What Is Sleep Apnea?

Sleep apnea is a chronic breathing disorder that causes your breathing to stop and restart repeatedly while you sleep. These breathing pauses can last ten seconds or longer at a time and occur up to 400 times every night. Sleep apnea usually happens when your airway becomes partially or entirely blocked. Sometimes, this condition occurs when the brain does not send proper signals to the muscles that control breathing during sleep.

An estimated 30 million people in the U.S. have sleep apnea. Loud snoring, gasping for air during sleep, and waking up feeling tired, are some of the most common sleep apnea symptoms. Leaving these symptoms untreated can often lead to serious health problems, including diabetes, heart attack, and stroke. Fortunately, treatment for sleep apnea can help restore normal breathing patterns and improve your sleep.

Types of Sleep Apnea 

There are three types of sleep apnea: obstructive, central, and complex. All three types have similar symptoms, but their causes and treatment options differ.

Obstructive Sleep Apnea (OSA) 

Obstructive sleep apnea (OSA) is the most common type. OSA occurs when the muscles in the throat relax and soft tissues in the mouth and throat collapse onto the airway. These actions can restrict normal airflow for short periods. Depending on the severity of the condition, people with OSA stop breathing on average between five to 30 times per hour or more each night.

Central Sleep Apnea (CSA)

Central sleep apnea (CSA) occurs when the brain briefly stops sending signals to the muscles that control your breathing. People with CSA have shallow, slow breathing or stop breathing altogether for short periods while sleeping. Conditions that affect the brainstem (e.g., infection, injury, or stroke) and certain medications (e.g., narcotic painkillers) are common causes of CSA.

Complex Sleep Apnea

Complex sleep apnea occurs when your breathing pauses occur as a result of both airway collapse and irregularities in your brain signaling. This type is often undiagnosed until people with OSA receiving CPAP therapy (the most common treatment for OSA) continue to have apnea episodes.

What Is Obstructive Sleep Apnea?

Symptoms of Sleep Apnea

What Causes Sleep Apnea?

How Is Sleep Apnea Diagnosed?

Symptoms

Along with repeated pauses in breathing while sleeping, common signs of sleep apnea can include:

• Loud snoring 
• Gasping for air or choking sounds during sleep 
• Waking up feeling tired or unrefreshed even after getting enough hours of sleep
• Excessive daytime sleepiness
• Morning headaches 
• Dry mouth
• Trouble focusing
• Memory problems or forgetfulness 
• Irritability or moodiness 
• Depression
• Anxiety
• Decreased libido (sex drive)
• Nocturnia (frequent urination at night)
• Frequently waking up at night or tossing and turning 
  

Causes

Sleep apnea causes brief pauses of breathing while you sleep. When you stop breathing, your blood oxygen levels drop until your brain signals to your respiratory muscles to restore normal breathing patterns. OSA and CSA have separate causes. But because complex sleep apnea is a mix of both types of sleep apnea, any of the following causes can contribute to complex symptoms.

Obstructive Sleep Apnea Causes 

Obstructive sleep apnea (OSA) occurs when the upper airway becomes partially or completely blocked during sleep. As a result, this can interfere with your breathing. You'll likely experience a blocked airway when soft tissues in the back of your throat (such as your tongue, uvula, or tonsils) collapse and prevent air from flowing into your lungs.

Genetic, environmental, and lifestyle factors all contribute to the development of obstructive sleep apnea, including:

• Enlarged tonsils or adenoids
• Obesity
• Anatomical differences, such as a small jaw, deviated septum, thick neck, or a narrow airway 
• Hormonal changes
• Metabolic or endocrine disorders, such as hypothyroidism or diabetes

Central Sleep Apnea Causes 

Central sleep apnea (CSA) occurs when there are problems with how your brain sends signals to your muscles that control breathing while you sleep. Underlying health conditions, certain medications, and genetic disorders can cause CSA, but sometimes the cause is unknown. 

Common causes of central sleep apnea include:

• Heart diseases, such as congestive heart failure and arrhythmias (irregular heartbeat)
• Neurological conditions, such as stroke, brain injury, or amyotrophic lateral sclerosis (ALS)
• Opioid-based medications that suppress the nervous system, such as oxycodone, fentanyl, or morphine 
• Genetic disorders, such as Prader-Willi syndrome or Rett syndrome
• Kidney disease or kidney failure
  

Risk Factors

Certain risk factors can increase the likelihood of developing sleep apnea—regardless of type. These include:

• Age: Sleep apnea becomes more common with age, with middle-aged and older adults at a higher risk
• Gender: People assigned male at birth are more likely to develop sleep apnea than people assigned female at birth
• Obesity: Obesity can lead to the accumulation of fat deposits in the neck and obstruct breathing
• Family history: People with a family history of sleep apnea or genetic conditions associated with sleep apnea are more likely to develop the condition
• Smoking: Smoking causes inflammation in the airways, which can affect your breathing
• Alcohol or drug use: Excessive alcohol consumption or opioid use can relax the muscles of the mouth and throat or interfere with the proper functioning of your brain

Diagnosis

Healthcare providers diagnose sleep apnea based on a careful review of your symptoms, sleep patterns, and medical history. But your provider will also use diagnostic tests to confirm the diagnosis of sleep apnea and determine the type and severity of your condition. 

When you visit your healthcare provider, they will ask about your symptoms and risk factors for sleep apnea. They will also learn more about your sleep patterns and lifestyle habits that may be contributing to your symptoms.

