Sleep Apnea

What is sleep apnea?

Sleep apnea is a condition that makes you stop breathing while you’re sleeping. This happens either because of blockage of your airway (obstructive sleep apnea) or because your brain doesn’t control your breathing as expected (central sleep apnea).

A lack of oxygen activates a survival reflex that wakes you up just enough to resume breathing. While that reflex keeps you alive, it also interrupts your sleep cycle. This prevents restful sleep. It can also put stress on your heart that may be life-threatening if untreated.

A healthcare provider can create a treatment plan to help you manage symptoms and prevent complications.

What are the types of sleep apnea?

There are three types of sleep apnea:

• Obstructive sleep apnea (OSA). In this condition, the muscles in your throat relax while you’re asleep, causing surrounding tissue to press on your windpipe. This blocks air movement.
• Central sleep apnea (CSA). With this condition, your brain doesn’t send signals to keep breathing-related muscles working while you sleep.
• Mixed/complex sleep apnea. This type is a combination of both obstructive and central sleep apnea types.

How common is sleep apnea?

One study estimates that about 1 billion people (between ages 30 to 69) around the world have obstructive sleep apnea. Central sleep apnea is less common than OSA but it’s not a rare condition.

What are the symptoms of sleep apnea?

Common symptoms of sleep apnea include:

• Waking up repeatedly in the middle of the night
• Breathing pauses while asleep (a sleeping partner may notice this)
• Unusual breathing patterns (fast breathing that gets deeper, then shallower again until breathing stops before starting again)
• Snoring
• Waking up feeling short of breath or like you’re choking
• Daytime fatigue, sleepiness or exhaustion when waking up

Other symptoms you might experience may include:

• Headaches, especially when waking up
• Night sweats
• Mood changes (depression and anxiety)
• Feeling restless at night
• Sexual dysfunction

Sleep apnea may look different in children.

What causes sleep apnea?

Sleep apnea happens because of:

• An airflow blockage in your upper airway during sleep
• A problem with how your brain regulates your breathing during sleep

What are the risk factors for sleep apnea?

Anyone can develop this condition. It affects children and adults. Some common risk factors of sleep apnea include having:

• A biological family history of sleep apnea
• Heart conditions, a stroke or elevated blood pressure
• Large tonsils
• Obesity

Your risk increases as you get older. People assigned male at birth (AMAB) are more likely to receive a diagnosis before age 50.

Also, while you have a higher risk of sleep apnea with obesity, anyone of any body size can develop this condition.

What are the complications of sleep apnea?

Sleep apnea may cause several different complications, many of which are severe or life-threatening. These include:

• Excessive daytime sleepiness or “microsleeps” where you fall asleep for very brief periods during the day (dangerous while driving or operating machinery)
• Arrhythmias (atrial fibrillation or left atrial appendage)
• High blood pressure
• Heart damage and heart failure
• Sudden cardiac death

How is sleep apnea diagnosed?

A healthcare provider will diagnose sleep apnea by asking you questions about your symptoms and medical history. If they suspect the condition, they’ll recommend testing to confirm a diagnosis.

What tests diagnose sleep apnea?

The most common tests for sleep apnea include:

• Polysomnogram. This is an overnight test that involves wearing sensors that monitor your heart rate, breathing, blood oxygen levels, brain waves and more.
• Home sleep apnea testing. This is the at-home version of a sleep study, but it doesn’t involve brain wave monitoring. There are some limitations to this test; for example, it can’t diagnose central sleep apnea.

If you suspect you or a loved one has sleep apnea, you might be able to help a healthcare provider diagnose it. Video and audio recordings of yourself or this person sleeping, especially where the provider can hear breathing, can give a provider key evidence they need to speed up the diagnostic process. You might also show evidence of air movement by holding a piece of tissue in front of a loved one’s face to make this movement visible on a recording.

What are the severity levels of sleep apnea?

Healthcare providers use the apnea/hypopnea index (AHI) to determine the severity of a sleep apnea diagnosis. The AHI measures the average hourly number of apnea (when you stop breathing while asleep) and hypopnea (decreased airflow) events. The severity levels of sleep apnea are:

• Mild sleep apnea (AHI 5-14 events per hour)
• Moderate sleep apnea (15-29 events per hour)
• Severe sleep apnea (30 or more events per hour)

What organ does sleep apnea affect?

