It’s called obstructive sleep apnea, better known as sleep apnea, a condition characterized by interruptions in breathing during sleep caused by total or partial obstruction of the upper airways. It is also known as OSAS (Obstructive Sleep Apnea Syndrome). The president of the United States also suffers from this ailment, Joe Biden, who in recent weeks has started using a device that should slow her down. But what exactly does it consist of? And does the device used to contain it have any side effects?
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What are sleep apnea
Sleep apnea occurs when breathing is repeatedly interrupted by breathing pauses during sleep. The obstructive ones (Osa), are the most common and they are generated, when you sleep, by the complete or partial obstruction of the upper airways; pathological central nocturnal ones are instead linked to a malfunction of the nervous or cardiovascular system: the airways are open, but the brain does not send adequate signals to the muscles that control breathing.
Given that they can also be serious, sleep apnea arises from different causes: in the case of obstructive apnea, the interruption of breathing generally occurs when the soft palate collapses during sleep due to relaxation of the muscles in the back of the throat. Obesity (with deposition of fat in the neck), tonsillar hypertrophy, adenoid hypertrophy in children, an increase in the volume of the tongue (macroglossia), or a reduction in the size or the retropositioning of the mandible (micrognathia and retrognathia). Central apneas, on the other hand, are usually caused by a dysfunction of the central respiratory control system, caused for example by neuromuscular diseases such as amyotrophic lateral sclerosis (ALS) or by a stroke or even heart failure.
The risk factors
As for the factors that increase the risk of obstructive sleep apnea, they should be sought in being overweight, the habit of smoking cigarettes, nasal congestion (potentially associated with septal deviations, nasal polyps, allergies), alcohol intake and sedatives, male gender and advanced age. To these are also added constitutional factors such as a bull neck, narrow airways, a small or retroposed jaw, large tonsils, adenoids and tongue, family history and menopause in women.
However, it must be said that these are dangerous disorders and that they can have very serious consequences. Repeated awakenings interfere with deep sleep, making severe daytime sleepiness likely. For this reason, obstructive apneas are currently a pathology to be diagnosed and treated for the issuance or renewal of a driving licence. They also increase the risk of high blood pressure, heart attack, stroke and cardiac arrhythmias, such as atrial fibrillation. For children and infants, the consequences of sleep apnea include learning and behavior disorders, growth retardation, and cardiopulmonary disease.
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How they care
So how to intervene? Depending on the causes of the apnea, it may be useful to go to specialized centers for sleep disorders or to a neurologist, cardiologist, ENT specialist or pulmonologist. The doctor will then evaluate which, among the various solutions available, is the most suitable for treatment. But to formulate the diagnosis, monitoring of breathing in sleep through polysomnography, an examination of breathing and heart and brain activity, is indicated. However, in cases of mild obstructive sleep apnea, lifestyle changes and weight loss may be sufficient.
And then there are the devices that are used in some patients to support breathing – this is the case of President Biden – such as continuous or intermittent positive pressure devices (CPAP or BIPAP), which provide a flow of air at a predefined pressure through a face or nose mask. In other cases, instead, the use of a mandibular advancement device, MAD, similar to an orthodontic appliance, is indicated, which helps keep the airways open during sleep by preventing the tongue from blocking the throat.
Finally, in well-selected cases, there are surgical therapies which can be maxillofacial (in case a forward movement of the jaw is necessary) or otorhinolaryngological, if the removal of adenoids, tonsils or soft tissues is indicated.
Anti-apnea devices, side effects
However, the use of anti-sleep apnea devices can also create annoying side effects. While not a common problem for all patients undergoing ventilation therapy, wind in the belly is certainly one of them. It must be said that, even if the main cause is the air pressure that the device blows into the patient, the correlation between CPAP and a swollen belly can occur for several reasons. First of all it is necessary to check that the value set on the device is in line with what was prescribed by the attending physician: if it is correct, it may be that it is not possible to counteract the pressure of the machine during the exhalation phase, with the result of swallowing air at each respiratory cycle.
Also, if you have the habit of moving during the night, the cause of the air in your belly with CPAP therapy could be the mask, because it could move in position making the algorithm of the ventilator believe that there is some leak, consequently increasing the pressure to counter it.
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Dry mouth and swollen eyes
Two other consequences of using CPAP therapy are dry mouth and puffy eyes. The first, common problem, is waking up with a dry mouth, which is due to the greater amount of air present in the oral cavity compared to normal. To give an example, we can think of what happens when we run and we are ‘out of breath’: precisely due to increased breathing (especially oral), the throat tends to dry out. How to fix this problem? Using a humidifier.
As for the eyes, swelling or redness upon awakening are mainly due to the mask which, by blowing out, sends the air into direct contact with them. This can happen for several reasons: incorrect size, poorly fitted mask, wear. Finally, red marks may appear on the face, caused by an incorrect size, a wrong model for the patient’s face, allergies to materials, detergents and the position taken during sleep.