Sleep Apnea

Overview

What is Sleep Apnea?

Sleep apnea is a common sleep disorder that affects more than 20 percent of people in the United States. It happens when your breathing temporarily stops while you sleep. Depending on the severity of your condition, your breathing may stop up to 30 times per hour — possibly more.

When you stop breathing, your organs quickly become oxygen-deprived. Your brain notices what’s happening and wakes you up to restart your breathing. Although you’re waking up repeatedly throughout the night, you’re unlikely to remember these events. A sleep partner, however, may notice you gasping for air as you awaken.

Other symptoms you or a partner may notice include:

There are two main types of sleep apnea:

Untreated sleep apnea can lead to serious health conditions.

Moderate to severe sleep apnea can increase your risk of:

You might also notice sleep apnea side effects like impaired mental function or mood disorders.

Because your sleep is so regularly disrupted, you’re also more at risk of daytime drowsiness, falling asleep at the wheel, and car accidents.

• Loud snoring
• Excessive daytime sleepiness
• Morning dry mouth
• Irritability
• Headache
• Obstructive sleep apnea (OSA). This is the most common type of sleep apnea. It happens when your airway becomes blocked or collapses during sleep.
• Central sleep apnea. Less common, this happens when your brain doesn’t send the right signals to your body to breathe.
• High blood pressure
• Heart failure
• Cardiovascular disease
• Stroke
• Fatty liver disease

Symptoms

Symptoms of Sleep Apnea

Symptoms of sleep apnea include:

During the day, you might notice:

It’s difficult to notice the symptoms of sleep apnea at night. If you sleep with a partner, ask them to look out for signs of sleep apnea, like snoring, snorting, and pauses in your breathing. If you sleep alone, talk with a doctor about participating in a sleep study.

It’s also worth noting that while snoring is a common symptom of sleep apnea, not everyone with sleep apnea snores. So, you should still speak to a healthcare professional if you notice other signs of sleep apnea.

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• Stops and starts in your breathing while sleeping
• Loud snoring
• Waking up with a snort, gasp, or choking sound
• Waking up often to urinate
• Waking up with a dry mouth or headache
• Excessive daytime sleepiness
• Trouble concentrating
• Mood changes
• Sexual dysfunction
• Decreased libido
• Falling asleep while watching TV, reading, working, or even sitting on the toilet

Causes

Causes of Sleep Apnea

Sleep apnea sounds a little scary — I mean, you stop breathing. So, what’s actually going on here? The cause depends on the type of sleep apnea you have.

Most people with sleep apnea have obstructive sleep apnea. This happens when your airway collapses or becomes temporarily blocked during the night. This can happen because:

Central sleep apnea happens when your brain doesn’t send the right signals to your muscles to breathe. Causes include:

• The muscles in your mouth and throat relax too much
• Your tongue falls backward during sleep
• You have large tonsils or adenoids (glands at the back of your throat)
• You have a thick neck or excess fat in the neck area
• Stroke
• Brain infection
• Conditions affecting the neck
• Medications like narcotic painkillers
• Being at a high altitude

Risk Factors

Risk Factors for Sleep Apnea

There are several risk factors for sleep apnea. These include:

• Obesity. If you have excess weight or obesity, you may have more fat deposits in your neck that can put pressure on your airway.
• Being male. Men are more likely to have sleep apnea.
• Drinking alcohol. Alcohol can cause the muscles in your mouth and throat to relax, which can block your airway.
• Smoking. Smoking can cause inflammation in your airway, making it narrower. Both alcohol and smoking can affect how your brain controls your breathing muscles.
• Age. As you get older, fatty tissue can build up in your tongue and neck, making them more likely to block your airway. Age can also affect how your brain controls your breathing, upping your odds of central sleep apnea.
• Genetics. If you have a family history of sleep apnea, you’re more likely to develop the sleep disorder yourself. Plus, genetics influence the size and shape of your airway and face.
• Changes in hormone levels. People with low thyroid hormone levels or high levels of insulin or growth hormone are more likely to have sleep apnea. Changes in hormone levels can affect the size and shape of your airway, tongue, and face. Hormonal changes during pregnancy and during and after menopause can also increase your risk of sleep apnea.
• Health conditions. Heart and kidney failure can cause a build-up of fluid in your neck, which could cut off your breathing. Conditions like stroke, amyotrophic lateral sclerosis (ALS), and myasthenia gravis can affect how your brain controls your breathing.

Diagnosis

Diagnosing Sleep Apnea

To diagnose sleep apnea, your healthcare provider might start by asking about your symptoms, risk factors, and medical and family history.

They may do a physical exam to check your mouth, neck, and throat.

You might also be asked to keep a sleep diary. This could include writing down how long you slept each night, whether you felt sleepy during the day, and whether you noticed any sleep apnea symptoms.

To confirm if you have sleep apnea, you’ll need to do a sleep study — also known as polysomnography.

During a sleep study , you’ll sleep with sensors on your body that track your:

You might need to spend the night in a sleep lab or your doctor may suggest an at-home sleep study, which involves sleeping with a portable device.

A healthcare provider can then check these recordings to help diagnose sleep apnea.

You might also be asked to do other tests — like blood tests — to rule out other health conditions that could be causing your symptoms.

• Breathing
• Oxygen levels
• Brain waves
• Heart rate

Treatment

Sleep Apnea Treatment

There are many different treatment options for sleep apnea. The best one for you will depend on the type of sleep apnea you have, how severe it is, and what’s causing it. You may also need more than one treatment.

Your healthcare provider might want to schedule regular checkups to make sure your sleep apnea treatment is working and make any changes if needed.

