Asthma

What Is Asthma?

Asthma (Az-muh) is a chronic disease that affects your airways. The airways are the tubes that carry air in and out of your lungs. If you have asthma, the inside walls of your airways are inflamed (swollen). The inflammation (IN-fla-MAY-shun) makes the airways very sensitive, and they tend to react strongly to things that you are allergic to or find irritating. When the airways react, they get narrower, and less air flows through to your lung tissue. This causes symptoms like wheezing (a whistling sound when you breathe), coughing, chest tightness, and trouble breathing, especially at night and in the early morning.

Asthma cannot be cured, but most people with asthma can control it so that they have few and infrequent symptoms and can live active lives.

When your asthma symptoms become worse than usual, it is called an asthma episode or attack. During an asthma attack, muscles around the airways tighten up, making the airways narrower so less air flows through. Inflammation increases, and the airways become more swollen and even narrower. Cells in the airways may also make more mucus than usual. This extra mucus also narrows the airways. These changes make it harder to breathe.

Asthma attacks are not all the same—some are worse than others. In a severe asthma attack, the airways can close so much that not enough oxygen gets to vital organs. This condition is a medical emergency. People can die from severe asthma attacks.
So, if you have asthma, you should see your doctor regularly. You will need to learn what things cause your asthma symptoms and how to avoid them. Your doctor will also prescribe medicines to keep your asthma under control.

Taking care of your asthma is an important part of your life. Controlling it means working closely with your doctor to learn what to do, staying away from things that bother your airways, taking medicines as directed by your doctor, and monitoring your asthma so that you can respond quickly to signs of an attack. By controlling your asthma every day, you can prevent serious symptoms and take part in all activities.

If your asthma is not well controlled, you are likely to have symptoms that can make you miss school or work and keep you from doing things you enjoy. Asthma is one of the leading causes of children missing school.

What Causes Asthma?

It is not clear exactly what makes the airways of people with asthma inflamed in the first place. Your inflamed airways may be due to a combination of things. We know that if other people in your family have asthma, you are more likely to develop it. New research suggests that being exposed to things like tobacco smoke, infections, and some allergens early in your life may increase your chances of developing asthma.

What Causes Asthma Symptoms and Attacks?

There are things in the environment that bring on your asthma symptoms and lead to asthma attacks. Some of the more common things include exercise, allergens, irritants, and viral infections. Some people have asthma only when they exercise or have a viral infection.

The list below gives some examples of things that can bring on asthma symptoms.

Allergens

• Animal dander (from the skin, hair, or feathers of animals)
• Dust mites (contained in house dust)
• Cockroaches
• Pollen from trees and grass
• Mold (indoor and outdoor)

Irritants

• Cigarette smoke
• Air pollution
• Cold air or changes in weather
• Strong odors from painting or cooking
• Scented products
• Strong emotional expression (including crying or laughing hard) and stress

Others

• Medicines such as aspirin and beta-blockers
• Sulfites in food (dried fruit) or beverages (wine)
• A condition called gastroesophageal (GAS-tro-e-sof-o-JEE-al) reflux disease that causes heartburn and can worsen asthma symptoms, especially at night
• Irritants or allergens that you may be exposed to at your work, such as special chemicals or dusts
• Infections

This is not a complete list of all the things that can bring on asthma symptoms. People can have trouble with one or more of these. It is important for you to learn which ones are problems for you. Your doctor can help you identify which things affect your asthma and ways to avoid them.

Who Is At Risk for Asthma?

In the United States, about 20 million people have asthma; nearly 5 million of them are children.

Asthma is closely linked to allergies. Most, but not all, people with asthma have allergies. Children with a family history of allergy and asthma are more likely to have asthma.

Although asthma affects people of all ages, it most often starts in childhood. More boys have asthma than girls, but in adulthood, more women have asthma than men.

Although asthma affects people of all races, African Americans are more likely than Caucasians to be hospitalized for asthma attacks and to die from asthma.


 

Chronic Obstructive Pulmonary Disease (COPD)

The airways and air sacs in the lung are normally elastic—that is, they try to spring back to their original shape after being stretched or filled with air, just the way a new rubber band or balloon would. This elastic quality helps retain the normal structure of the lung and helps to move the air quickly in and out. In COPD, much of the elastic quality is gone, and the airways and air sacs no longer bounce back to their original shape. This means that the airways collapse, like a floppy hose, and the air sacs tend to stay inflated. The floppy airways obstruct the airflow out of the lungs, leading to an abnormal increase in the lungs' size. In addition, the airways may become inflamed and thickened, and mucus-producing cells produce more mucus, further contributing to the difficulty of getting air out of the lungs.

