Certain mechanical and structural problems
in the airway cause the interruptions
in breathing during sleep. In some people,
apnea occurs when the throat muscles
and tongue relax during sleep and partially
block the opening of the airway. When
the muscles of the soft palate at the
base of the tongue and the uvula (the
small fleshy tissue hanging from the
center of the back of the throat) relax
and sag, the airway becomes blocked,
making breathing labored and noisy and
even stopping it altogether. Sleep apnea
also can occur in obese people when
an excess amount of tissue in the airway
causes it to be narrowed. With a narrowed
airway, the person continues his or
her efforts to breathe, but air cannot
easily flow into or out of the nose
or mouth. Unknown to the person, this
results in heavy snoring, periods of
no breathing, and frequent arousal's
(causing abrupt changes from deep sleep
to light sleep). Ingestion of alcohol
and sleeping pills increases the frequency
and duration of breathing pauses in
people with sleep apnea.
Because of the serious disturbances
in their normal sleep patterns, people
with sleep apnea often feel very sleepy
during the day and their concentration
and daytime performance suffer. The
consequences of sleep apnea range from
annoying to life threatening. They include
depression, irritability, sexual dysfunction,
learning and memory difficulties, and
falling asleep while at work, on the
phone, or driving. It has been estimated
that up to 50 percent of sleep apnea
patients have high blood pressure. Although
it is not known with certainty if there
is a cause and effect relationship,
it appears that sleep apnea contributes
to high blood pressure. Risk for heart
attack and stroke may also increase
in those with sleep apnea. In addition,
sleep apnea is sometimes implicated
in sudden infant death syndrome.
For many sleep apnea patients, their
spouses are the first ones to suspect
that something is wrong, usually from
their heavy snoring and apparent struggle
to breathe. Co-workers or friends of
the sleep apnea victim may notice that
the individual falls asleep during the
day at inappropriate times (such as
while driving a car, working, or talking).
The patient often does not know he or
she has a problem and may not believe
it when told. It is important that the
person see a doctor for evaluation of
the sleep problem.
In addition to the primary care physician,
pulmonologists, neurologists, or other
physicians with specialty training in
sleep disorders may be involved in making
a definitive diagnosis and initiating
treatment. 
Diagnosis
of sleep apnea is not simple because
there can be many different reasons
for disturbed sleep. Several tests are
available for evaluating a person for
sleep apnea.
Polysomnography is a test that records
a variety of body functions during sleep,
such as the electrical activity of the
brain, eye movement, muscle activity,
heart rate, respiratory effort, air
flow, and blood oxygen levels. These
tests are used both determine its severity.
The Multiple Sleep Latency Test (MSLT)
measures the speed of falling asleep.
In this test, patients are given several
opportunities to fall asleep during
the course of a day when they would
normally be awake. For each opportunity,
time to fall asleep is measured. People
without sleep problems usually take
an average of 10 to 20 minutes to fall
asleep. Individuals who fall asleep
in less than 5 minutes are likely to
require some treatment for sleep disorders.
The MSLT may be useful to measure the
degree of excessive daytime sleepiness
and to rule out other types of sleep
disorders.
Diagnostic tests usually are performed
in a sleep center, but new technology
may allow some sleep studies to be conducted
in the patient's home.
The specific therapy for sleep apnea
is tailored to the individual patient
based on medical history, physical examination,
and the results of polysomnography.
Medications are generally not effective
in the treatment of sleep apnea. Oxygen
administration may safely benefit certain
patients but does not eliminate sleep
apnea or prevent daytime sleepiness.
Thus, the role of oxygen in the treatment
of sleep apnea is controversial, and
it is difficult to predict which patients
will respond well. It is important that
the effectiveness of the selected treatment
be verified - this is usually accomplished
by polysomnography.
Mild Sleep Apnea is usually treated
by some behavioral changes. Losing weight,
sleeping on your side are often recommended.
There are oral mouth devices (that help
keep the airway open) on the market
that may help to reduce snoring in three
different ways. Some devices (1) bring
the jaw forward or (2) elevate the soft
palate or (3) retain the tongue (from
falling back in the airway and blocking
breathing). Sleep Apnea is a progressive
condition (gets worse as you age) and
should not be taken lightly.
