What it is, causes, symptoms & treatment

What is sleep apnea and how can be treated?

Sleep apnea refers to a condition where you stop breathing during sleep. Apnea is a condition that causes you to stop breathing during sleep. Obstructive sleep apnea can cause blockage in your airway or central apnea, where your brain isn’t properly controlling your breathing.

A survival reflex activates when there is a lack of oxygen. This allows you to wake up just enough for you to regain your breathing. This survival reflex helps you stay alive but it can also disrupt your sleep cycle. This can prevent restful sleep, and can also have serious consequences for your heart.

Who does sleep apnea affect?

Anyone can experience sleep apnea, from babies and children to seniors. Obstructive sleep apnea can be more common in certain situations and groups of people.

It’s more common among men before age 50 and those who were born to male parents (AMAB). It affects both women and those assigned to female birth at the same time (AFAB) after age 50.
As they age, people are more susceptible to developing it.
This is more common among people of Asian, Hispanic and Black descent.

People with central sleep apnea are more likely to have it than others.

Opioid pain medication users.
Adults over 60
Congestive heart failure or atrial fibrillation are common conditions.
Some people who use CPAP, or have obstructive sleeping apnea can experience central events called treatment-emergent central snoring apnea.
High altitude living can lead to central apneas.

What is the prevalence of sleep apnea in America?

Sleep apnea can be a common but not uncommon condition. Experts estimate that it affects between 5% and 10% of the world’s population.

What does sleep apnea do to my body?

It helps to understand the sleep cycle and how it works. Sleep happens in multiple stages:

1. Stage: Light sleep. This stage is short and begins just after you have fallen asleep. This stage accounts for approximately 5% of your total sleeping time.
Stage 2: Deeper Sleep This stage is deeper, and accounts for approximately 45% to 50% all your sleeping time (this number increases as you age).
Stage 3Slow wave sleep. This stage is your deepest sleep, accounting for 25% of your sleeping time (this number decreases with age). Stage 3 sleep is the most difficult stage to wake up. It can be very difficult to get someone out of this stage. This stage is where parasomnias such as sleepwalking or sleeptalking occur.
REM SleepREM is short for rapid eye movement. This stage is where you can dream. You can see the eyes of someone in REM sleep moving underneath their eyelids.

Typically, Stage 1 is where you go when you fall asleep. Stage 2 and 3 are where you cycle through. You’ll eventually go into REM sleep, and then start dreaming. You can start a new REM cycle after the first one and then go back to Stage 1 or 2. The average cycle takes between 90 and 110 minutes. Most people experience four to five cycles each night, assuming they get eight hours sleep.

How sleep apnea can disrupt your sleep cycle

Your brain continuously monitors your body’s health and adjusts your heart beat, blood pressure, breathing, and other parameters. If you stop breathing due to either hypopnea, apnea, or both, your blood oxygen levels may drop.

Apnea: When you have very little or no airflow, it means that your breathing stops while you are asleep. It is a combination of the Greek roots “a”, which means “not”, and “pnea,” that refers to breathing. It can also be translated as “breathless.”
Hypopnea: This combination combines the Greek word roots “hypo” and “pnea” which can be translated as “low” or even “under” in Greek. It means that you aren’t breathing enough oxygen to keep your blood levels high enough.

Your brain responds to drops in blood oxygen — either from hypopnea, or apnea — by activating a failsafe-like reflex that wakes you enough to breath again. their brain will attempt to restart your sleep cycle once you have resumé breathing.

Your sleep apnea severity will determine how often interruptions occur. The apnea/hypopnea Index (AHI), is the hourly average of hypopnea and apnea events. These are times when a person stops breathing. The AHI is the most important factor in determining severity of sleep apnea. This is the severity:

Mild sleep apneaAHI Level between 5 and 15 is this level. This means that they experience between 5 and 15 hypopnea- or apnea events an hour. Healthcare providers may also consider symptoms at this level. They may not treat it if you don’t have any other symptoms.
Moderate sleep apneaPeople with moderate sleep disorder have between 15 to 29 events per hour. This means that a person who is asleep for eight hours will stop breathing and/or wake up between 120- 239 times.
Sleep apnea severePeople suffering from severe sleep apnea may wake up more than 30 times per hour. This means that they can’t breathe and/or wake up more than 240 times in eight hours.

Obstructive events are short-term and can affect any stage. These events are most common in Stage 1 and Stage 2. People may not be able to recall apnea events. This means that they might not realize they have a problem until they are obvious. Although central events are more common in Stages 1, 2 and 3, they can also occur at any stage.

