Sleep apnea is a condition characterized by periodic pauses in breathing during sleep and it affects more than 18 million American adults.
Though sleep apnea on its own may not be immediately life-threatening, it can increase your risk for other health problems including hypertension, diabetes, and heart disease.
There are three types of sleep apnea, each differentiated by the causative factor. Obstructive sleep apnea (OSA) is the most prevalent form, affecting roughly 4% of American women and 2% of American men.
Unfortunately, this condition often goes undiagnosed which further increases the risk for dangerous complications.
In this article, we’ll provide an in-depth view of obstructive apnea including what it is, its symptoms and causes, and how it can be diagnosed and treated.
What is Obstructive Sleep Apnea?
Sleep apnea is a sleep disorder that causes the individual’s breathing to stop and start repeatedly during the course of a night’s sleep.
There are three different kinds of sleep apnea: obstructive sleep apnea, central sleep apnea, and mixed sleep apnea (also known as complex sleep apnea.
Obstructive sleep apnea is characterized by a partial or complete blockage of the airway during sleep while central sleep apnea occurs when the brain temporarily fails to send signals to the muscles responsible for controlling respiration.
Mixed sleep apnea combines the symptoms of both.
Obstructive sleep apnea occurs when the throat muscles relax during sleep, allowing the tongue or fatty tissues in the throat to collapse into the airway, blocking airflow.
When this happens, the restriction of airflow also results in reduced blood flow to the brain which signals the brain to partially awaken from sleep to get the body breathing again.
Pauses in breathing are often followed by loud gasping, snorting, or choking sounds as the individual breaths deeply enough to clear the blockage.
The severity of obstructive sleep apnea is measured by the number and length of pauses in breathing that occur during sleep.
There are three levels of obstructive sleep apnea:
- Mild Obstructive Sleep Apnea – The individual experiences 5 to 14 pauses in breathing per hour.
- Moderate Obstructive Sleep Apnea – The individual experiences 15 to 30 pauses in breathing per hour.
- Severe Obstructive Sleep Apnea – The individual experiences 30 or more pauses in breathing per hour.
Pauses in breathing typically last for 10 to 20 seconds but can last as long as several minutes.
Though the individual may remain asleep through the night, these pauses in breathing affect the depth and quality of that sleep, leading to symptoms such as daytime fatigue and morning grogginess.
What Are the Symptoms of Obstructive Sleep Apnea?
Aside from the pauses in breathing themselves, obstructive sleep apnea has a variety of other symptoms. Snoring is often the first indication of a sleep disorder like obstructive sleep apnea.
Other symptoms of obstructive sleep apnea include the following:
- Daytime sleepiness
- Morning grogginess
- Dry mouth or sore throat upon waking
- Night sweats
- Trouble concentrating
- Forgetfulness
- Depression or irritability
- Restless sleep
- High blood pressure
- Decreased libido
Children can be affected by obstructive sleep apnea as well, though it is difficult to measure the prevalence with any accuracy.
The prevalence of obstructive sleep apnea in children is thought to be at least 2% or 3% up to 10% or 20% of children who snore frequently.
Other symptoms of obstructive sleep apnea in children include the following:
- Choking or drooling in sleep
- Night sweats
- Bedwetting
- Restlessness in bed
- Ribcage collapses during exhalation
- Teeth grinding
- Daytime sluggishness or sleepiness
- Problems at school
- Behavioral problems
- Learning disorders
- Unusual sleeping positions
The symptoms of obstructive sleep apnea may not be immediately life-threatening, but they can contribute to a number of serious complications.
The daytime fatigue and sleepiness that results from interrupted sleep may impact your ability to concentrate at work or school – you may even fall asleep at work, in school, while watching TV, or even while driving.
Children with OSA may develop problems with attention, behavior, and learning in school due to poor sleep.
Another dangerous complication related to sleep apnea is heart disease as well as other cardiovascular issues.
Interruptions in breathing during sleep restrict the flow of oxygenated blood to the brain and other organs which causes an increase in blood pressure and puts excess strain on the cardiovascular system.
High blood pressure or hypertension can increase your risk of heart disease.
The greater the severity of your OSA, the greater your risk of serious cardiovascular complications such as coronary artery disease, heart failure, heart attack, and stroke.
Sleep apnea has been linked to other conditions as well including type 2 diabetes, adult asthma, and acid reflux. Studies have not yet identified a direct link between sleep apnea and type 2 diabetes, though they both share a primary risk factor – obesity – and 80% of diabetics or more also have OSA.
Again, studies have not yet forged a strong link between sleep apnea and adult asthma, but many people who suffer from asthma and sleep apnea improve with treatment.
Treating sleep apnea may also improve symptoms of acid reflux for people who suffer from both conditions.
What Causes Obstructive Sleep Apnea?
Obstructive sleep apnea is caused by the muscles in the back of the throat relaxing too much during sleep, causing temporary restriction of airflow.
The muscles implicated may include the soft palate, the uvula, the tonsils, and the tongue. When these muscles relax, it can cause a pause in breathing lasting anywhere from 10 seconds to several minutes.
The longer the pause, the lower the oxygen levels in your blood may drop, causing a buildup of carbon dioxide which triggers the brain to briefly wake the body from sleep to resume breathing.
Generally speaking, anyone can develop sleep apnea, but there are certain factors which may increase your risk. These include the following:
- Obesity – Roughly two-thirds of people with OSA are overweight or obese. Fat deposits around the airway can lead to obstructions in breathing during sleep.