Other Names for COPD

• Chronic obstructive airway disease
• Chronic obstructive lung disease

In the United States, chronic obstructive pulmonary disease (COPD) includes:

• Emphysema
• Chronic bronchitis

In the emphysema type of COPD, the walls between many of the air sacs are destroyed, leading to a few large air sacs instead of many tiny ones (see the How the Lungs Work section). Consequently, the lung looks like a sponge with many large bubbles or holes in it, instead of a sponge with very tiny holes. The large air sacs have less surface area for the exchange of oxygen and carbon dioxide than healthy air sacs. Poor exchange of the oxygen and carbon dioxide causes shortness of breath.

In chronic bronchitis, the airways have become inflamed and thickened, and there is an increase in the number and size of mucus-producing cells. This results in excessive mucus production, which in turn contributes to cough and difficulty getting air in and out of the lungs.

Most people with COPD have both chronic bronchitis and emphysema.

What Causes COPD?

Smoking Is the Most Common Cause of COPD

Most cases of chronic obstructive pulmonary disease (COPD) develop after repeatedly breathing in fumes and other things that irritate and damage the lungs and airways. Cigarette smoking is the most common irritant that causes COPD. Pipe, cigar, and other types of tobacco smoke can also cause COPD, especially if the smoke is inhaled. Breathing in other fumes and dusts over a long period of time may also cause COPD. The lungs and airways are highly sensitive to these irritants. They cause the airways to become inflamed and narrowed, and they destroy the elastic fibers that allow the lung to stretch and then return to its resting shape. This makes breathing air in and out of the lungs more difficult.

Other things that may irritate the lungs and contribute to COPD include:

• Working around certain kinds of chemicals and breathing in the fumes for many years
• Working in a dusty area over many years
• Heavy exposure to air pollution

Being around secondhand smoke (smoke in the air from other people smoking cigarettes) also plays a role in an individual developing COPD.

Genes—tiny bits of information in your body cells passed on by your parents—may play a role in developing COPD. In rare cases, COPD is caused by a gene-related disorder called alpha 1 antitrypsin deficiency. Alpha 1 antitrypsin (an-te-TRIP-sin) is a protein in your blood that inactivates destructive proteins. People with antitrypsin deficiency have low levels of alpha 1 antitrypsin; the imbalance of proteins leads to the destruction of the lungs and COPD. If people with this condition smoke, the disease progresses more rapidly.

Who Is At Risk for COPD?

Most people with chronic obstructive pulmonary disease (COPD) are smokers or were smokers in the past. People with a family history of COPD are more likely to get the disease if they smoke. The chance of developing COPD is also greater in people who have spent many years in contact with lung irritants, such as:

• Air pollution
• Chemical fumes, vapors, and dusts usually linked to certain jobs

A person who has had frequent and severe lung infections, especially during childhood, may have a greater chance of developing lung damage that can lead to COPD. Fortunately, this is much less common today with antibiotic treatments.

Most people with COPD are at least 40 years old or around middle age when symptoms start. It is unusual, but possible, for people younger than 40 years of age to have COPD.

What Are the Signs and Symptoms of COPD?

The signs and symptoms of chronic obstructive pulmonary disease (COPD) include:

• Cough
• Sputum (mucus) production
• Shortness of breath, especially with exercise
• Wheezing (a whistling or squeaky sound when you breathe)
• Chest tightness

A cough that doesn't go away and coughing up lots of mucus are common signs of COPD. These often occur years before the flow of air in and out of the lungs is reduced. However, not everyone with a cough and sputum production goes on to develop COPD, and not everyone with COPD has a cough.

The severity of the symptoms depends on how much of the lung has been destroyed. If you continue to smoke, the lung destruction is faster than if you stop smoking.

How Is COPD Diagnosed?

Doctors consider a diagnosis of chronic obstructive pulmonary disease (COPD) if you have the typical symptoms and a history of exposure to lung irritants, especially cigarette smoking. A medical history, physical exam, and breathing tests are the most important tests to determine if you have COPD.

Your doctor will examine you and listen to your lungs. Your doctor will also ask you questions about your family and medical history and what lung irritants you may have been around for long periods of time.

Breathing Tests

Your doctor will use a breathing test called spirometry (speh-ROM-eh-tree) to confirm a diagnosis of COPD. This test is easy and painless and shows how well your lungs work. You breathe hard into a large hose connected to a machine called a spirometer (speh-ROM-et-er). When you breathe out, the spirometer measures how much air your lungs can hold and how fast you can blow air out of your lungs after taking a deep breath.

