Surgery is the red flower that blooms among the leaves and thorns that are the rest of medicine. - Dr. Richard Selzer

A simple outpatient surgery might help those suffering from mild sleep apnea. The main aim of this surgery is to remove the tissues that cause obstruction. This includes removal of tonsils, adenoids and any other blockages. The following list outlines the major surgeries that are performed to treat sleep apnea.
 
Uvulopalatopharyngoplasty (UPPP): The term uvulo refers to the uvula, ( which is the piece of flesh in the back of the throat), palato is the palate, and pharyngoplasty is plastic surgery to the pharynx. This surgery removes the soft tissue on the back of the throat and palate, increasing the width of the airway at the throat opening. This method helps in reducing snoring but not apnea, as the tissues deep inside the throat are not removed. This surgery is highly recommended to patients suffering from mild apnea. It can be also be done using laser and is referred to as laser assisted uvuloplasty (LAUP).

Mandibular maxillar advancement surgery: The term mandibular relates to the lower jaw bone, and maxillar means the upper jaw. A surgical correction is performed on certain facial abnormalities, where the upper and lower part of the jaw is moved forward from the rest of the facial bones. This enlarges the space between the tongue and the soft palate and in turn helps in free supply of air. This is especially recommended for those with severe sleep apnea with craniofacial abnormalities.

Genioglossus Advancement surgery: In this form of surgery a small portion of the lower jaw which is attached to the tongue, is moved forward so that the tongue is pulled away from the airway which is blocked.

Hyoid Suspension surgery: In this surgery the hyoid bone in the neck and the point where tongue muscles are attached, are pulled forward in front of the larynx.

Somnoplasty: This is the most recent form of surgery which is being adopted to treat sleep apnea. In this method the tongue, throat and soft palate is pierced with a special electrode which is in the form of a needle and is connected to a radio frequency generator. The inner tissue, which blocks the upper airway, shrinks as it is heated to a temperature between 158 to 176 degrees for half an hour. This surgery is also called radio frequency volumetric tissue reduction of the palate.

Snoreplasty: This is also a recent advancement for reducing or eliminating snoring. Also called Injection Snoreplasty, a topical anesthesia is injected to numb the back of the throat and palate. This causes the mouth to stiffen during the next three weeks, thereby stopping the fluttering of the palate, that causes the noise of snoring. 

Turbinectomy: In this form of surgery removing bone and soft tissues opens up the nasal passage. This surgery is highly useful If the air passage is blocked due to deviated nasal septum, swelling of the turbinate due to allergy, chronic inflammation, chronic sinusitis, nasal polyps, swelling of the adenoids or any other tumor obstructing the nose.

Pillar procedure: This procedure is adopted to reduce snoring and to help patients suffering from mild to moderate sleep apnea. Three small inserts are injected into the soft palate to offer support for the tissues in the throat.

Tracheostomy: This is the last resort for those who suffer from persistent and severe sleep apnea. It is also a very age old form of surgery in the field of medicine. In this surgery a small incision is made in the neck and a tube with a valve is inserted. This valve is kept closed during the day time and opened up during the night to allow free flow of the air, thereby bypassing the blocked pathway.

The forms of surgeries discussed above are recommended for Obstructive Sleep Apnea. Help is also available in terms of Support Devices for treating both Obstructive and Central Sleep Apnea.

Sometimes it becomes difficult to spot a particular problem, as symptoms for many disorders will overlap and finding the right disorder becomes a major task. To worsen the situation, symptoms of sleep apnea occurs only in the night, as a result of which only a few people really know about it. The person affected by sleep apnea rarely knows about the symptoms that shows up. Only the person sleeping right next to the patient can truly identify the problem.
 