- Anatomical Abnormalities – Anatomical conditions which may increase your risk for sleep apnea include large tonsils or adenoids, large tongue, narrow palate, men with a collar size 17 inches or more, and women with a collar size 16 inches or more.
- High Blood Pressure – Hypertension or high blood pressure is very common in people with OSA.
- Chronic Nasal Congestion – Regardless of the cause, people with chronic nasal congestion at night have twice the risk for OSA – it may be due to narrowed airways.
- Diabetes – Having type 2 diabetes may increase your risk for sleep apnea and vice versa.
- Smoking and Alcohol – Being a smoker and drinking alcohol at bedtime may increase your risk.
- Sex – Men appear to develop OSA at twice the rate as women.
- Asthma – Research has indicated a link between asthma and an increased risk of obstructive sleep apnea, though the mechanisms of which are still under study.
- Family History – Having family members with obstructive sleep apnea may increase your risk for developing the condition.
If you have one or more risk factors for obstructive sleep apnea, you may want to take a closer look at your sleeping habits.
Ask your partner if they have noticed any OSA symptoms such as pauses in breathing, snoring, and gasping or choking during sleep.
If you’re concerned about your symptoms, talk to your doctor right away.
How is Obstructive Sleep Apnea Diagnosed?
Because some of the symptoms of obstructive sleep apnea can easily be attributed to other things, many people who suffer from this condition remain undiagnosed.
In some cases, it is not the sufferer but someone close to them who is the first to identify the problem.
If your partner notices loud snoring, pauses in breathing, or gasping and choking during the night, you should talk to your doctor about obstructive sleep apnea.
Snoring is a common problem that affects roughly 20% of the American population.
Being such a common problem, snoring is not often considered a serious problem but, in the case of obstructive sleep apnea, it can be.
If your partner notices that you snore loudly, you may want to talk to your doctor just to be safe – especially if it is punctuated by periods of silence throughout the night.
With this condition, snoring tends to be worst when the person is lying on their back, rather than their side.
When you visit your doctor to talk about obstructive sleep apnea, he will need information about your medical history, your symptoms, and your sleeping habits.
He may also need to talk to your partner or anyone who can provide more information about your symptoms during sleep.
In some cases, you may need to complete a sleep study either in a sleep lab or in your home.
During the sleep study, you’ll wear monitors to measure certain metrics including the following:
- Airflow
- Blood oxygen levels
- Breathing patterns
- Eye movements
- Electrical brain activity
- Heart rate
- Muscle activity
During the study, your doctor will be able to determine the severity of your obstructive sleep apnea based on the number of times your breathing becomes impaired per minute.
In addition to this test, your doctor will complete a physical exam to check your mouth, nose, and the back of your throat for extra tissue or anatomical abnormalities.
He may also measure your neck and waist circumferences to assess your risk level for OSA.
What Treatment Options Are Available for Obstructive Sleep Apnea?
Treatment options for obstructive sleep apnea can be divided into three categories: lifestyle changes, therapies, and surgical procedures. The treatment plan your doctor recommends will be determined by the severity of your OSA as well as your risk factors.
Lifestyle changes that may help with the treatment and management of obstructive sleep apnea include the following:
- Losing weight
- Exercising regularly
- Reducing alcohol consumption
- Quitting smoking
- Using nasal decongestants
- Changing sleeping positions
The two most common therapies used to treat obstructive sleep apnea are positive airway pressure and oral devices.
Continuous positive airway pressure (CPAP) therapy is typically administered through a facemask worn at night.
The facemask is connected to a device that delivers gentle airflow which creates enough pressure to keep the airway open at night.
Also Read: Best Sleep Masks
Oral devices can also be worn to keep the throat open by pulling the jaw forward or by holding the tongue in place during sleep.
In some cases, positional therapy such as sleeping on your side rather than your back can improve sleep apnea symptoms.
In severe cases of obstructive sleep apnea, surgical treatment may be required.
Here is an overview of the different surgical procedures which may be considered:
- Uvulopalatopharyngoplasty (UPPP) – This procedure involves removing tissue from the back of the mouth and top of the throat, often with a laser or with radiofrequency energy. In some cases, the tonsils and adenoids may be removed as well.
- Upper Airway Stimulation – For people who can’t tolerate CPAP therapy, a different device can be used to administer upper airway stimulation. This involves implanting a small impulse generator under the skin in the upper chest which detects breathing patterns and, when needed, stimulates the nerve that controls tongue movement to resolve airway blockages.
- Jaw Surgery – A procedure called maxillomandibular advancement involves moving the upper and lower parts of the jaw forward from the other facial bones to enlarge the space behind your tongue and soft palate, reducing the risk of airway obstruction.
- Tracheostomy – This procedure involves making a surgical opening in the neck and inserting a metal or plastic tube, allowing you to breathe directly through your neck to avoid blockages in the throat during sleep. This is usually only used in severe cases when other treatments fail.
- Implants – Typically recommended for mild cases of OSA, this procedure involves implanting three tiny polyester rods in the soft palate to stiffen and support the tissue, reducing upper airway collapse during sleep.
Obstructive sleep apnea is a very common condition and it is also very treatable. Lifestyle changes are the treatment of choice for mild cases of OSA, but severe cases may require additional therapies.
If you’re concerned about the risk of sleep apnea, talk to your doctor sooner rather than later to see what changes you can make to treat the condition or to reduce your risk for developing it.
Disclaimer: The information on this website is not intended to be used as a substitute for professional medical advice, clinical diagnosis, or treatment.
Always seek the advice of your personal physician or another qualified health provider with any questions you may have regarding a medical condition.
