{"id":737,"date":"2020-08-10T15:47:36","date_gmt":"2020-08-10T15:47:36","guid":{"rendered":"https:\/\/courses.lumenlearning.com\/abnormalpsych\/?post_type=chapter&#038;p=737"},"modified":"2022-07-26T20:06:15","modified_gmt":"2022-07-26T20:06:15","slug":"breathing-related-sleep-disorders","status":"publish","type":"chapter","link":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/chapter\/breathing-related-sleep-disorders\/","title":{"raw":"Breathing-Related Sleep Disorders","rendered":"Breathing-Related Sleep Disorders"},"content":{"raw":"<div class=\"textbox learning-objectives\">\r\n<h3>Learning Objectives<\/h3>\r\n<ul>\r\n \t<li>Describe sleep apnea and other breathing-related sleep disorders<\/li>\r\n<\/ul>\r\n<\/div>\r\n<h2>Sleep\u00a0Apnea<\/h2>\r\n<strong>Sleep apnea<\/strong> is defined by episodes during which a sleeper\u2019s breathing stops. Sleep apnea episodes can last 10\u201320 seconds or longer and often are associated with brief periods of arousal. While individuals suffering from sleep apnea may not be aware of these repeated disruptions in sleep, they do experience increased levels of fatigue. Many individuals diagnosed with sleep apnea first seek treatment because their sleeping partners indicate that they snore loudly and\/or stop breathing for extended periods of time while sleeping (Henry &amp; Rosenthal, 2013).\r\n\r\nSleep apnea is much more common in people who are overweight and it may exacerbate cardiovascular disease (S\u00e1nchez-de-la-Torre, Campos-Rodriguez, &amp; Barb\u00e9, 2012). While sleep apnea is less common in people who are thin, anyone, regardless of their weight, who snores loudly or gasps for air while sleeping, should be checked for sleep apnea.\r\n\r\nWhile people are often unaware of their sleep apnea, they are keenly aware of some of the adverse consequences of insufficient sleep. One person explained that the sleep apnea affected his daily life saying,\u00a0\u201cI\u2019m in a job where there\u2019s a premium on being mentally alert. I was really sleepy . . . and having trouble concentrating. . . . It was getting to the point where it was kind of scary\u201d (Henry &amp; Rosenthal, 2013, p. 52).\r\n\r\nThere are two main types of sleep apnea: obstructive sleep apnea<strong>,<\/strong> listed as obstructive sleep apnea hypopnea (OSAH) in the DSM-5, and central sleep apnea. <strong>Obstructive sleep apnea<\/strong> occurs when an individual\u2019s airway becomes blocked during sleep and air is prevented from entering the lungs. It is diagnosed if a person has at least five obstructive apneas per hour of sleep combined with breathing disturbances such as snoring and daytime sleepiness or at least fifteen obstructive apneas per hour of sleep without other symptoms. The apnea is characterized by at least ten-second disturbances in breathing. In <strong>central sleep apnea (CSA)<\/strong>, disruption in signals sent from the brain that regulate breathing cause periods of interrupted breathing (White, 2005). Central sleep apnea is less common than obstructive sleep apnea hypopnea (OSAH) and is more commonly associated with illnesses.\r\n\r\nApproximately 2%-9% of adults in the United States have obstructive sleep apnea and about 0.9% of adults over the age of 40 are diagnosed with central sleep apnea, but many cases are estimated to be undiagnosed. Both are more common in men than women. There are multiple factors that contribute to being at risk for sleep apnea, including obesity, hormonal imbalances, smoking cigarettes, family history, and the size and positioning of the jaw, throat, and tongue.[footnote]Sleep Apnea - Causes &amp; Symptoms. Sleep Foundation. (2020, September 25). https:\/\/www.sleepfoundation.org\/sleep-apnea.[\/footnote]\r\n<div class=\"textbox examples\">\r\n<h3>Watch It<\/h3>\r\nWatch this video to learn about sleep apnea, including its causes, symptoms, diagnosis, treatment, and pathology.\r\n\r\nhttps:\/\/www.youtube.com\/watch?v=cjQPGs_tvDY\r\n\r\nYou can view the <a href=\"https:\/\/course-building.s3-us-west-2.amazonaws.com\/Abnormal+Psychology\/transcripts\/SleepApneaCausesSymptomsDiagnosis_transcript.txt\" target=\"_blank\" rel=\"noopener\">transcript for \"Sleep apnea - causes, symptoms, diagnosis, treatment, pathology\" here (opens in new window)<\/a>.\r\n\r\n<\/div>\r\n<h2>Treatment<\/h2>\r\n<section><\/section>One of the most common treatments for sleep apnea involves the use of a special device during sleep. A <strong>continuous positive airway pressure (CPAP) <\/strong>device includes a mask that fits over the sleeper\u2019s nose and mouth, which is connected to a pump that pumps air into the person\u2019s airways, forcing them to remain open, as shown in Figure 1. Some newer continuous positive airway pressure (CPAP) masks are smaller and cover only the nose. This treatment option has proven to be effective for people suffering from mild to severe cases of sleep apnea (McDaid et al., 2009). However, alternative treatment options are being explored because consistent compliance by users of continuous positive airway pressure (CPAP) devices is a problem. EPAP (excitatory positive air pressure) device has shown promise in double-blind trials as one such alternative (Berry, Kryger, &amp; Massie, 2011).\u00a0Treatment of sleep apnea also involves treading comorbid medical conditions, sometimes through surgery or medications.\r\n<figure>\r\n\r\n[caption id=\"\" align=\"aligncenter\" width=\"732\"]<img src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images-archive-read-only\/wp-content\/uploads\/sites\/902\/2015\/02\/23224642\/CNX_Psych_04_04_CPAP.jpg\" alt=\"Photograph A shows a CPAP device. Photograph B shows a clear full face CPAP mask attached to a mannequin's head with straps.\" width=\"732\" height=\"301\" \/> <strong>Figure 1<\/strong>. (a) A typical CPAP device used in the treatment of sleep apnea is (b) affixed to the head with straps and a mask that covers the nose and mouth.[\/caption]<\/figure>\r\n<section>\r\n<ul>\r\n \t<li>Tongue Surgery\r\n<ul>\r\n \t<li>This procedure involves advancing one of the main <span id=\"urn:local-text-annotation-9mdv1qce9xo4m66ibmxwnzeiituwlj9t\" class=\"textannotation disambiguated wl-thing\" style=\"font-size: 1rem; orphans: 1; text-align: initial;\">tongue<\/span><span style=\"font-size: 1rem; orphans: 1; text-align: initial;\"> muscles, the <\/span><span id=\"urn:local-text-annotation-1clbkrspfbgja0hyfkmd3fh02ru1vveu\" class=\"textannotation disambiguated wl-thing\" style=\"font-size: 1rem; orphans: 1; text-align: initial;\">genioglossus muscle<\/span><span style=\"font-size: 1rem; orphans: 1; text-align: initial;\">, forward, thereby limiting the backward fall of the tongue during <\/span><span id=\"urn:local-text-annotation-bouttbq1larbhcq0svk7e5xaw6gypep8\" class=\"textannotation disambiguated wl-thing\" style=\"font-size: 1rem; orphans: 1; text-align: initial;\">sleep<\/span><span style=\"font-size: 1rem; orphans: 1; text-align: initial;\">. This procedure addresses the same sites of potential obstruction as the hyoid advancement, and numerous studies have shown a high success rate.