If you're like most people, you've experienced the occasional morning when, despite appearing to get a full night's sleep, you wake up feeling drowsy and unrested. That's not abnormal if it only happens every once in awhile.
However, if you wake up often with drowsiness you can't shake and feel tired every day, it could be a sign that you have sleep apnea.
There are many potential causes of sleep apnea, and each case requires special evaluation to determine what's causing the obstruction. Luckily, there are a variety of treatments and interventions that can help people with all types of sleep apnea sleep better and feel better.
Simple lifestyle changes, home treatments, or surgery can treat or even cure sleep apnea depending on what's causing the condition. In most cases, sleep apnea sufferers can find relief and get better sleep with the assistance of mouthpieces or medical devices such as positive airway pressure (PAP) machines.
While mild sleep apnea can seem like just a minor annoyance at first, it can lead to dangerous complications over time including hypertension and heart disease. It's important not to ignore the symptoms and get proper treatment from qualified health professionals as early as possible if you suspect you might have the disorder.
If you think you might have sleep apnea, this guide will help you get started with understanding the condition and what you can do to get better. However, it's no substitute for talking to a doctor, and if you have symptoms of sleep apnea you need to be diagnosed by a certified sleep specialist so you can get proper treatment right away.
Untreated sleep apnea can have devastating effects on long term health, and it's important for more people to recognize the symptoms and risks of the disorder. This sleep apnea guide will get you started in understanding what sleep apnea is, how it's caused, and what kinds of lifestyle changes and medical treatments are available to treat it.
What is Sleep Apnea?
Sleep apnea is a common, yet serious, sleep disorder that affects at least 9 percent of women and 24 percent of men. It is characterized by difficulty breathing and waking up often during the night while trying to sleep, which leaves sufferers sleepy and fatigued during the day.
Sleep apnea occurs when your body's airways have trouble staying open and become blocked while you sleep. This is often caused by swelled, sagging, or weighed-down throat tissue than narrows and obstructs your airways when you fall asleep and your muscles relax.
Because their airways are narrowed and breathing is more difficult, people with sleep apnea experience frequent pauses in breathing (called apneas) during the night. These lapses in breathing can last just a few seconds or even minutes, and can happen as often as thirty or more times per hour.
This causes people with sleep apnea to snore, gasp, choke, and wake up frequently during the night. However, since this happens while you are asleep, many people are not consciously aware of their symptoms until a friend, spouse, or other family member notices.
The gasping, choking, and frequent waking is very disruptive and makes it impossible to get normal, restful sleep. That's why feeling tired frequently during the day is often the first symptom people with sleep apnea notice.
People with sleep apnea are essentially sleep deprived, which hurts their mood, performance, and overall quality of life. Even if you're unaware of the interruptions to your sleep, it can leave you feeling very drowsy and irritable during the day.
The constant drowsiness can be dangerous, too, because it leaves you prone to mistakes and accidents, which is particularly dangerous when driving on the road or operating heavy machinery.
How Sleep Apnea Affects Your Body
Living with sleep apnea can be difficult, and the condition can negatively affect your health and daily life in many ways.
In the short term, sleep apnea disrupts your sleep and makes you feel fatigued and unfocused. In the long term, sleep apnea puts a tremendous amount of stress on your cardiovascular system and can lead to serious complications.
People with sleep apnea are constantly sleep deprived because frequent episodes of apnea severely disrupt their sleep. The disorder leaves sufferers feeling tired, foggy, and irritable day after day, and can make concentrating and coping with stress difficult.
What makes sleep apnea so serious, however, is that the narrowed airways and frequent pauses in breathing deprive your lungs of oxygen while you sleep. As a result, blood oxygen levels drop, making it difficult for the body supply its organs and tissues with the oxygen they need.
When oxygen levels in your body are low, it puts a lot of strain on your body, and especially your heart, to compensate. When sleep apnea is left untreated this happens for hours night after night, which is very dangerous and can lead to major health problems later on down the line.
Some of the potential long-term effects of sleep apnea include:
- High blood pressure
- Heart disease
- Liver disease
Key Facts about Sleep Apnea
Despite its name, sleep apnea is actually a breathing disorder. Even though it's a sleep-related condition, the most dangerous effects don't come from disrupted sleep, but rather from disrupted breathing.
