What You Need To Know About Obstructive Sleep Apnea

What is obstructive sleep apnea?

Obstructive sleep apnea (OSA) is a type of condition where your breathing involuntarily stops for short periods of time while you're sleeping. Normally, air will flow smoothly from your nose and mouth into your lungs consistently.

When you experience periods where your breathing stops, it's referred to as apneic episodes or apnea. The number of people suffering from OSA continues to increase and has significant safety, health, and economic consequences.

Obstructive sleep apnea is more common in men, individuals over the age of 65 years old, and women after menopause. Children also develop this condition.

When you have OSA, your normal airflow stops repeatedly throughout the night due to your throat's airway being too narrow. Snoring is a common characteristic of OSA. Your airflow must "squeeze" through your narrowed airway, creating snoring sounds.

There are two primary types of sleep apnea: OSA and central sleep apnea. With OSA, your upper airway becomes blocked (partially or completely) while you're sleeping due to anatomical changes.

With central sleep apnea (CSA), however, the problem isn’t a blocked airway. Instead, while sleeping, there are moments when you stop breathing because your brain and your respiratory muscles are not coordinating properly. When your brain's orders to activate the respiratory muscles aren't received, your breathing is disrupted.

Symptoms

There are numerous signs of OSA. You might not be aware you have the condition, but your spouse, a family member, or a close friend might notice you showing signs and symptoms.

Here are common OSA symptoms you might experience while you're sleeping:

  • Snoring that is typically loud and bothersome to those sleeping next to you

  • Choking or gasping sounds

  • Jerky or sudden body movements

  • Pauses in breathing observed by a person watching you sleep

  • Frequent awakenings from sleep, and

  • Restless turning and tossing.

You may also have some symptoms of OSA while awake:

  • Morning headaches

  • Feeling like you haven’t had  enough sleep despite sleeping for many hours

  • Sore or dry throat in the morning due to breathing through your mouth while sleeping

  • Tiredness or fatigue throughout the day, and

  • Daytime sleepiness.

Individuals with OSA also often experience psychological symptoms¹, including anxiety and depression. A related symptom is psychological stress.

Once you receive a diagnosis of obstructive sleep apnea, your doctor will typically address any psychological symptoms either indirectly through the use of continuous positive airway pressure (CPAP) to treat OSA, or directly through anxiety and depression interventions.

Complications of obstructive sleep apnea

Complications can occur with obstructive sleep apnea and it is considered a serious health condition².

Cardiovascular problems

Sudden drops in blood oxygen levels that occur during OSA strain the heart and increase blood pressure. Many individuals with OSA develop hypertension (high blood pressure), which could increase the risk of heart disease.

The more severe the OSA, the higher the risk of:

  • Irregular heartbeat (atrial fibrillation)

  • Heart failure

  • Coronary artery disease

  • Stroke

  • Heart attack

In fact, according to the National Institutes of Health³, with OSA, you have a 140% higher risk of heart failure, 60% higher risk of stroke, and 30% higher risk of coronary heart disease.

Daytime fatigue and sleepiness 

Since individuals with obstructive sleep apnea lack restorative sleep at night, they frequently have severe daytime drowsiness, irritability, and fatigue. They may have trouble concentrating and find they fall asleep while watching television, driving, or while at work.

Young people and children with OSA may perform poorly in school and often struggle with behavior and attention problems.

Eye problems

Research shows an association between OSA and certain eye disorders⁴, like glaucoma. However, doctors can usually treat eye complications.

Complications with surgery and medication 

OSA is also a concern with general anesthesia and specific medications that relax your upper airway and make your OSA worse, such as:

  • Narcotic analgesics

  • Sedatives

  • General anesthetics

If you struggle with obstructive sleep apnea, your breathing problems can become worse after having major surgery, particularly if you were lying on your back and sedated. Individuals with OSA may also be prone to complications following surgery.

Be sure to let the surgeon know you have OSA or are experiencing symptoms related to this condition before you have surgery.

Sleep-deprived partners

If you snore loudly, it can keep your partner from getting quality sleep and this could eventually hurt your relationship. Some partners might decide to just sleep in a different room.

Other conditions 

Individuals with OSA might also experience the following health concerns:

  • Morning headaches

  • Memory problems

  • Frequent urination at night

  • Depression, and

  • Mood swings

Causes

OSA occurs when the back throat muscles relax too much to let you breathe normally. These muscles support certain structures like your tonsils, tongue, soft palate (the roof of your mouth), and uvula (a triangular piece of skin that hangs from your soft palate).