Few of the indicators which will help to perceive a clear view of sleep apnea are:

• Loud Snoring - Sound generated due to the obstruction of free flow of air in the back of the nose and mouth. It occurs when a person sleeps on his back and ceases when he sleeps on his sides.
• Intermittent stoppages of breath in sleep which last for 10-20 seconds that occurs about 100 to 400 times in a night.
• When stoppage of breath occurs the person gets to inhale higher amount of air, which may cause the person to choke and gasp causing loss of sleep.
• Insomnia - Having trouble falling sleep, highly disturbed and un-refreshing sleep, or waking up too early in the morning are indicators that a person is suffering from Insomnia.
• Daytime sleepiness or sleeping at inappropriate times and places without the knowledge
• Dry mouth caused due to inhalation through the mouth
•  Heart burns - Chronic heart burn could cause damage to the sensitive tissues of the throat due to the acid that rises from the stomach to the esophagus thereby leading to Sleep Apnea. It is one of the early symptoms too to show up before Sleep Apnea manifests. 
• Person gets irritated easily even without getting provoked
• Morning headaches or hangovers due to insufficient sleep
• Forgetfulness or Absent Mindedness
• Sudden mood swings 
• Sudden weight gain - Sleep apnea and Heart burns could cause a person to suddenly gain weight or could lead to Obesity.
• Poor judgement or reduced analysis capability
• Personality changes 
• High blood pressure 
• Swelling of the legs (in certain advanced cases)
• Frequent urination at night - Due to low level of oxygen in the body, there is increase in pressure on the right side of the heart. It in turn triggers high level of hormone called atrial natriuretic peptide (ANP). ANP is a diuretic that is associated with increased number of visits to the bathroom.
• Decreased libido - Inability to breathe properly during sleep results in low production of hormone testosterone, resulting in decreased libido and sexual activity.

If the above indicators persist it is advisable to consult the physician. Tests will be performed on the patient to check whether there is any extra growth of tissues or blockages. A simple questionnaire can be administered on the patient and his/her family members to gain better insight into the symptoms experienced during sleep and the sleep pattern he/she is into.

The following tests can also be done by the physician to reconfirm:

•  Sleep studies 
• An ECG 
• Verify and record observations of low oxygen or increased carbon dioxide 
• Echocardiogram to assess normal functioning of the heart 
• Thyroid test

Surgery is always second best. If you can do something else, it's better - Dr. John Kirklin
As the saying goes, a patient has to first seek the help of support devices which might be a saviour from sleep apnea. These devices are used by patients who have mild to moderate sleep apnea. The main purpose of this treatment is to breathe normally during sleep. Additionally it helps avoiding snoring, choking and to reduce the risk of blood pressure, stroke and cardiac arrest. The following are the devices used in the treatment of sleep apnea.

Continuous Positive Airway Pressure (CPAP)
This method is used for both obstructive and central sleep apnea. In this method the patient's nose is covered using a mask through which air is blown at a pre-determined pressure level into the throat. The pressure level varies based on the individual. The required level of air pressure keeps the airways from closing up or obstructing throughout the night. It totally controls the snoring but not the sleep apnea. Once the device is removed all the symptoms reappear. The disadvantages of this method are dry or stuffy nose, irritation of the facial skin, bloated stomach, sore eyes and headache.

Obstructive Sleep Apnea

Dental devices - Listed below are the dental devices used to open up the airway for free air flow from the nasal passage to the lungs:

• Oral Mandibular Advancement Devices
• Splints
• Functional magnetic system
• Custom fit plastic mouth piece

Oral mandibular advancement devices, are used for mild to moderate apnea. They help in moving the lower jaw forward when the person is lying down.  These devices help keep the airway open whilst the person is asleep.

Splints are another type of oral devices which are used to hold the tongue in a fixed position to keep the airway open.

The Functional magnetic system is another type of oral device where two magnets positioned on opposite sides of the jaw are used to keep the airway open. Periodic checkups are required in this method as a follow up to ensure that it is working.

A Custom-fit plastic mouthpiece can also be used in correcting teeth and jaw problems. The mouthpiece is custom made to fit the patient's lower jaw and tongue to help keep the airway in the throat open. This procedure could damage teeth, gums and jaw. So it has to be used with great caution.

In general the above devices may give rise to the following problems:
• Due to long-term usage, permanent changes in the position of the teeth or jaw may occur.
• Some of these devices are quite expensive.
• During night pain in the mouth, dry lips, tooth discomfort and excessive salivation may occur.

CENTRAL SLEEP APNEA

The following are the devices which are specifically designed for Central sleep apnea:

Variable Positive Airway Pressure

This is also known as bilevel or BiPAP. This expensive method provides two different pressures levels; a higher pressure during inhalation and a lower pressure during exhalation. Provision is available to monitor the patient's breathing through electronic circuit. It is mainly prescribed for patients who have either a respiratory problem or who find it highly uncomfortable to breath in an increased pressure.