\u00a0<\/span><\/li>\r\n<\/ul>\r\n<\/li>\r\n \t<li>Nasal Surgery\r\n<ul>\r\n \t<li>Both daytime nasal obstruction and nocturnal <span id=\"urn:local-text-annotation-rc1q4s9hhuaw9l9jv3egrrrxni1uep9s\" class=\"textannotation disambiguated wl-thing\" style=\"font-size: 1rem; orphans: 1; text-align: initial;\">nasal congestion<\/span><span style=\"font-size: 1rem; orphans: 1; text-align: initial;\"> have been shown as risk factors for sleep-disordered breathing. Therefore, the <\/span><span id=\"urn:local-text-annotation-r7i9xk1eoon4unlcqt7wgqckvgq4zxtr\" class=\"textannotation disambiguated wl-thing\" style=\"font-size: 1rem; orphans: 1; text-align: initial;\">treatment<\/span><span style=\"font-size: 1rem; orphans: 1; text-align: initial;\"> of nasal obstruction plays an important role in sleep <\/span><span id=\"urn:local-text-annotation-8zlokn4o0xgo41efxjtngq7fbqrwxspa\" class=\"textannotation disambiguated wl-thing\" style=\"font-size: 1rem; orphans: 1; text-align: initial;\">apnea<\/span><span style=\"font-size: 1rem; orphans: 1; text-align: initial;\"> surgery. Three anatomic areas of the nose that may contribute to obstruction are the septum, the turbinates, and the nasal valve. The most common nasal surgical procedure consists of\u00a0straightening out the <\/span><span id=\"urn:enhancement-c821338f-a90e-458c-a924-c2cf52d3b591\" class=\"textannotation disambiguated wl-thing\" style=\"font-size: 1rem; orphans: 1; text-align: initial;\">septum<\/span><span style=\"font-size: 1rem; orphans: 1; text-align: initial;\"> and reducing the size of the turbinates, which creates more room in the nose and allows air to pass smoothly and without effort.<\/span><\/li>\r\n<\/ul>\r\n<\/li>\r\n \t<li>Tongue Surgery\r\n<ul>\r\n \t<li>The tongue has an established role in obstruction in sleep apnea. One treatment involves moving one of the main <span id=\"urn:local-text-annotation-9mdv1qce9xo4m66ibmxwnzeiituwlj9t\" class=\"textannotation disambiguated wl-thing\" style=\"font-size: 1rem; orphans: 1; text-align: initial;\">tongue<\/span><span style=\"font-size: 1rem; orphans: 1; text-align: initial;\"> muscles, the <\/span><span id=\"urn:local-text-annotation-1clbkrspfbgja0hyfkmd3fh02ru1vveu\" class=\"textannotation disambiguated wl-thing\" style=\"font-size: 1rem; orphans: 1; text-align: initial;\">genioglossus muscle<\/span><span style=\"font-size: 1rem; orphans: 1; text-align: initial;\">, forward; thereby limiting the backward fall of the tongue during <\/span><span id=\"urn:local-text-annotation-bouttbq1larbhcq0svk7e5xaw6gypep8\" class=\"textannotation disambiguated wl-thing\" style=\"font-size: 1rem; orphans: 1; text-align: initial;\">sleep<\/span><span style=\"font-size: 1rem; orphans: 1; text-align: initial;\">. This procedure addresses the same sites of potential obstruction as the hyoid advancement, and numerous studies have shown a high success rate. Another effective surgical treatment to reduce is to\u00a0reduce the amount of tissue at the <\/span><span id=\"urn:local-text-annotation-9z4vanz3m462fm7opves2m8jox0lm1s6\" class=\"textannotation disambiguated wl-thing\" style=\"font-size: 1rem; orphans: 1; text-align: initial;\">tongue<\/span><span style=\"font-size: 1rem; orphans: 1; text-align: initial;\"> base.<\/span><\/li>\r\n<\/ul>\r\n<\/li>\r\n \t<li>UPPP\r\n<ul>\r\n \t<li>UPPP, or in full, <span id=\"urn:local-text-annotation-j7l1g05gcvis7s480vkbnmwkvhrwm8vl\" class=\"textannotation disambiguated wl-thing\" style=\"font-size: 1rem; orphans: 1; text-align: initial;\">uvulopalatopharyngoplasty<\/span><span style=\"font-size: 1rem; orphans: 1; text-align: initial;\">, has been the most common sleep apnea surgical procedure performed during the past 25 years. This procedure was developed to remove excess tissue from the <\/span><span id=\"urn:local-text-annotation-zc2vag7i1vrfo7bhlru9r7agc6da4p0m\" class=\"textannotation disambiguated wl-thing\" style=\"font-size: 1rem; orphans: 1; text-align: initial;\">soft palate<\/span><span style=\"font-size: 1rem; orphans: 1; text-align: initial;\"> and <\/span><span id=\"urn:local-text-annotation-vj89dzjngyo0afnubc8w8el6k0tdf3p5\" class=\"textannotation disambiguated wl-thing\" style=\"font-size: 1rem; orphans: 1; text-align: initial;\">pharynx to remove the obstruction from the upper airway<\/span><span style=\"font-size: 1rem; orphans: 1; text-align: initial;\">.\u00a0<\/span><span id=\"urn:local-text-annotation-9vh34asg3ck5vss3eyb9sagmofy30vdb\" class=\"textannotation disambiguated wl-thing\" style=\"font-size: 1rem; orphans: 1; text-align: initial;\">Patients<\/span><span style=\"font-size: 1rem; orphans: 1; text-align: initial;\"> who suffer from <\/span><span id=\"urn:local-text-annotation-toeouoliwjj65rlz88wzzthz398rfunx\" class=\"textannotation disambiguated wl-thing\" style=\"font-size: 1rem; orphans: 1; text-align: initial;\">snoring<\/span><span style=\"font-size: 1rem; orphans: 1; text-align: initial;\"> gain a great deal of improvement from this procedure as <\/span><span id=\"urn:local-text-annotation-633kmenvm2o1sq4h667gdrtwdhv7flej\" class=\"textannotation disambiguated wl-thing\" style=\"font-size: 1rem; orphans: 1; text-align: initial;\">snoring<\/span><span style=\"font-size: 1rem; orphans: 1; text-align: initial;\"> is often due to the reverberation of the <\/span><span id=\"urn:local-text-annotation-wuvo25va9lnjpocdusadcmoveiysxw19\" class=\"textannotation disambiguated wl-thing\" style=\"font-size: 1rem; orphans: 1; text-align: initial;\">soft palate<\/span><span style=\"font-size: 1rem; orphans: 1; text-align: initial;\"> with the back wall of the <\/span><span id=\"urn:local-text-annotation-v0tixd60zf34yswr5tlgt6kllu2nhyep\" class=\"textannotation disambiguated wl-thing\" style=\"font-size: 1rem; orphans: 1; text-align: initial;\">pharynx<\/span><span style=\"font-size: 1rem; orphans: 1; text-align: initial;\">.