Behavioral Therapy
Behavioral changes are an important
part of the treatment program, and in
mild cases behavioral therapy may be
all that is needed. The individual should
avoid the use of alcohol, tobacco, and
sleeping pills, which make the airway
more likely to collapse during sleep
and prolong the apneic periods. Overweight
persons can benefit from losing weight.
Even a 10 percent weight loss can reduce
the number of apneic events for most
patients. In some patients with mild
sleep apnea, breathing pauses occur
only when they sleep on their backs.
In such cases, using pillows and other
devices that help them sleep in a side
position is often helpful.
Physical or Mechanical
Therapy
Nasal continuous positive airway pressure
(CPAP) is the most common effective
treatment for sleep apnea. In this procedure,
the patient wears a mask over the nose
during sleep, and pressure from an air
blower forces air through the nasal
passages. The air pressure is adjusted
so that it is just enough to prevent
the throat from collapsing during sleep.
The pressure is constant and continuous.
Nasal CPAP prevents airway closure while
in use, but apnea episodes return when
CPAP is stopped or used improperly.
Variations of the CPAP device attempt
to minimize side effects that sometimes
occur, such as nasal irritation and
drying, facial skin irritation, abdominal
bloating, mask leaks, sore eyes, and
headaches. Some versions of CPAP vary
the pressure to coincide with the person's
breathing pattern, and others start
with low pressure, slowly increasing
it to allow the person to fall asleep
before the full prescribed pressure
is applied. Dental appliances that reposition
the lower jaw and the tongue have been
helpful to some patients with mild sleep
apnea or who snore but do not have apnea.
Possible side effects include damage
to teeth, soft tissues, and the jaw
joint. A dentist or orthodontist is
often the one to fit the patient with
such a device.
Surgery
Some patients with sleep apnea may
need surgery. Although several surgical
procedures are used to increase the
size of the airway, none of them is
completely successful or without risks.
More than one procedure may need to
be tried before the patient realizes
any benefits. 
Some
of the more common procedures include
removal of adenoids and tonsils (especially
in children), nasal polyps or other
growths, or other tissue in the airway
and correction of structural deformities.
Younger patients seem to benefit from
these surgical procedures more than
older patients do.
Uvulopalatopharyngoplasty (UPPP) is
a procedure used to remove excess tissue
at the back of the throat (tonsils,
uvula, and part of the soft palate).
The success of this technique may range
from 30 to 50 percent. The long-term
side effects and benefits are not known,
and it is difficult to predict which
patients will do well with this procedure.
Laser-assisted uvulopalatoplasty (LAUP)
is done to eliminate snoring but has
not been shown to be effective in treating
sleep apnea. This procedure involves
using a laser device to eliminate tissue
in the back of the throat. Like UPPP,
LAUP may decrease or eliminate snoring
but not sleep apnea itself. Elimination
of snoring, the primary symptom of sleep
apnea, without influencing the condition
may carry the risk of delaying the diagnosis
and possible treatment of sleep apnea
in patients who elect LAUP. To identify
possible underlying sleep apnea, sleep
studies are usually required before
LAUP is performed.
Tracheostomy is used in persons with
severe, life- threatening sleep apnea.
In this procedure, a small hole is made
in the windpipe and a tube is inserted
into the opening. This tube stays closed
during waking hours, and the person
breathes and speaks normally. It is
opened for sleep so that air flows directly
into the lungs, bypassing any upper
airway obstruction. Although this procedure
is highly effective, it is an extreme
measure that is poorly tolerated by
patients and rarely used.
Other Procedures
Patients in whom sleep apnea is due
to deformities of the lower jaw may
benefit from surgical reconstruction.
Finally, surgical procedures to treat
obesity are sometimes recommended for
sleep apnea patients who are morbidly
obese.
There
are two types of sleep apnea: central
and obstructive. Central sleep apnea,
which is less common, occurs when the
brain fails to send the appropriate
signals to the breathing muscles to
initiate respiration. Obstructive sleep
apnea is far more common and occurs
when air cannot flow into or out of
the person's nose or mouth although
efforts to breathe continue.