As strange as it may sound, many sleep apnea sufferers don’t know the underlying cause of their obstructive sleep apnea (OSA).
But that’s not the fault of the patient. Sleep study reports contain an alphabet soup of medical acronyms (AHI, EEG, RDI, etc.) but I haven’t seen a single report that actually states the CAUSE of the patient’s sleep apnea.
In this section I’ll show you some simple and straightforward steps that you can follow at home to understand exactly what’s triggering your sleep apnea.
Why is it critically important to know the underlying cause? Because without knowing the cause, it’s very difficult to identify the most appropriate treatment.
Only by knowing what’s driving your apnea can you figure out the treatment that will most efficiently and effectively conquer it.
THREE PRIMARY CAUSES OF OBSTRUCTIVE SLEEP APNEA
Image Credit: healthysmart.org
There are three things that can potentially obstruct the flow of air into your body while you sleep:
1. Excessive tissue in the upper airway
Another way of saying this is there’s too much “flab” in the upper part of the throat.
This is especially common among people who are overweight (and extremely common among people who are obese).
When you’re awake during the day, the muscles in your throat are firm and keep the flab from collapsing together and cutting off your airflow.
But when you fall asleep your throat muscles relax and the flab presses together – cutting off your airflow. This is especially the case when you sleep on your back, because gravity causes the flab to sink down into your upper airway.
2. Weak muscles in the upper airway
As we age, the muscles in our upper airway tend to become weaker – which is one of the reasons obstructive sleep apnea is much more common in people over the age of 50.
As mentioned above, when we’re awake during the day, the muscles in our bodies are firm. When we fall asleep, the muscles in our body – including the muscles in our upper airway – relax.
In cases where a person’s muscles are extremely weak, this can cause a complete collapse of the upper airway – and blockage of air to the body.
(This is made worse when a person has weak throat muscles AND excessive tissue in the upper airway.)
The muscles in your upper airway can also be temporarily weakened by various substances. All of the following substances can temporarily relax the muscles in the upper airway, causing obstructive sleep apnea:
- Alcohol
- Drugs
- Smoking (nicotine is a muscle relaxant)
3. Structural obstructions of the nose, mouth, or throat:
“Structural obstructions” simply means there’s something in your nose, mouth, or throat that is physically blocking the flow of air into your body (something besides the excessive tissue that was mentioned previously).
The most common types of structural obstructions are:
A. Nasal obstructions. In this case, air cannot make it through the nose properly because something is blocking the airflow.
Most Common Types of Nasal Obstructions That Cause Sleep Apnea
- Deviated septum. The septum is the “wall” between your two nostrils. A “deviated” septum is one that’s crooked. So basically the wall between your nostrils is crooked, which reduces the flow of air when you breathe through your nose.
Deviated septums are extremely common. One estimate states that 80% of the population has some sort of misalignment to their nasal septum - but only a small fraction of those people have a septum that is bad enough to affect their breathing.
- Enlarged turbinates. Turbinates are sausage-shaped bones in the nasal cavities. They warm, moisten, and filter the air that we breathe in through our nose.
Sometimes a person’s turbinates become enlarged. This is mostly due to environmental allergies. When a person’s turbinates become enlarged, it blocks the flow of air through the nasal passage.
B. Oral obstructions. Like a nasal obstruction, when a person has an oral obstruction it means that air cannot make it into the body because something is blocking it.
But with an oral obstruction, the blockage occurs in the mouth or throat.
Most Common Types of Oral Obstructions That Cause Sleep Apnea
Deviated septums are extremely common. One estimate states that 80% of the population has some sort of misalignment to their nasal septum - but only a small fraction of those people have a septum that is bad enough to affect their breathing.
- Uvula is too large.
The uvula is the dangly bit at the back of your throat. When the uvula is too large, it can obstruct airflow.
- Tonsils are too large.
Enlarged tonsils are a very common cause of obstructive sleep apnea in children (and, much less commonly, in adults).
- Adenoids are too large.
Adenoids are bits of tissue that are part of the body’s immune system. Like the uvula and tonsils, when the adenoids are too large they can block airflow.
Technically, the adenoids are part of the nasal passage, as they sit at the back of the nasal cavity, where the nose blends into the throat.
But because they sit just behind the uvula (the dangly bit at the back of the throat), when they are removed surgically the adenoids are often removed along with the uvula and tonsils.
- Soft palate is too long or flabby.
The soft palate is the soft part of the roof of your mouth (toward the back of your mouth; the part that you can feel above your tongue is the hard palate).
Some people have soft palates that are too long. When they lie down and fall asleep, their soft palate falls into the opening of their airway, cutting off airflow.
Similarly, when the soft palate is too flabby, the palate also sinks into the upper airway when you’re asleep.
- Tongue is too large (specifically, the base of the tongue).
When we fall asleep, sometimes the base of our tongue slides back into our mouth. When the base of the tongue is too large, it can block the upper airway when the tongue slides back during sleep.