Narrowed airways and constant apneas leave sleep apnea sufferers struggling to breathe and forces their bodies to cope with low blood oxygen levels every night. This can have dangerous and potentially life-threatening effects on the body over time, which is why it's important to take the diagnosis and treatment of sleep apnea seriously.
Unfortunately, the early symptoms of the disorder are difficult to catch. General symptoms like drowsiness or irritability are easy to ignore or write off, and many other symptoms—like nighttime snoring and choking—happen while you're asleep and not consciously aware.
This makes it difficult for people with sleep apnea to recognize the signs and get early diagnoses. A total of at least five to ten percent of adults in the United States have sleep apnea, but researchers estimate that as many as 80% of them are undiagnosed and not receiving the treatment they need.
While the disorder seems to be more common in men, it likely has to do with their larger average size and weight (having a large neck, for example, increases your risk of sleep apnea.) However, many doctors believe that as obesity rates rise, this gap between the number of men and women with sleep apnea will close.
Sleep Apnea Symptoms
The major symptoms of sleep apnea can be divided into two main categories: daytime symptoms and symptoms that occur while you sleep.
Nighttime symptoms of sleep apnea include regular loud snoring, pauses in breathing, frequent waking, and gasping for air or choking while you sleep. However, most people don't even remember waking up during the night, and don't understand why they feel drowsy and unrested in the morning.
Even though frequent waking could be many things besides sleep apnea, waking up gasping, choking, or feeling breathless is a telltale sign on the disorder. Since many of the most obvious symptoms happen while you sleep, many people with sleep apnea never notice their symptoms until a friend, spouse, or family member does.
The most common daytime symptoms of sleep apnea include drowsiness, morning headaches, irritability, fatigue, trouble concentrating, and even depression. These symptoms are directly related to sleep disruptions and the lack of oxygen caused by nighttime symptoms.
These are the most common symptoms of sleep apnea:
- Sleepiness during the daytime
- Memory issues
- Trouble concentrating
- Morning headaches
- Sore throat and/or dry mouth when you wake up
- Loud snoring, gasping, or choking during sleep
- Waking frequently during the night
- Depression, irritability, or mood swings
Causes of Sleep Apnea
Sleep apnea can be caused by anything that narrows or obstructs your airways while you sleep. Most cases have physiological cause, such as excess weight, inflamed or excess throat tissue, or weakened muscles in the back of the throat. This is known as obstructive sleep apnea (OSA).
However, in very rare cases sleep apnea is caused by a neurological condition instead of a physical one. In this case, the signal that the brain uses to tell the respiratory system to breathe gets temporarily disrupted.
Obstructive Sleep Apnea
When you fall asleep, all of the muscles in your body soften and relax, including the muscles in your throat. In healthy people who don't have sleep apnea, the throat is kept open by special muscles that prevent the airways from collapsing. This allows comfortable, unobstructed breathing during the night.
People who have sleep apnea, however, have difficulty keeping their airways open while they sleep. The airways become severely narrowed and frequently collapse during the night, temporarily blocking their airways and causing lapses in breathing
Common Causes of Obstructive Sleep Apnea
- Large Neck: Sleep apnea is associated with neck size, which is in turn associated with being overweight or obese. People with necks that are at least 16-17 inches in diameter are more likely to have sleep apnea.
- Abnormal Soft Palate: The soft palate is the tissue at the back of the mouth and throat, and abnormalities in this area are a very common cause of sleep apnea. If the soft palate is enlarged, swollen, or abnormally stiff, it can narrow or obstruct the throat and cause sleep apnea. In other cases, some people's soft palates are simply more prone to collapsing.
- Weakened Throat Muscles: Some people's throat muscles are too weak or not properly stimulated when they breathe at night. Without functioning muscles to keep the airways open while you sleep, they frequently collapse, making breathing difficult and causing apnea.
- Abnormal Jaw Structure: People with slight alterations in their jaw structure can be at a greater risk for sleep apnea. It is associated primarily with the lower jaw; having an undersized, narrow, or jutting lower jaw can cause airway obstruction during sleep.