When your muscles relax, it narrows or closes your airway as you breathe in. This stops your breathing for ten or more seconds, potentially lowering your blood oxygen level and causing your carbon dioxide levels to build up.

Your brain recognizes your abnormal breathing and rouses you briefly from sleep so you can open up your airway again. You generally won't remember this because it's so brief. You wake up briefly with impaired breathing that will correct itself fast, within a couple of deep breaths. You might make choking, snorting, or gasping sounds.

This pattern can go on repeatedly five to 30 or more times an hour, throughout the entire night, impairing your ability to achieve the deep, restorative phases of sleep. This will likely leave you feeling sleepy and tired the next day.

Many individuals with obstructive sleep apnea are not even aware of their disrupted, poor-quality sleep.

Risk factors of obstructive sleep apnea

Anyone can develop OSA. However, there are certain factors that can put you at greater risk¹, including:

Excess weight

Many people with OSA are overweight. They accumulate fat deposits surrounding their upper airway that obstruct their breathing. Obstructive sleep apnea can also occur due to certain medical conditions linked with obesity, like polycystic ovary syndrome and hypothyroidism.

Large neck circumference

Having a neck circumference larger than 17 inches for a man and 16 inches for a woman may increase your risk of OSA.

Older age

Your risk of OSA increases as you get older. However, this risk seems to level off between the ages of 60 and 70.

Narrow airway

Narrow airways can be hereditary. Your adenoids or tonsils may also become larger, which block your airway.

High blood pressure

OSA is fairly common in individuals with high blood pressure (also called hypertension).

Chronic nasal congestion

Individuals with consistent nighttime nasal congestion are twice as likely to develop OSA, no matter what the cause is. This is probably due to narrowed airways.

Smoking

If you smoke, you have a higher risk of developing OSA.

Diabetes

OSA may be more common in people suffering from diabetes.

Gender

Generally, men are two to three times at risk for OSA compared to premenopausal women. However, the frequency of OSA increases in women following menopause.

Family history

If you have any family members with OSA, it could increase your risk.

Asthma

There's a link between asthma and the risk of OSA.

Alcohol and certain medications (e.g., sedatives)

Alcohol and certain drugs cause the relaxation of your throat muscles, increasing the risk of OSA. 

Find more information on the causes of sleep apnea here.

Diagnosis

Your doctor will assess your condition based on your symptoms, a thorough exam, and testing. They may refer you to a sleep professional for further assessment.

During the physical exam, the doctor will check your mouth and nose and the back of your throat for abnormalities or any extra tissue present. They may measure your waist and neck circumference and take a look at your blood pressure.

A sleep professional can perform other assessments to diagnose OSA, determine how severe it is, and come up with a treatment plan. The assessment may involve you staying overnight at a sleep center to monitor your breathing and certain other body functions while you sleep.

Testing for OSA

There are some tests your doctor might order to detect OSA, including the following:

Polysomnography

This is a sleep study where you'll be hooked up to certain equipment while sleeping to monitor your:

  • Breathing patterns

  • Lung, heart, and brain activity

  • Blood oxygen levels

  • Arm and leg movements

Sleep professionals may monitor you all night or run a "split-night" sleep study where they'll monitor you only for the first half of the night. If you're diagnosed with OSA, they'll give you CPAP therapy for the second half of the night.

Home sleep apnea test

Your doctor might give you an at-home version of polysomnography, under certain circumstances, to diagnose OSA. This is a test you take home and perform on yourself. It typically involves measurement of your breathing patterns, air flow, blood oxygen levels, and potentially your snoring intensity and limb movements.

Treatments

The goal of sleep apnea treatment is to ensure your airflow isn't blocked during sleep.

For milder cases of OSA, your doctor may suggest lifestyle changes, including:

  • Exercising regularly

  • Losing weight if you're overweight

  • Avoiding sleeping on your back

  • Quitting smoking if you smoke

  • Drinking alcohol moderately, if at all, and not drinking in the hours before your bedtime

  • Avoiding sleeping pills, anti-anxiety drugs, or other sedative medications

  • Using allergy or decongestant medications

If these don't help improve your sleep apnea or if you have moderate to severe OSA, your doctor might then recommend other treatments that can help open up blocked airways including:

Continuous Positive Airway Pressure (CPAP)

CPAP therapy is common and typically the first-line treatment for OSA. It's administered through a mask you wear while sleeping. The mask delivers positive airflow gently to keep your airways open throughout the night. CPAP is a very effective sleep apnea treatment.

