apnoea

Sleep apnea is a common disorder that causes your breathing to stop or get very shallow. Breathing pauses can last from a few seconds to minutes. They may occur 30 times or more an hour.

The most common type is obstructive sleep apnea. It causes your airway to collapse or become blocked during sleep. Normal breathing starts again with a snort or choking sound. People with sleep apnea often snore loudly. However, not everyone who snores has sleep apnea.

You are more at risk for sleep apnea if you are overweight, male, or have a family history or small airways. Children with enlarged tonsils or adenoids may also get it.

Doctors diagnose sleep apnea based on medical and family histories, a physical exam, and sleep study results.

When your sleep is interrupted throughout the night, you can be drowsy during the day. People with sleep apnea are at higher risk for car crashes, work-related accidents, and other medical problems. If you have it, it is important to get treatment. Lifestyle changes, mouthpieces, surgery, and breathing devices can treat sleep apnea in many people.

NIH: National Heart, Lung, and Blood Institute

Heart disease is the leading cause of the death in the United States. It is also a major cause of disability. But you can take steps to improve your health and help prevent heart disease. The first step is understanding your risk of heart disease. Your risk depends on many factors, some of which are changeable and others that are not. Learning about them and working on the things that you can change can lower your risk of heart disease.

There are some risk factors for heart disease that you cannot change:

• Your age. Your risk of heart disease increases as you get older. The risk is higher in:
  • Men age 45 and older
  • Women age 55 and older
• Your sex. Some risk factors may affect heart disease risk differently in women than in men. For example:
  • The hormone estrogen provides women some protection against heart disease
  • Diabetes raises the risk of heart disease more in women than in men.
• Your race or ethnicity. Certain groups have higher risks than others. For example:
  • African Americans are more likely than Whites to die of heart disease, while Hispanic Americans are less likely to die of it
  • Asian Americans as a group have lower rates of heart disease than other groups, but South Asian Americans have higher rates
• Your family history. You have a greater risk if you have a close family member who had heart disease at an early age, for example if:
  • Your father or brother was diagnosed before age 55
  • Your mother or sister was diagnosed before age 65

There are many heart disease risk factors that you can change. If you make these changes, you don't just help protect your heart. You can also improve your overall health and well-being.

You may have a lot of changes to make. If you need to, you can make the changes gradually, one at a time. What's most important is that you make them. Depending on your lifestyle, these changes could include:

