What is obstructive sleep apnea?
Obstructive sleep apnea (OSA) is the most common type of sleep disordered breathing. It occurs when your throat relaxes and your airway narrows, restricting airflow to your lungs. Your brain responds by waking you up to breathe. This cycle can happen multiple times during the night, every night, preventing you from getting restful sleep and potentially leading to other, more serious health conditions.
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Symptoms of obstructive sleep apnea
Dragging yourself through the day? Excessive daytime sleepiness may be just one obstructive sleep apnea symptom. Here are others to look out for:
- Loud snoring, choking, gasping for air during sleep
Snoring is one of the most common symptoms of sleep apnea. It occurs when your neck muscles relax and your throat partly closes and becomes narrow, causing the vibration sound known as snoring. - Daytime drowsiness
A lack of restful sleep can make it hard to get through the day. If you find yourself nodding off or feeling unnaturally tired despite thinking you slept well, you may be experiencing a symptom of OSA. - Depression
Depression and other mood changes, such as irritability and anxiety, can signal a problem with sleep. - Morning headaches
If you wake up regularly with morning headaches, it could be a sign that you’re not getting enough oxygen during the night. During apneas, when you temporarily stop breathing, your blood oxygen levels can drop, which may lead to headaches in the morning. - High blood pressure
Like headaches, apneas can also lead to high blood pressure. When you stop breathing during apneas, your body releases chemicals to wake you up. This can cause your heart rate and blood pressure to spike.
- A dry mouth
Do you find yourself waking up with a dry mouth? This could mean you were snoring or breathing through your mouth while sleeping, which could indicate your airway was obstructed. - Difficulty focusing and remembering things
Sleep deprivation due to apneas can lead to reduced sleep quality, which may make it difficult to focus or remember things during the day. Our brains and bodies need restorative sleep to function optimally. - Waking up exhausted
Ever wonder why you feel exhausted in the morning even though you’re sure you got enough sleep? One of the reasons may be sleep apnea, which disrupts your circadian rhythm, preventing you from getting the restorative sleep you need to feel rested. - Insomnia
Insomnia can be an unexpected symptom of OSA2. When you repeatedly wake up from apneas, it can be difficult to achieve quality sleep. This can lead to a frustrating cycle of not being able to sleep because you’re worried about not sleeping or being jolted awake by apneas. - Sexual dysfunction
Men with OSA may experience sexual issues due to the repeated drop in oxygen levels throughout the night, which can cause testosterone levels to go down.3
Talk with your bed partner
It can be difficult to identify some of the symptoms of OSA yourself. If you have a bed partner, discuss with them what you may be experiencing and let them know to to look out for so they can help you assess your potential risk.
Can obstructive sleep apnea be cured?
While there is no cure for sleep apnea, there are ways to reduce or manage symptoms. These could include adopting a healthier lifestyle, changing certain medications or taking advantage of sleep apnea treatments such as positive airway pressure (PAP) therapy.
Causes of obstructive sleep apnea
People may develop OSA for different reasons.4 There are many lifestyle choices that can put you at risk for developing OSA, including smoking, carrying excess weight, taking narcotics and alcohol use. Physical factors can also lead to a sleep apnea diagnosis. Enlarged tonsils or adenoids, a receding chin or a deviated septum can all cause obstructive sleep apnea symptoms.
Risk factors for obstructive sleep apnea
The following risk factors may increase your chances of developing obstructive sleep apnea:
Excess weight can lead to fat deposits in the upper airway tract, which can cause the airway to narrow while sleeping. Doctors often recommend weight loss as part of the treatment for OSA.5,6
As we get older, our brain’s ability to control our throat muscles may decrease. This can cause the upper airway to partially collapse during the night. The prevalence of sleep apnea is higher in people over 65 years.7
While the exact reasons are not known, men are more likely to develop OSA. This could be down to hormones, the anatomy of the upper airway, aging or even differences in obesity.8
Smoking can cause the upper airway to become inflamed, causing it to narrow and partially close while sleeping.9
Alcohol and sedatives can slow your breathing down and cause your throat muscles to relax to the point where your airway partially closes while you are asleep.9
Not surprising, if you suffer from allergies or nasal congestion, it can be harder to breathe at night. Without medications, you may experience obstructive sleep apnea symptoms.9
Some people may simply be predisposed to developing OSA due to their anatomy. Anatomical factors could include a large tongue, large tonsils or an abnormal bone structure in the upper jaw, lower jaw, face or skull.
Long-term effects of untreated obstructive sleep apnea
Undiagnosed and untreated OSA can have long-term consequences10 for you and those around you, including:
High blood pressure
Cardiovascular disease
Type 2 Diabetes
Stroke
Traffic Accidents
Workplace Errors
Understanding an obstructive sleep apnea diagnosis
Your test results will indicate the severity of your OSA based on what is called the apnea-hypopnea index (AHI).
AHI helps determine if your obstructive sleep apnea is mild, moderate or severe by measuring the number of times per hour that you stopped breathing (apneas) or your breathing was excessively shallow (hypopneas).