Spirometry is the most sensitive and commonly used test of lung functions. It can detect COPD long before you have significant symptoms.

Based on this test, your doctor can determine if you have COPD and how severe it is. Doctors classify the severity of COPD as:

• At risk (for developing COPD). Breathing test is normal. Mild signs that include a chronic cough and sputum production.
• Mild COPD. Breathing test shows mild airflow limitation. Signs may include a chronic cough and sputum production. At this stage, you may not be aware that airflow in your lungs is reduced.
• Moderate COPD. Breathing test shows a worsening airflow limitation. Usually the signs have increased. Shortness of breath usually develops when working hard, walking fast, or doing other brisk activities. At this stage, a person usually seeks medical attention.
• Severe COPD. Breathing test shows severe airflow limitation. A person is short of breath after just a little activity. In very severe COPD, complications like respiratory failure or signs of heart failure may develop. At this stage, the quality of life is greatly impaired and the worsening symptoms may be life threatening.

Your doctor may also recommend tests to rule out other causes of your signs and symptoms. These tests include:

• Bronchodilator (brong-ko-di-LA-tor) reversibility testing. This test uses the spirometer and medicines called bronchodilators. Bronchodilators work by relaxing tightened muscles around the airways and opening up airways quickly to ease breathing. Your doctor will use the results of this test to see if your lung problems are being caused by another lung condition such as asthma. However, since airways in COPD may also be constricted, your doctor can use the results of this test to help set your treatment goals.
• Other pulmonary function testing. For instance, your doctor could test diffusion capacity.
• Chest x ray. A chest x ray is a picture of your lungs. A chest x ray may be done to see if another disease, like heart failure, may be causing your symptoms.
• Arterial blood gas. This is a blood test that shows the oxygen level in your blood. It is measured in people with severe COPD to see if oxygen treatment is recommended.

How Is COPD Treated?

Quitting smoking is the single most important thing you can do to reduce your risk of developing chronic obstructive pulmonary disease (COPD) and slow the progress of the disease.

Your doctor will recommend treatments that help relieve your symptoms and help you breathe easier. However, COPD cannot be cured.

The goals of COPD treatment are to:

• Relieve your symptoms with no or minimal side effects of treatment
• Slow the progress of the disease
• Improve exercise tolerance (your ability to stay active)
• Prevent and treat complications and sudden onset of problems
• Improve your overall health

The treatment for COPD is different for each person. Your family doctor may recommend that you see a lung specialist called a pulmonologist (pull-mon-OL-o-gist).

Treatment is based on whether your symptoms are mild, moderate, or severe.

Medicines and pulmonary rehabilitation (rehab) are often used to help relieve your symptoms and to help you breathe more easily and stay active.

COPD Medicines

Bronchodilators

Your doctor may recommend medicines called bronchodilators that work by relaxing the muscles around your airways. This type of medicine helps to open your airways quickly and make breathing easier. Bronchodilators can be either short acting or long acting.

• Short-acting bronchodilators last about 4 to 6 hours and are used only when needed.
• Long-acting bronchodilators last about 12 hours or more and are used every day.

Most bronchodilator medicines are inhaled, so they go directly into your lungs where they are needed. There are many kinds of inhalers, and it is important to know how to use your inhaler correctly.

If you have mild COPD, your doctor may recommend that you use a short-acting bronchodilator. You then will use the inhaler only when needed.

If you have moderate or severe COPD, your doctor may recommend regular treatment with one or more inhaled bronchodilators. You may be told to use one long-acting bronchodilator. Some people may need to use a long-acting bronchodilator and a short-acting bronchodilator. This is called combination therapy.

Inhaled glucocorticosteroids (steroids)
 
Inhaled steroids are used for some people with moderate or severe COPD. Inhaled steroids work to reduce airway inflammation. Your doctor may recommend that you try inhaled steroids for a trial period of 6 weeks to 3 months to see if the medicine is helping with your breathing problems.

Flu shots
 
The flu (influenza) can cause serious problems in people with COPD. Flu shots can reduce the chance of getting the flu. You should get a flu shot every year.

Pneumococcal vaccine

This vaccine should be administered to those with COPD to prevent a common cause of pneumonia. Revaccination may be necessary after 5 years in those older than 65 years of age.