Supplemental oxygen

A variety of devices are available which can supply oxygen at different pressures to patients suffering from sleep apnea. This can be supplemented through out the time the patient sleeps.

Automatic Positive Airway Pressure (APAP)

This is a recent advancement where a machine adjusts air pressure continuously using pressure sensors. It continuously monitors the patient's breathing performance and adjusts pressure accordingly by increasing it when the user find it difficult to breathe, and decreasing when the air pressure is higher.

What is the most common type of sleep apnea observed in children?
The most common type of sleep apnea which children suffer from is Obstructive Sleep Apnea Syndrome. This type of sleep Apnoea is usually characterized by repetitive episodes of upper airway obstruction that occurs during their sleep. The majority of the children outgrow this problem if it is a minor problem. However it has been recognized as a cause of daytime attention and behavioral problems. It is also very difficult to diagnose this type of sleep apnea in children.
 
What can be the causes of sleep apnea?
1. Obstructive sleep apnea in children is almost always caused by obstructive tonsils and adenoids.
2. Down syndromes: It is a chromosomal abnormality. Low muscle tone, narrow nasopharynx, large tongue, enlarged tonsils and adenoids are the conditions that occur in the cases of down syndromes and predisposes to apnea.
3. Craniofacial Syndromes: They are caused due to unusual facial features; especially nose, mouth, jaws. This puts them at a higher risk of obstructive sleep apnea.

Are there any conditions associated with sleep apnea?
There are three conditions associated with sleep apnea.
1. Apparent Life-Threatening Events: It is a combination of apnea, change in color (mostly blue), change in muscle tone, choking, and / or gagging.
2. Apnea of Prematurity: This can be obstructive, central or mixed apnea. It is caused due to under-developed brain and respiratory conditions prevalent in premature babies.
3. Apnea of Infancy: This refers to apnea which occurs in children before 1 year and applies to infants who were born after full-term pregnancy.

What are the symptoms?
The common symptoms found in children with sleep apnea are:
* Excessive daytime sleepiness,
* snoring,
* mouth breathing, gasping / choking during sleep,
* restless sleep,
* sleeping in a strange position,
* developing high blood pressure, 
* failure to grow and thrive,
* frequent upper respiratory infection,
* enlarged tonsils and adenoids, 
* hyperactive behavior,
* personality changes,
* low productivity in school,
* interpersonal relationship problems,
* learning problems,
* irritability, difficulty in concentration,
* daytime cognitive and behavioral problems,
* Problems paying attention and aggressive behavior which could lead to problems at school.
* In more severe cases congestive heart failure can occur.

The symptoms vary with the age of the child. In some cases this problem can be seen as early as infancy. Due to obstructive apnea their nose and throat gets blocked. The result is restricted eating, as they find it tasteless, uncomfortable and painful. But the calorie requirements at this age are very high. Thereby it leads to underdevelopment in children.

How is Sleep Apnea treated?
Treatment through devices: 
1. C-PAP (Continuous positive airway pressure) - This method is used for both obstructive and central sleep apnea. In this method the patient's nose is covered by a mask. Through that mask the air is supplied into the throat at a predetermined pressure level. The pressure level can be controlled based on the individual. The controlled level of air pressure that is sent into the body keeps the airways from closing up or obstructing throughout the night.
2. Bi-Level positive airway pressure - This Expensive method provides two different pressure levels; a higher pressure level during inhalation and a lower pressure level during exhalation. An electronic circuit continuously monitors the patient's breathing.

Treatment through Surgery:
1. In children, removing their tonsils, adenoids or polyps may solve the problem.
2. Tracheostomy - In this surgery a small incision is made in the neck and a tube with a valve is inserted. During day time the valve is kept closed and opened up in the night to ensure free flow of the air thereby by-passing the blocked pathway.
3. Mandibular advancement surgery - A surgical correction of certain facial abnormalities is performed, where the upper and lower part of the jaw is moved forward from the rest of the facial bones. This enlarges the space between the tongue and the soft palate and helps in free movement of air. 
4. Uvulopalatoplasty - This surgery removes soft tissues at the back of the throat and palate, increasing the width of the airway at the throat opening. This method helps in reducing snoring but not very effective against apnea as the tissues deep inside the throat is not removed.

