You or your partner might think your snoring is normal — and it may be — but it could also be a sign of sleep apnea. Obstructive sleep apnea (OSA) is the most common type of sleep apnea, a disorder that causes you to stop breathing during sleep or that causes breathing to become very shallow during sleep, according to MedlinePlus . The pauses in breathing can last a few seconds or minutes, and typically end with a snort or a choking sound. There are three main types of sleep apnea. As the name suggests, obstructive sleep apnea occurs as a result of a physical blockage that interferes with normal breathing. The muscles in the back of the throat relax as a natural part of sleep, but they may collapse too much for people with obstructive sleep apnea, causing the airway to narrow or close, according to the Mayo Clinic . As a result, airflow is limited, as is the oxygen level in the blood. The individual is startled awake when the body senses an inability to breathe, which is why they may wake up gasping for air. This isn’t just a fluke that happens once or twice during the night. Obstructive sleep apnea is defined as having at least 15 events per hour of sleep or five or more events per hour of sleep plus other sleep apnea symptoms, such as snoring, daytime sleepiness, or gasping and choking in the middle of the night, according to a review published in February 2017 in Neurology Clinical Practice .
Signs and Symptoms of Obstructive Sleep Apnea Symptoms Most people associate sleep apnea with snoring. That link is accurate, though it’s important to note that not everyone who snores has sleep apnea. According to the National Heart, Lung, and Blood Institute , other obstructive sleep apnea symptoms include: Gasping for air during the night Uneven breathing during sleep Sleepiness during the day Dry mouth Headaches Decreased libido Urinating frequently during the night Children can also experience obstructive sleep apnea, though their signs of sleep apnea may be different and can include: Being overactive Excessive bed-wetting Asthma that seems to be getting worse Difficulty concentrating in school
Causes and Risk Factors of Obstructive Sleep Apnea Causes Obstructive sleep apnea is more common among people who are male, are overweight, have small airways, or have a family history of obstructive sleep apnea, according to MedlinePlus. Children are also at risk if they have enlarged tonsils or adenoids. Sometimes the narrowed airway can be due to your anatomy, meaning that the structure of your face and mouth causes the tongue to sit further back in the mouth. Because of this, there is a genetic component to sleep apnea, since your face shape may be similar to that of your family members. “One of the reasons for obstruction is the anatomical structure of the head and neck, which does have a relationship to the structure of the face,” says Colleen Lance, MD , a staff physician in the Sleep Disorders Center at the Cleveland Clinic in Willoughby Hills, Ohio. The narrow airway could also be due to excess body weight. Most (though not all) of people with obstructive sleep apnea are overweight. “Picture the airway like a building that does not have much in the way of scaffolding or support once you lie down and go to sleep at night,” says Dr. Lance. If the airway in your throat is already prone to compromise (say, due to the underlying anatomy of the airway, a change in muscle control, or a change in control of breathing once one falls asleep, which happens naturally), additional fatty tissue in people with more body weight will make that situation worse. According to research , rates of sleep apnea among people who were obese and seeking gastric bypass surgery were as high as 40 percent. The higher the body mass index (BMI), the greater the risk of obstructive sleep apnea; those with a BMI between 35 and 40 had a 71 percent risk and those with a BMI of 60 or higher were at a 95 percent risk. This could be because fat in the neck and around the tongue physically makes the airway smaller. Older people, smokers, and individuals with hypertension, chronic nasal congestion, asthma, or diabetes are also at an increased risk of obstructive sleep apnea, according to the Mayo Clinic . Often, someone might develop sleep apnea because they have several of these listed risk factors. “Apnea occurs for several reasons,” Lance says.
