If you stop breathing while you sleep, there may be various causes. These breathing interruptions are given different names depending on the cause: central sleep apnea syndrome (CSAS) originates in the centre – the brain – and can be caused by damage resulting from a stroke, for example, or be inherited. Drugs and alcohol can also cause breathing pauses. The most common form is the so-called “obstructive sleep apnea syndrome” (OSAS). This is a weakness of the circular musculature that is supposed to keep the entrance to the bronchial tube open. Severe overweight can also make breathing at night more difficult due to the pressure on the chest. Sleep apnea syndrome occurs in approximately 5-10% of the population. Studies have shown that up to 80% of patients with severe obesity suffer from OSAS.
These breathing interruptions are rarely noticed by those affected themselves. It is the partners who notice that there is very heavy snoring during sleep and then suddenly the breathing stops. These interruptions can last so long that you get scared and want to call the emergency services. However, suffocation does not occur: breathing always resumes, usually with a deep inhalation of air. Those affected usually only notice the consequences of this nocturnal oxygen deficiency: you feel tired all the time and you feel like you haven’t had enough sleep even after you wake up. Patients report headaches and feeling ‘exhausted’. The ability to concentrate also diminishes. In extreme cases, there may be attacks of microsleep during the day, which can then be really dangerous (driving, for example).
Sleep apnea syndrome can also cause physical problems: high blood pressure, heart failure, heart attacks and strokes are known to be consequences of OSAS. Men may also experience erectile dysfunction (impotence). Sudden hearing loss, depression, stomach ulcers and diabetes mellitus are also more common in patients with sleep apnea syndrome.
Diagnostics
If you suspect that you have OSAS, you should first consult your physician. After a thorough examination to determine the possible causes, but also to identify any consequences that have already occurred, a so-called ‘polysomnography’ or a ‘polygraph test’ may be necessary. In most cases, you receive measuring devices to take home, which can perform various measurements in your sleep. Examinations by other specialists (ENT, diabetologist) may also be necessary. In some cases, an overnight stay in a sleep laboratory is advisable and must be prescribed.
Treatment
If an obvious sleep apnea syndrome has been diagnosed, CPAP therapy may help. This involves wearing a small mask while sleeping to ensure that the throat does not collapse and block the airways. After a short adjustment period, patients report a great sense of relief and that the advantages of wearing such a mask while sleeping far outweigh the disadvantages.
There are also cases in which wearing a protective mouth guard can help. In certain cases, surgery can also help to improve the situation. This may be the case with tonsils or polyps. In rare cases, surgical removal of excess fat and connective tissue may be useful (uvulopalatopharyngoplasty). However, some patients find it helpful to wear a device while sleeping that prevents them from turning onto their back (backpack).
How does bariatric surgery help?
One of the many observations made after the introduction of weight loss surgery is that existing sleep apnea syndrome can also improve significantly when a lot of weight is lost. In many cases, the CPAP device can be discontinued after a few months. OSAS is thus one of a number of conditions that can be demonstrably improved or even cured by such surgery: diabetes (diabetes mellitus type 2), high blood pressure (arterial hypertension), joint problems, infertility.