<\/span><\/li>\r\n<\/ul>\r\n<\/li>\r\n \t<li>Hyoid Advancement\r\n<ul>\r\n \t<li>The <span id=\"urn:local-text-annotation-l7jhejqng9lm8rw9wl5e8mh5t2hgyl6n\" class=\"textannotation disambiguated wl-thing\" style=\"font-size: 1rem; orphans: 1; text-align: initial;\">hyoid<\/span><span style=\"font-size: 1rem; orphans: 1; text-align: initial;\"> bone is a small bone in the neck where the muscles of the <\/span><span id=\"urn:local-text-annotation-4fd827a59qzsrqi6ul9bpc0jdvznsdgc\" class=\"textannotation disambiguated wl-thing\" style=\"font-size: 1rem; orphans: 1; text-align: initial;\">tongue<\/span><span style=\"font-size: 1rem; orphans: 1; text-align: initial;\"> base and <\/span><span id=\"urn:local-text-annotation-2r745fi9f6sbpcortjpgb9i7qq8hfxpj\" class=\"textannotation disambiguated wl-thing\" style=\"font-size: 1rem; orphans: 1; text-align: initial;\">pharynx<\/span><span style=\"font-size: 1rem; orphans: 1; text-align: initial;\"> attach.\u00a0<\/span><span id=\"urn:local-text-annotation-trpkymb03dls4m4q2gotaez1lmcwzr2v\" class=\"textannotation disambiguated wl-thing\" style=\"font-size: 1rem; orphans: 1; text-align: initial;\">Patients<\/span><span style=\"font-size: 1rem; orphans: 1; text-align: initial;\"> with sleep apnea often have a large <\/span><span id=\"urn:local-text-annotation-chl0kiyuh1o3k6079b75ntqpjt1hrwvl\" class=\"textannotation disambiguated wl-thing\" style=\"font-size: 1rem; orphans: 1; text-align: initial;\">tongue<\/span><span style=\"font-size: 1rem; orphans: 1; text-align: initial;\"> base. During the deep stages of <\/span><span id=\"urn:local-text-annotation-v8ggmnq89pjrfvg35xblhc1b1ain6yo3\" class=\"textannotation disambiguated wl-thing\" style=\"font-size: 1rem; orphans: 1; text-align: initial;\">sleep<\/span><span style=\"font-size: 1rem; orphans: 1; text-align: initial;\">, normal muscle tone is relaxed, and the base of the\u00a0<\/span><span id=\"urn:local-text-annotation-y6dtpv866ysqmi8j1tsj6l4mrvn6wk77\" class=\"textannotation disambiguated wl-thing\" style=\"font-size: 1rem; orphans: 1; text-align: initial;\">tongue<\/span><span style=\"font-size: 1rem; orphans: 1; text-align: initial;\"> falls back and can make contact with the back wall of the <\/span><span id=\"urn:local-text-annotation-n33jy6tlwnp64mxq5f27enlkxkvwbktl\" class=\"textannotation disambiguated wl-thing\" style=\"font-size: 1rem; orphans: 1; text-align: initial;\">pharynx<\/span><span style=\"font-size: 1rem; orphans: 1; text-align: initial;\"> resulting in obstruction. Through a very minimally invasive procedure, the <\/span><span id=\"urn:enhancement-9ab764a1-78c6-17ad-fd76-ce7859df323a\" class=\"textannotation disambiguated wl-thing\" style=\"font-size: 1rem; orphans: 1; text-align: initial;\">hyoid<\/span><span style=\"font-size: 1rem; orphans: 1; text-align: initial;\"> bone is surgically repositioned anteriorly by placing a suture around it and suspending it to the front of the jaw bone. This procedure results in an expansion of the <\/span><span id=\"urn:local-text-annotation-bjhxhlpaqijqhgomrkv18l7141lkrcar\" class=\"textannotation disambiguated wl-thing\" style=\"font-size: 1rem; orphans: 1; text-align: initial;\">airway<\/span><span style=\"font-size: 1rem; orphans: 1; text-align: initial;\"> and prevents collapse.<\/span><\/li>\r\n<\/ul>\r\n<\/li>\r\n \t<li>Lower Jaw Advancement\r\n<ul>\r\n \t<li>Abnormality of the maxillofacial <span id=\"urn:enhancement-5f9f60f8-d737-f10f-9a7d-ead9c2cae92b\" class=\"textannotation disambiguated wl-thing\" style=\"font-size: 1rem; orphans: 1; text-align: initial;\">skeleton<\/span><span style=\"font-size: 1rem; orphans: 1; text-align: initial;\"> is a well-recognized risk factor of <\/span><span id=\"urn:local-text-annotation-8w8t0xsrfwrec5zmf84pgs6haz0su82s\" class=\"textannotation disambiguated wl-thing\" style=\"font-size: 1rem; orphans: 1; text-align: initial;\">obstructive<\/span><span style=\"font-size: 1rem; orphans: 1; text-align: initial;\"> sleep <\/span><span id=\"urn:local-text-annotation-4lwcvrjvrzsp9keeodzbdasz64j0qkdq\" class=\"textannotation disambiguated wl-thing\" style=\"font-size: 1rem; orphans: 1; text-align: initial;\">apnea<\/span><span style=\"font-size: 1rem; orphans: 1; text-align: initial;\">. Sleep apnea patients usually have small, narrow jaws that result in diminished airway dimension, which leads to nocturnal obstruction.\u00a0<\/span><span id=\"urn:enhancement-846743fc-6436-3fa3-f82c-9f3f5a18a446\" class=\"textannotation disambiguated wl-thing\" style=\"font-size: 1rem; orphans: 1; text-align: initial;\">Maxillomandibular advancement<\/span><span style=\"font-size: 1rem; orphans: 1; text-align: initial;\"> achieves enlargement of the entire <\/span><span id=\"urn:local-text-annotation-oqehrlq1unc5iekraddapovsxt1swaq6\" class=\"textannotation disambiguated wl-thing\" style=\"font-size: 1rem; orphans: 1; text-align: initial;\">upper airway<\/span><span style=\"font-size: 1rem; orphans: 1; text-align: initial;\"> through the expansion of the skeletal framework that encircles the airway.<\/span><\/li>\r\n<\/ul>\r\n<\/li>\r\n \t<li>Tracheostomy\r\n<ul>\r\n \t<li>Tracheostomy is a technique that creates a passageway for air to get to the lungs directly from the trachea in the neck. This technique bypasses any potential sites of obstruction from the <span id=\"urn:local-text-annotation-aoxwjekylvsc7rnrco9nltarilhl07nm\" class=\"textannotation disambiguated wl-thing\" style=\"font-size: 1rem; orphans: 1; text-align: initial;\">upper airway<\/span><span style=\"font-size: 1rem; orphans: 1; text-align: initial;\">. Permanent <\/span><span id=\"urn:local-text-annotation-z0xe6m59f91ujec3w1wfstz6hfcnagxc\" class=\"textannotation disambiguated wl-thing\" style=\"font-size: 1rem; orphans: 1; text-align: initial;\">tracheostomy<\/span><span style=\"font-size: 1rem; orphans: 1; text-align: initial;\"> as a long-term <\/span><span id=\"urn:local-text-annotation-eokonbdlee6j8wxkwqg294aeozdxkqlt\" class=\"textannotation disambiguated wl-thing\" style=\"font-size: 1rem; orphans: 1; text-align: initial;\">treatment<\/span><span style=\"font-size: 1rem; orphans: 1; text-align: initial;\"> of obstructive sleep apnea remains an option when all other forms of non-surgical and surgical <\/span><span id=\"urn:local-text-annotation-lojjizzipzcl1a38519fdb11qv0ok89l\" class=\"textannotation disambiguated wl-thing\" style=\"font-size: 1rem; orphans: 1; text-align: initial;\">treatments have failed<\/span><span style=\"font-size: 1rem; orphans: 1; text-align: initial;\">. Though it may seem excessive, it is an extremely effective surgical option reserved for the very sick <\/span><span id=\"urn:local-text-annotation-5g9ed8qw427m1kzvui0xz89uimhun0le\" class=\"textannotation disambiguated wl-thing\" style=\"font-size: 1rem; orphans: 1; text-align: initial;\">patient<\/span><span style=\"font-size: 1rem; orphans: 1; text-align: initial;\">.