How Is Obstructive Sleep Apnea Diagnosed? Diagnosis It’s easy for some of these symptoms to be ignored. Think about it: If you’re sleepy and have a headache, you might just chalk it up to work or family stress rather than a sleep-related breathing disorder. These vague symptoms, plus the fact that many other symptoms occur while you’re sleeping, are part of the reason why sleep apnea is underdiagnosed. According to the American Academy of Sleep Medicine , about 23.5 million Americans are estimated to be living with obstructive sleep apnea but have not been diagnosed. it may also be because patients don’t normally complain about sleep and focus on other issues during appointments with their healthcare providers, and because snoring has been accepted by many as a cultural norm, says Safia Khan, MD , a sleep disorders specialist and assistant professor in the department of family and community medicine and the department of neurology at UT Southwestern Medical Center in Dallas. “People think snoring is normal even when it’s not normal,” she says. “Snoring may not translate into obstructive sleep apnea, but oftentimes it’s one of the clues.” Diagnosis is relatively simple: Your doctor will likely order a polysomnography, a sleep study that measures your breathing, heart rate, oxygen levels, brain activity, and eye and leg movement as you sleep, according to Stanford Medicine . This is often done at a sleep center or can sometimes be done at home. This sleep study can determine if you’re waking up throughout the night, but it cannot pinpoint where the obstruction is located. Further tests can do that, including a nasopharyngoscopy and a sleep endoscopy. Both of these tests use an endoscope to see why the airflow is being compromised. The sleep endoscopy involves light sedation. Prognosis of Obstructive Sleep Apnea According to an article updated in June 2022 in StatPearls , the short-term prognosis of obstructive sleep apnea is good. The trouble is that many people don’t keep up with their sleep apnea treatment. Half of people stop using a continuous positive airway pressure (CPAP) device within one month, according to the StatPearls article. Dr. Khan says that some people have a hard time sleeping with a mask and being hooked up to a machine all night. She adds that these individuals may opt for another treatment or no treatment at all. You don’t want to stop sleep apnea treatment early, however. Obstructive sleep apnea is important to manage, since if it’s left uncontrolled over a long period of time, it can raise the risk of heart issues and elevated blood pressure, according to Johns Hopkins Medicine . It can also increase the risk of accidents and stroke, alter heart function, and ultimately shorten life expectancy. If left untreated, it can lead to anxiety, depression, loss of interest in sex, and poor performance at work or school, according to the MedlinePlus .
Duration of Obstructive Sleep Apnea Duration To cure obstructive sleep apnea, something would need to change with the anatomy of the airway, Lance says. “For adults, the most effective way to change airway anatomy would mean weight loss or possibly surgery.” She adds, however, that these usually result in an improvement in sleep apnea symptoms rather than a complete cure. “Reversal altogether is something we generally don’t see,” Khan says. “Typically, patients will have sleep apnea for the rest of their life.” If you use CPAP to manage your sleep apnea, chances are that you will always need to use it. Symptoms may become less severe over time, however. “Losing weight will help improve sleep apnea,” Khan says. “Sometimes aging brings on changes in jaw structure that make it better or sometimes worse.”
