Sleep apnea is one of the most common sleep disorders, affecting 22 million Americans, while an estimated 80 percent of cases remain undiagnosed. People with sleep apnea often experience daytime sleepiness, poor concentration, and medical conditions such as high blood pressure and heart disease. Read on to learn more about the causes and symptoms of sleep apnea, and discover how you can treat this potentially serious condition.
What is Sleep Apnea?
Sleep apnea is a sleep disorder characterized by reduced breathing or repeated stops and starts in breathing.
As oxygen levels in the body fall, sleep is briefly interrupted. People will experience moments of very light sleep or they may wake suddenly. Breathing then starts again and the cycle repeats between five and 30 times a night. The periods of awakening are usually so brief that people do not remember them.
Those with sleep apnea often toss and turn at night, they may gasp for air during sleep, and they often snore. In fact, snoring and sleep apnea often go hand-in-hand, although not everyone who snores has sleep apnea and not everyone with sleep apnea snores.
Usually, people with sleep apnea don’t realize they have a sleep disorder—their bed partner often notices the episodes of gasping or snoring. Left untreated, sleep apnea contributes to heart disease, diabetes, and high blood pressure.
Central vs. Obstructive Sleep Apnea
There are three types of sleep apnea:
- Obstructive sleep apnea: this is the most common form of sleep apnea, occurring when the muscles in the throat relax during sleep.
- Central sleep apnea: in this type, the brain fails to send the correct signals to the muscles that control breathing.
- Complex sleep apnea: when someone has both obstructive and central sleep apnea, it is called complex sleep apnea.
Sleep Apnea Causes
The reasons for sleep apnea depend on the type of the condition.
Obstructive Sleep Apnea Causes
Obstructive sleep apnea happens when muscles in the back of the throat relax. The airway then narrows and sufferers cannot breathe properly. Oxygen levels in the blood drop and the brain sends signals to awaken you from sleep so you can breathe in enough oxygen.
Central Sleep Apnea Causes
Central sleep apnea occurs when the brain does not communicate properly with the muscles responsible for breathing. People with central sleep apnea simply fail to breathe for short periods of time. They may wake up feeling short of breath or struggle to stay asleep.
Some people are more at risk of developing sleep apnea than others. Factors that increase risk include:
- Men are twice as likely as women to develop sleep apnea, although women’s risk rises after menopause.
- Older adults are significantly more at risk of both central and obstructive sleep apnea.
- Being overweight or obese. People who are obese are four times more likely to have the condition than people of normal weight.
- Larger neck size. Men who have a neck circumference of seventeen inches or more, and women with a neck circumference of fifteen includes or more, are also at high risk of sleep apnea.
- Narrow throat or nasal congestion. Those with a naturally narrow throat or enlarged tonsils are more likely to have a blocked airway and obstructive sleep apnea, as are those who struggle to breathe through their nose.
- People with a family history of sleep disorders are more at risk.
- Use of alcohol, tobacco, or certain medications. Alcohol, cigarettes, sedatives, and tranquilizers all increase obstructive sleep apnea risk. Opioid medications increase central sleep apnea risk.
- Heart disorders or stroke. People with congestive heart failure or a history of stroke have an increased risk of central sleep apnea.
Sleep Apnea Symptoms
Sleep apnea symptoms in men and women are generally the same, and there is significant overlap between the symptoms of different types of apnea.
The most common symptoms and signs of sleep apnea include:
- Loud snoring, that may be followed by periods of quiet
- Short pauses in breathing during sleep
- Abrupt awakenings
- Shortness of breath during the abrupt awakenings
- Waking up in the morning with a sore throat and dry mouth
- Headaches upon waking
- Excessive daytime sleepiness
- Problems with attention and concentration
- Poor performance at work or school
- Feeling irritable during the day
If you have any of the symptoms of sleep apnea, see your doctor. They will evaluate your symptoms and may perform a physical exam.
Sleep Apnea Quiz
This short quiz may help you determine if it’s time to see your doctor. If you answer yes to any of the following, make an appointment without delay.
- Are you frequently sleepy during the day, despite feeling like you slept through the night?
- Has someone ever told you that you snore loudly?
- Has someone told you that you gasp or hold your breath while sleeping?
- Do you struggle to concentrate at work, school, or when driving?
Sleep Apnea Test
Typically, a doctor will recommend a sleep disorder test in order to confirm a diagnosis of sleep apnea. Sometimes, home sleep apnea tests are available.
A sleep apnea test involves monitoring your breathing, heart rate, blood oxygen levels, and other signs while sleeping. Tests to diagnose sleep apnea include:
- Nocturnal polysomnography. This test is carried out at a sleep center. It involves using equipment to check your heart, lung, and brain activity, blood oxygen levels, limb movements, and breathing patterns.
- Home sleep tests. Home tests measure heart rate, blood oxygen levels, and breathing patterns. People who score abnormal results on this test may then require a nocturnal polysomnography to confirm the diagnosis.
After a diagnosis of obstructive sleep apnea, your doctor may send you for further testing to look for blockages in the nose and throat. People with central sleep apnea may need to see a neurologist or cardiologist.
