Apnea means a temporary cessation, complete or near-complete, of breathing wherein there is no movement of the muscles of inhalation. It can be involuntary – drug-induced (such as by opiate toxicity), mechanical or physiological (by strangulation or choking), or a consequence of some neurological disease or trauma. Voluntary apnea is holding one’s breath by simultaneously closing the vocal cords, keeping the mouth shut and blocking the nasal cavity, or constantly activating expiratory muscles, thus not allowing any inspiration. Heightened emotions such as sobbing, crying, or laughing can be the triggers. These emotional breath-holding spells, often witnessed in children, result from frustration, emotional stress, psychological issues or simply tantrums. More about this we shall keep for another time. Today, my focus is on OSA.

OSA, or obstructive sleep apnea, is a sleep disorder wherein your breathing repeatedly stops and starts, often due to a blockage or narrowing in your upper airway that keeps air from moving through your windpipe while you’re asleep.

The blockage and consequent lack of airflow can cause your blood oxygen levels to drop. This triggers a survival reflex in your brain that wakes you up just enough to breathe again. While that reflex is key in keeping you breathing, it leads to fragmented and non-restorative sleep.

People with severe sleep apnea can have over thirty episodes of intermittent apnea per hour every night.

Frequent wakeups at night can cause you daytime exhaustion and a wide range of other frustrating symptoms. Over time, these symptoms can lead to dangerous and sometimes life-threatening complications.

OSA is the most common sleep-related breathing disorder and affects up to 1 billion people around the world between the ages of 30 and 70.

What are the symptoms of obstructive sleep apnea?

Symptoms of OSA that you or a sleeping partner will notice at night include:

• Loud snoring
• Frequent wakeups in the middle of the night
• Pauses in breathing during sleep
• Waking up out of breath as if you’re gasping or choking
• Night sweats
• Feeling restless

Daytime symptoms may include:

• Fatigue, sleepiness or exhaustion
• Mood swings such as depression or anxiety
• Difficulty concentrating or remembering
• Headaches (often when waking up)
• Dry mouth
• Sexual dysfunction

What does OSA sound like?

This is what it sounds like when a 39-year-old male has an involuntary pause in breathing for 24 seconds in a case of OSA.

You might notice the following characteristics in a sleeping partner with OSA:

• Loud snoring that usually starts soon after falling asleep
• Snoring stops suddenly (while breathing stops)
• A snort or gasp for breath before snoring starts again

What causes obstructive sleep apnea?

A blockage in your upper airway causes obstructive sleep apnea. Your muscles relax when you sleep, even the ones that allow air to flow into your lungs. But there should still be enough room for air to get into your body. With sleep apnea, relaxed muscles and tissues block the airway. This prevents airflow, which causes you to stop breathing.

What are the risk factors?

OSA can happen to anyone at any age or any body size. It’s more common if you:

• Are obese, more so if you have central obesity – its standardised marker being your waist-hip ratio (WHR), set by the World Health Organization (WHO) – if more than 0.90 (in men) or 0.85 (in women). 
• Suffer from a structural abnormality like – an underbite when your bottom teeth extend beyond your top front teeth (common in kids habituated to thumb-sucking or pacifiers). 
• Have a smaller lower jaw or a large tongue.
• Have a large neck (collar size >15 inches for women and >17 inches for males).
• Suffer from enlarged tonsils or adenoids.
• Have a genetic condition that affects how your head and neck develop, like Down syndrome, acromegaly, etcetera.
• Are pregnant.
• Are addicted to smoking, alcohol or sedatives/hypnotics/antidepressants.

OSA is more common as you age, but it can also affect children.

What are the possible long-term effects of OSA?

The cycle of restricted airflow, waking and falling asleep again, continuing throughout the night, stops you from sleeping soundly and prevents your vital organs from getting enough oxygen. Untreated, it can lead to serious and sometimes life-threatening complications that may include:

• Perpetual daytime drowsiness (dangerous if you’re driving or doing something that needs your full, undivided attention)
• Chronic health conditions like high blood pressure or Type 2 diabetes
• Arrhythmias (atrial fibrillation) culminating in heart damage and heart failure
• Stroke
• Sudden cardiac death

How is it diagnosed?

It is recommended that you consult an ENT specialist or a sleep physician if you or a loved one seems to have this condition. The specialist will provide a final diagnosis after taking down your medical history, conducting a physical examination, and recommending specific tests:

• Overnight sleep study (polysomnogram): This is an overnight test where you sleep in a medical facility while they monitor your sleep.
• Home sleep apnea testing: The test is similar to an overnight sleep study but doesn’t involve brain wave monitoring and other types of sensors, and you get to stay home.

With permission, you can record video or audio of the person sleeping to show to the doctor. This can help speed up the diagnostic process.

You may further be referred to an orthodontist if a malformation and/or a malfunction of the upper airways is detected by your consulting physician.

What are the treatment options?

OSA is a treatable condition. Treatment options may include:

• Lifestyle changes, including sleeping position adjustments (not sleeping on your back) or maintaining a weight that’s healthy for you.
• Using a continuous positive airway pressure (CPAP) machine.
• Wearing oral appliances, such as a mandibular advancement device or a tongue-stabilizing device, can help improve the airflow during sleep by positioning your jaw or tongue forward.
• Surgery: Common types of surgeries to open your airway and treat OSA include:
  • Uvulopalatopharyngoplasty (UPPP): Removing tissue from the back of your throat
  • Tracheostomy: Opening your windpipe to bypass a blockage
  • Tonsillectomy/adenoidectomy: Removing tonsils or adenoids
  • Nerve stimulation: Implanting a device to stimulate airway muscles during sleep.

Homoeopathy Helps

Homoeopathic remedies such as Lachesis, Opium, Sulphur, Arsenicum album, Grindelia Robusta, Sambucus, Ammonium Carb, Ignatia, Cenchris Contortrix and many more, based on the totality of your individualising symptoms can give you relief in OSA provided there are no developmental abnormalities or malformations in the structure of your airway. The medicines are most effective when congestion, a blockage – allergic or pathological, such as a polyp, an enlarged tonsil or an adenoid, or an undue relaxation of muscles of the tongue/ back of your throat are causing you the issue.