- Abnormal Mouth Structure: Minor characteristics in the mouth, such as an unusually large tongue or enlarged tonsils can obstruct the airways at night, causing sleep apnea.
- Gastroesophageal Reflux Disease (GERD): GERD and acid reflux occur when acidic fluids from the stomach leak up into the esophagus, which is especially likely to happen at night when you lie on your back. This can cause throat irritation and muscle spasms, which are thought to obstruct breathing and cause sleep apnea.
Central Sleep Apnea
Central sleep apnea is caused by problems in the central nervous system (the brain). It happens when signaling in the brainstem gets disrupted, causing the brain to repeatedly fail to send signals telling the lungs to breathe.
People with central sleep apnea experience more severe and abrupt drops in blood oxygen levels. This often causes a violent, uncomfortable awakening, which is why people with central sleep apnea can often remember waking up.
Causes of Central Sleep Apnea
- Heart disease: Heart disease, heart failure, or stroke is a common cause of a condition called Cheyene-Stokes breathing. This causes an irregular breathing pattern and repeated cycles of increased and then reduced airflow. Breathing can become so weak during the reduced airflow cycle that it stops altogether, causing sleep apnea.
- Medications: Some medications, especially opioids, can disrupt breathing patterns or even stop breathing altogether. Drugs that can induce central sleep apnea include oxycodone, codeine sulfate, and morphine sulfate.
- Altitude: Exposure to thin air at high altitudes can cause irregular breathing and a cycle of rapid breathing followed by slow, restricted breathing. This can cause sleep apnea in some people.
- Other Causes: Some cases of central sleep apnea have no obvious cause. These cases are diagnosed as idiopathic sleep apnea.
Since central sleep apnea is very rare, this guide focuses primarily on obstructive sleep apnea. However, most of the information that follows applies to both types and should be generally useful to people with all types of sleep apnea.
How Sleep Apnea is Diagnosed
Sleep apnea can go unnoticed for years since it only affects you while you sleep. This also makes it difficult for doctors to diagnose, since they have to monitor while you are sleeping to know if you have sleep apnea for sure.
Some doctors will diagnose sleep apnea based on symptoms and medical history alone, but often they will ask you to do a sleep study to confirm the diagnosis. That means either doing a home sleep apnea test or spending the night at a sleep study test lab for monitoring.
To do a home sleep apnea test, you take home a small monitor that measures things like your heart rate, breathing, and even blood oxygen concentration while you sleep. Afterward, you give the monitor back to a sleep specialist who will analyze the data to determine whether or not you have sleep apnea.
Sleep Study Test
A full sleep study, also known as a polysomnogram, has to be done in a certified sleep study test center. While this is less convenient than a home test, getting monitored at a sleep study center will give you much more accurate and detailed results.
To do the study, you'll have to check in to a hospital or specialized sleep center where you'll stay the night in a private room. Technicians will hook you up to a variety of equipment so they can monitor you while you sleep.
Most people are able to sleep through the study without much difficulty, even though it might seem strange and somewhat uncomfortable at first. It's worth the time and inconvenience to get an accurate diagnosis, however, and sleep centers can also set you up with a CPAP machine (a nighttime device that helps you breathe) to treat your sleep apnea if the test is positive.
Complications that Occur with Sleep Apnea
Sleep apnea sufferers experience low blood oxygen levels night after night, which can lead to serious complications in the long term. Lets look at some of the major health complications that can result from sleep apnea:
Heart Problems and High Blood Pressure
People with sleep apnea are deprived of oxygen when they sleep, which puts a lot of pressure on the heart and circulatory system. Low blood oxygen levels force the heart to work harder to deliver enough oxygen to all the different parts of the body, straining the cardiovascular system and causing increased blood pressure.
This can be detrimental to cardiovascular health and lead to hypertension, irregular heart rhythms, and heart disease. Because of this, sleep apnea can be life threatening to people with existing heart problems. In the most severe cases, sleep apnea can cause heart attacks, stroke, or even sudden death.
