Obstructive sleep apnea (OSA) is when you can’t breathe while asleep because of a blockage of your windpipe. This can happen for many reasons, ranging from the structure of your head and neck to having excess body weight. When severe, OSA prevents restful sleep. It can also contribute to severe or even life-threatening conditions.
Obstructive sleep apnea (OSA) is when a blockage in your airway keeps air from moving through your windpipe while you’re asleep. The blockage and lack of airflow can cause your blood oxygen levels to drop, triggering a survival reflex in your brain that wakes you up just enough to breathe again.
While that reflex is key in keeping you breathing, it also disrupts your sleep. As more disruptions in your sleep happen, your sleep quality suffers. That can lead to a wide range of symptoms, many of which are disruptive or potentially dangerous.
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OSA can happen to anyone, but it’s more common under some circumstances and in some populations:
OSA is uncommon but widespread. Experts estimate it affects about 5% to 10% of people worldwide. In older adults (age 65 and up), it’s much more common, climbing to 20% or more. However, it’s common for people not to realize that they have this condition, so experts aren’t certain about the true scope of this issue.
When learning about OSA, it’s helpful to know how the human sleep cycle works. The sleep cycle happens in multiple stages:
The stages of sleep also happen in a particular order. When you fall asleep, you typically enter stage 1 and then move into and cycle between stages 2 and 3. Then, you go into REM sleep and start dreaming. After the first REM cycle, you start a new cycle and go back into stage 1 or 2. One cycle normally takes about 90 to 110 minutes before another begins. Most people go through four or five cycles per night (assuming they get a full eight hours).
The word “apnea” comes from Greek and means “breathless.” Obstructive sleep apnea means that it happens because of an obstruction or blockage. OSA happens most commonly because of how the muscles in your body relax as you move into some stages of sleep. As the muscles relax, the soft tissue around them settles downward because of gravity.
As soft tissues in your head and neck relax and sag downward, they can press on your windpipe, blocking air from passing through. Think of this as holding a straw between your thumb and index finger. The more pressure you put on the straw, the harder it is to pull liquid through it to drink. Likewise, air can’t pass through your windpipe if there’s enough downward pressure sealing it shut. That can cause either an apnea or a hypopnea:
Your brain can detect a drop in blood oxygen levels from apneas and hypopneas, and has a reflex that kicks in to keep you alive and breathing. That reflex wakes you up just enough for muscles in your head and neck to tense up slightly, taking the pressure off your windpipe.
However, the downside of these events is that they also disrupt your sleep cycle. These usually happen during stage 3 and REM sleep, and it’s extremely common for people not to remember these events. Your body will try to resume your sleep cycle as soon as blood oxygen levels return to normal, which means your muscles will relax again. If that causes another event, this process will repeat itself.
The apnea/hypopnea index (AHI) is the average hourly number of apnea or hypopnea events — times when a person stops breathing. The AHI is the main factor determining the severity of sleep apnea. The higher a person’s apnea index, the more severe their OSA. The severity breaks down like so:
OSA has many symptoms. Some of these happen while a person’s awake, while others happen when a person’s asleep.
Awake-centered symptoms include:
Sleep-centered symptoms include:
While OSA is more common as people age, it’s still possible in children. The symptoms of OSA in children are mostly similar to those in adults, with a few exceptions. The childhood symptoms include:
OSA is the more common form of sleep apnea, and many factors can contribute to it or be the sole reason for it. Some of these happen on their own, while others can happen in combinations. The following are factors that can contribute to or cause OSA:
Central sleep apnea is when there’s a problem in your brain or nervous system that keeps your body from breathing while you’re asleep. While it’s different than OSA, a person can develop a form that starts with central sleep apnea and then develops the obstruction symptom of OSA. Experts call this mixed sleep apnea or complex sleep apnea.
OSA isn’t contagious, so you can’t give it to or catch it from someone else.
Two main tests can help diagnose OSA. One is more common and is a definitive way to diagnose this condition. The other is a way to diagnose cases that aren’t severe or to confirm that a person still has OSA after certain medical procedures or body changes. The tests are:
There are many approaches to treating OSA, depending on how severe it is and what exactly causes it. None of these are cures, but they can prevent apnea events or reduce how often they happen.
Possible treatments include:
These nonmedical treatments or approaches can improve OSA or resolve it. They aren’t cures, but they can reduce OSA to the point where it stops happening or isn’t severe enough to cause symptoms. These include:
Positive airway pressure is a method that uses a specialized device to increase the air pressure inside your airway while you inhale. This method can treat sleep apnea.
Pushing pressurized air down your windpipe keeps it open so you can breathe. These devices push air through a hose that attaches to a special mask you wear on your face while you sleep. Masks can cover your nose, mouth or both, and many different types and styles are available.
The best-known PAP device is the Continuous Positive Airway Pressure (CPAP) machine. However, there are other types of PAP machines, too. These devices increase the air pressure inside your airway and lungs when you inhale, keeping surrounding tissue from pressing your airway shut.