Treatment and Medication Options for Obstructive Sleep Apnea Treatment The good news is that treatment can dramatically improve outcomes and reduce the risk of complications for people with obstructive sleep apnea. There aren’t drugs or oral medications that help with sleep apnea. Depending on your specific case and the severity of your issues, treatment can involve lifestyle changes, wearing a device that keeps your airway open while you sleep, or even surgery. Lifestyle and Behavioral Changes That Can Help A few lifestyle tweaks may be able to either reduce symptoms of sleep apnea or reverse the condition altogether. According to Stanford Medicine , these include: Changing Your Sleep Position Some people only experience symptoms when sleeping on their backs. Sleeping on your side could be better and reduce or resolve symptoms. Not sure how to teach yourself to reposition? Sew a tube sock stuffed with two or three tennis balls to the back of your shirt, making it uncomfortable to sleep on your back. Losing Weight Starting a new diet or exercise routine may seem daunting if you’re tired from the interrupted sleep you’ve been getting. But losing weight could improve your symptoms, though not if there are physical reasons you’re having trouble breathing. Avoiding Alcohol and Sedatives These can relax the muscles in the airway, leading them to collapse while you’re sleeping. “These changes can definitely help — especially for those with mild sleep apnea,” Khan says. Treatment Options The most common obstructive sleep apnea treatment is a CPAP device. According to the American Thoracic Society (PDF), this device keeps your airway open by blowing air into a mask worn over your nose and mouth while you sleep. This is the gold standard in treating obstructive sleep apnea, but some people stop using the device because it can lead to a dry mouth, nasal congestion, and eye irritation, according to a review published in February 2017 in Neurology Clinical Practice . Alternative and Complementary Therapies Mouth pieces can help keep your airway open. Considered an alternative therapy, according to UpToDate , these devices work by keeping either your jaw forward or the tongue from blocking the throat. Your doctor may suggest one of these if your symptoms are mild to moderate and you have trouble using the CPAP. “Patient satisfaction is high with these,” Khan says. Surgery and Other Procedures If the issue stems from tonsils or adenoids blocking your airway, surgery may be done to take them out. Surgery may also be recommended to move the tongue forward or clear out tissue from the throat. Surgery is generally a last resort if other options have failed. “We typically reserve surgery for when people have already tried other treatment modalities and have not been successful,” Lance says. “Surgeries for apnea usually reduce apnea without curing it.” Lance adds that individuals with moderate to severe apnea who have tried CPAP and failed, have a BMI less than 32, and have a particular pattern of collapse as determined by a sleep endoscopy may be candidates for hypoglossal nerve stimulation. “This is a surgically implanted device similar to a heart pacemaker,” Lance says. “It stimulates a nerve each time you breath while sleeping, moving the tongue forward with each breath.” There is also a new option called eXciteOSA , Khan says. It’s available through medical professionals and is not covered by most insurance plans. “It stimulates the muscles in the tongue and upper airway, and it works out the muscles,” Khan says. You use it while awake for 30 minutes, and it opens the airway enough for it to help with mild sleep apnea.
Prevention of Obstructive Sleep Apnea You don’t have control over some obstructive sleep apnea risk factors, such as the physical anatomy of your mouth and airways, but there are some that you can change. Minimizing those risk factors is the best way to prevent obstructive sleep apnea. Lance suggests: Eating a healthy diet and exercising to maintain a healthy weight Avoiding sleeping on your back Treating underlying nasal allergies Avoiding alcohol, sedatives, and painkillers near bedtime “If there is suspicion, testing is key in order to guide therapy or prevention,” Lance says.
Complications of Obstructive Sleep Apnea Complications Unfortunately, obstructive sleep apnea can lead to serious complications, particularly if left untreated. According to the Cleveland Clinic , it can contribute to risk of: Hypertension stroke Heart failure Arrythmias Cardiomyopathy Diabetes Obesity Heart attack The link between obstructive sleep apnea and heart trouble is because people with sleep apnea typically have higher blood pressure because pauses in breathing cause lowered oxygen levels at night, change pressure in the heart, and increase inflammation.
Research and Statistics: How Many People Have Obstructive Sleep Apnea? Research and Statistics Nearly 30 million Americans have obstructive sleep apnea, according to the American Academy of Sleep Medicine . It’s more common in men — 14 percent of men have the condition compared with 5 percent of women. Obstructive sleep apnea affects between 2 and 9 percent of Americans, according to the Sleep Foundation . As mentioned, it often goes undiagnosed, so these numbers may be even higher in reality.
