Sleep Apnea Causes and Treatments

Studies estimate that millions of people around the world have sleep apnea, with some claiming even 1 billion people across the globe are dealing with this condition. 

Wondering if you’re one of those who have undiagnosed sleep apnea may induce some anxiety, but you have plenty of options for treatment. We’ll go over the main types of sleep apnea, the warning signs, and what you can do to keep your breathing and slumber steady all night.

Disclaimer: Please note that the content in this article is meant for informational purposes only and should not be construed as medical advice or serve as a substitute for seeing a medical professional regarding any sleep problems you may have. Please see your doctor regarding any urgent medical issues.

What is Sleep Apnea?

During a sleep apnea episode, breathing pauses throughout the night. Fortunately, your body typically catches on to the problem pretty quickly and gets you breathing again. However, these pauses can make your oxygen levels dip, disrupt sleep patterns, and lead to other health problems.

For some, these pauses are obvious because they are punctuated by loud gasps, while others may show no outward signs that their breathing has taken a little break. Either way, sleep apnea is very common: almost 6 million Americans have a sleep apnea diagnosis, and experts think more than 40 million are undiagnosed.

Common Types of Sleep Apnea

Obstructive Sleep Apnea 

In obstructive sleep apnea episodes, your airways (the pathway from your mouth to your lungs) get blocked during the night, so air can’t get in or out as easily. This is the most common type of sleep apnea, making up the majority of diagnoses. 

Obstructive sleep apnea episodes typically last from 10 to 120 seconds and happen when your muscles relax during sleep and let floppy tissues (like the tongue) drop into your airway. People with mild sleep apnea may have five to 15 episodes per hour, while those with severe sleep apnea may have 30 or more episodes per hour. 

Central Sleep Apnea

When you have central sleep apnea, your brain periodically stops sending messages to your breathing muscles, causing pauses in breathing. This version of sleep apnea is rarer than the obstructive variant and is usually caused by a neurologic condition or medication.

Complex Sleep Apnea

Complex sleep apnea is a mix of the two types, and the most common pattern is the development of central sleep apnea while being treated for obstructive sleep apnea. It’s the rarest form of sleep apnea, as it requires symptoms of the other two to occur together.

Sleep Apnea Symptoms 

So, what does all this breath-pausing do to you? The sleep interruptions and low oxygen that come with sleep apnea can have quite a few effects, some more noticeable than others.

The most common symptom of sleep apnea is snoring in your sleep. 

Below, you can find some other symptoms we associate with sleep apnea:

• Very loud snoring
• A loud snort or gasp after snoring
• Waking up feeling unrefreshed
• Falling asleep easily through the day
• Drowsiness while driving
• Irritability
• Forgetfulness
• Depression
• Hyperactive behavior (most common in children)
• High blood pressure (hypertension)
• Persistent headaches

Central sleep apnea (CSA) symptoms look mostly the same as those experienced in OSA, but snoring can be less common.

What Causes Sleep Apnea?

Sleep apnea can have many causes, and this is where obstructive and central sleep apnea are different.

Risk Factors for Obstructive Sleep Apnea

Obstructive sleep apnea is caused by muscle relaxation during sleep. Muscles should relax during sleep, as it helps your body rest and recover. But sleepers with OSA usually have other risk factors that lead to compromising the airway, such as:

• Male sex
• Age above 60
• A short lower jaw
• Different palate (roof of your mouth) shapes 
• Large neck diameter
• Large tongue
• Excess body weight

When you gain weight, you gain it everywhere — even in your tongue and around your neck, and that extra tissue can block off your airway while you sleep.

Risk Factors for Central Sleep Apnea

Central sleep apnea is caused by inadequate communication between your brain and breathing muscles. Quite a few conditions can cause this, including:

• Heart failure
• Respiratory depression (usually from narcotic medications)
• End-stage kidney failure
• Neurological conditions such as a stroke, brain tumor, or degenerative neurological disorders

There are some conditions that can give you the risk for either OSA or CSA. These can be things like high altitude or the use of opioid medications. Even using a CPAP machine for OSA or other disorders can lead to the development of complex sleep apnea. 