Pulmonary Rehabilitation

Pulmonary rehabilitation (rehab) is a coordinated program of exercise, disease management training, and counseling that can help you stay more active and carry out your day-to-day activities. What is included in your pulmonary rehab program will depend on what you and your doctor think you need. It may include exercise training, nutrition advice, education about your disease and how to manage it, and counseling. The different parts of the rehab program are managed by different types of health care professionals (doctors, nurses, physical therapists, respiratory therapists, exercise specialists, dietitians) who work together to develop a program just for you. Pulmonary rehab programs can include some or all of the following aspects.

Medical evaluation and management

To decide what you need in your pulmonary rehab program, a medical evaluation will be done. This may include getting information on your health history and what medicines you take, doing a physical exam, and learning about your symptoms. A spirometry measurement may also be done before and after you take a bronchodilator medicine.

Setting goals

You will work with your pulmonary rehab team to set goals for your program. These goals will look at the types of activities that you want to do. For example, you may want to take walks every day, do chores around the house, and visit with friends. These things will be worked on in your pulmonary rehab program.

Exercise training

Your program may include exercise training. This training includes showing you exercises to help your arms and legs get stronger. You may also learn breathing exercises that strengthen the muscles needed for breathing.

Education

Many pulmonary rehab programs have an educational component that helps you learn about your disease and symptoms, commonly used treatments, different techniques used to manage symptoms, and what you should expect from the program. The education may include meeting with (1) a dietitian to learn about your diet and healthy eating; (2) an occupational therapist to learn ways that are easier on your breathing to carry out your everyday activities; or (3) a respiratory therapist to learn about breathing techniques and how to do respiratory treatments.

Program results (outcomes)

You will talk with your pulmonary rehab team at different times during your program to go over the goals that you set and see if you are meeting them. For example, if your goal is to walk every day for 30 minutes, you will talk to members of your pulmonary team and tell them how often you are walking and for how long. The team is interested in helping you reach your goals.

Oxygen Treatment

If you have severe COPD and low levels of oxygen in your blood, you are not getting enough oxygen on you own. Your doctor may recommend oxygen therapy to help with your shortness of breath. You may need extra oxygen all the time or some of the time. For some people with severe COPD, using extra oxygen for more than 15 hours a day can help them:

• Do tasks or activities with less shortness of breath
• Protect the heart and other organs from damage
• Sleep more during the night and improve alertness during the day
• Live longer

Surgery

For some people with severe COPD, surgery may be recommended. Surgery is usually done for people who have:

• Severe symptoms
• Not had improvement from taking medicines
• A very hard time breathing most of the time

The two types of surgeries considered in the treatment of severe COPD are:

• Bullectomy. A bullectomy (bul-EK-to-me) may be done for some people with COPD who have severe symptoms and giant bullae. A bulla is a large air sac. A giant bulla may compress the good lung. A bullectomy is surgery that removes the bulla. A bullectomy may make it easier for more oxygen to get into the blood because the good lung expands. However, this surgery is indicated in only a few patients.
• A lung transplant may be done for some people with very severe COPD. A transplant involves removing the lung of a person with COPD and replacing it with a healthy lung from a donor.

How Can COPD Be Prevented From Progressing?

If you smoke, the most important thing you can do to stop more damage to your lungs is to quit smoking. For information on how to quit smoking, visit the Web site of the U.S. Office of the Surgeon General. Many hospitals have smoking cessation programs or can refer you to one.

It is also important to stay away from people who are smoking and places where you know there will be smokers.

Staying away from other lung irritants such as pollution, dust, and certain cooking or heating fumes is also important. For example, you should stay in your house when the outside air quality is poor.

Managing Complications and Preventing Sudden Onset of Problems

People with chronic obstructive pulmonary disease (COPD) often have symptoms that suddenly get worse. When this happens, you have a much harder time catching your breath. You may also have chest tightness, more coughing, change in your sputum, and a fever. It is important to call your doctor if you have any of these signs or symptoms.

Your doctor will look at things that might be causing these signs and symptoms to suddenly worsen. Sometimes the signs and symptoms are caused by a lung infection. Your doctor may want you to take an antibiotic medicine that helps fight off the infection.
Your doctor may also recommend additional medicines to help with your breathing. These medicines include bronchodilators and glucocorticosteroids.

Your doctor may recommend that you spend time in the hospital if:

• You have a lot of difficulty catching your breath.
• You have a hard time talking.
• Your lips or fingernails turn blue or gray.
• You are not mentally alert.
• Your heartbeat is very fast.
• Home treatment of worsening symptoms doesn't help.

Living With COPD

Although there is no cure for chronic obstructive pulmonary disease (COPD), your symptoms can be managed, and damage to your lungs can be slowed. If you smoke, quitting is the most important thing you can do to help your lungs. Information is available on ways to help you quit smoking. You also need to try to stay away from people who are smoking or places where there is smoking.