• Controlling your blood pressure.High blood pressure is a major risk factor for heart disease. It is important to get your blood pressure checked regularly - at least once a year for most adults, and more often if you have high blood pressure. You can also take steps, including lifestyle changes, to prevent or control high blood pressure.
• Keeping your cholesterol and triglyceride levels under control:
  • High levels of cholesterol can clog your arteries and raise your risk of coronary artery disease and heart attack. Lifestyle changes and medicines (if needed) can lower your cholesterol.
  • Triglycerides are another type of fat in the blood. High levels of triglyceride may also raise the risk of coronary artery disease, especially in women.
• Staying at a healthy weight. Being overweight or having obesity can increase your risk of heart disease. This is mostly because they are linked to other heart disease risk factors, including high blood cholesterol and triglyceride levels, high blood pressure, and diabetes. Controlling your weight can lower these risks.
• Eating a healthy diet. Try to limit saturated fats, foods high in sodium (salt), and added sugars. Instead, eat plenty of fresh fruit, vegetables, and whole grains. The DASH diet is an example of an eating plan that can help you to lower your blood pressure and cholesterol, two things that can lower your risk of heart disease.
• Getting regular physical activity. Regular physical activity has many benefits, including strengthening your heart and improving your circulation. It can also help you maintain a healthy weight and lower cholesterol and blood pressure. All of these can lower your risk of heart disease.
• Limiting alcohol. Drinking too much alcohol can raise your blood pressure. It also adds extra calories, which may cause weight gain. Both of those raise your risk of heart disease. It's best not to drink, but if you do:
  • Have no more than 2 drinks per day if you are a man.
  • Have no more than 1 drink per day if you are a woman.
• Not smoking. Cigarette smoking raises your blood pressure and puts you at higher risk of heart attack and stroke.
  • If you do not smoke, don't start.
  • If you do smoke, quitting will lower your risk of heart disease. You can talk with your health care provider for help in finding the best way for you to quit.
• Managing stress.Stress is linked to heart disease in many ways. It can raise your blood pressure. Extreme stress can be a "trigger" for a heart attack. Also, some common ways of coping with stress, such as overeating, heavy drinking, and smoking, are bad for your heart. Some ways to help manage your stress include exercise, listening to music, focusing on something calm or peaceful, and meditating.
• Managing diabetes. Having diabetes doubles your risk of diabetic heart disease. That is because over time, high blood glucose (blood sugar) from diabetes can damage your blood vessels and the nerves that control your heart and blood vessels. So, it is important to get tested for diabetes, and if you have it, to keep it under control.
• Getting enough sleep. If you don't get enough sleep, you raise your risk of high blood pressure, obesity, and diabetes. Those three things can raise your risk of heart disease. To improve your sleep:
  • If you are an adult, try to get 7 to 9 hours of sleep per night.
  • Make sure that you have good sleep habits, such as keeping a regular sleep schedule and creating a good sleeping environment in your bedroom.
  • If you have frequent sleep problems, contact your health care provider. One problem, sleep apnea, causes people to briefly stop breathing many times during sleep. This interferes with your ability to get a good rest and can raise your risk of heart disease. If you think you might have sleep apnea, ask your provider about having a sleep study. And if you do have sleep apnea, make sure that you get treatment for it.

Snoring is the sound you make when your breathing is blocked while you are asleep. The sound is caused by tissues at the top of your airway that strike each other and vibrate. Snoring is common, especially among older people and people who are overweight.

When severe, snoring can cause frequent awakenings at night and daytime sleepiness. It can disrupt your bed partner's sleep. Snoring can also be a sign of a serious sleep disorder called sleep apnea. You should see your health care provider if you are often tired during the day, don't feel that you sleep well, or wake up gasping.

To reduce snoring:

• Lose weight if you are overweight. It may help, but thin people can snore, too.
• Cut down or avoid alcohol and other sedatives at bedtime
• Don't sleep flat on your back

NIH: National Institute on Aging

Adenoids are a patch of tissue that is high up in the throat, just behind the nose. They, along with the tonsils, are part of the lymphatic system. The lymphatic system clears away infection and keeps body fluids in balance. The adenoids and tonsils work by trapping germs coming in through the mouth and nose.

Adenoids usually start to shrink after about age 5. By the teenage years, they are almost completely gone. By then, the body has other ways to fight germs.

Enlarged adenoids are adenoids that are swollen. It is a common problem in children.

Your child's adenoids can be enlarged, or swollen, for different reasons. It may just be that your child had enlarged adenoids at birth. Adenoids can also become enlarged when they are trying to fight off an infection. They might stay enlarged even after the infection is gone.

Enlarged adenoids can make it hard to breathe through the nose. Your child might end up breathing only through the mouth. This may cause:

• A dry mouth, which can also lead to bad breath
• Cracked lips
• A runny nose

Other problems that enlarged adenoids can cause include:

• Loud breathing
• Snoring
• Restless sleep
• Sleep apnea, a disorder that causes you to repeatedly stop breathing during sleep
• Ear infections

To find out if your child has enlarged adenoids, the health care provider will:

• Ask about your child's medical history, including asking about your child's symptoms
• Check your child's ears, throat, and mouth
• Feel your child's neck

Since the adenoids are higher up than the throat, the provider cannot see them just by looking through your child's mouth. To check the size of your child's adenoids, your provider may use:

• A special mirror in the mouth
• A long, flexible tube with a light (an endoscope)
• An x-ray

The treatment depends on what is causing the problem. If the symptoms are not too bad, your child may not need treatment. If treatment is needed, your child may get nasal spray to reduce the swelling or antibiotics if the provider thinks that there is a bacterial infection.

