Home » Sleep Disorders » Sleep Apnea
August 2020 |  Reviewed by:  Seema Khosla, MD and Imran Shaikh, MD

What is obstructive sleep apnea?

There are different types of sleep apnea, including central sleep apnea, and obstructive sleep apnea is the most common. It is a common and serious sleep disorder that causes you to stop breathing during sleep. If you have sleep apnea, your airway becomes blocked repeatedly during sleep. The amount of air reaching your lungs is limited. When this happens, you may snore loudly or make choking noises. Your brain and body become oxygen deprived and you may wake up. This may happen a few times a night, or in more severe cases, several hundred times a night.

In many cases, an apnea, or a short pause in breathing, is caused by the tissue in the back of the throat collapsing. The muscles of the upper airway relax when you fall asleep. If you sleep on your back, gravity can cause the tongue to fall back. This narrows the airway, which reduces the amount of air that can reach your lungs. The narrowed airway causes snoring by making the tissue in the back of the throat vibrate as you breathe.

If you feel tired or unrefreshed after waking up even though you have had a full night of sleep, it may be due to sleep apnea. During the day, you may feel fatigued, have difficulty concentrating or may even unintentionally fall asleep. This is because your body is waking up numerous times during the night, even though you might not be conscious of each awakening.

The lack of oxygen your body receives can have a negative impact on your health. This includes:

  • High blood pressure
  • Heart disease
  • Stroke
  • Pre-diabetes and diabetes
  • Depression

There are many people with sleep apnea who have not been diagnosed or received treatment. Your medical provider can diagnose sleep apnea using a sleep study in a sleep lab or at home. There are several treatments to help you manage sleep apnea.

What are symptoms of obstructive sleep apnea?

The most common symptom of sleep apnea is snoring. However, not everyone who snores has sleep apnea. Snoring is likely to be a sign of sleep apnea when it is followed by silent breathing pauses and choking or gasping sounds. People with sleep apnea often have daytime sleepiness or fatigue.

Common symptoms of sleep apnea include:

  • Loud or frequent snoring
  • Silent pauses in breathing
  • Choking or gasping sounds
  • Daytime sleepiness or fatigue
  • Unrefreshing or restless sleep
  • Insomnia
  • Morning headaches
  • Waking frequently during the night to go to the bathroom
  • Difficulty concentrating
  • Memory loss
  • Decreased sexual desire
  • Difficulty maintaining an erection
  • Irritability

What are risk factors for obstructive sleep apnea?

The major risk factor for sleep apnea is excess body weight. You are much more likely to have sleep apnea if you are overweight or obese. However, sleep apnea can occur in slim people too. Common risk factors for sleep apnea include:

  • Excess weight: Your risk for sleep apnea is higher if you are overweight (with a body mass index of 25 or more) or obese (with a body mass index of 30 or higher).
  • Large neck size: Your risk for sleep apnea is higher if you have a neck size of 17 inches or more for men, or 16 inches or more for women. A large neck has more soft tissue that can block your airway during sleep.
  • Middle age: Sleep apnea can occur at any age. However, it is more common between young adulthood and middle age.
  • Male gender: Sleep apnea is more common in men than in women. For women, the risk of sleep apnea increases with menopause.
  • Hypertension: High blood pressure is common in people who have sleep apnea.
  • Sedation: Medication or alcohol can interfere with the ability to awaken from sleep and can lengthen periods of apnea.
  • Airway abnormalities: Examples are a deviated septum or nasal polyps.
  • Family history: You have a higher risk of sleep apnea if a family member also has it. Inherited traits that increase the risk for sleep apnea include obesity and physical features such as a recessed jaw. Other common family factors—such as physical activity and eating habits—may play a role.

How to diagnose obstructive sleep apnea?

Self test

The following questions will help you assess your risk for sleep apnea:

  1. Do you experience any of these problems?
    • Daytime sleepiness
    • Unrefreshing sleep
    • Fatigue
    • Insomnia
  1. Do you ever wake from sleep with a choking sound or gasping for breath?
  2. Has your bed partner noticed that you snore or stop breathing while you sleep?
  3. Do you have any of these other symptoms?
    • Waking frequently during the night to go to the bathroom
    • Morning headaches
    • Difficulty concentrating
    • Memory loss
    • Decreased sexual desire
    • Irritability
  1. Do you have any of these physical features?
    • Obesity, body mass index of 30 or higher
    • Large neck size, 17 inches or more for men, 16 inches or more for women
    • Enlarged tongue or tonsils
    • Recessed or small jaw
    • Nasal polyps or deviated septum
  1. Do you have any of these other medical problems that are common in people with sleep apnea?
    • High blood pressure
    • Mood disorders
    • Coronary artery disease
    • Stroke
    • Congestive heart failure
    • Heart attack
    • Atrial fibrillation
    • Type 2 diabetes

Self-assessment tool: Are you at-risk for obstructive sleep apnea?

This resource helps you identify the common symptoms of sleep apnea. It also helps you understand your risk factors for this chronic disease. Download, print and complete this self-assessment tool to discuss your sleep apnea risk with your medical provider.

Diagnosis

Your medical provider can diagnose obstructive sleep apnea using an in-lab sleep study or a home sleep apnea test. More complex cases of sleep apnea may require an appointment with a sleep doctor. Sleep doctors are trained experts who can diagnose and treat a variety of sleep disorders.

Your medical provider will need to know your symptoms, and whether they began when you gained weight or stopped exercising. If you can, ask a partner or roommate or relative if they have ever heard you snore loudly or make choking noises in your sleep.

