Sleep apnea: causes, symptoms, treatments, and how it impacts you

Sharon Brandwein
A woman sleeps with a breathing machine to treat sleep apnea.
Sleep apnea interferes with sleep and can be a serious health concern for millions of Americans. (Getty Images) (grandriver via Getty Images)

Along with diet and exercise, sleep is the third pillar of health. And frankly, a good night's sleep is often the answer to whatever ails you. But for 30 million people in the United States, sleep apnea turns a good night's sleep into a pipe dream.

If you have sleep apnea, nightly breathing interruptions disturb your sleep and leave you gasping for air. Add to this the loud snoring linked to sleep apnea, and you have a formula for poor-quality sleep and some morning side-eye from your partner.

Sleep apnea is a sleep disorder that causes sleepers to repeatedly stop breathing throughout the night. "This often results in a drop in blood oxygen levels and brief yet frequent awakenings from sleep," says Dr. Audrey Wells, a board-certified sleep and obesity medicine physician and adviser at CPAP.com, a website devoted to CPAP (continuous positive air pressure) therapy.

Pulling back the covers a bit further, Wells tells Yahoo that there are three types of sleep apnea.

  • Obstructive sleep apnea (OSA). This is the most common type of sleep-disordered breathing. According to Wells, OSA occurs when the "muscles of the tongue, soft palate or other soft tissues become relaxed during sleep and collapse into the back of the throat or airway." Collapses can be partial (hypopnea) or complete (apnea). Apneas can last anywhere from 10 to 20 seconds per episode, and depending on the severity of the condition, they may happen hundreds of times per night. Obstructive sleep apnea is more prevalent in males than females; however, menopause is a known risk factor for women.

  • Central sleep apnea (CSA). This occurs "when the brain isn't signaling properly to the muscles that control your breathing," says Wells. "It is much less common than OSA and can be a result of certain conditions, such as heart failure, stroke, neuromuscular conditions or the use of opioid pain medications."

  • Treatment-emergent central sleep apnea (TECSA), also known as complex sleep apnea, is a type of sleep apnea that typically develops when a patient starts CPAP therapy for OSA. This can occur when CPAP machine air pressures are too high (more on that a little later). TECSA is uncommon, and predicting who may develop the condition is difficult. It often resolves on its own.

One of the most common risk factors associated with sleep apnea is obesity. But Wells cautions that it's not just the number on a scale — patterns of weight distribution matter too. She explains that although fat deposits in the upper airway, tongue and neck can increase the risk of airway obstruction during sleep, people who carry weight in their midsection aren't necessarily off the hook. Those extra pounds can also impair breathing and the ability to keep the airway open while asleep.

While it's estimated that at least 20% of people diagnosed with OSA are not obese, Wells tells us that "recognizing the relationship between sleep apnea and weight is still important because weight is a modifiable risk factor."

Wells adds: "Age is another significant contributor to sleep apnea risk. In this case, repeated airway collapses are related to multiple factors, including laxity of the tissues in the upper airway, potential changes related to neuromuscular control of breathing and hormonal changes."

Dr. Christopher Allen, a board-certified sleep medicine physician, pediatric neurologist and sleep science adviser for Aeroflow Sleep, tells us that in addition to a family history of sleep apnea, other causes of obstructive sleep apnea may include:

  • A naturally narrow airway

  • Chronic nasal congestion

  • Smoking

  • Alcohol use

There's a significant overlap between the symptoms of obstructive sleep apnea and central sleep apnea. It's important not to try self-diagnosis — leave your diagnosis to the experts. Some of the more common symptoms of OSA and CSA include:

  • Loud snoring

  • Pauses in breathing during sleep

  • Frequent nighttime awakenings

  • Gasping or choking during sleep

  • Fragmented sleep and restlessness

  • Dry mouth or sore throat upon waking

Unfortunately, that's not the end of it. The effects of sleep apnea can bleed into your waking life as well. Daytime symptoms may include:

  • Morning headaches

  • Difficulty concentrating

  • Irritability or mood changes

  • Impaired memory

  • Reduced motivation

"Sleep issues represent a blind spot in health since you are unconscious while sleeping," says Wells, who notes that "even with an attentive bed partner, conditions like OSA can go unrecognized." Ultimately, she urges people to seek medical help if they experience any of the symptoms outlined above or notice those symptoms in their bedmates.