BIPOC and Obstructive Sleep Apnea BIPOC While people from any ethnicity can develop obstructive sleep apnea, research has shown that it’s more common among specific Black, Indigenous, and People of Color (BIPOC) groups. This may be due to the higher rates of obesity among these groups, according to a review published in February 2016 in Sleep Medicine . Or it could be due to different jaw and tongue structures that make the airways more susceptible to collapse, Khan says. Though these disparities exist, they are not well understood and require further research. Black Americans and Obstructive Sleep Apnea Black Americans experience a burden of sleep apnea symptoms, primarily daytime sleepiness, according to the Sleep Medicine review. Some research suggests that Black Americans may develop hypertension more quickly in response to obstructive sleep apnea. Black Americans often receive a late diagnosis and don’t respond as well to treatment, partly due to more resistance to using a CPAP machine. Black American children are also at increased risk. They are up to 6 times more likely than white American children to develop obstructive sleep apnea and have a 20 percent increase in severity of symptoms, according to the review. Some physical reasons contribute to the increased risk of obstructive sleep apnea among Black Americans, including face shape and tongue size. Khan notes that Black Americans may be more likely than people of other races to have larger tongues with a high arch. Hispanic Americans and Obstructive Sleep Apnea According to a study published in April 2022 in PLoS One , the prevalence of obstructive sleep apnea is about 34 percent among Hispanic men and 18 percent among Hispanic women — rates that are significantly higher than those in the general population. The prevalence of obesity among Hispanic Americans is high, which may contribute to why they experience obstructive sleep apnea in higher numbers. Hispanic Americans may also be more likely to have larger tongues that can interfere with the open airway, Khan says. Native Americans and Obstructive Sleep Apnea Native Americans are more likely than white Americans and Asian Americans to be obese and therefore are at an increased risk of developing obstructive sleep apnea. According to the U.S. Department of Health and Human Services Office of Minority Health , American Indian or Alaska Native adults are 50 percent more likely to be obese than non-Hispanic white Americans. There is not much research surrounding obstructive sleep apnea and Native Americans specifically, though one study found that the odds of moderate to severe obstructive sleep apnea were 1.7 times higher among Native Americans than white Americans.
Conditions Related to Obstructive Sleep Apnea Related Conditions Obstructive sleep apnea is connected to several other conditions and health factors: Cardiovascular Disease The prevalence of obstructive sleep apnea is between 40 to 80 percent among patients with high blood pressure, heart trouble, or stoke, according to an article published in July 2021 in Circulation . Obstructive sleep apnea (particularly when poorly managed) can increase the risk of several heart problems. Type 2 Diabetes People with type 2 diabetes were 48 percent more likely to have obstructive sleep apnea than those without diabetes, according to a study published in May 2019 in Diabetes Care . The relationship isn’t well understood. The researchers said it could be due to the increased obesity rates among people with type 2 diabetes; obesity, diabetes-related foot disease, and insulin treatment were all predictors of obstructive sleep apnea among people with type 2 diabetes. Reduced Cognitive Functioning This association is debated among experts, but a review published in December 2021 in Behavioral Sciences found that obstructive sleep apnea resulted in poor cognitive performance. CPAP use can improve these deficits, though. There isn’t conclusive evidence, but researchers have postured that untreated sleep apnea could raise the risk of dementia, given this link to cognitive deficits. Researchers continue to investigate the connection. COVID-19 A meta-analysis published in June 2021 in Sleep Medicine found that people with COVID-19 who had obstructive sleep apnea experienced more severe cases and higher mortality rates. These patients should be closely monitored. Opioid Use Nearly 60 percent of people taking opioids to manage chronic pain also experienced sleep apnea, with obstructive sleep apnea being the most common type experienced by 72 percent of those individuals, according to a study published in 2019 in BMJ Open Respiratory Research . The researchers noted this could be due to relaxed airways and weaker breathing while on the drugs. Increased Accidents Research found that having obstructive sleep apnea increased the risk of car accidents by 2.5 times. Severity of excessive daytime sleepiness (a common sleep apnea symptom) was a predictor of accident risk.
Q & A’s
Resources We Trust Mayo Clinic: Pediatric Obstructive Sleep ApneaCleveland Clinic: Obstructive Sleep ApneaStanford Medicine: Treatments for Obstructive Sleep Apnea (OSA)StatPearls: Obstructive Sleep ApneaAmerican Lung Association: Treating and Managing Sleep Apnea