Sleep apnea is a very serious disorder and is widespread across every country. Unfortunately there is lack of awareness about its prevalence. It mainly affects the middle aged overweight population of which almost four percent of men and two percent of women are sufferers.
 
It is always advisable to meet the physician when you or your partner experiences snoring and sudden jerky movements during sleep combined with constant choking and gasping for breath. 

Especially snoring is loudest when a person sleeps on the back, and quietens down when slept on the sides. This problem will always be followed by sleepiness during the day time (hypersomnia) and irritability. 

As the person had a highly disturbed sleep and had been deprived of deep sleep, the chances of him / her sleeping in the daytime will be high, and it could happen even with out their knowledge. When a person with apnea doses off in the day time, there will be no signs of yawing or tiredness. Their brain will immediately switch off the moment they sleep. A person who experiences such a problem is advised to immediate seek medical supervision.

For self checking, a "sleep log" is maintained, where the sleep pattern and sleep deprivation is noted. Persons with average scores obtained in "diagnostic criteria for obstructive sleep apnea" and a high score in the Epworth Sleepiness Scale (ESS) (which measures the level of sleep deprivation and sleepiness) are at a higher risk to develop sleep apnea. The tests mentioned above are of self rating nature. If the scores are not satisfactory, then immediate medical attention is necessary.

Snoring does not always have to be an indicator to sleep apnea. If it happens to be the case where snoring and gasping for breath is followed by excessive daytime sleepiness at inappropriate period of time then it is considered as an indicator of sleep apnea. Along with these conditions mentioned above heartburn, lethargy, inability to concentrate, frequent headaches can also exist at times.

If a child snores, attention of the pediatrician is immediately required. Children are also suceptible to obstructive sleep apnea. But sometimes the cause of snoring might be due to nose and throat problems, such as enlarged tonsils, and obesity.

If one or more conditions mentioned below holds good for the child then there are high chances that the child might develop or have already developed sleep apnea. The conditions are
- Does the child have a problem with breathing throughout the night?
- Does the child snore ?
- When the child sleeps on the sides does snoring reduce ?
- Does he/she wake up many times in the night and feels tired during the day?,
All of the above combined with their activity schedule, academic reports and behavior pattern are to be taken into account while consideration the possibility of them suffering from sleep apnea. Early treatment to the problem could help the child sleep better and sound in the night.

Getting them good medical supervision will completely cure them from sleep apnea and help them to get a sound sleep; not the one that sounds of snoring !

1. Is nasal surgery necessary?
There are many home remedies and devices, which can be used to treat sleep apnea. However, these are not always effective in eliminating sleep apnea and surgery becomes inevitable. If there is a problem in the septum, or middle structure of the nose, it needs to be straightened out. Small bones on the side of the nasal cavities should be reduced for solving the problem. It can be recommended to relieve snoring. 
 
2.  How is snoring graded depending on it severity?
There are different grades of snoring, which starts from mild to severe cases. It is better to consult the physician when a person experiences milder form of snoring. Immediate medical supervision is required when the person touches the forth level.

1.  Snoring can be heard only when watched very closely.
2.  Snoring can be heard in whole of the bedroom
3.  Snoring can be heard outside the bedroom when the door is opened
4.  Snoring can be heard outside the bedroom even when the door is closed.

3.  Does Snoring lead to sleep apnea?
Snoring is one of the important symptoms of apnea. It does not mean snoring is the cause. People with tonsils, adenoids or polyps can also snore. In some cases, even persons who do not snore exhibit other symptoms of apnea.

4.  Does sleep apnea cause heart burn?  Which comes first?
It is a vicious circle. Due to acid refluxes, soft tissues in the throat and the larynx can be damaged. The burning sensation and the damaged throat keeps them awake. But it is still not known whether the acid reflux disorder was present before the sleep apnea or vice versa.

5.  Are there any particular age group who are highly susceptible to apnea?
No, there is no particular age for sleep apnea to occur. From infancy, until old age any person can develop sleep apnea. Researches have found that men are highly susceptible to sleep apnea than women.