Type 2 Diabetes
Researchers believe that struggling to breathe during the night coupled with low blood oxygen levels can lead to insulin resistance and reduce your body's ability to control your blood sugar. Because of this, sleep apnea leaves you at a higher risk for developing metabolic syndrome and type 2 diabetes.
It doesn't help that many people with sleep apnea are also overweight or obese, which is a major contributing factor to insulin resistance and type 2 diabetes.
People with sleep apnea often show signs of liver dysfunction and scarring, known as nonalcoholic fatty liver disease. The exact cause is unknown, but researchers suspect that low oxygen levels caused by sleep apnea worsen chronic inflammation, which can harm the liver.
One study found that two-thirds of obese, middle-aged adults with sleep apnea also had fatty liver disease that was strongly associated with the disorder. The more severe sleep apnea someone has, the more severe liver disease they are likely to have also.
Liver disease also tends to be associated with high blood pressure and obesity, which can compound the problem in some people with sleep apnea.
Risk Factors for Sleep Apnea
Some preexisting characteristics, such as genetics, age, and body mass index, can put you at a greater risk of developing sleep apnea. Some of these factors, like gender and age, are uncontrollable, but some, like smoking, can be mitigated by healthy habits and lifestyle changes.
Here are some of the major risk factors for sleep apnea:
- Being overweight, especially with a body mass index above 25
- High blood pressure (hypertension)
- Heart disease (common cause of central sleep apnea)
- Opioid medications
- Family history of sleep apnea
- Age (most common between young adulthood and middle age, and in people older than 65)
- Being male (less common in women)
Treatments for Sleep Apnea
Getting treated for sleep apnea is very important for short-term and long-term health. If you think you have sleep apnea, don't wait to see a doctor and figure out a treatment plan.
Proper sleep apnea treatment can improve symptoms immediately, reducing drowsiness and improving overall quality of life. But, most importantly, sleep apnea treatments focus on allowing your body to get enough oxygen at night, protecting you from a host of serious health problems that can result from low blood oxygen levels.
There are a number of different lifestyle changes and home treatments, including mouthpieces and breathing devices, that are effective at treating most cases of sleep apnea. In severe and unique cases, when typical treatments don't work, doctors might recommend surgery as a last resort to eliminate airway obstructions causing the disorder.
One of the most common causes, or major contributors, to sleep apnea is being overweight or obese. The reason for this is that excess weight presses down on your chest and neck as you sleep, which can put pressure on your airways.
The extra pressure can narrow your airways and cause them to collapse and obstruct your breathing. Luckily, this kind of sleep apnea can be reversed with healthy habits and weight loss.
If you are overweight and have sleep apnea, don't be afraid to talk to your doctor or a nutritionist about losing weight. They can help you set up a nutrition and exercise plan and reach a healthy BMI to treat the disorder.
Avoid Alcohol and Sedatives
Many people who have trouble sleeping and wake up frequently during the night turn to sedatives like alcohol and sleeping medication to help them get better sleep. However, if sleep apnea is the culprit behind your nighttime woes, sedatives will only worsen symptoms and disrupt your sleep even more.
Sleep apnea often results from muscles in the back of the throat sagging and narrowing or blocking airways. Sedatives relax and weaken the muscles in your body, including your throat, which makes the sagging and breathing obstruction even worse.
Change Sleep Habits
You're more likely to experience symptoms of sleep apnea when you sleep on your back. That's because the weight of your chest and neck can press down on your airways, causing shallow breathing and apnea.
If you have sleep apnea and have a habit of sleeping on your back, simply switching to sleeping on your side can greatly improve your symptoms. It can be hard to remember this while you're asleep, however, which is why doctors recommend wearing modified pajamas that force you to sleep on your side.
All you have to do is sew a pocket or, alternatively, a sock, to the back of a shirt you can sleep in. Then, before you go to bed, stuff the pocket or sock with a tennis ball. That way, whenever you try to roll onto your back during the night, the tennis ball will make you uncomfortable and remind you to turn back over to your side.
People who smoke have a higher risk of getting sleep apnea. If you smoke more than two packs a day, you are at least 40 times more likely to develop the disorder.
