What you need to know about sleep apnea

Do you struggle to stay alert during your waking hours, slogging through the day feeling tired, even after logging a full night in bed? If so, you may have sleep apnea.

Many people have sleep apnea without even realizing it. In fact, it’s one of the most common sleep disorders, affecting more than 22 million Americans.

Here’s what you need to know about sleep apnea, including symptoms to watch out for and ways to treat it.

What is sleep apnea?

When you have sleep apnea, your breathing is interrupted in bouts of 10 seconds or more throughout the night. Although you may partially awaken from sleep each time as you struggle to breathe, you typically wake up in the morning without remembering these episodes.

The most common type of sleep apnea is obstructive sleep apnea (OSA). When you have OSA, the muscles in the back of your throat relax, causing your upper airway to narrow and become blocked. This reduces or stops the flow of air and decreases the amount of oxygen that reaches your body. When your brain detects that you are unable to breathe, you wake up briefly, gasping or choking in an attempt to reopen your airway. Waking up repeatedly this way makes it difficult for you to reach the deeper phases of sleep that provide rest and recuperation.

The other kind of sleep apnea is central sleep apnea (CSA), when the brain doesn’t send the proper signals to your muscles to breathe. This causes slower or more shallow breathing and may cause you to skip breaths. Most people with sleep apnea have a combination of OSA and CSA.

What are the symptoms of sleep apnea?

Most people with sleep apnea are excessively sleepy during waking hours. They may also have restless sleep, loud snoring (with periods of silence followed by gasps), morning headaches, trouble concentrating, irritability, forgetfulness, mood or behavior changes, anxiety, and depression. Sometimes, only your partner notices the snoring, stoppages in breathing, or gasping you experience during sleep.

If you have even a few of these symptoms, you should talk to a healthcare provider (HCP) about getting screened for sleep apnea.

What are the consequences of sleep apnea?

Excessive daytime sleepiness is one of the main symptoms, and it’s also one of the most dangerous consequences of sleep apnea. If you don’t get enough rest at night, you may fall asleep at critical times during the day, such as while driving or operating heavy machinery.

Sleep apnea also appears to increase the risk for strokes and transient ischemic attacks (also known as ministrokes). It’s also associated with coronary heart disease, heart failure, irregular heartbeat, heart attack, and high blood pressure. Undiagnosed or untreated sleep apnea can also contribute to conditions such as glaucoma, diabetes, cancer, and cognitive and behavioral disorders.

What factors increase the risk of sleep apnea?

Some things that increase your risk of sleep apnea are outside your control, such as your family history, age, or sex. (Older people and men are more likely to develop it.) Your anatomy may also play a role, because the size and shape of your neck, jaw, tongue, and throat can affect airflow.

There are also some risk factors that you have some control over:

• Drinking alcohol relaxes the muscles in the mouth and throat, closing the upper airway. It can also affect how the brain controls sleep and the muscles involved in breathing.
• Smoking can cause irritation in the upper airway and may also affect how the brain controls sleep and the muscles involved in breathing.
• Being overweight or obese can narrow the airway. Unhealthy eating and lack of physical activity may contribute to overweight and obesity.

Sleeping on your back can also make it easier for the tissues in your throat to collapse, blocking your airway.

If you are concerned about having risk factors for sleep apnea, talk with a HCP about ways you can adjust your lifestyle, such as by developing a healthy diet, aiming for a healthy weight, quitting smoking, and limiting alcohol intake. Your HCP may recommend that you sleep on your side and adopt other healthy sleep habits so you can get the recommended 7 to 9 hours of sleep each night.

How do HCPs screen for sleep apnea?

If an HCP suspects you may have sleep apnea, they may refer you to a sleep specialist or a center for a sleep study. Sometimes, these studies are done at home.

Sleep studies have a range of benefits. They can:

• Detect times when breathing stops or slows
• Detect abnormal activity in the muscles that control breathing
• Monitor oxygen in the blood
• Monitor electrical activity in the brain and heart

Whether you are diagnosed with mild, moderate, or severe sleep apnea is based on the number of sleep apnea events (or instances in which you briefly stop breathing) that occur in an hour during the sleep study.

• Mild sleep apnea involves 5 to 14 apnea events in an hour.
• Moderate sleep apnea involves 15 to 29 apnea events in an hour.
• Severe sleep apnea involves 30 or more apnea events in an hour.

Additional tests may be ordered to rule out other medical conditions that can cause sleep apnea.

What are the treatments for sleep apnea?

There are a variety of treatments for sleep apnea, depending on a person’s medical history and the severity of the condition. Lifestyle changes that may help improve the condition include:

• Avoiding alcohol
• Avoiding medications that relax the central nervous system (such as sedatives and muscle relaxants)
• Losing weight
• Quitting smoking

Some people benefit from using special pillows or devices that keep them from sleeping on their backs. Oral appliances can be used to hold the lower jaw forward to keep the airway open and to prevent the tongue and muscles in the upper airway from collapsing and blocking the airway.

The most widely used treatments for moderate and severe cases of sleep apnea are positive airway pressure machines. Typically used with a mask, a positive airway pressure machine allows pressurized air to flow into the throat to keep the airway open. Devices include:

• CPAP (continuous positive airway pressure)
• BiPAP (bilevel positive airway pressure)
• VPAP (variable positive airway pressure)
• APAP (automatic positive airway pressure)

If you have severe obstructive sleep apnea that is caused by obstruction to the upper airway, such as due to large tonsils or adenoids, you may need surgery to correct the problem. Surgical procedures include uvulopalatopharyngoplasty (UPPP) to remove tissues at the back of the throat or jaw advancement to enlarge the airway.

Nerve stimulators may sometimes be used to deliver mild stimulation to certain muscles that open the airways. Occasionally, medications may be helpful, but these should only be used with the advice of an HCP.

Some people may need a combination of treatments to improve their condition and to help them get back to sleeping soundly.