Sleep Apnea: Causes, Symptoms, and Treatments
Sleep apnea is a sleep disorder marked by difficulty breathing while you sleep (your breathing slows down or stops completely). These breathing disruptions reduce your sleep quality, causing daytime fatigue. Other potential consequences for untreated sleep apnea include high blood pressure, heart disease, and asthma.
Types of Sleep Apnea
There are three types of sleep apnea:
- Obstructive sleep apnea (OSA) occurs when soft tissues at the back of your throat block your airway. It’s the most common type of sleep apnea.
- Central sleep apnea occurs when the brain fails to communicate with your breathing muscles.
- Complex sleep apnea occurs when a person shows signs of both obstructive and central sleep apnea.
Causes of Sleep Apnea
The physical structure of your throat or a pre-existing medical condition can cause you to develop sleep apnea. Common causes include:
- Obesity, because the extra fat in your neck can block your airway.
- Enlarged tonsils (tonsillitis) that narrow your upper airway. Tonsillitis is most prevalent in children, although adults can develop it.
- Similarly, enlarged adenoids can cause sleep apnea. Adenoids are a patch of tissue in your throat, behind the nose. Enlarged adenoids are more common in children—adenoids grow smaller as we leave childhood and are all but gone as a teen.
- An endocrine disorder, since your endocrine system produces hormones that can affect how you breathe during sleep. Disorders include hypothyroidism, acromegaly, and polycystic ovary syndrome.
- Advanced kidney and heart failure, because fluids may build up and block your upper airway.
Symptoms of Sleep Apnea
Symptoms of sleep apnea include loud snoring, reduced or paused breathing, and gasps for air while you sleep. You may not notice those symptoms if you live alone, but daytime symptoms include morning headaches and dry mouth, trouble concentrating or remembering things, and excessive daytime sleepiness.
Women with sleep apnea tend to report more headaches, fatigue, depression, anxiety, insomnia, and sleep disruptions than men. Children with sleep apnea may wet the bed, experience worsened asthma symptoms, be hyperactive, or have problems with learning and difficulty concentrating at school.
Risk Factors for Sleep Apnea
A risk factor is a variable that increases your risk of developing sleep apnea. Risk factors include:
- Age: While sleep apnea can develop at any age, the risk increases with age.
- Obesity: If you’re overweight and not physically active, you have a higher risk of developing sleep apnea. Particularly if you have a large neck circumference—greater than 17 inches for men and more than 16 inches for women.
- Gender: Men are more likely to develop sleep apnea than women, although the difference between the two decreases as we look at older age groups.
- Premature birth: Babies born before 37 weeks have an increased chance of breathing problems.
- Family history: Genes related to sleep apnea include facial and skull structure, brain controls for sleep and breathing, and obesity and inflammation.
- Race and ethnicity: In the United States, sleep apnea is more common in African-Americans, Hispanics, and Native Americans.
Sleep apnea also increases the risk of developing:
- Heart disease, heart attacks, and heart failure
- High blood pressure
- Pregnancy complications
- Chronic kidney disease
- Eye disorders, such as glaucoma
- Various cancers, such as pancreatic, renal, and skin cancer
- Barrett’s esophagus, where your esophagus tissue becomes more like intestinal tissue
Diagnosing Sleep Apnea
Before diagnosing you with sleep apnea based upon your symptoms, medical history, and risk factors, a doctor will conduct a physical exam and refer you to a sleep specialist for a polysomnogram, which is a sleep study that records bodily functions.
The physical exam will look for signs such as enlarged tonsils, obesity, a large neck circumference, a narrowed upper airway, jaw structure, heart rate, and your tongue size and position.
Your doctor may want to rule out medical conditions that can cause sleep apnea with a blood test and a pelvic ultrasound. Your doctor may also quiz you on recent medications and traveling history—if you visited anywhere with an altitude higher than 6,000 feet, you may have sleep apnea symptoms a few weeks after from spending time in a low-oxygen area.
To diagnose sleep apnea, a sleep study may be done at home or in a specialized sleep center. Sleep center studies can collect more information such as your blood oxygen levels, your brain and heart activity, and apnea events where your breathing slows or stops.
Sleep Apnea Treatment Options
The most common treatment for sleep apnea is a CPAP machine. CPAP stands for continuous positive airway pressure, which perfectly describes how the device increases the air pressure inside your throat to prevent your airway from collapsing. As a bonus, CPAP therapy reduces snoring.
CPAP machines have a variety of mask options—some have masks you can place over your nose and mouth, while others have a more compact mask that goes over the nose or prongs that fit inside your nostrils. It may take a few nights for you to adjust to the mask, particularly if it’s a large one that covers the face and mouth. Your doctor may even recommend a sleep study with your CPAP machine to determine your ideal settings.
If your sleep apnea is tied to obesity, regular exercise and weight loss can alleviate and even eliminate symptoms. Harvard Medical School says experts emphasize pairing weight loss with CPAP therapy to treat OSA.
Sleeping on your side can alleviate symptoms of sleep apnea, as the position prevents gravity from collapsing the soft tissues in the back of the throat. If you’re switching from back or stomach sleeping and need a new mattress for side sleeping, look for a bed with a soft to medium feel.
Oral appliances such as mouthpieces can be custom-fit to open your upper airway. A doctor may prescribe a mouthpiece if you have mild sleep apnea, and you may need to visit a dentist or orthodontist to get fitted for your mouthpiece.
Surgical procedures can alleviate sleep apnea:
- If a child has swollen tonsils or adenoids, a tonsillectomy or adenoidectomy will remove them.
- Uvulopalatopharyngoplasty (UPPP) is a surgical procedure to open up the upper airway by removing soft tissues in the back of the throat—typically all or part of the uvula, part of the soft palate, tissue at the side of the throat, and whatever remains of the tonsils and adenoids.
- Jaw advancement surgery moves the upper and lower jaw forward to increase space in your airway.
- Tracheostomy creates a hole through the neck into your trachea, commonly known as your windpipe. A breathing tube is slipped through the hole and into your windpipe for added breathing. Tracheostomies can be temporary or permanent.
Frequently Asked Questions
Common symptoms of sleep apnea are loud snoring, short periods during sleep where you stop breathing and gasp for air, waking with a dry mouth or headache, frequent wakings in the night, daytime sleepiness, and irritable moods. Not every person with sleep apnea snores, so if you experience other symptoms, talk to your doctor.
Side sleeping is the best for alleviating sleep apnea. However, if you’re a committed back sleeper, you can sleep with your upper body elevated by using a wedge pillow or adjustable bed base.
Did We Help?
If you suspect you have sleep apnea, talk to your doctor about your symptoms, and discuss the possibility of arranging a sleep study. Sleep apnea is treatable with a few lifestyle changes and equipment like a CPAP machine or mouthguard. It may take some time to get used to the feel and sound of a CPAP machine, but getting a better night’s sleep will make it all worthwhile.
This article is for informational purposes and should not replace advice from your doctor or other medical professional.