In some cases, your child may need an adenoidectomy.

An adenoidectomy is surgery to remove the adenoids. The provider may recommend this surgery if:

• Your child has repeated infections of the adenoids. Sometimes the infections can also cause ear infections and fluid buildup in the middle ear.
• Taking antibiotics doesn't get rid of a bacterial infection of the adenoids.
• The enlarged adenoids block the airways.

If there is also a problem with the tonsils, your child will probably have a tonsillectomy (removal of the tonsils) at the same time that the adenoids are removed.

After having the surgery, your child usually goes home the same day. Your child will probably have some throat pain, bad breath, and a runny nose. It can take several days to feel all better.

Almost 1 of every 10 infants born in the United States are premature, or preemies. A premature birth is when a baby is born before 37 completed weeks of pregnancy. A full-term pregnancy is 40 weeks.

Important growth and development happen throughout pregnancy - especially in the final months and weeks. Because they are born too early, preemies weigh much less than full-term babies. They may have health problems because their organs did not have enough time to develop. Problems that a baby born too early may have include:

• Breathing problems
• Feeding difficulties
• Cerebral palsy
• Developmental delay
• Vision problems
• Hearing problems

Preemies need special medical care in a neonatal intensive care unit, or NICU. They stay there until their organ systems can work on their own.

Centers for Disease Control and Prevention

Sleep is a complex biological process. While you are sleeping, you are unconscious, but your brain and body functions are still active. They are doing a number of important jobs that help you stay healthy and function at your best. So when you don't get enough quality sleep, it does more than just make you feel tired. It can affect your physical and mental health, thinking, and daily functioning.

Sleep disorders are conditions that disturb your normal sleep patterns. There are more than 80 different sleep disorders. Some major types include:

• Insomnia - being unable to fall asleep and stay asleep. This is the most common sleep disorder.
• Sleep apnea - a breathing disorder in which you stop breathing for 10 seconds or more during sleep
• Restless leg syndrome (RLS) - a tingling or prickly sensation in your legs, along with a powerful urge to move them
• Hypersomnia - being unable to stay awake during the day. This includes narcolepsy, which causes extreme daytime sleepiness.
• Circadian rhythm disorders - problems with the sleep-wake cycle. They make you unable to sleep and wake at the right times.
• Parasomnia - acting in unusual ways while falling asleep, sleeping, or waking from sleep, such as walking, talking, or eating

Some people who feel tired during the day have a true sleep disorder. But for others, the real problem is not allowing enough time for sleep. It's important to get enough sleep every night. The amount of sleep you need depends on several factors, including your age, lifestyle, health, and whether you have been getting enough sleep recently. Most adults need about 7-8 hours each night.

There are different causes for different sleep disorders, including:

• Other conditions, such as heart disease, lung disease, nerve disorders, and pain
• Mental illnesses, including depression and anxiety
• Medicines
• Genetics

Sometimes the cause is unknown.

There are also some factors that can contribute to sleep problems, including:

• Caffeine and alcohol
• An irregular schedule, such as working the night shift
• Aging. As people age, they often get less sleep or spend less time in the deep, restful stage of sleep. They are also more easily awakened.

The symptoms of sleep disorders depend on the specific disorder. Some signs that you may have a sleep disorder include that:

• You regularly take more than 30 minutes each night to fall asleep
• You regularly wake up several times each night and then have trouble falling back to sleep, or you wake up too early in the morning
• You often feel sleepy during the day, take frequent naps, or fall asleep at the wrong times during the day
• Your bed partner says that when you sleep, you snore loudly, snort, gasp, make choking sounds, or stop breathing for short periods
• You have creeping, tingling, or crawling feelings in your legs or arms that are relieved by moving or massaging them, especially in the evening and when trying to fall asleep
• Your bed partner notices that your legs or arms jerk often during sleep
• You have vivid, dreamlike experiences while falling asleep or dozing
• You have episodes of sudden muscle weakness when you are angry or fearful, or when you laugh
• You feel as though you cannot move when you first wake up

To make a diagnosis, your health care provider will use your medical history, your sleep history, and a physical exam. You may also have a sleep study (polysomnogram). The most common types of sleep studies monitor and record data about your body during a full night of sleep. The data includes:

• Brain wave changes
• Eye movements
• Breathing rate
• Blood pressure
• Heart rate and electrical activity of the heart and other muscles

Other types of sleep studies may check how quickly you fall asleep during daytime naps or whether you are able to stay awake and alert during the day.