Symptoms and causes

What are the signs of sleep apnea and how can they be treated?

Sleep apnea can present with many symptoms. Some are more obvious than others. These are the symptoms:

You feel tired, or even completely exhausted upon waking up.. People with sleep apnea often feel tired even after getting a good night’s rest.
Daytime sleepiness. This can lead to drowsiness while driving, working, or doing other activities.
Snoring. This is a common symptom of sleep apnea, but it doesn’t happen in all cases. It is possible to have sleep apnea even without snoring.
Changes in mood. Sleep apnea is characterized by anxiety and depression.
Brain function disruptions. These include memory loss, difficulty concentrating and other brain-related problems.
Reluctantly waking up in the middle of the night. This symptom is more difficult to spot because most people don’t remember when they woke up or why. This is a common symptom that people who experience it often recall waking up due to heartburn or needing the bathroom.
Breathing pauses While you’re asleep, others can see.. These symptoms may be noticed by a spouse, partner, or another loved one while you are asleep.
Unusual patterns of breathing. Cheyne Stokes breathing (CSB), is a distinct breathing pattern that can occur with central sleep apnea. CSB is characterized by rapid breathing that becomes deeper and shallower until the breathing stops completely. After a few seconds of not breathing, they will start to breathe again.
Insomnia.
Night sweats and feeling sleepy at night.
Sexual dysfunction.
Feeling short of breath, or like you are choking when you wake up.
HeadachesWhen you wake up.

Children with sleep apnea

they can experience sleep apnea differently. Children can experience sleep apnea by experiencing the following symptoms:

Hyperactivity, trouble focusing or poor performance in school. This can look like symptoms of attention-deficit/hyperactivity disorder (ADHD).
Loud snoring.
Bedwetting.
Frequent arm and leg movements during sleep.
Unusual sleeping positions, or sleeping with their neck extended.
Night sweats or heartburn are known as reflux (heartburn)..

What causes sleep apnea

Sleep apnea is a condition that can be caused by specific factors. There are also indications that it may run in families. There are three types of sleep apnea. Each one is different. These are the types:

Obstructive sleep apnea

This is the most common. Obstructive sleep apnea occurs when the muscles in your neck and head relax while you’re sleeping, which causes the surrounding tissue to press against your windpipe. This blocks air’s ability pass through it.

Central sleep apnea

Sleep apnea is caused by a problem within your brain. Normal circumstances mean that your brain controls your breathing throughout the day, even while you are sleeping. When your brain stops sending signals to the muscles that control breathing, you have central sleep apnea.

There are many causes of central sleep apnea, which can include:

Sleep apnea in mixed/complex sleep

A mixed/complex form of sleep apnea is also available. This combination has both central and obstructive events.

Diagnostics and tests

What is the diagnosis of sleep apnea?

A healthcare provider will ask questions about your history and symptoms to diagnose sleep apnea. They will likely request that you undergo sleep apnea testing if they suspect that you have sleep apnea from your answers and symptoms.

What tests are used to diagnose sleep apnea

These are the most frequent tests for sleep apnea:

Overnight sleep study (polysomnogram). This is an overnight sleep test in which you are placed in a medical facility (often called a “sleep laboratory”) and monitored for your sleep. The test uses sensors to monitor your heart rate and brain waves. This test is considered the gold standard in diagnosing sleep apnea by experts.
Test your home for sleep apnea. This type of testing allows you to do a home sleep study. This is similar to an overnight study but does not involve brain wave monitoring. It can’t diagnose central sleeping apnea. This test is not recommended if providers suspect that you may have more severe cases or if there are other medical conditions or sleep disorders. Experts recommend that you have an overnight sleep study if your home study does not show sleep apnea.

Management and Treatment

Understanding Pap Therapy for Sleep Apnea

What is the best way to treat sleep apnea?

There are many ways to treat sleep apnea. These vary depending on what type of sleep disorder it is and how severe. Although none of these are a cure for apnea, they can be used to prevent them from happening or reduce the severity.

You should include many treatments in your daily or nightly routine. These treatments can reduce or eliminate the effects of sleep apnea on your life, as long as they are used regularly.