6.  What is the difference between hypopnea and Apnea?
Both Hypopnea and apnea are respiratory disorders, which occurs during sleep. Hypopnea is less severe than apnea. The difference between apnea and a hypopnea is that, in apnea, the airflow is fully blocked, while in case of hypopnea, there is a partial airflow from the nose to the lungs. Nevertheless, both does damage the normal sleep pattern, causing low oxygen levels in the body.

7.  Can sleep apnea patients drive?

No, it is highly risky for an apnea patient to drive. While driving mind and body should be alert and the person driving should possess high reflexes. Due to sleeplessness in the night and daytime sleepiness, there is a chance of mind not to be alert. Sleep apnea patients sleep with out their knowledge at day times. Therefore, it is dangerous to drive.
 
8.  Before diagnosis of apnea will the person know that they are gasping for breath during sleep?
No. Persons suffering from apnea, wake up often to regularize the breathing pattern by taking in more air. It is always a partial awakening, just enough for the body's functions to resume to normal. While there is no necessity for the person to become aware of it, it is barely enough to disturb the sleep pattern. That is, the person is always in the state of REM and they never get into deep sleep. The same applies to daytime sleepiness where people are unaware of the fact that they are tired. They sleep without their knowledge at anytime and anywhere.

For Children

1.  Polysomnography: Though it is commonly used for diagnosis in children, it was not designed for the purpose. As the children's physiology and respiratory rates are high, the machine designed for adults can not be precisely used.
2.  Esophageal pressure monitors: To note the increased respiratory effort in children with upper airway resistance syndrome, esophageal pressure monitoring is essential. Polysomnography is not very useful in these conditions. A pressure probe kept in the esophagus measures frequent or extreme negative pressures that lead to disruption of their sleep.
3.  Apnea-hypopnoea index and minimum oxygen saturation levels are taken as indicators to test the average number of apneas and hypopnoeas in an hour of sleep.
4.  Video photography is used to record apnea events and night time awakening in children.
5.  Nasopharyngoscopy provides information on the degree of obstruction in the nasal passage of the child.
6.  Lateral neck radiography gives information about the size of the adenoids.
7.  Pulse oximetry, is a screening tool for obstructive sleep apnea disorder. But greater accuracy cannot be obtained.

For Adults

1.  Before going to the physician it is necessary for the person to maintain a sleep dairy about how loud the person is snoring, whether they wake up in sleep, whether they are experiencing difficult breathing (choking or gasping).
2.  Sound-activated audio recorder is another instrument, which helps in self-diagnosis.
3.  Endoscopy of nose and throat can verify blockages.
4.  X-rays or a CT scan of the head and neck can be obtained if necessary, to get a better picture.
5.  The basic diagnosis in the doctors office and includes a general examination on the pattern of sleep, the activities of the person throughout the day and medical history. This information is obtained from the patient and his family.
6.  Checking for any growth of extra tissues in mouth, nose and throat especially tonsils, uvula and soft palate.
7.  Polysomnogram: It is a painless sleep recording monitor which tests the breathing pattern in the night. It is mostly performed at sleep centers or laboratories in a hospital. It records the brain activity, eye movement, muscle activity, breathing and heart rate, amount of airflow in and out of the lungs when the body is at rest and the percentage of oxygen in the blood. After recording these details, the number of times breathing is impaired during sleep is tailed and the severity is graded.
8.  Multiple sleep latency test (MSLT): This test is performed to measure the speed at which the person falls asleep. In this test, several opportunities are given to the patient, to fall asleep during the course of a day when they are normally awake.
9.  Oximetry: In this painless method simple sleeve is inserted over one finger of the person to monitor and record oxygen levels throughout the night at home. During sleep, the oxygen level during apneas will drop down and subsequent rises with awakenings. If the results are abnormal, polysomnography is done to reconfirm the diagnosis.
10.  Electroencephalogram (EEG): This is done to monitor repeated awakenings in sleep and apnea can be diagnosed by checking brain waves of the patient.

Is your partner's snore disturbing you? Hang on! It is not something to fight over but an issue which needs immediate medical attention.

Snoring is due to a blockage in the breathing passage. This might be due to allergies, throat weakness, mis-positioned jaw or tongue and fatty deposits in and around the throat. There might also be a major problem hiding behind the snoring, which is called obstructive sleep apnea.
 