It is important to keep the air in your home clean. Here are some things that may help you in your home:

• Keep smoke, fumes, and strong smells out of your home.
• If your home is painted or sprayed for insects, have it done when you can stay away from your home.
• Cook near an open door or window.
• If you heat with wood or kerosene, keep a door or window open.
• Keep your windows closed and stay at home when there is a lot of pollution or dust outside.

If you are taking medicines, take them as ordered and make sure you refill them so you do not run out.

See your doctor at least two times a year, even if you are feeling fine. Make sure you bring a list of medicines you are taking to your doctor visit.
 
Ask your doctor or nurse about getting a flu shot and pneumonia vaccination.

Keep your body strong by learning breathing exercises and walking and exercising regularly.

Eat healthy foods. Ask your family to help you buy and fix healthy foods. Eat lots of fruits and vegetables. Eat protein food like meat, fish, eggs, milk, and soy.

If your doctor has told you that you have severe COPD, there are some things that you can do to get the most out of each breath. Make your life as easy as possible at home by:
 
• Asking your friends and family for help.
• Doing things slowly.
• Doing things sitting down.
• Putting things you need in one place that is easy to reach.
• Finding very simple ways to cook, clean, and do other chores. Some people use a small table or cart with wheels to move things around. Using a pole or tongs with long handles can help you reach things.
• Keeping your clothes loose.
• Wearing clothes and shoes that are easy to put on and take off.
• Asking for help moving your things around in your house so that you will not need to climb stairs as often.
• Picking a place to sit that you can enjoy and visit with others.

If you are finding that it is becoming more difficult to catch your breath, your coughing has gotten worse, you are coughing up more mucus, or you have signs of infection (such as a fever and feeling poorly), you need to call your doctor right away. Your doctor may do a spirometry test, blood work, and a chest x ray. Your doctor may also:

• Order antibiotics, which are medicines that help fight off infection
• Change the type and dosage of the bronchodilator and glucocorticosteroid medicines you have been taking
• Order oxygen or increase the amount of oxygen you are currently using

It is helpful to have certain information on hand in case you need to go to the hospital or doctor right away. You should plan now to make sure you have:
 
• The phone numbers for the doctor, hospital, and people who can take you to the hospital or doctor
• Directions to the hospital and doctor's office
• A list of the medicines you are taking

When To Get Emergency Help

You should get emergency help if:

• You find that is hard to talk or walk.
• Your heart is beating very fast or irregularly.
• Your lips or fingernails are gray or blue.
• Your breathing is fast and hard, even when you are using your medicines.

Key Points

• Smoking is the most common cause of chronic obstructive pulmonary disease (COPD).
• COPD is a disease that slowly worsens over time, especially if you continue to smoke.
• Breathing in other kinds of lung irritants, like pollution, dust, or chemicals, over a long period of time may also cause or contribute to COPD. Secondhand smoke and genetic disorders can also play a role in COPD.
• There is no cure for COPD (which includes emphysema and chronic bronchitis), and it is a major cause of illness and death.
• In COPD, much of the elastic quality of the airways and air sacs in the lung is gone. The airways collapse and obstruct the normal airflow. Airways may also become inflamed and thickened.
• The signs and symptoms of COPD are different for each person. Common signs are cough, sputum production, shortness of breath, wheezing, and chest tightness.
• COPD usually occurs in people who are at least 40 years old. COPD is not contagious.
• If you have COPD, you are more likely to have lung infections, which can be fatal.
• Your doctor can use a medical history, physical exam, and breathing tests, such as spirometry, to diagnose—or rule out—COPD even before you have significant symptoms.
• If the lungs are severely damaged, the heart may be affected. A person with COPD dies when the lungs and heart are unable to function and get oxygen to the body's organs and tissues, or when a complication such as a severe infection occurs.
• Treatment for COPD may help prevent complications, prolong life, and improve a person's quality of life. Quitting smoking, staying away from people who are smoking, and avoiding exposure to other lung irritants are the most important ways to reduce your risk of developing COPD or to slow the progress of the disease.
• Treatment may include medicines such as bronchodilators, steroids, flu shots, and pneumococcal vaccine to avoid or reduce further complications.
• As the symptoms of COPD get worse over time, a person may have more difficulty with walking and exercising. You should talk to your doctor about exercising and whether you would benefit from a pulmonary rehab program—a coordinated program of exercise, physical therapy, disease management training, advice on diet, and counseling.
• Oxygen treatment and surgery to remove part of a lung or even to transplant a lung may be recommended for persons with severe COPD.
• If you have a sudden worsening of signs or symptoms, it is important to contact your doctor and seek emergency treatment.
• Be prepared and have information on hand that you or others would need in a medical emergency, such as information on medicines you are taking, directions to the hospital or your doctor’s office, and people to contact if you are unable to speak or call them.
 