There are many possible treatments:

Non-medical (conservative) treatments
Adaptive ventilation devices and positive airway pressure
Oral appliances (mouthpieces).
Nerve stimulators
Surgery.
Only for central sleep apnea

Conservative treatments

These non-medical approaches or treatments can often improve or eliminate obstructive sleeping apnea. These aren’t treatments that cure apnea, but can help reduce it to the point where it doesn’t occur or cause symptoms. These include:

Weight loss. For people with excess weight or obesity, a 10% reduction in body weight can dramatically improve sleep apnea.
Sleep aids and position changes during sleep. Sleep apnea is more common when you sleep on your back. Support pillows and similar products can be used to change how you sleep. They will keep you from putting your back on the ground so that soft tissue doesn’t press against your windpipe, preventing you from breathing.
Nasal sprays, adhesive strips, etc. These over-the-counter medications improve your breathing by making it easier to allow air to flow through your nose. They can’t treat severe or moderate sleep apnea but they can help with snoring, mild sleep apnea, and other symptoms.
The underlying condition must be treated. Central sleep apnea can be improved by treating conditions like heart failure.
Changes in medication. Your doctor may be able help you reduce or stop the use of opioid pain medication. This could improve your central sleep apnea.

Adaptive ventilation and positive airway pressure (PAP).

A method called positive airway pressure uses a specialized device that increases the pressure in your airway as you inhale. This can be used to treat central, obstructive and mixed sleep apneas.

Pressurized air is pushed down your windpipe to open it up so that you can breathe. These devices blow air through a hose attached to a mask that you wear while you sleep. There are many styles and types of masks that can be used to cover your nose, mouth, or both.

The Continuous Positive Airway Pressure (CPAP), is the most well-known PAP device. There are many other types of PAP devices. For more information, see our CPAP Machine article. These devices can increase the pressure in your lungs and airway when you inhale. This keeps your airway from being compressed by surrounding tissue.

Oral devices

Obstructive sleep apnea is when soft tissue around your neck or head, particularly around your jaw and mouth, presses down on your windpipe. Special mouthpiece devices can hold your tongue and jaw in a way that reduces pressure on your windpipe. These devices are often made by dentists and sleep medicine specialists.

Nerve stimulators

Your tongue’s movement is controlled by the hypoglossal nerve, which comes from Greek. An attached nerve stimulator can stimulate this nerve, moving your tongue slightly forward while you sleep. This prevents your tongue from relaxing while you sleep and presses back on your windpipe.

An electrode attaches under your jaw to the nerve and connects to a device under your skin in your chest. The stimulator can be turned on while you sleep or off when you wake up. The electric current is strong enough not to cause your tongue to relax, but gentle enough so that you don’t feel uncomfortable.

Central sleep apnea can also be used to stimulate the nerves in a similar way. This stimulation affects your phrenic nervous system. These nerves link your spinal cord to your diaphragm. This is the layer of muscle beneath your lungs that controls your ability inhale or exhale. The phrenic nerve is stimulated, allowing the muscles to flex and help you breathe.

Surgery

Surgery on the nose, mouth, and throat can prevent obstructions in your nose and windpipe. These surgeries are usually only effective for adults and can have a limited impact on the health of individuals. These surgeries include:

Somnoplasty. .
Tonsillectomy/adenoidectomy. This makes it easier to breathe and decreases the amount of soft tissue that could block your breathing. This is especially helpful for children suffering from obstructive sleeping apnea.
Uvulopalatopharyngoplasty (UPPP). They widen the space between your mouth and throat, making it easier to let air through.
Jaw surgery. Different surgical procedures can subtly alter the position of your jaw, so that soft tissue cannot press against your airway. These procedures are particularly helpful for those suffering from sleep apnea due to structural reasons such as micrognathia.
Nasal surgery. Septoplasty is a common type of nasal surgery. This straightens your nose’s soft tissue, making it easier to allow air to flow through your nose and into your nasal passages.

Central sleep apnea medication

There are medications that can help with central sleep apnea, including adaptive ventilation, positive airway pressure and phrenic nervous stimulators. Some examples of these medications include hypnotic (sleep-promoting) medications, respiratory-stimulating drugs and more. These medications are not officially approved for use.

What is the best thing to eat and drink when I have sleep apnea

Sleep apnea sufferers should not drink heavily or use any drugs that cause excessive sedation, such as sleeping pills and other recreational and legal drugs. These drugs can make sleep apnea more severe. Talk to your healthcare provider about the possible side effects of drugs.

Side effects/complications of treatment

Many factors influence the side effects and complications of treatments, including the treatment itself. For information about what you can do to reduce side effects and prevent them from happening, your healthcare provider is the best resource.

How can I take care of my symptoms/take care of myself?

Sleep apnea can cause severe disruption in your life, and could lead to life-threatening complications. (See more under the Outlook/Prognosis section). You shouldn’t attempt to diagnose or treat it yourself. You should make an appointment with a specialist if you suspect you may have sleep apnea.