Bilevel Positive Airway Pressure (BiPAP or BPAP)

BiPAP devices are used for obstructive sleep apnea in some cases if CPAP therapy doesn't work. BiPAP devices have settings, low and high, that will respond to your breathing. The pressure will change when you inhale and exhale.

Oral appliances

Oral appliances work by changing the position of your jaw, bringing it forward, and therefore opening up the airway and space in the back of your throat. These are fitted by dentists and often must be regularly adjusted. They are useful for snoring and mild OSA. 

Positional therapy

Sleeping on your back can worsen OSA for some individuals. Positional therapy is used to help people with OSA learn how to effectively sleep in other positions.

Surgery

Uvulopalatopharyngoplasty (UPPP) is a surgical procedure that involves the surgeon removing extra tissues from the back of your throat. It's a very common procedure that also helps relieve snoring.

While this can be a very successful surgery, it is important to be aware of surgical complications and that there is a chance it may not eliminate sleep apnea completely.

As a last resort, the surgeon might perform a tracheostomy. During this procedure, the surgeon punctures an opening in your windpipe that bypasses the blockage in your throat.

Other types of surgery might be needed to address structural issues in your face and elsewhere when OSA doesn't respond to treatments like CPAP.

Here's what else you need to know about treating sleep apnea.

Prevention

There are things you can do to help prevent obstructive sleep apnea. For instance, it may help if you:

  • Quit smoking, if you smoke.

  • Stop all use of sleep medications or alcohol (they relax the back throat muscles, which make it more difficult for you to breathe).

  • Sleep on your side, not on your back.

  • Lose weight if you're overweight.

Doctors & specialists

An important first step is recognizing you have OSA. But, where should you turn if you're experiencing symptoms and/or have questions about this disorder?

The following types of doctors and specialists may be involved in your OSA diagnosis and treatment.

1. Primary care doctor

If you have questions about morning headaches, snoring, memory issues, or other sleep apnea signs, you'll first see your primary care doctor. They'll take steps to provide you with a diagnosis and tailor a treatment plan for you.  They might also give you a referral to a specialist.

2. Sleep professional

Sleep professionals have undergone special testing and training for sleep-related disorder diagnoses, including OSA. They often start with another specialty, like neurology or otolaryngology. The best sleep professional for your situation will depend on the cause of your OSA.

3. Ear, nose, and throat doctor

These doctors, also called otolaryngologists, specialize in disorders that involve the structures inside your face and head. They can help if:

  • You have a naturally small airway.

  • Your airways are narrow due to a body part shape.

  • Your tongue or tonsils are large compared to your windpipe opening.

4. Neurologist

When you get older, your brain might have more difficulty signaling the muscles in your throat to stay stiff during sleep. This narrows your airways. In addition, your tongue might relax too much, which affects the amount of air you breathe in. The neurologist focuses on the way your nerves and brain signal muscles, ensuring that there is proper coordination between the systems.

5. Mental health professional (e.g., psychiatrist, psychologist)

In some cases, behavior change by itself could resolve or help treat OSA. Sleeping on your side, losing weight, and quitting smoking could help keep your airways open. Mental health professionals who specialize in behavioral health could help tailor a plan to modify factors like these.

These experts can also assist you in managing the impact of poor quality sleep on mental conditions, including anxiety, depression, and bipolar disorder.

6. Dentist

Dentists don't just work on your teeth. They also have special training in the treatment of sleep-related breathing disorders like sleep apnea. They might be able to fit you with a special oral device that will move your jaw forward so you can breathe easier.

Typically, dentists will work with a board-certified sleep professional to manage your care and oversee your treatment. The dentist will make any necessary changes to your oral device.

7. Surgeon

If your OSA doesn't respond to various treatments like breathing machines, weight loss, or oral devices, you may require surgery. The type of surgical procedure you get will depend on what's causing your OSA. Sometimes, surgeons can perform a simple surgery to stiffen or shrink the tissue in your throat or mouth that's causing the airway blockage.

Other times, they'll need to perform more extensive surgery where they'll remove your tonsils or any extra tissue. In these types of surgeries, they'll provide you with general anesthesia and you'll spend some time in the hospital. It is common to experience discomfort in your throat for about a week or two following the surgery.

Clinical trials for obstructive sleep apnea

Actively recruiting
remedē System Therapy Study
AZ, CA, CO, IL and 8 more locations (US)
Actively recruiting
MCI: CPAP Treatment of OSA (Memories2)
MO, PA, TX, VA (US)
Actively recruiting
A randomized controlled trial assessing the combined effect of acetazolamide and oxygen therapy as a novel treatment for sleep apnoea.
VIC (AU)