Sleep apnea isn’t limited to only one organ in your body. In fact, it affects many different body systems. The two most affected include your circulatory system (heart) and nervous system (brain).

How is sleep apnea treated?

A healthcare provider will recommend different treatment options based on the type of sleep apnea and the severity. These may include:

• Using a breathing device like a continuous positive airway pressure (CPAP) machine
• Managing any underlying conditions that cause or increase your risk of sleep apnea
• Changing your sleeping position (not on your back) to avoid putting pressure on your airways
• Wearing an oral appliance (mouthpiece) to keep your airway open
• Using a neuromuscular electrical stimulation (NMES) device to prevent your tongue and upper airway muscles from blocking your airway during sleep
• Taking medications
• Undergoing surgery

Sleep apnea surgery

Surgeries on your nose, mouth and throat may help prevent airway blockages during sleep. These surgeries include:

• Jaw surgery. Different procedures can change the position of your jaw so soft tissue can’t press back on your airway.
• Nasal surgery. One common form of nasal surgery is septoplasty. This straightens the soft tissue in your nose, making it easier for air to travel through your nose and nasal passages.

How can sleep apnea be prevented?

You can’t prevent all causes of sleep apnea. But you can take steps to reduce your risk by:

• Reaching and maintaining a weight that’s healthy for you
• Eating nutritious foods and participating in regular physical activities
• Practicing good sleep hygiene (like setting a regular bedtime and turning off electronics)
• Managing any existing health conditions, like high cholesterol, high blood pressure and Type 2 diabetes
• Seeing your healthcare provider at least once a year for a check-up
• Avoiding smoking and drinking beverages that contain alcohol

Is there a cure for sleep apnea?

There isn’t a cure for all types of sleep apnea. For example, weight loss or surgical treatment options may cure obstructive sleep apnea. Your provider can give you more information about what this might look like for your situation.

What can I expect if I have sleep apnea?

Sleep apnea is a condition that can severely disrupt your sleep. You may not perform at your best during the day if you’re not getting restful sleep at night. This may put you at risk of injury or accidents that can interfere with your work, hobbies or social activities.

This condition can also cause complications that may be life-threatening. A healthcare provider can help you find the right treatment option that works for you. You may need to try a couple of different options or combinations to see what works best.

What’s the life expectancy of someone with sleep apnea?

Sleep apnea complications may reduce your life expectancy if untreated. A healthcare provider will work with you to manage the condition and prevent this.

Many factors go into determining your life expectancy, so your provider is the best person to talk to about your situation since it may or may not match statistics.

How do I take care of myself?

There are several key steps you can take to manage this condition:

• Make lifestyle changes as best you can. Changing how you live your life, especially regarding what you eat and physical activity, can be a challenge. Don’t feel ashamed to talk to your healthcare provider about these if they’re difficult. Not only are they common, but your provider can also give you suggestions or recommendations to make things easier.
• Stick to your treatment plan closely. You’ll have a better outcome if you follow your provider’s treatment plan. This reduces your risk of possible complications.
• Talk to your provider about what you’re experiencing. Let your provider know if you have trouble sticking to your treatment plan, for whatever reason. You may have issues with how a PAP device mask fits or you notice side effects from a medication. Your provider can help you, so let them know if you have any questions or concerns.
• See your provider as recommended. Follow-up visits can be crucial, especially early on, to make sure your treatments are working as they should.

When should I go to the ER?

You should go to the emergency room if you notice any symptoms of the following:

• Heart attack. Chest pain (pressure or tightness), cold sweats, heartburn, shortness of breath.
• Stroke. Sudden weakness or numbness on one side of your body, confusion, vision changes, difficulty walking or dizziness.
• Difficulty breathing. Feeling like you can’t get enough air into your lungs, tight chest or noisy breathing.

What questions should I ask my healthcare provider?

If you recently received a sleep apnea diagnosis, you may want to ask your provider:

• What type of treatment do you recommend?
• Are there side effects of the treatment?
• How do I avoid sleeping on my back?
• How do I make a PAP mask more comfortable to wear?