- Jaw is small/narrow.
When the jaw is abnormally narrow, it reduces the size of the upper airway. This can result in too little air getting into the upper airway.
Now you know the primary causes of obstructive sleep apnea. Let’s move on to how you can diagnose your sleep apnea at home.
Now you know the primary causes of obstructive sleep apnea. Let’s move on to how you can diagnose your sleep apnea at home.
HOW TO DIAGNOSE SLEEP APNEA AT HOME
Can sleep apnea be diagnosed in the comfort of your own home?
The simple answer is “yes, it can.”
An array of methods exist for self-diagnosing sleep apnea. In this chapter we will cover in plain English the ways that you can test yourself at home to know if you have obstructive sleep apnea, as well as how to determine the underlying cause of your sleep apnea.
Methods for diagnosing your sleep apnea at home range from simple (but effective) questionnaires to at-home diagnostic equipment that can be ordered from the Internet.
There are three main methods for testing your sleep apnea at home:
- Questionnaires
- Examining your body
- Home diagnostic tests
We’ll start with the easiest method: questionnaires.
Self-Diagnosis Method #1: Questionnaires
Many self-diagnosis questionnaires have been tested over the past decade, but there are only two that have been proven to accurately diagnose whether a person has obstructive sleep apnea or not.
These two questionnaires are:
- The STOP-BANG Questionnaire
- The Berlin Questionnaire
If you haven’t done a sleep study yet and you’re not 100% sure that you have obstructive sleep apnea, answer the questions from one of the questionnaires below to find out for sure if you have OSA.
● STOP-BANG Questionnaire
The STOP-BANG questionnaire focuses on the most common indicators of obstructive sleep apnea. Those indicators include snoring, daytime tiredness, and health conditions that are strongly related to OSA.
“STOP-BANG” is an acronym to help patients remember the questions in the questionnaire. The questions are:
Snoring
Do you snore loudly (louder than talking or loud Y/Nenough to be heard through closed doors)?
Y/N
Tired
Do you often feel tired, fatigued, or sleepy during Y/Ndaytime?
Y/N
Observed apnea
Observed apnea Has anyone observed you stop breathing duringyour sleep?
Y/N
Blood Pressure
Blood Pressure Do you have or are you being treated for high Y/Nblood pressure?
Y/N
BMI
Is your BMI more than 35?
Y/N
Age
Are you over 50 years old?
Y/N
Neck Circumference
Is your neck circumference greater than 17” (males) Y/Nor 16” (females)?
Y/N
Gender
Are you male?
Y/N
You have a high risk of OSA if you answered “yes” to three or more questions above.
You have a low risk of OSA if you answered “yes” to less than three questions above.
● Berlin Questionnaire
The Berlin Questionnaire has also proven effective in diagnosing obstructive sleep apnea, and is less reliant on measures of weight than the STOP-BANG questionnaire.
(In other words, there are some people who have OSA who are not overweight. The Berlin Questionnaire might be more appropriate for these people to determine if they have obstructive sleep apnea, because it does not take weight into consideration.)
The questions on the Berlin Questionnaire are:
Category 1 (Snoring):
Do you snore?
How loud is your snoring?
How often do you snore?
Does your snoring ever bother other people?
Has anyone noticed that you quit breathing during your sleep?
Category 2 (Daytime Fatigue):
How often do you feel tired or fatigued after your sleep?
During your waking time, do you feel tired, fatigued, or not up to par?
Have you ever nodded off or fallen asleep while driving a vehicle?
If you do fall asleep or nod off while driving, how often does this occur?
Category 3 (Blood Pressure):
Do you have high blood pressure?
How loud is your snoring?
If you have a positive score for two or more of the three categories, then you are at high risk of having obstructive sleep apnea.
Self-Diagnosis Method #2: Examining Your Body
Once you’ve used a self-diagnosis questionnaire (or overnight sleep study) to understand whether or not you have OSA, the next step is to figure out what’s causing it.
Only when you understand the cause of your obstructive sleep apnea can you identify the appropriate treatment.
This section will show you how to examine your body to determine the cause of your OSA. The section is broken down into three sections:
1. How to know if you have excessive tissue in the upper airway
2. How to know if you have weak muscles in the upper airway
3. How to if you have structural obstructions of the nose, mouth, or throat
How to Know if You Have Excessive Tissue in Your Upper Airway
Nobody appreciates being called overweight – people simply don’t like to admit that they may have an issue with their size.
However, just because you have excess flabby tissue around the throat area doesn’t necessarily mean you’re overweight. That’s the most common reason for the excess flab - but not the only one.
Aging can also contribute to excess flabby throat tissue. As we age our skin naturally loses its elasticity, and this presents us with loose, flabby folds of skin.
The picture above shows two differently built women. The woman on the right is slighter than the woman on the left. You can observe the excess flabby tissue on the bigger woman - around her throat.