[footnote]Sleep Apnea - Treatment Options. Sleep Foundation. (2020, September 25). https:\/\/www.sleepfoundation.org\/sleep-apnea.[\/footnote]<\/span><\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ul>\r\n<\/section><section><\/section><section><\/section><section><\/section><section>\r\n<div class=\"textbox key-takeaways\">\r\n<h3>Key Takeaways: Sleep Apnea<\/h3>\r\n<iframe title=\"38. Breathing-Related Sleep Disorders\" src=\"https:\/\/lumenlearning.h5p.com\/content\/1291235142576760048\/embed\" width=\"1088\" height=\"542\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><script src=\"https:\/\/lumenlearning.h5p.com\/js\/h5p-resizer.js\" charset=\"UTF-8\"><\/script>\r\n\r\n<\/div>\r\n<div class=\"textbox exercises\">\r\n<h3>SIDS<\/h3>\r\n[caption id=\"\" align=\"alignright\" width=\"244\"]<img src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images-archive-read-only\/wp-content\/uploads\/sites\/902\/2015\/02\/23224644\/CNX_Psych_04_04_SIDS.jpg\" alt=\"The \u201cSafe to Sleep\u201d campaign logo shows a baby sleeping on his back and the words \u201csafe to sleep.\u201d\" width=\"244\" height=\"124\" \/> <strong>Figure 2<\/strong>. The Safe to Sleep campaign educates the public about how to minimize risk factors associated with SIDS. This campaign is sponsored in part by the National Institute of Child Health and Human Development.[\/caption]\r\n\r\nIn <strong>sudden infant death syndrome (SIDS)<\/strong>, an infant stops breathing during sleep and dies. Infants younger than 12 months appear to be at the highest risk for SIDS, and boys have a greater risk than girls. A number of risk factors have been associated with SIDS, including premature birth, smoking within the home, and hyperthermia. There may also be differences in both brain structure and function in infants that die from SIDS (Berkowitz, 2012; Mage &amp; Donner, 2006; Thach, 2005).\r\n\r\nThe substantial amount of research on SIDS has led to a number of recommendations to parents to protect their children (Figure 2). For one, research suggests that infants should be placed on their backs when put down to sleep, and their cribs should not contain any items that pose suffocation threats, such as blankets, pillows, or padded crib bumpers (cushions that cover the bars of a crib). Infants should not have caps placed on their heads when put down to sleep in order to prevent overheating, and people in the child\u2019s household should abstain from smoking in the home. Recommendations like these have helped to decrease the number of infant deaths from SIDS in recent years (Mitchell, 2009; Task Force on Sudden Infant Death Syndrome, 2011).\r\n\r\n<\/div>\r\n<\/section>\r\n<div class=\"textbox tryit\">\r\n<h3>Try It<\/h3>\r\nhttps:\/\/assess.lumenlearning.com\/practice\/cdf1c176-77cb-4e33-b404-0db4996d2fd4\r\n\r\nhttps:\/\/assess.lumenlearning.com\/practice\/bcfc614a-1b11-4a39-ab75-9c0208cabf81\r\n\r\n<\/div>\r\n<div class=\"textbox learning-objectives\">\r\n<h3>Glossary<\/h3>\r\n<strong>central sleep apnea:\u00a0<\/strong>sleep disorder with periods of interrupted breathing due to a disruption in signals sent from the brain that regulate breathing\r\n\r\n<strong>continuous positive airway pressure (CPAP):\u00a0<\/strong>device used to treat sleep apnea; includes a mask that fits over the sleeper\u2019s nose and mouth, which is connected to a pump that pumps air into the person\u2019s airways, forcing them to remain open\r\n\r\n<strong>obstructive sleep apnea:\u00a0<\/strong>sleep disorder defined by episodes when breathing stops during sleep as a result of blockage of the airway\r\n\r\n<strong>sleep apnea:\u00a0<\/strong>sleep disorder defined by episodes during which breathing stops during sleep\r\n\r\n<strong>sudden infant death syndrome (SIDS):\u00a0<\/strong>infant (one-year-old or younger) with no apparent medical condition suddenly dies during sleep\r\n\r\n<\/div>","rendered":"<div class=\"textbox learning-objectives\">\n<h3>Learning Objectives<\/h3>\n<ul>\n<li>Describe sleep apnea and other breathing-related sleep disorders<\/li>\n<\/ul>\n<\/div>\n<h2>Sleep\u00a0Apnea<\/h2>\n<p><strong>Sleep apnea<\/strong> is defined by episodes during which a sleeper\u2019s breathing stops. Sleep apnea episodes can last 10\u201320 seconds or longer and often are associated with brief periods of arousal. While individuals suffering from sleep apnea may not be aware of these repeated disruptions in sleep, they do experience increased levels of fatigue. Many individuals diagnosed with sleep apnea first seek treatment because their sleeping partners indicate that they snore loudly and\/or stop breathing for extended periods of time while sleeping (Henry &amp; Rosenthal, 2013).<\/p>\n<p>Sleep apnea is much more common in people who are overweight and it may exacerbate cardiovascular disease (S\u00e1nchez-de-la-Torre, Campos-Rodriguez, &amp; Barb\u00e9, 2012). While sleep apnea is less common in people who are thin, anyone, regardless of their weight, who snores loudly or gasps for air while sleeping, should be checked for sleep apnea.<\/p>\n<p>While people are often unaware of their sleep apnea, they are keenly aware of some of the adverse consequences of insufficient sleep. One person explained that the sleep apnea affected his daily life saying,\u00a0\u201cI\u2019m in a job where there\u2019s a premium on being mentally alert. I was really sleepy . . . and having trouble concentrating. . . . It was getting to the point where it was kind of scary\u201d (Henry &amp; Rosenthal, 2013, p. 52).<\/p>\n<p>There are two main types of sleep apnea: obstructive sleep apnea<strong>,<\/strong> listed as obstructive sleep apnea hypopnea (OSAH) in the DSM-5, and central sleep apnea. <strong>Obstructive sleep apnea<\/strong> occurs when an individual\u2019s airway becomes blocked during sleep and air is prevented from entering the lungs. It is diagnosed if a person has at least five obstructive apneas per hour of sleep combined with breathing disturbances such as snoring and daytime sleepiness or at least fifteen obstructive apneas per hour of sleep without other symptoms. The apnea is characterized by at least ten-second disturbances in breathing. In <strong>central sleep apnea (CSA)<\/strong>, disruption in signals sent from the brain that regulate breathing cause periods of interrupted breathing (White, 2005). Central sleep apnea is less common than obstructive sleep apnea hypopnea (OSAH) and is more commonly associated with illnesses.