Snoring is the noise that is produced due to the movement of air between the narrow air passage formed by soft tissues at the back of your nose and throat. Snoring in obstructive sleep apnea is a serious problem which interferes with normal breathing while sleeping. A person who is affected by sleep apnea snores when he sleeps on his back and does not when he sleeps on his sides.

Chemistry behind sleep apnea and snoring:
Due to obstruction in the nasal passage, the soft tissues of the throat, soft palate, and the tongue collapses the upper airway which makes breathing difficult for a brief period of time.

To worsen the problem, the airway is being tightly sealed due to the negative pressure of inhaling which makes it harder on the soft tissues. In due course, the person has to wake up to create tension on the muscles, tongue and throat to draw more air to replenish the lungs by opening up the airway. This in turn causes snorting, startling, and waking patterns.

A person affected by apnea, first snores, then stops breathing for a brief period of 10-20 seconds, which quietens the snoring, suddenly gasps for breath and wakes up with snort to inhale more air. This pattern is called sleep-snore-apnea-wake pattern. It is a very disruptive for a normal sleep pattern. This occurs to mostly 93.3% of people with sleep apnea. This pattern will occur for around 100-400 times per night in extreme cases.

Medical Treatment:
1. Using of 'Breathe Right strips' might relieve the blocked nasal passage during sleep.
2. Wearing a mask at night helps the throat open and improve breathing.
3. Using of decongestants and antihistamine on the nasal passage will prevent it from clogging.
4. Use of special pillows to stretch the neck has been found effective. This method reduces snoring and improves sleep.
5. Sleeping in the upright position helps in improving the oxygen levels in overweight people with sleep apnea. Therefore elevating the head of the bed helps in such scenarios.
6. CPAP: In this method the patient's nose is covered by a mask. Through that mask the air is supplied into the throat at a predetermined pressure level. The optimal level of air pressure which is sent in, keeps the airways from closing up or obstructing throughout the night. It provides total control over snoring.
7. Turbinectomy: In this form of surgery the nasal passages are opened by removing bone and soft tissues.
8. Dental appliances are specially constructed appliances that will hold the tongue or the jaw forward to open the airway at the back of the throat.
9. Laser surgery can be performed to remove excess tissue from the uvula and soft palate.
10. Injection Snoreplasty, a topical anesthetic is injected to numb the back of the throat and palate. This causes the mouth to stiffen during the next three weeks, thereby stopping the fluttering of palate which causes the noise in snoring.

Sleep that knits up the ravelled sleave of care,
Sore labour's bath,
Balm of hurt minds,
Great nature's second course,
Chief nourisher in life's feast. - William Shakespeare.

Do you really know why we sleep?

'Sleep' is nature's gift to the human body where the body gets a chance to recharge and repair muscles and in building our immune system. During sleep, brain organizes and stores memories. The whole body goes in to "energy saver" mode. In very simple terms, a good night's sleep rejuvenates the body and the brain for the next dawn.

People who are unable to get a good sleep might run in to developing numerous sleep-related problems. These problems manifest into a large number of bodily disorders. Sleep Apnea is one such problem.

Apnea takes its origin from the Greek word, which means "Without Breath". Sleep apnea is a disorder where there is an interruption to breathing during sleep. It is progressive as it increases with age. In this condition, the patient misses a breath for about 10 to 20 seconds every time for around 40-100 times in a night's sleep. In severe cases, it even touches 400 times in a night. Sometimes it can be quite dangerous. Sleep apnea is a progressive sleep disorder (it gets worse as you age).

Types of sleep apnea.
There are three types of sleep apnea; namely Obstructive, Central, and Mixed.

Obstructive Sleep Apnea is highly prevalent in the population compared to its counterparts. As the name implies it is caused due to an obstruction in the free flow of the air. During sleep, there is not enough air from nose to lungs as the windpipe is blocked or collapsed briefly during breathing, due to the relaxation of muscles.

The cause might be due to tonsils, overweight of the person, smaller airway, respiratory infection, improper facial structure, worn out airway muscles, obstruction in the nasal passages, reduction in blood oxygen saturation and sometimes the structure of the jaw. It can prevail in people who take drugs too. So little time is spent in deep sleep that the brain briefly raises to activity when they resume breathing, resulting in sleep deprivation. This causes tiredness, weakness and in advanced cases stroke, asthma and sometimes depression.