This is likely because smoke irritates the airways, causing swelling and inflammation that can narrow airways and cause obstruction. It's important to quit smoking to reduce your risk for the disease and improve symptoms if you've already been diagnosed.
Wear a Nighttime Mouthpiece
In many cases, special mouthpieces are an effectively first-line treatment for obstructive sleep apnea. They resemble the kinds of mouthguards athletes wear for sports, and there are more than a hundred approved by the FDA to treat sleep apnea.
These oral appliances are most effective in cases where the primary cause of sleep apnea is jaw or tongue mis-alignment. Mouthpieces keep the lower jaw and/or tongue from falling back, and helps prevent the collapse of muscles in the upper airways.
Mouthpieces have an advantage over other treatment options because they are simple, effective, and relatively cheap. In contrast to PAP breathing devices, which are too difficult and uncomfortable for some people to wear at night, mouthpieces are quiet, comfortable, and you can use them anywhere.
Use a Positive Airway Pressure Breathing Device
One of the most effective ways to treat sleep apnea is with a positive airway pressure (PAP) breathing device. This involves using a machine attached to a breathing mask that supplies a constant stream of pressurized air.
It works by directing pressurized air into the throat constantly during sleep, keeping the throat open and preventing the walls of the airways from collapsing. This reduces shallow breathing and prevents apnea, successfully increasing oxygen levels and reducing symptoms of sleep apnea.
There are several different types of PAP breathing machines: BiPAP, CPAP, and VPAP. BiPAP machines provide a stream of air at a single, constant pressure while BiPAP machines supply a different amount of air pressure when you inhale and when you exhale. VPAP machines are even more variable, and automatically adjust the pressure of the air stream while you sleep.
PAP breathing machines can be placed on your bedside table and are compatible with a wide variety of breathing masks. If you use a BiPAP or CPAP machine and have trouble sleeping, finding a more comfortable mask or adjusting your air pressure can make it more comfortable.
Upper Airway Stimulation
Another type of medical treatment for sleep apnea is upper airway stimulation (UAS). It is often recommended to patients who cannot use a PAP breathing machine, either because it doesn't treat their condition or because it is too uncomfortable.
An upper airway stimulation system has three main parts: a handheld remote and two sensor implants. One sensor is implanted in your chest to detect your breathing, while the other sensor is implanted by key muscles near your airways.
To use the UAS system, you simply use the remote to turn on the implanted sensors when you go to sleep at night. While you're asleep, the breathing sensor checks for abnormalities and apnea, and stimulates the muscles in your airways to keep them open and allow you to breathe better.
Sometimes lifestyle changes, mouthpieces, and breathing devices are not enough to improve nighttime breathing and prevent apnea during sleep. In some of these cases it takes surgery to find and correct the obstruction.
There are a several types of throat surgeries that can be used to treat certain kinds of sleep apnea, but none of them are particularly effective. The success of a surgery mainly depends on whether doctors are able to find the exact cause of the sleep apnea and a precise location that can be modified to fix it.
There are many potential areas in the throat and upper airways that can cause sleep apnea, and the disorder cannot be cured unless all the areas are treated. Many people require multiple operations over time to completely correct their sleep apnea.
Uculopalatopharyngoplasty (UPPP), is the most common type of surgery performed for sleep apnea, but it still only has about a fifty percent rate of success.
Sleep apnea is a serious, yet hidden condition that affects an increasing number of Americans every year. As obesity rates continue to rise, it will become an even more prevalent and urgent public health issue.
Luckily, when it's caught, sleep apnea is actually a very treatable condition. There are a variety of treatments, including lifestyle changes, surgeries, and breathing devices that can help you manage or cure the disorder.
It's important not to ignore the signs of sleep apnea if you experience any of the telltale symptoms, especially if you are overweight or have other risk factors. Your doctor will be able to discuss the likelihood that you have the disorder with you and refer you to a sleep center or sleep specialist if needed.
Nobody deserves to feel sleepy day after day and suffer the long-term health consequences of sleep apnea. But with proper treatment and understanding of the disease, you can get the help and support you need for a healthy life and better night's sleep.