Treatments for sleep disorders depend on which disorder you have. They may include:

• Good sleep habits and other lifestyle changes, such as a healthy diet and exercise
• Cognitive behavioral therapy or relaxation techniques to reduce anxiety about getting enough sleep
• CPAP (continuous positive airway pressure) machine for sleep apnea
• Bright light therapy (in the morning)
• Medicines, including sleeping pills. Usually, providers recommend that you use sleeping pills for a short period of time.
• Natural products, such as melatonin. These products may help some people but are generally for short-term use. Make sure to check with your health care provider before you take any of them.

Atrial fibrillation, also known as AFib or AF, is one of the most common types of arrhythmias. Arrhythmias are problems with the rate or rhythm of your heartbeat. They can cause your heart to beat too slowly, too fast, or in an irregular way.

If you have AFib, your heart beats irregularly and sometimes much faster than normal. Also, your heart's upper and lower chambers do not work together as they should. When this happens, the lower chambers do not fill completely or pump enough blood to your lungs and body. This can cause symptoms such as dizziness, fatigue, and a pounding heartbeat.

AFib may happen in brief episodes, or it may be a permanent condition. It's very important to treat it, since AFib can put you at risk for stroke and other heart conditions.

AFib is most often caused by changes to the heart's tissue or the electrical signaling that helps the heartbeat. These changes can happen due to different conditions and factors, such as high blood pressure, coronary artery disease, congenital heart defects, infections, and aging. Sometimes the cause is unknown.

Anyone can develop AFib, but there are certain things that raise your risk for it:

• Aging. The risk of atrial fibrillation increases as you get older, especially when you are over age 65.
• Family history and genetics. AFib can run in families. So can heart disease, which raises your risk of AFib.
• Some lifestyle choices. Your risk is higher if you drink a lot of alcohol, use certain illegal drugs such as cocaine and methamphetamines, or smoke.
• Having certain health conditions, such as:
  • High blood pressure
  • Diabetes
  • Heart failure
  • Heart valve diseases
  • Obesity
  • Hyperthyroidism
  • Chronic kidney disease
  • COPD and other lung diseases
  • Sleep apnea
• Race. AFib is more common in people with European ancestry.
• Recent surgery. You may be at risk of atrial fibrillation in the early days and weeks after surgery on your heart, lungs, or esophagus.

Some people who have AFib don't have any symptoms and don't know they have it. If you do have symptoms, you may only notice them once in a while. Or you may have symptoms that are more frequent. And in some cases, the symptoms might be severe. If you have heart disease, you are more likely to notice your symptoms. And those symptoms could get worse if your heart disease gets worse.

The symptoms of AFib can include:

• Extreme fatigue, which is the most common symptom
• Heart palpitations (the feeling that your heart is skipping a beat, fluttering, pounding, or beating too hard or too fast)
• Trouble breathing, especially when lying down or when exercising
• Chest pain
• Dizziness or fainting
• Low blood pressure

If AFib is not treated, it can lead to serious health problems (complications) such as:

• Stroke
• Heart failure
• Blood clots
• Sudden cardiac arrest (SCA)
• Cognitive impairment and dementia

To help prevent these problems, it's important to contact your health care provider if you are having symptoms. If you do have AFib, the sooner you are diagnosed and treated, the better.