OSA happens when soft tissue in your head or neck — especially around your mouth and jaw — presses downward on your windpipe. Special mouthpiece devices can help hold your jaw and tongue in a position that keeps pressure off your windpipe. Dentists and sleep medicine specialists often work together to make these for people who need them.
The hypoglossal nerve (the name comes from Greek and means “under the tongue”) is what controls your tongue’s movements. A nerve stimulator attached to the hypoglossal nerve can stimulate that nerve, pushing your tongue slightly forward when you breathe while you’re sleeping. That keeps your tongue from relaxing and pressing backward on your windpipe while you sleep, which is one of the ways that OSA happens.
An electrode attaches to the nerve under your jaw and connects to a device implanted under the skin in your chest. You can turn the stimulator on before you sleep and turn it off after you wake up. The electrical current is strong enough to keep your tongue from relaxing too much but mild enough that it’s not uncomfortable.
Surgeries on your nose, mouth and throat can help prevent blockages of your nose, throat and windpipe. However, the impact of these in adults is usually limited and varies from person to person. These surgeries include:
People with OSA should avoid heavy drinking, frequent use of sleeping pills or other drugs (recreational and otherwise) that cause heavy sedation. These can make OSA worse. Your healthcare provider can talk to you about drugs that can cause that and how you can avoid the effects.
The complications and side effects of the treatments depend on many factors, especially the treatments themselves. Your healthcare provider is the best source of information for what you can do to minimize the side effects or prevent them when possible.
OSA can severely disrupt your life and even create the potential for life-threatening complications and events (see more about these under the Outlook/Prognosis section below). That means you shouldn’t try to self-diagnose or self-treat it. If you think you have OSA, you should schedule an appointment with a specialist or ask a primary care provider to refer you to one.
If you suspect you or a loved one has OSA, you might be able to help a healthcare provider diagnose it. Video and audio recordings of a person sleeping, especially where you can hear breathing, can give a provider key evidence they need to speed up the diagnostic process.
Many factors can affect how long it takes to recover or feel better when you have sleep apnea. The type of treatment you receive, especially if it’s an ongoing treatment like nightly use of a PAP device, can also make a difference.
For some people, treatment may be enough for them to feel better very quickly. To see the full benefits, others may need three to six months of consistent nightly treatment. Your healthcare provider can tell you more about the timeline for your recovery and when you should expect to feel better.
Positive airway pressure devices can sometimes bring very fast results. Older devices may take some tweaking and adjusting (a process known as “titration”) of their settings, but many newer PAP devices can often adjust their settings automatically.
While some people may need to get used to wearing a mask to sleep, most people can overcome that fairly quickly. If you find yourself struggling with this, you aren’t alone. Many people struggle to acclimate to the masks. You can talk to your provider for tips on how to get used to wearing a mask or for recommendations on different types of masks that might work better for you.
While OSA is sometimes preventable, it isn’t always something people can avoid. An example of this is how some people who have a healthy body weight or below-healthy weight can still develop OSA. For those individuals, the cause of their OSA is usually related to their head and neck structure, so they can’t prevent it.
The best things you can do to reduce your risk of sleep apnea include:
OSA can severely disrupt your life, and it increases your risk for life-threatening complications and events that are medical emergencies. Even if you don’t develop life-threatening or dangerous problems, people with sleep apnea can’t get restful sleep, so they constantly feel tired. In the worst cases, this condition can make them so tired that they may fall asleep during the day, leading to accidents, problems with work, hobbies, social activities, etc.
OSA is a dangerous condition because it can cause several different complications, many of which are severe or life-threatening. These include:
OSA is a chronic (long-term) condition. For some people, it’s possible to resolve it by reducing their weight or undergoing certain treatments. For others, it may be a life-long issue.
The outlook for OSA depends on many factors. The severity and type of sleep apnea do make a difference. However, sticking to your treatment method once you find one that works is usually the biggest determining factor in how this condition will affect you.
It’s critical to adhere to treatment closely. Using and sticking with treatments — especially ongoing ones like positive airway pressure devices — can make a huge difference. Many people stick with treatments for a month or so but then stop using them. That can increase the risk of complications and a negative outcome, so it’s essential that you keep on using them as long as you have sleep apnea.
There are several things you can do to help you manage OSA:
You should go to the ER if you notice any of the symptoms of a heart attack or stroke, both of which are more likely to happen with sleep apnea.
A note from Cleveland Clinic
Obstructive sleep apnea is a widespread condition that affects the sleep quality of millions of people around the world. This condition keeps you from getting enough quality sleep, leaving you feeling fatigued and drained. This condition also increases your risk of developing life-threatening heart and circulatory problems, including stroke. However, with treatment, you can adapt to or even overcome this condition, letting you get the restful sleep you need.
Last reviewed by a Cleveland Clinic medical professional on 11/15/2022.
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