What Is Sleep Apnea?
Sleep apnea is a serious sleep disorder that happens when your breathing stops and starts while you're asleep. If it goes untreated, it can cause loud snoring, daytime tiredness, or more serious problems like heart trouble or high blood pressure.
This condition is different from regular, or primary, snoring. Primary snoring may be caused by nose or throat conditions, your sleep style (especially back sleeping), being overweight or older, or using alcohol or other depressants. While both types of snoring happen when tissues in the back of your throat vibrate, people with sleep apnea tend to:
- Snore much more loudly than those with regular snoring
- Pause for over 10 seconds while they breathe
- Take shallow breaths, gasp, or choke
- Be restless during sleep
Is sleep apnea dangerous?
Sleep apnea itself isn't thought to be fatal. But research has found that people who have the condition are twice as likely to die suddenly within a given time period than those who don't--especially if it's not treated. That's because of its links to serious conditions like high blood pressure, heart disease, stroke, and diabetes.
Sleep Apnea Types
There are three types of sleep apnea:
Obstructive sleep apnea. This is the most common type. It results when your airways repeatedly get completely or partially blocked as you sleep. This usually happens because the soft tissue at the back of your throat collapses when the muscles in your face and neck relax while you sleep. During these episodes, your diaphragm and chest muscles must work harder than normal to open your airways. You may start to breathe with loud gasps, and your body may jerk. This can affect your sleep, lower the flow of oxygen to your vital organs, and lead to abnormal heart rhythms.
Central sleep apnea. With this type, your airway doesn't get blocked. Instead, your brain fails to tell your muscles to breathe because of issues in your respiratory control center. It's related to the function of your central nervous system. This type most often affects people with neuromuscular disease such as amyotrophic lateral sclerosis (ALS, or Lou Gehrig's disease), those who've had a stroke, or those who have heart failure or other forms of heart, kidney, or lung disease.
Complex sleep apnea syndrome. With this condition, you have a combination of obstructive and central sleep apnea. When you have the obstructive type but it turns into the central type after you get treatment, that's called treatment-emergent central sleep apnea.
Effects of Sleep Apnea
When you briefly stop breathing because of sleep apnea, the oxygen levels in your blood drop. This triggers a brain reflex that wakes you up long enough to start breathing again.
These repeated awakenings keep you from spending enough time in the deep stages of sleep. The more serious your condition is, the more often your sleep will be interrupted.
Losing sleep makes you feel tired during the day. You may be less productive at work or school, and feel irritable, moody, or sad. You might be forgetful or find it hard to concentrate. And you're more likely to have accidents at work or while driving.
Sleep Apnea Causes
What causes sleep apnea depends on what type you have:
Obstructive sleep apnea. Things that narrow your airway or interfere with your airflow, including obesity, enlarged tonsils or adenoids, or a thick neck, can cause this type.
Central sleep apnea. Anything that affects your brain's control of your breathing and chest muscles can cause this type. This includes hormone levels as well as certain health conditions. Opioid use can have this effect, as can changes that come with aging.
Some research has indicated that apnea might run in families
Sleep Apnea Risk Factors
This condition can affect anyone, but some things put you more at risk:
- Being overweight
- A large neck circumference that could make your airways more narrow
- A narrowed airway that you inherited or developed from large tonsils or adenoids
- Being male (or having been identified as male at birth)
- Older age
- A family history of sleep apnea
- Smoking
- Use of alcohol, sedatives, or tranquilizers
- Nasal congestion
- Medical conditions such as type 2 diabetes, congestive heart failure, high blood pressure, Parkinson's disease, PCOS, hormonal disorders, a previous stroke, or chronic lung diseases like asthma
Sleep Apnea Symptoms
You probably won't notice your first symptoms of obstructive sleep apnea, but your bed partner may make you aware of them. The most common signs are:
- Snoring
- Fatigue or sleepiness during the day
- Restlessness while sleeping, or often waking up at night
- Dry mouth or sore throat when you wake up
- Waking up suddenly after gasping or choking
- Trouble concentrating, forgetfulness, or crankiness
- Depression or anxiety
- Frequent need to get up to pee at night
- Night sweats
- Sexual dysfunction
- Headaches
People with central sleep apnea usually say they wake up a lot or have insomnia. They also might have a choking or gasping sensation when they awaken.
Sleep apnea symptoms in women
Women (and those who were identified as female at birth) who have the condition may be less less likely than men to snore. For them, signs of sleep apnea may include:
- Fatigue
- Daytime drowsiness
- Anxiety or depression
- Headaches, often in the morning
- Trouble sleeping, including often waking up during the night
Sleep apnea symptoms in children
The symptoms might not be as obvious in children. Warning signs include:
- Sluggishness or sleepiness, which could be mistaken for laziness in the classroom
- Hyperactivity or problems focusing at school
- Poor academic performance
- Trouble swallowing
- Daytime mouth breathing
- An inward movement of the rib cage when inhaling
- Sweating a lot at night
- Heartburn
- Unusual sleeping positions, like sleeping on their hands and knees, or with the neck extended
- Often moving their arms or legs during sleep
- Loud snoring
- Bedwetting
Sleep Apnea Diagnosis
Before making a diagnosis, your doctor will ask you about your symptoms and your sleep and health history. They might also ask your bed partner about your symptoms, since you may not be aware of them. They'll try to find out whether:
- You take any medications such as opioids or other drugs that could affect your sleep
- There's a history of sleep disorders in your family
- You've traveled recently to places with altitudes higher than 6,000 feet
- You have any conditions linked to sleep apnea, like atrial fibrillation, hard-to-control high blood pressure, or type 2 diabetes.