Your medical provider will also try to determine if there is something else that is causing your sleep problems or making the symptoms worse, such as:

  • Another sleep disorder
  • A medical condition
  • Medication use
  • A mental health disorder
  • Substance abuse

Keeping a sleep diary for two weeks can help your medical provider or a sleep doctor make an accurate diagnosis. This information about what time you went to bed each night, when you woke up in the morning and how many times you woke up each night could contain clues about how to diagnose and correct your sleep problem.

How to test for obstructive sleep apnea?

An objective evaluation of your sleep may be needed before your medical provider can make a diagnosis. Options include:

In-lab overnight sleep study

This type of sleep study requires you to stay overnight at a sleep center, in a bed that may resemble a hotel room. You will sleep with sensors hooked up to various parts of your body. These sensors record your brain waves, heartbeat, breathing and movement. Medical providers usually recommend this kind of sleep study for more complex cases. It is the more expensive option but is usually covered by health insurance plans. An overnight sleep study provides your doctor with the most complete information about your sleep.

Home sleep apnea test

Some patients with many risk factors for sleep apnea and no other medical disorders may be candidates for a home sleep apnea test. This type of sleep study lets you sleep in your own home while a small monitor collects data as you sleep. The testing equipment is less complicated than what is used in an in-lab sleep study. You will be shown how to hook up the testing equipment yourself. After your home sleep apnea test, you can take the device back to your medical provider or send it by mail.

Other apps and sleep tracking devices may claim to be able to detect sleep apnea, but their results can be unreliable. Be sure to discuss these devices with your medical provider.

After your sleep study or home sleep apnea test, you will schedule a follow-up appointment to discuss the results. If you are diagnosed with sleep apnea, your medical provider will discuss your treatment options with you.

How to treat obstructive sleep apnea?

Sleep apnea is a serious sleep disorder that needs to be treated. Your medical provider or a sleep doctor can help you select a treatment plan that is right for you. Depending on the treatment, she may work in collaboration with other members of the sleep team, including dentists, psychologists, physician assistants, nurses and technologists. Your plan may include any combination of these treatments:

CPAP (continuous positive airway pressure)

CPAP is a machine that uses a steady stream of air to gently keep your airway open throughout the night so you are able to breathe. You sleep with a mask with a hose that is attached to a machine kept at the bedside. Masks and machines may vary depending on your treatment and comfort needs. CPAP is the frontline treatment for sleep apnea and is recommended for most patients.

Oral appliance therapy

An oral appliance is a device that fits in your mouth over your teeth while you sleep. It may resemble a sports mouth guard or an orthodontic retainer. The device prevents the airway from collapsing by holding the tongue in position or by sliding your jaw forward so that you can breathe when you are asleep. Some patients prefer sleeping with an oral appliance over a CPAP machine. A dentist trained in dental sleep medicine can fit you with an oral appliance after you are diagnosed with sleep apnea. Oral appliance therapy is recommended for patients with mild to moderate apnea who cannot tolerate CPAP or simply prefer to try the oral appliance instead of a CPAP device.

Surgery

There are a variety of surgical options you can elect to have if CPAP or oral appliance therapy does not work for you. The most common options reduce or eliminate the extra tissue in your throat that collapses and blocks your airway during sleep. More complex procedures can adjust your bone structures including the jaw, nose and facial bones. Weight loss surgery may also be an option. Talk to your sleep doctor about what surgery is right for you.

Upper airway stimulation

One surgical solution is upper airway stimulation. This is a small, implantable device that can treat sleep apnea. It is implanted in your chest wall, like a pacemaker. A wire then goes up to a nerve that stimulates your tongue to gently move it forward as you breathe during sleep. It is operated via remote control so you can decide when to turn it on. Before you can have this implanted, an ear nose and throat doctor will give you some medication to make you sleepy. They will then take a small scope and look at your airway as you sleep. This allows them to see why you have sleep apnea. If it is because your tongue blocks your airway, you may be a good candidate for this procedure. If your airway collapses all the way around, you are not a good candidate for this procedure.

Weight management

In some cases weight loss can help improve or eliminate your sleep apnea symptoms if you are overweight or obese. Overweight people often have thick necks with extra tissue in the throat that may block the airway. There is no guarantee that losing weight will eliminate your sleep apnea, though it may help.

Positional therapy

Positional therapy is a behavioral strategy to treat positional sleep apnea. Some people have sleep apnea primarily when sleeping on their back. Their breathing returns to normal when they sleep on their side. Positional therapy may involve wearing a special device around your waist or back. It keeps you sleeping in the side position. Another option is a small device worn on the back of the neck. It gently vibrates when you start to sleep on your back. Without waking you up, the vibration alerts your body to change positions. Positional therapy can be used alone or together with another sleep apnea treatment.

Lifestyle changes

There are a variety of lifestyle changes that can help you reduce your snoring and improve your sleep apnea symptoms. Behavioral changes such as quitting smoking or not drinking alcohol may improve sleep apnea symptoms. Alcohol relaxes your throat muscles that can cause you to snore or for your airway to collapse. If you have allergies, taking a decongestant before you go to bed may help improve airflow through your nose.

If you have difficulty staying with your treatment plan or cannot sleep even with treatment, your medical provider may recommend cognitive behavioral therapy. A behavioral sleep specialist will help you eliminate the thoughts and behaviors that are preventing you from getting restful sleep or adhering to your treatment.

If you think you may have sleep apnea, talk to your medical provider or use the sleep center directory to find an accredited sleep center near you.

Patient Support

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