Sleep Apnea Treatment
Mild cases of sleep apnea often improve with lifestyle changes and home devices. More severe cases may require a CPAP machine or surgery. But even people with severe cases can benefit from home treatments.
Sleep apnea treatment options include:
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Losing even a few pounds can reduce pressure on the neck and throat, which can ease symptoms of obstructive sleep apnea. Sometimes, obese people who achieve a healthy weight can go into complete remission. However, sleep apnea will likely return if you put the weight back on. Lose weight, and keep it off, by tracking your weight loss efforts with a digital body fat scale.
Staying active, with or without weight loss, can ease obstructive sleep apnea. Exercise is also a great way to avoid some of the complications of sleep apnea, including heart disease, high blood pressure, and diabetes.
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Aim for at least 30 minutes of moderate exercise daily. If you can’t get out of the house every day, use a pedal exerciser while sitting down, or increase the intensity of home workouts using resistance bands.
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Alcohol and Tobacco Avoidance
Using alcohol, sedatives, or tranquilizers before bed can relax the throat muscles, increasing the likelihood of obstructive sleep apnea. Avoid alcohol completely, or at least in the hours before bedtime.
Smokers are three times more likely to have sleep apnea because it causes inflammation and fluid retention in the airways. Cut your risk of developing sleep apnea, and avoid exacerbating existing apnea, by quitting smoking.
Some people can reduce their sleep apnea simply by propping up the head, neck and shoulders at nighttime. The easiest way to do this is with pillows and supports. Consider using a wedge pillow designed to keep your head elevated while you are able to rest comfortably. This will also help to prevent acid reflux which can in turn disrupt your sleep.
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Breathing machines can treat moderate to severe cases of sleep apnea. There are a few types of machines, but a continuous positive airway pressure (CPAP) machine is the most common. People who use CPAP wear a sleep apnea mask placed over their nose. The machine delivers air pressure through the mask to keep the airways open.
Other types of breathing machines for sleep apnea include bilevel positive airway pressure (BiPAP) machines and expiratory positive airway pressure (EPAP) devices. Both work in a similar manner to CPAP, although there are some slight differences.
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If you are more prone to snoring or sleep apnea episodes when lying on your back, try sleeping on your side. Sleeping on your back allows your tongue and soft palate to block your airways and reduce your oxygen intake. We recommend using a knee pillow to help you sleep on your side.
A mouth guard isn’t as effective as CPAP at keeping the airways open but it is easier to use and offers some benefits. Some types of sleep apnea mouthpieces keep the throat open by bringing the jaw forward. Ask your dentist about oral devices for sleep apnea—you may need to try a few before you find the right fit for you.
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A neck brace can be helpful for some people with sleep apnea. A brace can hold the neck in the right position to reduce throat closure. The best neck support for sleeping should be soft, comfortable, and customizable. This neck brace follows the natural contours of your neck and is comfortable for use day and night.
Doctors do not usually prescribe medication for sleep apnea. However, some medications can help people manage daytime sleepiness. Also, allergies can contribute to sleep apnea. If your allergies are making symptoms worse, ask your doctor about antihistamines.
Some people may benefit from using a saline nasal spray at night to keep the nasal passages open. Avoid using nasal decongestants unless your doctor advises you to, as these can make symptoms worse if taken for more than a few days.
Surgery is only necessary if other treatments do not provide relief. Common sleep apnea surgery options include removing excess tissue (including the tonsils) from the mouth and throat, repositioning the jaw to keep the throat open, or implanting rods into the soft palate. You may also need surgery to remove nasal polyps, fix a deviated septum, or to deal with excessive weight.
Sleep Apnea Side Effects and Risks
Severe sleep apnea is a serious condition that can result in major complications. Some of the complications and side effects of sleep apnea include:
Low Energy and Mood Disorders
People with sleep apnea can experience daytime fatigue, putting them at increased risk of car accidents or workplace incidents. Ongoing fatigue can eventually lead to irritability, moodiness, or depression.
In addition to fatigue and moodiness, sleep apnea can take its toll on relationships in other ways. Loud snoring can disrupt bed partners, who may also experience fatigue and irritability. Moving to a separate bedroom can help.
High Blood Pressure and Heart Problems
The cardiovascular system is put under pressure at night due to sudden drops in blood oxygen levels. This increases the risk of high blood pressure, heart attack, and stroke. In people with sleep apnea, death can result from an irregular heartbeat.
Sleep apnea increases the risk of type II diabetes, high blood sugar, and a large waist size.
Nonalcoholic Fatty Liver Disease
Those with sleep apnea often show abnormal liver function and signs of liver scarring, a condition called nonalcoholic fatty liver disease.
Complications Arising from Surgery
Surgery carries a higher risk for people with sleep apnea because they are more likely to have breathing problems, especially when lying on their back or when under anesthesia.
Getting Help for Sleep Apnea
Sleep apnea is a common but serious condition that requires treatment without delay. If you think you or a loved one show signs and symptoms of sleep apnea, make an appointment with your doctor. Once you get a diagnosis of sleep apnea, you can begin to take steps to address the condition. Some of the best home treatments for sleep apnea include losing weight, avoiding alcohol and tobacco, and using sleep masks, pillows, and mouth guards.