Tired during the day due to breathing interruptions at night
Those who regularly feel tired and lacking in energy during the day, even though they have slept at least eight hours, could suffer from obstructive sleep apnea (OSA). Around two percent of women and four percent of men between the ages of 30 and 60 are affected by nightly breathing interruptions. Due to the lack of oxygen, there is an increased risk of heart attack, stroke, high blood pressure and lung diseases. If sleep apnea is suspected, patients should urgently consult a doctor.
Nocturnal respiratory arrests in sleep apnea increase the risk of cardiovascular diseases Sleep apnea is characterized by nocturnal respiratory arrest and a reduced oxygen supply as well as repeated wake-up reactions. However, the wake-up reactions usually do not actually wake the person concerned, but act as an alarm function of the body, which leads to an increase in body functions such as the acceleration of the pulse. Most of those affected are not aware of these wake-up reactions. Nevertheless, the next morning they feel sleepy and suffer from the typical extreme daytime tiredness, lack of concentration and exhaustion. Often, those affected snore loudly, so that the partners wake up from it and notice the nighttime breathing stops.
Since the breathing interruptions cause a lack of oxygen, which increases the risk of heart attack, stroke, lung diseases and high blood pressure as well as stress diseases such as tinnitus and sudden hearing loss, a doctor should be consulted to find out the reason for the sleep apnea. Treatment is recommended from ten breath stops per night.
In the sleep laboratory, doctors can carry out various measurements (e.g. EKG, EEG, oxygen content of the blood). The cause of sleep apnea can also be reliably diagnosed using sleep endoscopy. The patient is put to sleep. The doctor can then closely monitor with a probe, which triggers the closure of the airways. The tongue is often the cause of the symptoms. Obesity, a long neck suppository and oversized almonds can also play a role.
To determine the severity of sleep apnea, use the Apnea Index (AI), which indicates how many 10-second pauses in breathing occur during sleep. Ideally, it is less than five per hour. The higher the apnea index, the more severe the sleep apnea.
Treatment options for sleep apnea The CPAP mask works most effectively for many patients. This is worn on the face during the night as a nose or full face mask. The patient is supplied with air by overpressure, so that a closure of the airways is prevented. However, quite a few patients feel disturbed by the mask and the device in their nightly bed rest.
In addition, there is the possibility of wearing various other devices such as clips or rings, which are usually intended to prevent snoring. In some cases, however, they also work against sleep apnea by keeping smoking open.
Orthodontics, so-called lower jaw protrusion splints made of plastic, shift the lower jaw forward so that the upper airways do not close. They are used when a backward displacement of the lower jaw and the base of the tongue causes the airways to close.
To change the sleeping posture, there are special pillows or pajamas, into which tennis balls have been sewn, for example, so that back sleepers no longer turn on their backs. However, these tools are only effective for mild forms of sleep apnea.
Surgery only in severe cases of sleep apnea In severe cases, surgery may be necessary. So there is the possibility to tighten or shorten the soft palate. The length of the tongue or the base of the tongue can also be changed surgically.
A relatively new technique that is currently being tested in clinical trials worldwide is the tongue pacemaker. A so-called neurostimulator is implanted under the skin slightly below the clavicle. A cable that leads to the costal arch transmits the respiratory rate via the movements of the diaphragm. A second cable with an electrode is connected to the hypoglossal nerve, which is responsible for the activation of the tongue muscles. When the patient breathes in, the tongue pacemaker sends an impulse to the tongue nerve, so that the tongue muscles are tense and the airways remain free. The device is switched on in the evening using the remote control and switched off again tomorrow. In Germany, the procedure is currently being tested at the sleep medicine center of the Berlin Charité and at the ENT clinic in Mannheim. (ag)
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