<\/p>\n<p>Approximately 2%-9% of adults in the United States have obstructive sleep apnea and about 0.9% of adults over the age of 40 are diagnosed with central sleep apnea, but many cases are estimated to be undiagnosed. Both are more common in men than women. There are multiple factors that contribute to being at risk for sleep apnea, including obesity, hormonal imbalances, smoking cigarettes, family history, and the size and positioning of the jaw, throat, and tongue.<a class=\"footnote\" title=\"Sleep Apnea - Causes &amp; Symptoms. Sleep Foundation. (2020, September 25). https:\/\/www.sleepfoundation.org\/sleep-apnea.\" id=\"return-footnote-737-1\" href=\"#footnote-737-1\" aria-label=\"Footnote 1\"><sup class=\"footnote\">[1]<\/sup><\/a><\/p>\n<div class=\"textbox examples\">\n<h3>Watch It<\/h3>\n<p>Watch this video to learn about sleep apnea, including its causes, symptoms, diagnosis, treatment, and pathology.<\/p>\n<p>https:\/\/www.youtube.com\/watch?v=cjQPGs_tvDY<\/p>\n<p>You can view the <a href=\"https:\/\/course-building.s3-us-west-2.amazonaws.com\/Abnormal+Psychology\/transcripts\/SleepApneaCausesSymptomsDiagnosis_transcript.txt\" target=\"_blank\" rel=\"noopener\">transcript for &#8220;Sleep apnea &#8211; causes, symptoms, diagnosis, treatment, pathology&#8221; here (opens in new window)<\/a>.<\/p>\n<\/div>\n<h2>Treatment<\/h2>\n<section><\/section>\n<p>One of the most common treatments for sleep apnea involves the use of a special device during sleep. A <strong>continuous positive airway pressure (CPAP) <\/strong>device includes a mask that fits over the sleeper\u2019s nose and mouth, which is connected to a pump that pumps air into the person\u2019s airways, forcing them to remain open, as shown in Figure 1. Some newer continuous positive airway pressure (CPAP) masks are smaller and cover only the nose. This treatment option has proven to be effective for people suffering from mild to severe cases of sleep apnea (McDaid et al., 2009). However, alternative treatment options are being explored because consistent compliance by users of continuous positive airway pressure (CPAP) devices is a problem. EPAP (excitatory positive air pressure) device has shown promise in double-blind trials as one such alternative (Berry, Kryger, &amp; Massie, 2011).\u00a0Treatment of sleep apnea also involves treading comorbid medical conditions, sometimes through surgery or medications.<\/p>\n<figure>\n<div style=\"width: 742px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images-archive-read-only\/wp-content\/uploads\/sites\/902\/2015\/02\/23224642\/CNX_Psych_04_04_CPAP.jpg\" alt=\"Photograph A shows a CPAP device. Photograph B shows a clear full face CPAP mask attached to a mannequin's head with straps.\" width=\"732\" height=\"301\" \/><\/p>\n<p class=\"wp-caption-text\"><strong>Figure 1<\/strong>. (a) A typical CPAP device used in the treatment of sleep apnea is (b) affixed to the head with straps and a mask that covers the nose and mouth.<\/p>\n<\/div>\n<\/figure>\n<section>\n<ul>\n<li>Tongue Surgery\n<ul>\n<li>This procedure involves advancing one of the main <span id=\"urn:local-text-annotation-9mdv1qce9xo4m66ibmxwnzeiituwlj9t\" class=\"textannotation disambiguated wl-thing\" style=\"font-size: 1rem; orphans: 1; text-align: initial;\">tongue<\/span><span style=\"font-size: 1rem; orphans: 1; text-align: initial;\"> muscles, the <\/span><span id=\"urn:local-text-annotation-1clbkrspfbgja0hyfkmd3fh02ru1vveu\" class=\"textannotation disambiguated wl-thing\" style=\"font-size: 1rem; orphans: 1; text-align: initial;\">genioglossus muscle<\/span><span style=\"font-size: 1rem; orphans: 1; text-align: initial;\">, forward, thereby limiting the backward fall of the tongue during <\/span><span id=\"urn:local-text-annotation-bouttbq1larbhcq0svk7e5xaw6gypep8\" class=\"textannotation disambiguated wl-thing\" style=\"font-size: 1rem; orphans: 1; text-align: initial;\">sleep<\/span><span style=\"font-size: 1rem; orphans: 1; text-align: initial;\">. This procedure addresses the same sites of potential obstruction as the hyoid advancement, and numerous studies have shown a high success rate.\u00a0<\/span><\/li>\n<\/ul>\n<\/li>\n<li>Nasal Surgery\n<ul>\n<li>Both daytime nasal obstruction and nocturnal <span id=\"urn:local-text-annotation-rc1q4s9hhuaw9l9jv3egrrrxni1uep9s\" class=\"textannotation disambiguated wl-thing\" style=\"font-size: 1rem; orphans: 1; text-align: initial;\">nasal congestion<\/span><span style=\"font-size: 1rem; orphans: 1; text-align: initial;\"> have been shown as risk factors for sleep-disordered breathing. Therefore, the <\/span><span id=\"urn:local-text-annotation-r7i9xk1eoon4unlcqt7wgqckvgq4zxtr\" class=\"textannotation disambiguated wl-thing\" style=\"font-size: 1rem; orphans: 1; text-align: initial;\">treatment<\/span><span style=\"font-size: 1rem; orphans: 1; text-align: initial;\"> of nasal obstruction plays an important role in sleep <\/span><span id=\"urn:local-text-annotation-8zlokn4o0xgo41efxjtngq7fbqrwxspa\" class=\"textannotation disambiguated wl-thing\" style=\"font-size: 1rem; orphans: 1; text-align: initial;\">apnea<\/span><span style=\"font-size: 1rem; orphans: 1; text-align: initial;\"> surgery. Three anatomic areas of the nose that may contribute to obstruction are the septum, the turbinates, and the nasal valve. The most common nasal surgical procedure consists of\u00a0straightening out the <\/span><span id=\"urn:enhancement-c821338f-a90e-458c-a924-c2cf52d3b591\" class=\"textannotation disambiguated wl-thing\" style=\"font-size: 1rem; orphans: 1; text-align: initial;\">septum<\/span><span style=\"font-size: 1rem; orphans: 1; text-align: initial;\"> and reducing the size of the turbinates, which creates more room in the nose and allows air to pass smoothly and without effort.