To confirm the diagnosis, your healthcare provider will order a polysomnography (also known as a sleep study). A sleep study is an overnight test that takes place at a medical center (sleep lab), where electrodes placed on your body will monitor your brain activity, eye movement, breathing patterns, heart rate, and blood oxygen levels while you sleep.

Some people can undergo a home sleep apnea test—a simplified version of a polysomnography that focuses on key measurements, such as airflow, blood oxygen levels, and breathing patterns. Your healthcare provider will provide instructions on preparing and setting up the portable testing machine before sleeping, or a specialist will visit your home to assist you.

How Is Sleep Apnea Treated?

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Treatment

Treatment for sleep apnea helps keep your airways open to reduce the number of apnea events you experience while you sleep. Healthcare providers often recommend a combination of the following treatments, depending on the type and severity of sleep apnea you have.

Lifestyle Changes

Making healthy lifestyle choices is a key component of sleep apnea treatment. This may include:

• Managing weight: Maintaining a healthy weight that is right for you can help reduce pressure on the airway during sleep
• Avoiding alcohol: Alcohol can relax the muscles in the throat, making an airway blockage more likely
• Quitting smoking: If you smoke, quitting can help reduce inflammation in your airways and reduce apnea episodes
• Sleeping on your side: Sleeping on your back can make the tongue fall back and increase the likelihood of other soft tissues in the back of the throat blocking the airway

Breathing Devices

Breathing devices are the gold standard treatment for obstructive sleep apnea. A breathing device is hooked to a hose, which connects to a mask worn over your nose and mouth. The machine delivers pressurized air through the night to keep your airway open. Depending on the severity of sleep apnea, your healthcare provider may prescribe:

• Continuous positive airway pressure (CPAP): CPAP machines send a constant flow of pressurized air through a hose and mask to keep the airway open and ensure your body gets the oxygen it needs during sleep
• Bilevel positive airway pressure (BiPAP): BiPAP machines are similar to a CPAP, but BiPAP delivers two types of pressurized air: one when you inhale air and another when you exhale
• Autotitrating (adjustable) positive airway pressure (APAP): APAP machines automatically change airflow pressure through the night based on your breathing pattern

Oral Appliances

If you do not want or cannot tolerate CPAP therapy, your healthcare provider may refer you to a dentist who can provide custom-fit oral appliances to help treat sleep apnea. These appliances fit in your mouth and help keep your airways open during sleep. This may include:

• Mandibular repositioning mouthpiece: A device that fits over your teeth and holds your lower jaw forward to keep your airways open
• Tongue retraining devices: A plastic device that sits on your lips and has a hole to place your tongue, which holds it in place to prevent the tongue from slipping back while you sleep and blocking your airway

Medications

Medications are not a standard treatment for sleep apnea but may be necessary for people with central sleep apnea. Medicines, including Diamox (acetazolamide) and Uniphyl (theophylline), are respiratory stimulant drugs that may help prevent apnea episodes during sleep.

Surgery

Surgery is sometimes necessary for people with severe sleep apnea. Your healthcare provider may only recommend surgery if your body isn't responding well to other standard treatments. Surgical procedures that may help treat sleep apnea include:

• Adenotonsillectomy: Removing your tonsils and adenoids
• Removal of tissue: Taking out soft tissue from your mouth and throat may help enlarge your upper airway
• Jaw advancement: Moving the upper or lower jaw forward can help prevent the jaw from falling back and blocking the airway

How To Prevent Sleep Apnea

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How to Prevent Sleep Apnea 

Keep in mind: it's not always possible to prevent sleep apnea, but there are ways you can reduce your risk and improve your overall sleep quality. These include:

• Maintain a healthy weight: Extra body weight is a significant risk factor for sleep apnea, and maintaining a healthy weight helps reduce pressure on your airway. 
• Sleep on your side: If you snore or experience sleep apnea in certain positions, such as on your back, sleeping on your side helps reduce airway obstructions.
• Quit smoking: Smoking irritates the airways and causes inflammation of the soft tissues in your throat. Quitting smoking (or never starting) can help reduce your risk of sleep apnea and support your overall health. 
• Avoid alcohol and sedatives before bed: Alcohol, opioid pain relievers, and sedatives can relax the muscles in your throat and cause or worsen sleep apnea. 

Related Conditions

Over time, sleep apnea increases the risk of many chronic health conditions, including: 

• Cardiovascular disease: People with sleep apnea are at an increased risk of heart disease and heart problems, including stroke, high blood pressure, coronary artery disease, and heart failure.
• Diabetes: Untreated sleep apnea increases the risk and severity of type 2 diabetes. Research shows that OSA, in particular, causes inflammation, oxidative stress, and glucose intolerance—all factors that play a role in the development of diabetes.
• Depression and anxiety: Frequent sleep disruptions can reduce your quality of sleep and increase the risk of mood disorders, including anxiety and depression.

Living With Sleep Apnea 

While sleep apnea is a chronic condition, it is also treatable. If you snore or wake up feeling tired more often than not, talk to a healthcare provider about your symptoms. Healthy lifestyle choices, such as eating nutritious foods, exercising regularly, quitting smoking, and avoiding alcohol before bedtime, can help manage sleep apnea.

With the right treatment, most people with sleep apnea will notice improved sleep quality and a lower risk of developing associated health problems. If you are receiving treatment for sleep apnea and continue to have symptoms, talk to your healthcare provider about adjusting your treatment plan.