Here are the common sleep apnea treatments.

Breathing Machines

Breathing machines use air pressure to keep your airway open throughout the night.

As you sleep, you wear a mask connected to a machine by a flexible tube. Different types of masks are available; some cover your mouth and nose, and others have just a nosepiece.

It might be uncomfortable to sleep with at first, but your medical supply company will explain the best ways to sleep with a breathing machine and which settings to use.

There are a few different types of breathing machines:

A healthcare provider can work with you to find the most comfortable and effective machine for you.

Oral Appliances or Devices

Your healthcare provider might suggest an oral device if you can’t or don’t want to use a breathing machine.

These devices are made especially to fit your teeth and mouth. Sleeping with the device in place will help keep your airway open.

Devices include:

Losing Weight

If you have overweight or obesity, losing weight can help to improve your sleep apnea.

Weight loss medications can be useful for some people who have struggled to achieve or maintain weight loss in the past.

These include:

Some drugs, like Zepbound, are FDA-approved for people with overweight or obesity who also have obstructive sleep apnea.

A healthcare provider can tell you if weight loss drugs are safe for you and explain the pros and cons of each.

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You can also work toward your weight loss goals by:

Healthy Lifestyle Changes

Beyond weight loss, your provider might recommend other healthy lifestyle changes to improve your sleep apnea.

These might include:

Changes to Your Sleep Set Up

Sleeping on your side may improve your sleep apnea as it can reduce the chances of your tongue falling back and blocking your airway.

If you’re a back sleeper who can’t break the habit, you can get special pillows, bumpers, or wearable devices that encourage you to sleep on your side — and stop you from rolling over onto your back during the night.

Surgery

People with severe sleep apnea may opt for surgery. Surgery helps treat sleep apnea by widening the airway.

This can include:

You can also have surgery to implant a tongue stimulator into your chest. This device is placed below your collarbone and has wires leading to the nerves that control your tongue and the surrounding muscles.

The device sends mild electrical impulses to the nerves to keep your tongue and muscles from collapsing and blocking your airway.

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• Continuous positive airway pressure (CPAP) machine. A CPAP machine is the most common sleep apnea treatment. It delivers continuous air pressure as you inhale and exhale.
• Auto-adjusting positive airway pressure (APAP) machine. As the name suggests, an auto-adjusting positive airway pressure machine adjusts air pressure automatically as you breathe in and out.
• Bilevel positive airway pressure (BPAP or BiPAP) machine. BPAP machines deliver different levels of air pressure as you inhale and exhale.
• Mandibular repositioning mouthpieces. These devices look similar to a retainer. They hold your lower jaw forward, preventing it from sliding back and blocking your airway.
• Tongue-retaining devices. These devices hold your tongue in place, preventing it from falling back and blocking your airway.
• Neuromuscular electrical stimulation (NMES) devices. These devices use electrical stimulation to stimulate your tongue and the muscles in your upper airway. This can prevent them from collapsing and blocking your airway. If you have mild obstructive sleep apnea, there’s a device that’s approved by the U.S. Food and Drug Administration (FDA) that you can use for 20 minutes a day to tone your tongue.
• Semaglutide ( Ozempic ® , Wegovy ® )
• Tirzepatide ( Mounjaro ® , Zepbound ® )
• Metformin
• Topiramate
• Eating nutritious foods like fruits, vegetables, protein , and whole grains
• Moving more throughout the day, including walking, jogging, and general activity
• Drinking more water
• Getting enough sleep — this is easier said than done when you have sleep apnea, but you should prioritize sleep as much as you can
• Quitting smoking
• Cutting down on alcohol
• Getting more physical activity
• Removing some tissue from your throat or mouth
• Removing your tonsils or adenoids
• Moving your upper or lower jaw forward

Prevention

Sleep Apnea Prevention Tips

You can’t always prevent sleep apnea. Some risk factors, like genetics and aging, are beyond our control.

But, some sleep apnea risk factors are under our control.

For example, maintaining a healthy weight can reduce your odds of developing sleep apnea.

Quitting smoking and limiting how much alcohol you drink can also help lower your odds of developing sleep apnea.

If you’re a back sleeper, you might want to consider switching to sleeping on your side, even if you don’t have sleep apnea right now. This can help keep your airway open.

8 Sources

• Cumpston E, et al. (2023). Sleep apnea syndrome. https://www.ncbi.nlm.nih.gov/books/NBK564431/
• National Heart, Lung, and Blood Institute. (2022). Sleep studies. https://www.nhlbi.nih.gov/health/sleep-studies
• National Heart, Lung, and Blood Institute. (2022). What is sleep apnea? https://www.nhlbi.nih.gov/health/sleep-apnea
• National Library of Medicine. (2021). Sleep apnea. https://medlineplus.gov/sleepapnea.html
• National Library of Medicine. (2023). Central sleep apnea. https://medlineplus.gov/ency/article/003997.htm
• National Library of Medicine. (2023). Obstructive sleep apnea — adults. https://medlineplus.gov/ency/article/000811.htm
• U.S. Food and Drug Administration. (2021). FDA authorizes marketing of novel device to reduce snoring and mild obstructive sleep apnea in patients 18 years and older. https://www.fda.gov/news-events/press-announcements/fda-authorizes-marketing-novel-device-reduce-snoring-and-mild-obstructive-sleep-apnea-patients-18
• U.S. Food and Drug Administration. (2024). Always tired? You may have sleep apnea. https://www.fda.gov/consumers/consumer-updates/always-tired-you-may-have-sleep-apnea