Sleep Apnea

What Is Sleep Apnea?

Sleep apnea is a common disorder that can be very serious. In sleep apnea, your breathing stops or gets very shallow while you are sleeping. Each pause in breathing typically lasts 10 to 20 seconds or more. These pauses can occur 20 to 30 times or more an hour.

The most common type of sleep apnea is obstructive sleep apnea. During sleep, enough air cannot flow into your lungs through your mouth and nose even though you try to breathe. When this happens, the amount of oxygen in your blood may drop. Normal breaths then start again with a loud snort or choking sound.

When your sleep is upset throughout the night, you can be very sleepy during the day. With sleep apnea, your sleep is not restful because:

• These brief episodes of increased airway resistance (and breathing pauses) occur many times.
• You may have many brief drops in the oxygen levels in your blood.
• You move out of deep sleep and into light sleep several times during the night, resulting in poor sleep quality.

People with sleep apnea often have loud snoring. However, not everyone who snores has sleep apnea. Some people with sleep apnea don’t know they snore.

• Sleep apnea happens more often in people who are overweight, but even thin people can have it.
• Most people don’t know they have sleep apnea. They don’t know that they are having problems breathing while they are sleeping.
• A family member and/or bed partner may notice the signs of sleep apnea first.

Untreated sleep apnea can increase the chance of having high blood pressure and even a heart attack or stroke. Untreated sleep apnea can also increase the risk of diabetes and the risk for work-related accidents and driving accidents.

What Causes Sleep Apnea?

Sleep apnea happens when enough air cannot move into your lungs while you are sleeping. When you are awake, and normally during sleep, your throat muscles keep your throat open and air flows into your lungs. In obstructive sleep apnea, however, the throat briefly collapses, causing pauses in your breathing. With pauses in breathing, the oxygen level in your blood may drop. This happens if the following conditions occur:

• Your throat muscles and tongue relax more than is normal.
• Your tonsils and adenoids are large.
• You are overweight. The extra soft tissue in your throat makes it harder to keep the throat area open.
• The shape of your head and neck (bony structure) results in somewhat smaller airway size in the mouth and throat area.

With the throat frequently fully or partly blocked during sleep, enough air cannot flow into your lungs, even though your efforts to breathe continue. Your breathing may become hard and noisy and may even stop for short periods of time (apneas).

Central apnea is a rare type of sleep apnea that happens when the area of your brain that controls your breathing doesn’t send the correct signals to the breathing muscles. Then there is no effort to breathe at all for brief periods. Snoring does not typically occur in central apnea.

Who Is At Risk for Obstructive Sleep Apnea?

Anyone can have obstructive sleep apnea.

It is estimated that more than 12 million Americans have obstructive sleep apnea. More than half the people who have sleep apnea are overweight, and most snore heavily.

Sleep apnea is more common in men. One out of 25 middle-aged men and 1 out of 50 middle-aged women have sleep apnea that causes them to be very sleepy during the day. Sleep apnea is more common in African Americans, Hispanics, and Pacific Islanders than in Caucasians. If someone in your family has sleep apnea, you are more likely to develop it than someone without a family history of the condition.

Adults who are most likely to have sleep apnea:
 
• Snore loudly.
• Are overweight.
• Have high blood pressure.
• Have a decreased size of the airways in their nose, throat, or mouth. This can be caused by the shape of these structures or by medical conditions causing congestion in these areas, such as hay fever or other allergies.
• Have a family history of sleep apnea.

Obstructive sleep apnea can also occur in children who snore. If your child snores, you should discuss it with your child’s doctor or health care provider.

What Are the Signs and Symptoms of Sleep Apnea?

The most common signs of sleep apnea are:

• Loud snoring
• Choking or gasping during sleep
• Fighting sleepiness during the day (even at work or while driving)

Your family members may notice the symptoms before you do. Otherwise, you will likely not be aware that you have problems breathing while you are asleep.
Others signs of sleep apnea may include:

• Morning headaches
• Memory or learning problems
• Feeling irritable
• Not being able to concentrate on your work
• Mood swings or personality changes; perhaps feeling depressed
• Dry throat when you wake up
• Frequent urination at night

How Is Sleep Apnea Diagnosed?