The second type is Central Sleep Apnea and is relatively rare. As the name suggests, it is due to disorder in the central nervous system. It happens when the brain malfunctions and misses to send a "go-ahead" signal for breathing. Sometimes the signal sent is interrupted. For a healthy person, at times of rest, breathing is normal. When oxygen levels suddenly go low and / or carbon dioxide levels climbs up, the brain immediately send signals to inhale more. In case of Central sleep apnea, this very basic control for breathing rate is malfunctioning, that causes failure to give the signals for inhalation, causing the individual to miss one or more breathing cycles. This results in severe decrease in oxygen levels in the body leading to hypoxia.

Central sleep apnea results in insomnia, although they may also experience a choking or gasping sensation upon awakening. In severe cases, right side heart fails and may even lead to death. It is also common in people suffering from one or more heart problems in conjunction with lung disorders.

The last type is Mixed Sleep Apnea, where a person having Obstructive sleep apnea prevailing for a long time and who is untreated develops Central sleep apnea.
If sleep apnea is untreated, it could lead to snoring, high blood pressure, cardiovascular diseases, memory problems, weight gain, impotency, headaches, abnormal daytime sleepiness (including falling asleep at inappropriate times), limited attention span, lethargy and in severe cases swelling of the legs.
The need for the day is awareness in the public, without which the problem could go undiagnosed and untreated, despite the fact that this serious disorder can have significant consequences.

As a popular saying goes "self help is the best help an individual can offer to himself".  Always self-care is the most correct way to deal with obstructive sleep apnea and sometimes for central sleep apnea and mixed apnea too.
 
The following are some of the self care guidelines that helps a person cope with sleep apnea:

1.  A person who is over-weight might run a higher risk of developing sleep apnea. Due to excessive fatty growth of the body tissues there might be blockages in the airways. Therefore the best way to avoid sleep apnea is to lose weight in a healthy way. For those who are already suffering from sleep apnea even a slight loss in the excess weight might help them from throat constriction.
2.  In obstructive sleep apnea, any contributor to the obstruction in the throat worsens the problem. Therefore avoiding alcohol, smoking and over the counter tranquilizers and sleeping pills will prevent the aggravating condition. Especially smoking has to be totally avoided as it adversely affects the condition causing congestion to happen. In case of alcohol it is better to restrain the usage at least 5 hours before sleep.
3.  Most patients with this condition prevailing, cannot sleep on the back. This is due to the fact that the problem aggravates when the tongue and the soft palate rests on the throat causing a blockage to the airway. Sleeping on the back could cause a person to run into apnea more than 40-50 times in a night compared to when they roll on to their sides.

Some suggestions for a person to avoid apnea with respect to sleeping positions:

1.  To prevent sleeping on the back just roll a small ball into the shirt. 
2. Stretching or elevating the Neck during sleep can improve the condition of sleep apnea. To stretch the neck a special pillow made for the purpose can be used. This method effectively reduces snoring and improves sleep.
3.  Sleeping in the elevated upright position might help in improving the oxygen levels in overweight people with sleep apnea. So Elevating the head of the bed providing a slant for the back might help.
4.  Using of decongestants and antihistamine on the nasal passage will prevent it from clogging. But it should be used often and this method needs direction from a physician.
5.  Using of nasal strips such as 'Breathe Right Strips' might relieve the blocked nasal passages during sleep.
6.  Sometimes it may be necessary to wear a mask at night to keep the throat open and improve breathing.
7.  People with food allergies should avoid such foods that cause reactions, as it adds to their congestion.
8.  Avoid having the meal just before bed time as it increases the congestion.
9.  Learn to play "Didgeridoo"; an Australian wind instrument. It helps decreasing the collapsibility of the upper airways. 
10. Follow regular sleep timings.
11. Keeping sinuses clear will reduce the problem and if needed take the help of a humidifier.

These self care suggestions will help a person with sleep apnea improve his overall health, personal life and quality of sleep. In addition emotional support from the family is must, apart from helping the person in following a medical regime and recovering fast.