To find out if you have AFib, your provider:

• Will ask about your medical history, including your symptoms, lifestyle, and any other health conditions you may have
• Will ask about your family history, to find out if you have relatives who have or had AFib
• Will do a physical exam
• May order blood tests
• Will likely order heart tests, such as an electrocardiogram (also called an EKG or ECG) and echocardiogram
• May ask you to wear a heart monitor device that records your heart's electrical activity

The treatments for AFib may include:

• Blood thinner medicines that help prevent blood clots from forming.
• Medicines to control your heart's rhythm and rate.
• Following heart-healthy lifestyle changes, such as:
  • Following a heart-healthy eating plan that limits saturated fats, salt, and cholesterol. An example is the DASH eating plan.
  • Limiting or avoiding alcohol, because it can increase your heart rate.
  • Aiming for a healthy weight.
  • Getting regular physical activity.
  • Managing stress.
  • Quitting smoking.
• Procedures such as:
  • Electrical cardioversion, which restores your heart rhythm using low-energy shocks to your heart.
  • Catheter ablation, which scars the tissue that is causing the arrhythmia. The scar tissue blocks the abnormal heart signals.
• Surgeries such as:
  • Surgery to put in a pacemaker to help control the arrhythmia.
  • A Maze procedure, which creates scar tissue in a maze-like pattern in certain parts of the heart.
  • Left atrial appendage closure, a surgery on a small sac in the muscle wall of your left atrium (the upper left chamber of your heart). It helps prevent blood clots and can reduce your risk of stroke. This surgery is for people who are not able to take blood thinners.

There are steps you can take to help lower your risk of atrial fibrillation, such as:

• Making heart-healthy lifestyle changes:
  • Following a heart-healthy eating plan
  • Limiting or avoiding alcohol
  • Aiming for a healthy weight
  • Getting regular physical activity
  • Managing stress
  • Not smoking
• Avoiding illegal drugs, such as cocaine and methamphetamines
• Taking antiarrhythmic medicine (medicine to treat arrhythmia) if you are having heart surgery
• Treating any health conditions that could raise your risk of AFib

NIH: National Heart, Lung, and Blood Institute

When you're short of breath, it's hard or uncomfortable for you to take in the oxygen your body needs. You may feel as if you're not getting enough air. Sometimes you can have mild breathing problems because of a stuffy nose or intense exercise. But shortness of breath can also be a sign of a serious disease.

Many conditions can make you feel short of breath:

• Lung conditions such as asthma, emphysema, or pneumonia
• Problems with your trachea or bronchi, which are part of your airway system
• Heart disease can make you feel breathless if your heart cannot pump enough blood to supply oxygen to your body
• Anxiety and panic attacks
• Allergies

If you often have trouble breathing, it is important to find out the cause.

Down syndrome is a condition in which a person has an extra chromosome or an extra piece of a chromosome. This extra copy changes how a baby's body and brain develop. It can cause both mental and physical challenges during their lifetime. Even though people with Down syndrome might act and look similar, each person has different abilities.

Chromosomes are tiny "packages" in your cells that contain your genes. Genes carry information, called DNA, that controls what you look like and how your body works. People with Down syndrome have an extra copy of chromosome 21. In some cases, they may have an extra copy of part of the chromosome. Having an extra copy of a chromosome is called trisomy. So sometimes Down syndrome is also called trisomy 21.

Down syndrome is usually not inherited. It happens by chance, as an error when cells are dividing during early development of the fetus. It is not known for sure why Down syndrome occurs or how many different factors play a role.

One factor that increases the risk of having a baby with Down syndrome is the age of the mother. Women ages 35 and older are more likely to have a baby with Down syndrome.

The symptoms of Down syndrome are different in each person. And people with Down syndrome may have different problems at different times of their lives. They usually have mild to moderate intellectual disabilities. Their development is often delayed. For example, they may start talking later than other children.