<\/span><\/li>\n<\/ul>\n<\/li>\n<li>Tongue Surgery\n<ul>\n<li>The tongue has an established role in obstruction in sleep apnea. One treatment involves moving one of the main <span id=\"urn:local-text-annotation-9mdv1qce9xo4m66ibmxwnzeiituwlj9t\" class=\"textannotation disambiguated wl-thing\" style=\"font-size: 1rem; orphans: 1; text-align: initial;\">tongue<\/span><span style=\"font-size: 1rem; orphans: 1; text-align: initial;\"> muscles, the <\/span><span id=\"urn:local-text-annotation-1clbkrspfbgja0hyfkmd3fh02ru1vveu\" class=\"textannotation disambiguated wl-thing\" style=\"font-size: 1rem; orphans: 1; text-align: initial;\">genioglossus muscle<\/span><span style=\"font-size: 1rem; orphans: 1; text-align: initial;\">, forward; thereby limiting the backward fall of the tongue during <\/span><span id=\"urn:local-text-annotation-bouttbq1larbhcq0svk7e5xaw6gypep8\" class=\"textannotation disambiguated wl-thing\" style=\"font-size: 1rem; orphans: 1; text-align: initial;\">sleep<\/span><span style=\"font-size: 1rem; orphans: 1; text-align: initial;\">. This procedure addresses the same sites of potential obstruction as the hyoid advancement, and numerous studies have shown a high success rate. Another effective surgical treatment to reduce is to\u00a0reduce the amount of tissue at the <\/span><span id=\"urn:local-text-annotation-9z4vanz3m462fm7opves2m8jox0lm1s6\" class=\"textannotation disambiguated wl-thing\" style=\"font-size: 1rem; orphans: 1; text-align: initial;\">tongue<\/span><span style=\"font-size: 1rem; orphans: 1; text-align: initial;\"> base.<\/span><\/li>\n<\/ul>\n<\/li>\n<li>UPPP\n<ul>\n<li>UPPP, or in full, <span id=\"urn:local-text-annotation-j7l1g05gcvis7s480vkbnmwkvhrwm8vl\" class=\"textannotation disambiguated wl-thing\" style=\"font-size: 1rem; orphans: 1; text-align: initial;\">uvulopalatopharyngoplasty<\/span><span style=\"font-size: 1rem; orphans: 1; text-align: initial;\">, has been the most common sleep apnea surgical procedure performed during the past 25 years. This procedure was developed to remove excess tissue from the <\/span><span id=\"urn:local-text-annotation-zc2vag7i1vrfo7bhlru9r7agc6da4p0m\" class=\"textannotation disambiguated wl-thing\" style=\"font-size: 1rem; orphans: 1; text-align: initial;\">soft palate<\/span><span style=\"font-size: 1rem; orphans: 1; text-align: initial;\"> and <\/span><span id=\"urn:local-text-annotation-vj89dzjngyo0afnubc8w8el6k0tdf3p5\" class=\"textannotation disambiguated wl-thing\" style=\"font-size: 1rem; orphans: 1; text-align: initial;\">pharynx to remove the obstruction from the upper airway<\/span><span style=\"font-size: 1rem; orphans: 1; text-align: initial;\">.\u00a0<\/span><span id=\"urn:local-text-annotation-9vh34asg3ck5vss3eyb9sagmofy30vdb\" class=\"textannotation disambiguated wl-thing\" style=\"font-size: 1rem; orphans: 1; text-align: initial;\">Patients<\/span><span style=\"font-size: 1rem; orphans: 1; text-align: initial;\"> who suffer from <\/span><span id=\"urn:local-text-annotation-toeouoliwjj65rlz88wzzthz398rfunx\" class=\"textannotation disambiguated wl-thing\" style=\"font-size: 1rem; orphans: 1; text-align: initial;\">snoring<\/span><span style=\"font-size: 1rem; orphans: 1; text-align: initial;\"> gain a great deal of improvement from this procedure as <\/span><span id=\"urn:local-text-annotation-633kmenvm2o1sq4h667gdrtwdhv7flej\" class=\"textannotation disambiguated wl-thing\" style=\"font-size: 1rem; orphans: 1; text-align: initial;\">snoring<\/span><span style=\"font-size: 1rem; orphans: 1; text-align: initial;\"> is often due to the reverberation of the <\/span><span id=\"urn:local-text-annotation-wuvo25va9lnjpocdusadcmoveiysxw19\" class=\"textannotation disambiguated wl-thing\" style=\"font-size: 1rem; orphans: 1; text-align: initial;\">soft palate<\/span><span style=\"font-size: 1rem; orphans: 1; text-align: initial;\"> with the back wall of the <\/span><span id=\"urn:local-text-annotation-v0tixd60zf34yswr5tlgt6kllu2nhyep\" class=\"textannotation disambiguated wl-thing\" style=\"font-size: 1rem; orphans: 1; text-align: initial;\">pharynx<\/span><span style=\"font-size: 1rem; orphans: 1; text-align: initial;\">.<\/span><\/li>\n<\/ul>\n<\/li>\n<li>Hyoid Advancement\n<ul>\n<li>The <span id=\"urn:local-text-annotation-l7jhejqng9lm8rw9wl5e8mh5t2hgyl6n\" class=\"textannotation disambiguated wl-thing\" style=\"font-size: 1rem; orphans: 1; text-align: initial;\">hyoid<\/span><span style=\"font-size: 1rem; orphans: 1; text-align: initial;\"> bone is a small bone in the neck where the muscles of the <\/span><span id=\"urn:local-text-annotation-4fd827a59qzsrqi6ul9bpc0jdvznsdgc\" class=\"textannotation disambiguated wl-thing\" style=\"font-size: 1rem; orphans: 1; text-align: initial;\">tongue<\/span><span style=\"font-size: 1rem; orphans: 1; text-align: initial;\"> base and <\/span><span id=\"urn:local-text-annotation-2r745fi9f6sbpcortjpgb9i7qq8hfxpj\" class=\"textannotation disambiguated wl-thing\" style=\"font-size: 1rem; orphans: 1; text-align: initial;\">pharynx<\/span><span style=\"font-size: 1rem; orphans: 1; text-align: initial;\"> attach.\u00a0<\/span><span id=\"urn:local-text-annotation-trpkymb03dls4m4q2gotaez1lmcwzr2v\" class=\"textannotation disambiguated wl-thing\" style=\"font-size: 1rem; orphans: 1; text-align: initial;\">Patients<\/span><span style=\"font-size: 1rem; orphans: 1; text-align: initial;\"> with sleep apnea often have a large <\/span><span id=\"urn:local-text-annotation-chl0kiyuh1o3k6079b75ntqpjt1hrwvl\" class=\"textannotation disambiguated wl-thing\" style=\"font-size: 1rem; orphans: 1; text-align: initial;\">tongue<\/span><span style=\"font-size: 1rem; orphans: 1; text-align: initial;\"> base. During the deep stages of <\/span><span id=\"urn:local-text-annotation-v8ggmnq89pjrfvg35xblhc1b1ain6yo3\" class=\"textannotation disambiguated wl-thing\" style=\"font-size: 1rem; orphans: 1; text-align: initial;\">sleep<\/span><span style=\"font-size: 1rem; orphans: 1; text-align: initial;\">, normal muscle tone is relaxed, and the base of the\u00a0<\/span><span id=\"urn:local-text-annotation-y6dtpv866ysqmi8j1tsj6l4mrvn6wk77\" class=\"textannotation disambiguated wl-thing\" style=\"font-size: 1rem; orphans: 1; text-align: initial;\">tongue<\/span><span style=\"font-size: 1rem; orphans: 1; text-align: initial;\"> falls back and can make contact with the back wall of the <\/span><span id=\"urn:local-text-annotation-n33jy6tlwnp64mxq5f27enlkxkvwbktl\" class=\"textannotation disambiguated wl-thing\" style=\"font-size: 1rem; orphans: 1; text-align: initial;\">pharynx<\/span><span style=\"font-size: 1rem; orphans: 1; text-align: initial;\"> resulting in obstruction. Through a very minimally invasive procedure, the <\/span><span id=\"urn:enhancement-9ab764a1-78c6-17ad-fd76-ce7859df323a\" class=\"textannotation disambiguated wl-thing\" style=\"font-size: 1rem; orphans: 1; text-align: initial;\">hyoid<\/span><span style=\"font-size: 1rem; orphans: 1; text-align: initial;\"> bone is surgically repositioned anteriorly by placing a suture around it and suspending it to the front of the jaw bone. This procedure results in an expansion of the <\/span><span id=\"urn:local-text-annotation-bjhxhlpaqijqhgomrkv18l7141lkrcar\" class=\"textannotation disambiguated wl-thing\" style=\"font-size: 1rem; orphans: 1; text-align: initial;\">airway<\/span><span style=\"font-size: 1rem; orphans: 1; text-align: initial;\"> and prevents collapse.