Sleep apnea doctor
If they suspect you have apnea, your doctor may refer you to a sleep specialist, a doctor trained to diagnose and treat sleep disorders. They may want you to visit a sleep center, which is a clinic where sleep studies are done.
Sleep studies
A sleep study is the most effective way to diagnose apnea. Sleep studies can be done in a couple of different ways:
Home testing. For this test, you wear a simple breathing monitor while you sleep in your own bed. The monitor tracks your breathing patterns, blood oxygen levels, and heart rate to give your doctor clues about how well you're breathing.
Overnight study or polysomnogram. This more thorough test requires you to spend the night in a sleep clinic. You'll be hooked up to sensors that check not only your breathing but also your brain, heart, and lung activity and the movements of your arms and legs. A sleep technologist will be on hand to monitor the test.
Sleep Apnea Severity
Sleep testing tracks how often your breathing stops or slows down as you sleep. Based on how many of these episodes you have per hour, your doctor can diagnose you with:
Mild sleep apnea. This means you average from 5 to 15 of these events per hour.
Moderate sleep apnea. You have between 15 and 39 episodes per hour, on average.
Severe sleep apnea. More than 30 events an hour means your condition is severe.
Sleep Apnea Treatment
Can sleep apnea be cured?
There's no cure for the condition, but there are many ways to reduce or get rid of your symptoms.
Your doctor will suggest a treatment based on how serious your condition is. For mild cases, you may only need to make lifestyle changes. Your doctor may suggest that you lose weight, stop smoking, or treat nasal allergies if you have them.
If these don't ease your symptoms, or if you have moderate to severe sleep apnea, your doctor will recommend other treatments.
Sleep apnea machines (sleep apnea masks)
A few different types of devices can be used to treat the condition. All use masks that you wear over your face every night to deliver air into your airways. If you find the mask uncomfortable, talk to your doctor about other options.
Continuous positive airway pressure (CPAP). The best-known type of device, this machine blows air into your airways through a mask that covers your nose and mouth. This keeps your upper airway passages open.
Bilevel positive airway pressure (BPAP or BiPAP). While CPAP machines use the same level of air pressure for inhalation and exhalation, this type uses greater force as you inhale. This works better for some people.
Auto-positive airway pressure machine (auto-pap or APAP). This automatically adjusts the air pressure while you sleep to respond to changes in your breathing. For example, it may help if you only need help breathing while you're in certain sleep positions or during certain stages of sleep.
Adaptive servo-ventilation (ASV). This computerized device "learns" your breath pattern, then customizes its air pressure levels to normalize your breathing. ASV seems to be more effective for complex sleep apnea treatment than other forms of positive airway pressure. But it may not be a good fit for those with central sleep apnea and advanced heart failure.
Oral appliance
You can also wear an oral appliance such as a sleep mouth guard or tongue retaining device to help to keep your throat open. While positive airway pressure machines are generally more effective, oral appliances may be easier to use. Your dentist can help you find one that's right for you.
Supplemental oxygen
If you have central sleep apnea, you may need to use extra oxygen when you sleep. There are many forms of oxygen and different devices that can deliver it to your lungs.
Treatment for other medical issues
Central sleep apnea may be caused by heart or neurotransmitter disorders. If you treat these conditions, you may also control your sleep apnea symptoms.
Medications
While the FDA hasn't approved any drug specifically to treat apnea, doctors may prescribe sleep medications or drugs to aid breathing for people with central sleep apnea. If you take opioids or other medications that may be making your condition worse, your doctor may switch you to different drugs.
Surgery
If other treatment options don't help, your doctor may suggest surgery. It's usually recommended only if you've tried another form of treatment for over three months or if you have a jaw structure problem. Possible procedures include:
- Nerve stimulation. In an outpatient procedure, the doctor implants a device in your chest that uses electrical impulses to stimulate the nerve that controls your tongue's movements. This helps keep your tongue from blocking your airway.
- Tissue shrinkage. In this noninvasive procedure, the doctor uses radiofrequency waves to shrink tissue in the rear of your mouth and back of your throat.
- Tissue removal. A surgeon takes out excess tissue at the back of your mouth and top of your throat, as well as your tonsils and adenoids.
- Jaw repositioning. A surgeon moves your jaw forward to make more room behind your tongue and palate.
- Tracheostomy. You'll have this type of surgery only if you have very serious sleep apnea. A surgeon creates a new airway by cutting an opening into your neck, then inserting a tube you can breathe through. You cover it during your waking hours, but open it to help you breathe while you sleep.