Your doctor will do a physical exam and take a medical history that includes asking you and your family questions about how you sleep and how you function during the day. As part of the exam, your doctor will check your mouth, nose, and throat for extra or large tissues; for example, tonsils, uvula (the tissue that hangs from the middle of the back of the mouth), and soft palate (the roof of your mouth in the back of your throat).

Your doctor may order a sleep recording of what happens with your breathing while you sleep. A sleep recording is a test that is often done in a sleep center or sleep laboratory, which may be part of a hospital. You may stay overnight in the sleep center, although sleep studies are sometimes done in the home. The most common sleep recording used to find out if you have sleep apnea is called a polysomnogram (poly-SOM-no-gram), or PSG. This test records:

• Brain activity
• Eye movement
• Muscle activity
• Breathing and heart rate
• How much air moves in and out of your lungs while you are sleeping
• The percentage of oxygen in your blood

A PSG is painless. You will go to sleep as usual. The staff at the sleep center will monitor your sleep throughout the night. The results of your PSG will be analyzed by a sleep medicine specialist to see if you have sleep apnea, how severe it is, and what treatment may be recommended.

In certain circumstances, the PSG can be done at home. A home monitor can be used to record your heart rate, how air moves in and out of your lungs, the amount of oxygen in your blood, and your breathing effort. For this test, a technician will come to your home and help you apply the monitor that you will wear overnight. You will go to sleep as usual, and the technician will come back the next morning to get the monitor and send the results to your doctor.

Once all your tests are completed, the sleep medicine specialist will review the results and work with you and your family to develop a treatment plan. In some cases, you may also need to see another physician for evaluation of:
 
• Lung problems (treated by a pulmonologist)
• Problems with the brain or nerves (treated by a neurologist)
• Heart or blood pressure problems (treated by a cardiologist)
• Ear, nose, or throat problems (treated by an ENT specialist)
• Mental health, such as anxiety or depression (treated by a psychologist or psychiatrist)

How Is Sleep Apnea Treated?
 
Treatment is aimed at restoring regular nighttime breathing and relieving symptoms such as very loud snoring and daytime sleepiness. Treatment will also help associated medical problems, such as high blood pressure, and reduce the risk for heart attack and stroke.

Changes in Activities or Habits

If you have mild sleep apnea, some changes in daily activities or habits may be all that are needed:

• Avoid alcohol, smoking, and medicines that make you sleepy. They make it harder for your throat to stay open while you sleep.
• Lose weight if you are overweight. Even a little weight loss can improve your symptoms.
• Sleep on your side instead of your back. Sleeping on your side may help keep your throat open.

People with moderate or severe sleep apnea will need to make these changes as well. They also will need other treatments, such as the following.

Continuous Positive Airway Pressure

Continuous positive airway pressure (CPAP) is the most common treatment for sleep apnea. For this treatment, you wear a mask over your nose during sleep. The mask blows air into your throat at a pressure level that is right for you. The increased airway pressure keeps the throat open while you sleep. The air pressure is adjusted so that it is just enough to stop the airways from briefly getting too small during sleep.

Treating sleep apnea may help you stop snoring. Stopping snoring does not mean that you no longer have sleep apnea or that you can stop using CPAP.
Sleep apnea will return if CPAP is stopped or if it is not used correctly. Usually, a technician comes to your home to bring the CPAP equipment. The technician will set up the CPAP machine and make adjustments based on your doctor’s orders.

CPAP treatment may cause side effects in some people. Some side effects are:
 
• Dry or stuffy nose
• Irritation of the skin on your face
• Bloating of your stomach
• Sore eyes
• Headaches

If you are having trouble with CPAP side effects, work with your sleep medicine specialist and technician. Together you can do things to reduce these side effects, such as:

• Use a nasal spray to relieve a dry, stuffy, or runny nose.
• Adjust the CPAP settings.
• Adjust the size/fit of the mask.
• Add moisture to the air as it flows through the mask.
• Use a CPAP machine that can automatically adjust the amount of air pressure to the level that is required to keep the airway open.
• Use a CPAP machine that will start with a low air pressure and slowly increase the air pressure as you fall asleep.

People with severe sleep apnea symptoms generally feel much better once they begin treatment with CPAP. When using CPAP, it is very important that you follow up with your doctor. If you are having side effects, talk to your doctor.

Mouthpiece

A mouthpiece (oral appliance) may be helpful in some people with mild sleep apnea. Some doctors may also recommend this if you snore loudly but do not have sleep apnea.