Some of the common physical signs of Down syndrome include:

• A flat face
• Eyes that slant up
• A short neck
• Small hands and feet
• Poor muscle tone
• Loose joints

Many people with Down syndrome have the common physical signs and have healthy lives. But some people with Down syndrome might have one or more birth defects or other health problems. Some of the more common ones include:

• Hearing loss
• Sleep apnea (a disorder that causes you to repeatedly stop breathing during sleep)
• Ear infections
• Eye diseases
• Congenital heart defects (heart defects that are present at birth)
• Digestive problems
• Problems with the upper part of the spine
• Obesity

Health care providers can check for Down syndrome during pregnancy or after a child is born.

There are two basic types of tests that help find Down syndrome during pregnancy:

• Prenatal screening tests can show whether your unborn baby has a higher or lower chance of having Down syndrome. If a screening test shows that your baby could have Down syndrome, you'll need another test to find out for sure.
• Prenatal diagnostic tests can diagnose or rule out Down syndrome by checking the chromosomes in a sample of cells.

These tests have a small risk of causing a miscarriage, so they're often done after a screening test shows that an unborn baby could have Down syndrome.

After a baby is born, the provider may make an initial diagnosis of Down syndrome based on the physical signs of the syndrome. The provider can use a karyotype genetic test to confirm the diagnosis. The test can check for extra chromosomes in a sample of the baby's blood.

There is no single, standard treatment for Down syndrome. Treatments are based on each person's physical and intellectual needs, strengths, and limitations.

Services early in life focus on helping children with Down syndrome develop to their full potential. These services include speech, occupational, and physical therapies. They are typically offered through early intervention programs in each state. Children with Down syndrome may also need extra help or attention in school, although many children are included in regular classes.

Since people with Down syndrome can have birth defects and other health problems, they will need regular medical care. They may need to have certain extra health screenings to check for problems that happen more often in people with Down syndrome.

Centers for Disease Control and Prevention

Fatigue is a feeling of weariness, tiredness, or lack of energy. It can interfere with your usual daily activities. Fatigue can be a normal response to physical activity, emotional stress, boredom, or lack of sleep. But sometimes it can be a sign of a mental or physical condition. If you have been feeling tired for weeks, contact your health care provider. They can help you find out what's causing your fatigue and recommend ways to relieve it.

Fatigue itself is not a disease; it's a symptom. It can have many different causes, including pregnancy and various medical problems, treatments, and lifestyle habits such as:

• Medical problems:
  • Chronic (long-lasting) diseases such as diabetes, COPD (chronic obstructive pulmonary disease), and heart, liver, kidney and thyroid diseases
  • Untreated pain and diseases like fibromyalgia
  • Anemia
  • Infections
  • Parkinson's disease
  • Sleep apnea and other sleep disorders
  • Recent stroke
  • Mental disorders such as depression and anxiety
• Treatments:
  • Cancer treatments such as chemotherapy, radiation, and bone marrow transplants
  • Recovering from major surgery
  • Taking certain medicines, such as antidepressants, antihistamines, and medicines for nausea and pain
• Lifestyle habits:
  • Not getting enough sleep
  • Staying up too late
  • Drinking too much alcohol
  • Substance use
  • Having too much caffeine (which can keep you from getting a good night's sleep)
  • Getting too little or too much exercise

Overwhelming fatigue is part of a disorder called myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). The fatigue caused by this disorder is different from a tired feeling that goes away after you rest. Instead, the fatigue in ME/CFS lasts a long time, does not get better with rest, and limits your ability to do ordinary daily activities.

If you've had fatigue that does not get better after several weeks, call your provider. They will ask questions about your sleep, daily activities, appetite, and exercise. They will likely do a physical exam and order lab tests. Once they decide on a diagnosis, they can tell you what treatments might help.

You can also make some lifestyle changes to feel less tired:

• Get regular physical activity
• Improve your sleep habits
• Stop smoking (if you smoke), since smoking is linked to many diseases that can cause fatigue
• Manage stress
• Eat a healthy diet and avoid alcohol

It also may be helpful for you to keep a fatigue diary. This can help you find patterns throughout the day, such as when you feel more tired and when you have more energy. It can also help you plan for activities that may give you more energy.

NIH: National Institute on Aging