments such as the didgeridoo have been shown to help reduce snoring and sleep apnea, as well as improve daytime sleepiness. Performing a series of tongue and throat exercises for 30 minutes a day has been shown to lower apnea rates by almost 40% after 3 months.

Surgery
Surgical intervention has been recommended for a number of individuals with excess soft tissue causing airway obstruction during sleep. The outcome of these surgical interventions is mixed, and some surgical interventions are more effective than others. If you are interested in this approach, please discuss it with your medical doctor.