While we already know that sleep apnea can lead to daytime fatigue, irritability and difficulty concentrating, Allen tells us that long-term complications of untreated or under-treated sleep apnea may include high blood pressure, heart disease, stroke, diabetes and depression. Moreover, he adds that uncontrolled sleep apnea can also increase the propensity for accidents as a result of increased daytime fatigue and can lead to metabolic syndrome — a cluster of conditions that increase the risk of heart disease and other health problems.

Dr. Anthony Izzo, Sleep Center medical director at Community Neuroscience Services, explains that sleep apnea is usually diagnosed with a sleep study, also called a polysomnography test.

Sleep studies are typically conducted in a clinical setting and require an overnight stay in a sleep lab. During the study, patients are hooked up to a series of monitoring devices that record brain activity, eye movements, heart rate, breathing patterns and blood oxygen levels and are under observation by sleep technicians.

"To diagnose sleep apnea on a home or in-lab sleep test, we count the number of disturbances in a patient's breathing and divide it by the amount of time they slept to come up with a per-hour average of respiratory disturbances, called the 'AHI,'" says Izzo, referring to the Apnea-Hypopnea Index. "This metric helps your doctor determine the severity of your sleep apnea and can help guide treatment choices." Obstructive sleep apnea can be categorized as mild, moderate or severe.

  • Mild sleep apnea: 5-15 apnea or hypopnea events per hour

  • Moderate sleep apnea: 15-30 events per hour

  • Severe sleep apnea: 30+ events per hour

"The first line of therapy for OSA is continuous positive airway pressure (CPAP)," says Izzo. He explains that CPAP delivers lightly pressurized air through a mask without additional oxygen. There are various types of CPAP masks, such as those that fit under the nose, cover the entire nose, or encompass both the nose and mouth. The choice of mask style is based entirely on individual preference, not the severity of sleep apnea.

While CPAP is regarded as the gold standard for OSA treatment, compliance is a significant challenge for most people. According to Izzo, many people initially find CPAP difficult to adjust to, but over time, they experience such improvements in their sleep that they can't imagine sleeping without it.

Other treatments for obstructive sleep apnea include:

  • Custom-made mouth guards: Mandibular advancement devices, as they're also known, are usually reserved for mild or mild-to-moderate sleep apnea.

  • Hypoglossal nerve stimulators: These surgically implanted devices are used for moderate-to-severe sleep apnea.

  • Lifestyle changes: Weight loss can reduce excess tissue around the airway, minimizing obstruction. Avoiding alcohol and smoking also helps by preventing airway relaxation and reducing inflammation.

  • Positional therapy: This involves encouraging side sleeping to keep the airway open. Methods include positional devices, alarms and behavioral techniques to prevent back sleeping.

While Allen acknowledges that untreated sleep apnea can lead to serious health complications, he says people can lead normal, healthy lives as long as they manage their symptoms.

Moreover, he adds that while adapting to CPAP or other treatments may take time, consistent use and adherence to those options can improve quality of life.

"Given that sleep apnea can be a structural or neurological condition, there are no home remedies for the disorder per se," says Allen. "However, lifestyle modifications, like losing weight, exercising regularly and sleeping on your side, may help decrease the severity or alleviate symptoms."

Sleep apnea is a serious and chronic medical condition that requires ongoing care and management.

While there is no outright cure for most cases, it can be effectively managed with treatment and lifestyle changes.

Untreated sleep apnea can lead to a host of symptoms over the short and long term. Short-term issues associated with the condition are fragmented sleep, difficulty concentrating, irritability or mood changes and impaired memory. Long-term health issues associated with untreated sleep apnea include high blood pressure, heart disease, stroke, diabetes and depression.

A continuous positive airway pressure (CPAP) machine is considered the gold standard for treating sleep apnea. The machine delivers a steady stream of air through a mask worn over the nose or mouth, keeping the airway open and preventing apneas, or temporary cessation of breathing.

Consistent CPAP usage may improve sleep quality and reduce the risks associated with sleep apnea.

  • Audrey Wells, board-certified sleep and obesity medicine physician and adviser at CPAP.com

  • Christopher Allen, board-certified sleep medicine physician, pediatric neurologist and sleep science adviser for Aeroflow Sleep

  • Anthony Izzo, Sleep Center medical director at Community Neuroscience Services in Worcester, Mass.

Advertisement