AHI Ranges
< 5 Normal
5 – 14 Mild sleep apnea
15 – 29 Moderate sleep apnea
30+ Severe sleep apnea
Obstructive sleep apnea treatment options
While sleep apnea can be serious, the good news is that it is very treatable. Your doctor can discuss treatment options with you based on the type and severity of your condition.11
Positive airway pressure (PAP) therapy is considered the optimal way to treat obstructive sleep apnea. The most common form of PAP therapy is continuous positive airway pressure, or CPAP. The CPAP device delivers a consistent and continuous level of pressurized air through a tube and mask to keep your airway open while you sleep.
Unfortunately, some people cannot tolerate the consistent and continuous level of pressure delivered with CPAP therapy, so alternative treatments may be discussed. One option is APAP therapy, which allows the level of delivered air to adjust based on the person’s needs and only delivers the amount of pressure needed at any given moment.
Another option is a bilevel PAP device, which is a type of CPAP that delivers two different pressure levels—one for inhaling and one for exhaling.
Some people who need alternative types of PAP therapy may have central sleep apnea, a form of sleep apnea in which the brain fails to send a signal to the body to breathe.
Your doctor may recommend lifestyle changes to help manage your obstructive sleep apnea symptoms. This could include weight loss, cutting down on alcohol or giving up smoking.
While CPAP therapy remains the gold standard for treating mild to moderate sleep apnea, your doctor may offer oral appliance therapy as another option. An oral appliance, or a mandibular repositioning device (MRD), holds your lower jaw in a forward position to help keep the airway open and reduce snoring.
Your doctor may look at your medications to try and determine if they’re contributing to your sleep apnea symptoms. Certain medications can exacerbate sleep apnea symptoms by causing the airway to relax and narrow. These may include antihistamines, opiates and benzodiazepines for anxiety.
Allergies and chronic nasal congestion may cause blood vessels in your nose to swell and your airway too narrow. Your doctor might prescribe decongestants to help alleviate symptoms.
While there are surgeries available to help with obstructive sleep apnea symptoms, less invasive treatments are usually the first line of defense. The most common surgery performed in the United States is Uvulopalatopharyngoplasty (UPPP). During this procedure, surgeons remove extra tissue in the throat to open the upper airway.
Other less common surgical options include surgery to remove the tonsils or adenoids, nasal surgery to fix a crooked or deviated septum, jaw surgery to change the position of the jaw, or somnoplasty, which uses radiofrequency to shrink the tissue in the upper airway.
Hypoglossal nerve stimulator therapy (HGNS) is for people with moderate to severe sleep apnea who have failed on CPAP and/or oral appliance therapy.
References:
- Source: The Lancet Respiratory Medicine, 2019, Volume 7 (8), 687-698 DOI: 10.1016/S2213-2600(19)30198-5; https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(19)30198-5/fulltext
- Source: Cho, YW, et al. Comorbid Insomnia with Obstructive Sleep Apnea: Clinical Characteristics and Risk Factors. J Clin Sleep Medicine. 2018 Mar 15; 14(3): 409–417. Published online 2018 Mar 15. doi: 10.5664/jcsm.6988
- Source: Gue Y, et al., Erectile Dysfunction and Obstructive Sleep Apnea: A Review. National Library of Medicine. Front Psychiatry. 2022; 13: 766639. Published online 2022 May 26. doi: 10.3389/fpsyt.2022.766639
- Source: Malhotra, A., et al., 2020. Endotypes and phenotypes in obstructive sleep apnea. Current opinion in pulmonary medicine, 26(6), 609–614. https://doi.org/10.1097/MCP.0000000000000724)
- Source: Epstein LJ, Kristo D, Strollo PJ, Jr., et al. Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med 2009; 5(3): 263-76.
- Source: Hudgel DW, Patel SR, Ahasic AM, et al. The Role of Weight Management in the Treatment of Adult Obstructive Sleep Apnea. An Official American Thoracic Society Clinical Practice Guideline. Am J Respir Crit Care Med 2018; 198(6): e70-e87.
- Source: Bixler EO, et al. Effects of age on sleep apnea in men: I. Prevalence and severity. Am J Respir Crit Care Med 1998; 157: 144–148.
- Source: Lin, CM, et al., Gender Differences in Obstructive Sleep Apnea and Treatment Implications. Sleep Med Rev. Author manuscript; available in PMC 2009 Dec 1. Published in final edited form as: Sleep Med Rev. 2008 Dec; 12(6): 481–496.Published online 2008 Oct 31. doi: 10.1016/j.smrv.2007.11.003
- Source: Kline LR. Clinical presentation and diagnosis of obstructive sleep apnea in adults. In: Collop N, Finlay G, editors. UpToDate. Waltham, MA: Wolters Kluwer N.V.; 2023.
- Source: Knauert, M et al., Clinical consequences and economic costs of untreated obstructive sleep apnea syndrome. World J Otorhinolaryngol Head Neck Surg. 2015 Sep; 1(1): 17–27.Published online 2015 Sep 8. doi: 10.1016/j.wjorl.2015.08.001
- Source: Epstein LJ, Kristo D, Strollo PJ, Jr., et al. Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med 2009; 5(3): 263-76.