<\/span><\/li>\n<\/ul>\n<\/li>\n<li>Lower Jaw Advancement\n<ul>\n<li>Abnormality of the maxillofacial <span id=\"urn:enhancement-5f9f60f8-d737-f10f-9a7d-ead9c2cae92b\" class=\"textannotation disambiguated wl-thing\" style=\"font-size: 1rem; orphans: 1; text-align: initial;\">skeleton<\/span><span style=\"font-size: 1rem; orphans: 1; text-align: initial;\"> is a well-recognized risk factor of <\/span><span id=\"urn:local-text-annotation-8w8t0xsrfwrec5zmf84pgs6haz0su82s\" class=\"textannotation disambiguated wl-thing\" style=\"font-size: 1rem; orphans: 1; text-align: initial;\">obstructive<\/span><span style=\"font-size: 1rem; orphans: 1; text-align: initial;\"> sleep <\/span><span id=\"urn:local-text-annotation-4lwcvrjvrzsp9keeodzbdasz64j0qkdq\" class=\"textannotation disambiguated wl-thing\" style=\"font-size: 1rem; orphans: 1; text-align: initial;\">apnea<\/span><span style=\"font-size: 1rem; orphans: 1; text-align: initial;\">. Sleep apnea patients usually have small, narrow jaws that result in diminished airway dimension, which leads to nocturnal obstruction.\u00a0<\/span><span id=\"urn:enhancement-846743fc-6436-3fa3-f82c-9f3f5a18a446\" class=\"textannotation disambiguated wl-thing\" style=\"font-size: 1rem; orphans: 1; text-align: initial;\">Maxillomandibular advancement<\/span><span style=\"font-size: 1rem; orphans: 1; text-align: initial;\"> achieves enlargement of the entire <\/span><span id=\"urn:local-text-annotation-oqehrlq1unc5iekraddapovsxt1swaq6\" class=\"textannotation disambiguated wl-thing\" style=\"font-size: 1rem; orphans: 1; text-align: initial;\">upper airway<\/span><span style=\"font-size: 1rem; orphans: 1; text-align: initial;\"> through the expansion of the skeletal framework that encircles the airway.<\/span><\/li>\n<\/ul>\n<\/li>\n<li>Tracheostomy\n<ul>\n<li>Tracheostomy is a technique that creates a passageway for air to get to the lungs directly from the trachea in the neck. This technique bypasses any potential sites of obstruction from the <span id=\"urn:local-text-annotation-aoxwjekylvsc7rnrco9nltarilhl07nm\" class=\"textannotation disambiguated wl-thing\" style=\"font-size: 1rem; orphans: 1; text-align: initial;\">upper airway<\/span><span style=\"font-size: 1rem; orphans: 1; text-align: initial;\">. Permanent <\/span><span id=\"urn:local-text-annotation-z0xe6m59f91ujec3w1wfstz6hfcnagxc\" class=\"textannotation disambiguated wl-thing\" style=\"font-size: 1rem; orphans: 1; text-align: initial;\">tracheostomy<\/span><span style=\"font-size: 1rem; orphans: 1; text-align: initial;\"> as a long-term <\/span><span id=\"urn:local-text-annotation-eokonbdlee6j8wxkwqg294aeozdxkqlt\" class=\"textannotation disambiguated wl-thing\" style=\"font-size: 1rem; orphans: 1; text-align: initial;\">treatment<\/span><span style=\"font-size: 1rem; orphans: 1; text-align: initial;\"> of obstructive sleep apnea remains an option when all other forms of non-surgical and surgical <\/span><span id=\"urn:local-text-annotation-lojjizzipzcl1a38519fdb11qv0ok89l\" class=\"textannotation disambiguated wl-thing\" style=\"font-size: 1rem; orphans: 1; text-align: initial;\">treatments have failed<\/span><span style=\"font-size: 1rem; orphans: 1; text-align: initial;\">. Though it may seem excessive, it is an extremely effective surgical option reserved for the very sick <\/span><span id=\"urn:local-text-annotation-5g9ed8qw427m1kzvui0xz89uimhun0le\" class=\"textannotation disambiguated wl-thing\" style=\"font-size: 1rem; orphans: 1; text-align: initial;\">patient<\/span><span style=\"font-size: 1rem; orphans: 1; text-align: initial;\">.<a class=\"footnote\" title=\"Sleep Apnea - Treatment Options. Sleep Foundation. (2020, September 25). https:\/\/www.sleepfoundation.org\/sleep-apnea.\" id=\"return-footnote-737-2\" href=\"#footnote-737-2\" aria-label=\"Footnote 2\"><sup class=\"footnote\">[2]<\/sup><\/a><\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/section>\n<section><\/section>\n<section><\/section>\n<section><\/section>\n<section>\n<div class=\"textbox key-takeaways\">\n<h3>Key Takeaways: Sleep Apnea<\/h3>\n<p><iframe loading=\"lazy\" title=\"38. Breathing-Related Sleep Disorders\" src=\"https:\/\/lumenlearning.h5p.com\/content\/1291235142576760048\/embed\" width=\"1088\" height=\"542\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><script src=\"https:\/\/lumenlearning.h5p.com\/js\/h5p-resizer.js\" charset=\"UTF-8\"><\/script><\/p>\n<\/div>\n<div class=\"textbox exercises\">\n<h3>SIDS<\/h3>\n<div style=\"width: 254px\" class=\"wp-caption alignright\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images-archive-read-only\/wp-content\/uploads\/sites\/902\/2015\/02\/23224644\/CNX_Psych_04_04_SIDS.jpg\" alt=\"The \u201cSafe to Sleep\u201d campaign logo shows a baby sleeping on his back and the words \u201csafe to sleep.\u201d\" width=\"244\" height=\"124\" \/><\/p>\n<p class=\"wp-caption-text\"><strong>Figure 2<\/strong>. The Safe to Sleep campaign educates the public about how to minimize risk factors associated with SIDS. This campaign is sponsored in part by the National Institute of Child Health and Human Development.<\/p>\n<\/div>\n<p>In <strong>sudden infant death syndrome (SIDS)<\/strong>, an infant stops breathing during sleep and dies. Infants younger than 12 months appear to be at the highest risk for SIDS, and boys have a greater risk than girls. A number of risk factors have been associated with SIDS, including premature birth, smoking within the home, and hyperthermia. There may also be differences in both brain structure and function in infants that die from SIDS (Berkowitz, 2012; Mage &amp; Donner, 2006; Thach, 2005).<\/p>\n<p>The substantial amount of research on SIDS has led to a number of recommendations to parents to protect their children (Figure 2). For one, research suggests that infants should be placed on their backs when put down to sleep, and their cribs should not contain any items that pose suffocation threats, such as blankets, pillows, or padded crib bumpers (cushions that cover the bars of a crib). Infants should not have caps placed on their heads when put down to sleep in order to prevent overheating, and people in the child\u2019s household should abstain from smoking in the home. Recommendations like these have helped to decrease the number of infant deaths from SIDS in recent years (Mitchell, 2009; Task Force on Sudden Infant Death Syndrome, 2011).