What is sleep apnea?

Sleep apnea is a serious, potentially life-threatening condition. It is far more common than previously thought. Sleep apnea happens in all age groups and both genders, although it is more common in men. It is estimated that as many as 18 million Americans have sleep apnea.

Sleep apnea is a breathing disorder characterized by brief interruptions of breathing during sleep. There are two types of sleep apnea:

• Central sleep apnea happens when the brain fails to send the appropriate signals to the muscles to start breathing. Central sleep apnea is less common than obstructive sleep apnea.

• Obstructive sleep apnea happens when air can’t flow into or out of the nose or mouth although efforts to breathe continue.

Sleep apnea is characterized by a number of involuntary breathing pauses or "apneic events" during a single night's sleep. There may be as many as 20 to 30 or more events per hour. These events are usually accompanied by snoring between apnea episodes. But, not everyone who snores has sleep apnea. Sleep apnea may also be characterized by choking sensations. The frequent interruptions of deep, restorative sleep often lead to early morning headaches and excessive daytime sleepiness.

During the apneic event, you can’t breathe in oxygen or exhale carbon dioxide. This results in low levels of oxygen and increased levels of carbon dioxide in the blood. This alerts the brain to resume breathing and cause an arousal. With each arousal, a signal is sent from the brain to the upper airway muscles to open the airway. Breathing is resumed, often with a loud snort or gasp. Frequent arousals, although necessary for breathing to restart, prevent restorative, deep sleep.

Early recognition and treatment of sleep apnea is important, as it may be associated with:

• Irregular heartbeat

• High blood pressure

• Heart attack

• Stroke

• Daytime sleepiness

• Increased risk of motor vehicle accidents

What are the causes of sleep apnea?

Certain mechanical and structural problems in the airway cause the interruptions in breathing during sleep. Apnea happens:

• When the throat muscles and tongue relax during sleep and partially block the opening of the airway.

• When the muscles of the soft palate at the base of the tongue and the uvula relax and sag, the airway becomes blocked, making breathing labored and noisy and even stopping it altogether.

• In obese people when an excess amount of tissue in the airway causes it to be narrowed.

• With a narrowed airway, the person continues his or her efforts to breathe, but air can’t easily flow into or out of the nose or mouth.

Who is at risk for sleep apnea?

Sleep apnea seems to run in some families, suggesting a possible genetic basis. People most likely to have or develop sleep apnea include those who:

• Snore loudly

• Are overweight

• Have high blood pressure

• Have some physical abnormality in the nose, throat, or other parts of the upper airway

Use of alcohol and sleeping pills increases the frequency and duration of breathing pauses in people with sleep apnea.

What are the symptoms of sleep apnea?

In either form of sleep apnea, your breathing pauses a number of times during sleep. These are called apneic events. There may be as many as 20 to 30 or more events per hour. Between events, you may snore. But, not everyone who snores has sleep apnea. Sleep apnea may also cause a choking sensation. When breathing starts, you may make a loud snort or gasp. These frequent breaks in deep, restorative sleep often lead to headaches and excessive daytime sleepiness.

Other symptoms include dry mouth or sore throat and problems paying attention.

How is sleep apnea diagnosed?

Diagnosis of sleep apnea is not simple because there can be many different causes. Primary healthcare providers, pulmonologists, neurologists, or other healthcare providers with specialty training in sleep disorders may be involved in making a diagnosis and starting treatment. Several tests are available for evaluating sleep apnea, including:

• Polysomnography. This test records a variety of body functions during sleep, such as the electrical activity of the brain, eye movement, muscle activity, heart rate, respiratory effort, air flow, and blood oxygen levels.

• Multiple Sleep Latency Test (MSLT). This test measures the speed of falling asleep. People without sleep problems usually take an average of 10 to 20 minutes to fall asleep. People who fall asleep in less than 5 minutes are likely to need some type of treatment for sleep disorders.

Diagnostic tests usually are done in a sleep center, but new technology may allow some sleep studies to be done in your home.

How is sleep apnea treated?

Specific treatment will be determined by your healthcare provider based on:

• Your age, overall health, and medical history

• Severity of the disease

• Your tolerance for specific medicines, procedures, or therapies

• Expectations for the course of the disease

• Your opinion or preference

Medicines are generally not effective in the treatment of sleep apnea. Therapy may include the following:

• Giving oxygen may safely help some people, but does not end sleep apnea or prevent daytime sleepiness. Its role in the treatment of sleep apnea is controversial.

• Behavioral changes are an important part of a treatment program, and in mild cases of sleep apnea, behavioral therapy may be all that is needed. You may be advised to:

  • Avoid the use of alcohol.

  • Avoid the use of tobacco.

  • Avoid the use of sleeping pills.

  • Lose weight if overweight (even a 10% weight loss can reduce the number of apneic events for most people).

  • Use pillows and other devices to help sleep in a side position.

• Physical or mechanical therapy options are also available. Nasal continuous positive airway pressure (CPAP) is a device that is used nightly in which you wear a mask over the nose during sleep, and pressure from an air blower forces air through the nasal passages. Dental appliances that reposition the lower jaw and the tongue have been helpful to some people with mild sleep apnea, or who snore but do not have apnea.

• Some people with sleep apnea may need surgery. Examples of these procedures include:

  • Surgical procedures to remove adenoids and tonsils, nasal polyps, or other growths or tissue in the airway, or to correct structural deformities may be done.

  • Uvulopalatopharyngoplasty (UPPP) is a procedure used to remove excess tissue at the back of the throat (tonsils, uvula, and part of the soft palate).

  • Surgical reconstruction for deformities of the lower jaw may benefit some people.

  • Surgical procedures to treat obesity are sometimes recommended for a person with sleep apnea who is obese.

Key points about sleep apnea

Sleep apnea is a breathing disorder characterized by brief interruptions of breathing during sleep. Sleep apnea is a serious, potentially life-threatening condition that is far more common than generally understood.

• There are two types of sleep apnea:

  • Central sleep apnea

  • Obstructive sleep apnea

• Sleep apnea seems to run in some families, suggesting a possible genetic basis.

• Diagnosis of sleep apnea is not simple because there can be many different causes.

• Medications are generally not effective in the treatment of sleep apnea.

• Treatment may involve behavioral changes, weight loss, CPAP therapy and sometimes surgery. 

Next steps

• Know the reason for your visit and what you want to happen.

• Before your visit, write down questions you want answered.

• Bring someone with you to help you ask questions and remember what your provider tells you.

• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.

• Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.

• Ask if your condition can be treated in other ways.

• Know why a test or procedure is recommended and what the results could mean.

• Know what to expect if you do not take the medicine or have the test or procedure.

• If you have a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your provider if you have questions.