How you can help with diagnosis

You might be able help a healthcare provider diagnose sleep apnea if you suspect that you or your loved one suffers from it. A provider may need to have audio and video recordings of the person asleep, in order to quickly diagnose the condition.

What is the best time to feel better after treatment?

Treatments will determine how long it takes to feel better or recover from sleep apnea. Some people feel relief almost immediately while others need to be treated every night for three to six months to reap the full benefits. You can talk to your healthcare provider about the recovery timeline and when to expect to feel better.

Positive airway pressure devices are often very effective in treating sleep apnea. While older devices might require some adjustments (a process called “titration”) to adjust the settings, many modern devices can be adjusted automatically to meet your needs. This is especially true if you have mild or moderate sleep apnea.

Some people might need to adjust to wearing a mask while they sleep. However, most people can do it quickly. People often notice improvements in their sleep quality when they use a positive pressure device to help them sleep through the night.

Prevention

What can I do to reduce or prevent sleep apnea from happening?

Sometimes, sleep apnea can be prevented. This is especially true if someone is overweight or obese. Some people can have sleep apnea even if they are healthy or underweight. These people can’t stop their sleep apnea because it is often caused by a structural problem.

To reduce the risk of developing sleep apnea, here are some things that you can do:

Outlook / Prognosis

What should I do if I have sleep apnea

Sleep apnea can cause severe disruptions in your life and increase your risk for serious medical emergencies. Although it does not cause any serious complications, sleep apnea patients can’t get enough sleep and feel tired all the time. This condition can lead to fatigue and even death.

Sleep apnea can lead to serious complications

Sleep apnea can be dangerous because it can lead to many complications that can make your life more difficult or even fatal. These complications include:

Heart disease and heart failure. Sleep apnea is a condition that causes an increase of pressure in the blood vessels surrounding your heart and in some chambers of the heart. This pressure increase can put strain on your heart and eventually cause damage to the muscle.
Arrhythmias are especially common atrial fibrillation. Because it causes blood to stop flowing through your upper left chamber, atrial fibrillation can be dangerous. This disruption can cause blood to pool and linger too long. This can lead to blood clots that can travel directly from your brain to your heart, causing strokes.
Sudden cardiac death. Sleep apnea can cause severe arrhythmias, which can lead to your heart stopping. Sudden cardiac death is a potentially fatal condition.
Daytime drowsiness. Although it may seem harmless to feel sleepy during the day, it can pose a danger depending on your activities. You and others can be seriously injured if you fall asleep while operating dangerous machinery or driving.

How long does sleep apnea take?

Sleep apnea can be a chronic, long-term condition. Some people can resolve the condition by losing weight or receiving certain treatments. It may become a chronic condition that can last a lifetime for others.

The future of sleep apnea

Many factors influence the outlook for sleep apnea. It all depends on the severity and type. But, the most important factor in determining how this condition impacts your life is adhering to treatment.

It is important to follow the treatment instructions closely. It can make a big difference to stick with treatment, especially ongoing ones such as positive airway pressure devices. People often stop using positive airway pressure devices after a few months. This can increase the chance of complications and lead to a worse outcome.

Living with

How can I take care myself?

To manage this condition, there are several steps you can take:

Change your lifestyle as much as you can. It can be difficult to make changes in your lifestyle, including diet and exercise. Talk to your healthcare provider about your struggles. These are not uncommon. Your healthcare provider may be able to help you reduce or even eliminate them.
Follow your treatment plan carefully. People who stick to their treatments and make it a regular part of their lives — not missing a single night — are more likely have positive outcomes and to avoid serious or dangerous complications.
Talk to your provider about the symptoms you are experiencing. If you have difficulty adhering to treatment due to issues with the PAP device, talk to your provider. People often have problems with the fit and pressure settings of a PAP device. . You will get a restful night’s sleep if you stick to your treatment plan.
As a recommendation, consult your provider. It is important to schedule follow-up visits, especially early in the treatment, to ensure that your treatments are effective.

What time should I visit the ER?

If you have symptoms such as a stroke or heart attack, it is important to visit the ER immediately.

Note from Cleveland Clinic

Sleep apnea can be a common condition that causes a person to have trouble breathing during sleep. This causes people to wake up only enough to breathe and interrupt their sleep, preventing them from feeling refreshed. Sleep apnea can progress to more serious and even fatal complications over time. Early diagnosis is crucial for proper treatment. There are many options for treating this condition.

Positive airway pressure devices are the most popular and effective treatments. . These treatments will have the best results if you keep them in mind and make them a part of your daily life. Talk to your healthcare provider if you are having trouble adhering to treatment. These professionals can help you overcome your problems and get you a good night’s rest.