The muscles here will be weak. They’re not toned and strong - as the slighter built woman’s are. The weakened muscles can collapse on themselves.
When this occurs during sleep, the airway can easily become completely blocked off. Strengthening and toning the throat muscles will help sleep apnea sufferers.
How to Know if You Have Weak Muscles in Your Upper Airway
Image Credit: drkarennation.com
Various studies confirm that the muscles in the upper airway weaken with age, so if you’re aged 50+ the chances are good that your upper airway muscles have already started to weaken.
Beyond age, there are two key signs of weak throat muscles:
- Snoring
- Difficulty swallowing
How to Know if You Have Structural Obstructions of the Nose, Mouth, or Throat
● Testing Your Tongue
Did you know that your tongue can give away a lot of information regarding sleep apnea? You’ll be amazed how simply taking a peek at your tongue in a mirror can reveal so much!
The image on the left displays a healthy, regular tongue. Some normal features of a tongue are:
- Smooth edges
- Free motion
- Slightly red in color
- Soft texture
- No lumps or bumps
- Thin white coating
The image on the right shows a tongue with numerous indentations. The term used for this is “scalloping.” This is caused by the tongue sitting against the molars.
If your tongue has “scalloping”, it might mean that your tongue is too large, and could be causing – or at least contributing to – your sleep apnea
Other signs to look for are:
- A palate that’s high-arched.
- A jawline that’s smaller than average.
- A high-sitting tongue. Grab a mirror and try looking at the back of your throat. If you can’t see the back of your throat clearly - your tongue’s sitting high.
● Elongated Soft Palate
The soft palate is composed of muscle fibers. The fibers are encased in mucous membranes. The job of the soft palate is to shut off the nasal passages when a person swallows.
If the soft palate is longer than average, it’ll narrow the gap leading from the nose to the throat, which can block a person’s airway. The extra length can also be the cause of snoring. It becomes a noisy, fluttering valve during a relaxed state of breathing.
The image on the left displays an elongated soft palate. The palate is resting on the tongue’s base, indicated by the white arrows. This blocks off the airway.
You can observe in a mirror whether you have an elongated soft palate. Open your mouth wide; stick your tongue out and downward.
Look at the back of your mouth. On either side of the uvula (the dangly thing in the middle of your throat) there should be a good clearance.
If there’s little or no noticeable gap, then the chances are good that your soft palate is elongated.
● Enlarged Uvula
The uvula is the cone shaped tissue that hangs down from the soft palate. Its function is to work in conjunction with the soft palate. During swallowing they both prevent any food entering the nasal passages.
The image on the right shows a larger than normal uvula (marked by the three arrows). The uvula is resting on the base of the tongue.
Like the elongated soft palate, an enlarged uvula can restrict normal airflow by creating a blockage.
The airway is much more likely to be closed off if the person has an enlarged uvula. The added size of the uvula often contributes to snoring.
Just like the elongated soft palate - it becomes a fluttering, noisy valve when the breathing is relaxed.
● Enlarged Tonsils
Enlarged (also called “hypertrophic”) tonsils are generally seen in children - but adults can also suffer this condition. The tonsils are so swollen and large that they obstruct breathing. Swallowing can also be difficult.
The image above, of the enlarged uvula, also displays hypertrophic tonsils (marked by the two small arrows on the left and right).
Along with the other two conditions mentioned above, the diagnosis for enlarged tonsils is often visual. The tonsils will be especially pronounced and naturally bulging out. They can be so enlarged that they may touch one another.
● Deviated Septum
As mentioned previously, a deviated septum is when the “wall” between your two nostrils is crooked. This obstructs the proper flow of air through the nasal passage.
The main symptoms of a deviated septum are:
- Difficulty breathing through the nose
- Nasal congestion, usually one side more than the other
- Recurrent sinus infections
- Nosebleeds
- Snoring
● Enlarged Turbinates
Turbinates are small bones in your nasal cavity that are part of your body’s immune system. When the turbinates become enlarged they also obstruct the proper flow of air through the nasal passage.
The main symptoms of enlarged turbinates are:
- Chronic stuffy nose
- Difficulty breathing through the nose (forcing you to breathe through your mouth)
- Snoring
Self-Diagnosis Method #3: Home Diagnostic Tests
Two home diagnostic tests exist for sleep apnea. One tests for oxygen levels within the blood, and the other collects events occurring during sleep, known as “sleep data.”
The oximetry (oxygen levels) test involves the sleeper wearing a clamp on his or her finger (available at wrist pulse oximeter for about $600 – but often on sale. If the oxygen levels read low during sleep, this is an indication of sleep apnea.
The at home sleep apnea testing device (similar price range as the wrist pulse oximeter) requires the sleeper to wear sensors.
The sensors are usually connected to the person’s finger, chest and breath.
Data collected includes respiratory episodes, intensity of snoring, pulse rate, and blood oxygen saturation.
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