Surgery to remove large tonsils or adenoids or weight loss surgery may help lessen snoring and help with the overall treatment of sleep apnea.
Sleep Apnea Complications
Along with daytime fatigue, untreated sleep apnea can lead to serious medical conditions such as:
High blood pressure or heart problems. Sudden drops in blood oxygen levels while you sleep can raise your blood pressure and put stress on your cardiovascular system. Obstructive sleep apnea could also put you at higher risk for recurrent heart attacks, strokes, or abnormal heartbeats.
Type 2 diabetes. Sleep apnea increases your risk for insulin resistance (in which your body doesn't use insulin as it should) as well as type 2 diabetes. Sleep loss can lead to higher blood sugar levels. And excess weight is a risk factor for both apnea and type 2 diabetes.
Metabolic syndrome. High blood pressure and a lack of sleep can contribute to metabolic syndrome, a group of conditions that includes high blood pressure, abnormal cholesterol levels, high blood sugar, and extra fat around the waistline. People with the syndrome are at higher risk for both heart diseaseand type 2 diabetes.
Issues with medications and surgery. Obstructive sleep apnea can cause complications with certain drugs or after major surgery. That's because you're likely to have breathing problems, especially when you're under anesthesia or lying on your back.
Liver complications. The condition may cause you to have abnormal results on a liver function test. Your liver is also more likely to show signs of scarring.
Long-term effects of sleep apnea
Untreated sleep apnea can lead to several long-term health conditions that could shorten your lifespan. Furthermore, the constant fatigue, brain fog, and mood changes that may result from lack of sleep can seriously affect your quality of life.
Sleep apnea and pregnancy
Hormone changes during pregnancy can raise your risk for sleep apnea. And if you have the condition, you're at higher risk for pregnancy complications like:
- High blood pressure
- Gestational diabetes
- Cesarean section
- Premature birth
- Low birth weight
It's safe to use positive airway pressure devices while you're pregnant. Talk to your doctor if you think you have symptoms of sleep apnea.
Living With Sleep Apnea
Healthy lifestyle and sleep habits are an important part of managing your condition.
Follow a healthy diet. Reaching and maintaining a weight that's healthy for you can improve your symptoms. One study found that people who followed a Mediterranean diet rich in fruits, vegetables, and whole grains had fewer episodes of apnea even if they didn't lose weight. Talk to your doctor about the best ways to lose weight and improve your eating habits.
Get regular exercise. Physical activity helps you control your weight while it improves the quality of your sleep. Try to exercise for at least 30 minutes a day on at least five days of the week.
Practice good sleep hygiene. Try to go to bed and get up around the same time each day, even on weekends. Keep your bedroom dark, cool, and quiet, and avoid using electronic devices close to bedtime.
Elevate your head. Use a wedge pillow or an adjustable bed to keep your head higher than the rest of your body while you sleep. This helps keep your air passages open.
Learn to sleep on your side. Your airways are more likely to collapse when you sleep on your back. Sleeping on your stomach can also keep you from snoring, but is more stressful on your back and neck.
Avoid substances that disrupt sleep. Cigarettes, alcohol, sleeping pills, and sedatives can all make your symptoms worse.
Don't give up on treatment. It's the best way to ensure a good outcome. If your doctor has recommended a positive airway pressure (PAP) machine, make sure you use it just as prescribed. Let them know if you have any issues using it, so they can look for work-arounds. Keep all your follow-up appointments so they stay up to date on your condition.
Sleep apnea and driving
Because the condition increases your risk for traffic accidents, it's important not to drive if your sleep apnea isn't treated. Until you're sure your treatment is working, drive only when you have someone else in the car who can make sure you're alert. Your doctor can recommend a driver rehabilitation specialist to check whether it's safe for you to drive, or an occupational therapist who can help you work on driving skills.
Takeaways
Sleep apnea is a sleep disorder in which you briefly stop breathing while you sleep, causing you to repeatedly wake up during the night. This keeps you from getting enough sleep and raises your risk for several serious health conditions. The right treatment can reduce or get rid of your symptoms and protect your health.
Sleep Apnea FAQs
How do you fix sleep apnea?
The treatment for sleep apnea depends on which type you have and how serious it is. For mild sleep apnea, it may be enough to lose weight, stop smoking, or treat respiratory allergies. The most common treatment is a positive airway pressure (PAP) machine, which blows air into your airways through a mask while you sleep. In some cases, your doctor may recommend medications or surgery.
What happens if sleep apnea goes untreated?
If you don't get treatment for sleep apnea, you'll probably sleep poorly. You'll keep waking up briefly during the night and won't spend enough time in the deep stages of sleep. This can lead to daytime sleepiness, mood changes, and trouble concentrating. In the long term, untreated sleep apnea raises your risk for serious health conditions like high blood pressure, heart disease, and diabetes.
Can sleep apnea go away?
There's no cure for sleep apnea. But your symptoms can improve or even go away with proper treatment. Your doctor can help determine the best treatment for you, whether it's lifestyle changes like weight loss, a PAP machine, or surgery.