A custom-fit plastic mouthpiece will be made by a dentist or orthodontist. An orthodontist is a specialist in correcting teeth or jaw problems. The mouthpiece will adjust your lower jaw and your tongue to help keep the airway in your throat open while you are sleeping. Air can then flow easily into your lungs because there is less resistance to breathing.

Possible side effects of the mouthpiece include damage to your:

• Teeth
• Gums
• Jaw

Follow up with your dentist or orthodontist to check for any side effects and to be sure that your mouthpiece fits.
 
Surgery

Some people with sleep apnea may benefit from surgery. The type of surgery depends on the cause of the sleep apnea.

• Surgery may be done to remove the tonsils and adenoids if they are blocking the airway. This surgery is especially helpful for children.
• Uvulopalatopharyngoplasty (U-vu-lo-PAL-a-to-fa-RIN-go-plas-te) (UPPP) is a surgery that removes the tonsils, uvula (the tissue that hangs from the middle of the back of the roof of the mouth), and part of your soft palate (the roof of your mouth in the back of your throat). This surgery is only effective for some people with sleep apnea.
• Laser-assisted uvulopalatoplasty (U-vu-lo-PAL-a-to-plas-te) (LAUP) is a surgery that can stop snoring but is probably not helpful in treating sleep apnea. A laser device is used to remove the uvula and part of the soft palate. Because this surgery stops the main symptom of sleep apnea (snoring), it is important to have a sleep study first.
• Tracheostomy (TRA-ke-OS-to-me) is a surgery used in severe sleep apnea. A small hole is made in the windpipe and a tube is inserted. Air will flow through the tube and into the lungs. This surgery is very successful but is needed only in patients not responding to all other possible treatments.

Other possible surgeries for some people with sleep apnea include:

• Rebuilding the lower jaw
• Surgery on the nose
• Surgery to treat obesity

Currently, there are no medicines for the treatment of sleep apnea.

Living With Sleep Apnea

Getting treatment for sleep apnea and following your doctor’s advice can help you and your family members.

• Getting treatment for sleep apnea can help snoring and can improve your sleep.
• Treating sleep apnea helps you feel rested during the day.
• Many people will benefit by making healthy changes, such as stopping smoking and losing weight.
• Some people will need to wear a mask at night to help keep the throat open and improve breathing.
• A few people will need to have surgery to remove tonsils and adenoids, part of the uvula (the tissue that hangs from the middle of the back of the roof of the mouth), and/or the soft palate (the roof of your mouth in the back of your throat) that may block the airway.
• Regular and ongoing followup is needed; your sleep medicine specialist will check whether your treatment is working and whether you are having any side effects.

What Can Family Do To Help?

Often, people with sleep apnea do not know they have it. They are not aware that their breathing stops and starts many times while they are sleeping. Family members or bed partners are usually the first ones to notice that the person snores and stops breathing while sleeping.

There are many things family members can do to help a loved one who has sleep apnea, including:

• Letting the person know if he or she snores loudly during sleep or has breathing stops and starts
• Encouraging the person to get medical help
• Helping the person follow the doctor’s treatment plan, including continuous positive airway pressure (CPAP)
• Making sure the person puts on the CPAP mask before falling asleep
• Providing emotional support
• Helping with insurance paperwork

Sleep apnea can be very serious. People with sleep apnea are at higher risk for car crashes, work-related accidents, and other medical problems due to their sleepiness. It is important that people with sleep apnea see their doctor to treat and control this disorder.

Treatment may improve a person’s overall health and happiness as well as the quality of sleep for both the person and the entire family.

Key Points

• Sleep apnea is a common breathing disorder that can be very serious.
• In sleep apnea, your breathing stops or becomes very shallow for periods of 10 to 20 seconds or longer many times during the night.
• The most common type of sleep apnea is obstructive sleep apnea.
• It is estimated that more than 12 million Americans have sleep apnea.
• The most common signs of sleep apnea are loud snoring and choking or gasping during sleep and being sleepy during the day.
• Having a physical exam and providing your doctor with information about your sleep will help to diagnose sleep apnea. Your doctor may also want you to have special sleep tests.
• Treatment is aimed at restoring regular nighttime breathing and relieving symptoms such as loud snoring and daytime sleepiness. Treatment will also help associated medical problems, such as high blood pressure, and reduce the risk for heart attack and stroke.
• Continuous positive airway pressure (CPAP) is the most common treatment for sleep apnea.
• Some people with sleep apnea may benefit from surgery.
• Family members can help a person who snores loudly or stops breathing while sleeping by encouraging him or her to get medical help.
• Treatment for sleep apnea may improve a person’s overall health and happiness as well as the quality of sleep for both the person and the entire family.