<\/p>\n<\/div>\n<\/section>\n<div class=\"textbox tryit\">\n<h3>Try It<\/h3>\n<p>\t<iframe id=\"assessment_practice_cdf1c176-77cb-4e33-b404-0db4996d2fd4\" class=\"resizable\" src=\"https:\/\/assess.lumenlearning.com\/practice\/cdf1c176-77cb-4e33-b404-0db4996d2fd4?iframe_resize_id=assessment_practice_id_cdf1c176-77cb-4e33-b404-0db4996d2fd4\" frameborder=\"0\" style=\"border:none;width:100%;height:100%;min-height:300px;\"><br \/>\n\t<\/iframe><\/p>\n<p>\t<iframe id=\"assessment_practice_bcfc614a-1b11-4a39-ab75-9c0208cabf81\" class=\"resizable\" src=\"https:\/\/assess.lumenlearning.com\/practice\/bcfc614a-1b11-4a39-ab75-9c0208cabf81?iframe_resize_id=assessment_practice_id_bcfc614a-1b11-4a39-ab75-9c0208cabf81\" frameborder=\"0\" style=\"border:none;width:100%;height:100%;min-height:300px;\"><br \/>\n\t<\/iframe><\/p>\n<\/div>\n<div class=\"textbox learning-objectives\">\n<h3>Glossary<\/h3>\n<p><strong>central sleep apnea:\u00a0<\/strong>sleep disorder with periods of interrupted breathing due to a disruption in signals sent from the brain that regulate breathing<\/p>\n<p><strong>continuous positive airway pressure (CPAP):\u00a0<\/strong>device used to treat sleep apnea; includes a mask that fits over the sleeper\u2019s nose and mouth, which is connected to a pump that pumps air into the person\u2019s airways, forcing them to remain open<\/p>\n<p><strong>obstructive sleep apnea:\u00a0<\/strong>sleep disorder defined by episodes when breathing stops during sleep as a result of blockage of the airway<\/p>\n<p><strong>sleep apnea:\u00a0<\/strong>sleep disorder defined by episodes during which breathing stops during sleep<\/p>\n<p><strong>sudden infant death syndrome (SIDS):\u00a0<\/strong>infant (one-year-old or younger) with no apparent medical condition suddenly dies during sleep<\/p>\n<\/div>\n\n\t\t\t <section class=\"citations-section\" role=\"contentinfo\">\n\t\t\t <h3>Candela Citations<\/h3>\n\t\t\t\t\t <div>\n\t\t\t\t\t\t <div id=\"citation-list-737\">\n\t\t\t\t\t\t\t <div class=\"licensing\"><div class=\"license-attribution-dropdown-subheading\">CC licensed content, Shared previously<\/div><ul class=\"citation-list\"><li>Sleep Problems and Disorders. <strong>Provided by<\/strong>: OpenStax College. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/openstax.org\/books\/psychology-2e\/pages\/4-3-stages-of-sleep\">https:\/\/openstax.org\/books\/psychology-2e\/pages\/4-3-stages-of-sleep<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY: Attribution<\/a><\/em>. <strong>License Terms<\/strong>: Download for free at https:\/\/openstax.org\/books\/psychology-2e\/pages\/1-introduction.<\/li><li>Sleep Problems and Disorders. <strong>Provided by<\/strong>: Lumen Learning. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/courses.lumenlearning.com\/waymaker-psychology\/chapter\/sleep-problems-and-disorders\/\">https:\/\/courses.lumenlearning.com\/waymaker-psychology\/chapter\/sleep-problems-and-disorders\/<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY: Attribution<\/a><\/em><\/li><\/ul><div class=\"license-attribution-dropdown-subheading\">All rights reserved content<\/div><ul class=\"citation-list\"><li>Sleep Apnea. <strong>Provided by<\/strong>: Osmosis. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/www.youtube.com\/watch?v=cjQPGs_tvDY\">https:\/\/www.youtube.com\/watch?v=cjQPGs_tvDY<\/a>. <strong>License<\/strong>: <em>Other<\/em>. <strong>License Terms<\/strong>: Standard YouTube License<\/li><\/ul><\/div>\n\t\t\t\t\t\t <\/div>\n\t\t\t\t\t <\/div>\n\t\t\t <\/section><hr class=\"before-footnotes clear\" \/><div class=\"footnotes\"><ol><li id=\"footnote-737-1\">Sleep Apnea - Causes &amp; Symptoms. Sleep Foundation. (2020, September 25). https:\/\/www.sleepfoundation.org\/sleep-apnea. <a href=\"#return-footnote-737-1\" class=\"return-footnote\" aria-label=\"Return to footnote 1\">&crarr;<\/a><\/li><li id=\"footnote-737-2\">Sleep Apnea - Treatment Options. Sleep Foundation. (2020, September 25). https:\/\/www.sleepfoundation.org\/sleep-apnea. <a href=\"#return-footnote-737-2\" class=\"return-footnote\" aria-label=\"Return to footnote 2\">&crarr;<\/a><\/li><\/ol><\/div>","protected":false},"author":29,"menu_order":13,"template":"","meta":{"_candela_citation":"[{\"type\":\"cc\",\"description\":\"Sleep Problems and Disorders\",\"author\":\"\",\"organization\":\"OpenStax College\",\"url\":\"https:\/\/openstax.org\/books\/psychology-2e\/pages\/4-3-stages-of-sleep\",\"project\":\"\",\"license\":\"cc-by\",\"license_terms\":\"Download for free at https:\/\/openstax.org\/books\/psychology-2e\/pages\/1-introduction.\"},{\"type\":\"cc\",\"description\":\"Sleep Problems and Disorders\",\"author\":\"\",\"organization\":\"Lumen Learning\",\"url\":\"https:\/\/courses.lumenlearning.com\/waymaker-psychology\/chapter\/sleep-problems-and-disorders\/\",\"project\":\"\",\"license\":\"cc-by\",\"license_terms\":\"\"},{\"type\":\"copyrighted_video\",\"description\":\"Sleep Apnea\",\"author\":\"\",\"organization\":\"Osmosis\",\"url\":\"https:\/\/www.youtube.com\/watch?v=cjQPGs_tvDY\",\"project\":\"\",\"license\":\"other\",\"license_terms\":\"Standard YouTube License\"}]","CANDELA_OUTCOMES_GUID":"f9d6ff92-5f36-43a4-bd6e-7fa6083f557b, e2fb6a37-2341-42ce-a718-bbb3b5d30504","pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":[],"pb_section_license":""},"chapter-type":[],"contributor":[],"license":[],"class_list":["post-737","chapter","type-chapter","status-publish","hentry"],"part":148,"_links":{"self":[{"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/pressbooks\/v2\/chapters\/737","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/wp\/v2\/users\/29"}],"version-history":[{"count":47,"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/pressbooks\/v2\/chapters\/737\/revisions"}],"predecessor-version":[{"id":7518,"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/pressbooks\/v2\/chapters\/737\/revisions\/7518"}],"part":[{"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/pressbooks\/v2\/parts\/148"}],"metadata":[{"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/pressbooks\/v2\/chapters\/737\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/wp\/v2\/media?parent=737"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/pressbooks\/v2\/chapter-type?post=737"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/wp\/v2\/contributor?post=737"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/wp\/v2\/license?post=737"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}