How is Sleep Apnea Diagnosed?

Whether your partner shoves you all night for your raucous snores, or you feel sleepy all day after a supposed full night of sleep, it’s important to get any sleep apnea symptoms checked out. Check out some of the important steps below.

First, your healthcare provider will want to hear about your health history and do a physical exam. Also let them know if anyone in your family has a history of sleep apnea, as there could be a genetic component. 

Nocturnal polysomnography

The best way to determine whether you have sleep apnea is through a sleep study. In this study, also called nocturnal polysomnography, you spend the night in a medical facility with sensors on your scalp, face, chest, limbs, and one finger. While you sleep, staff monitor your heart rate, breathing, oxygen level, muscle movements, and brain waves. 

Your brain waves morph as you flow through cycles of the four sleep stages (light sleep to deep sleep), so measuring these waves gives your provider clues to your sleeping patterns. Sleep apnea disruptions are easily identified as abnormalities in these studies, also called the apnea-hypopnea index or AHI.

Apnea refers to a pause in breathing, while hypopnea refers to strained breathing in which your blood oxygen levels drop. The number of events you have on the AHI will determine the severity of your sleep apnea.

For the pediatric AHI, the ranges are a bit tighter. Mild sleep apnea in children is 1 to 4 events per hour, moderate is 5 to 9, and 10 or above is considered severe.

At-Home Sleep Tracking

Home sleep studies have fewer bells and whistles, and typically measure just your breathing and oxygen levels on a portable device. These can include sleep-tracking rings or watches. 

Of course, they come with their own caveats and may not always be 100% accurate, especially when results are compared against lab-run polysomnography. But if you’re getting concerning results, it may be time to talk with a doctor and schedule that sleep study.

Sleep Apnea in Women

Though most folks with sleep apnea are assigned male at birth, women can be diagnosed with the condition as well, though it often goes undiagnosed. Many of the risk factors are the same, such as excess weight or physiological structures of the mouth or airway.

If you experience any symptoms that could be attributed to sleep apnea, it’s important to talk to a healthcare provider. Studies show that women with OSA present with more daytime symptoms than men, like daytime drowsiness, irritability, or memory loss. Be on the lookout for anything out of the ordinary.

Sleep Apnea in Children

Sleep apnea is a problem for all, but for children, it can negatively affect their development. Less oxygen to the brain impairs cognitive function and delays growth.

A common risk factor for childhood sleep apnea is asthma. Like adults, weight can also play a role. The rate of childhood obesity has increased steadily over the past years, bringing with it an increased rate of childhood OSA.

Sleep apnea treatment in children typically involves removing their tonsils, which can be very effective. Traditional methods such as CPAP or weight-loss management can also be explored, depending on the severity of the condition.

What is the Impact of Untreated Sleep Apnea?

Pursuing a sleep apnea diagnosis may feel like a colossal pain in the neck, but the inconvenience is worth it. Untreated sleep apnea can disrupt your sleep, and chronic poor sleep leads to all sorts of no-fun symptoms and conditions, both in the short-term and over a longer period. 

Short-term effects of sleep apnea: 

• Mental health issues
• Low libido
• Daytime sleepiness
• Poor work or school performance

Long-term effects of sleep apnea: 

• Heart disease
• Stroke
• High blood pressure
• Early-onset dementia

You may go years without realizing that these symptoms come from sleep apnea. It’s important to stay in touch with your body and bring any concerns you have to a healthcare provider.

Sleep Apnea Treatments

​​Now that you know everything you ever wanted (and didn’t want) to know about sleep apnea, we can talk about solutions. For central sleep apnea, treatments typically revolve around its underlying cause, and therefore may be more complex or individualized. 

For OSA, though, treatment can include a mix of lifestyle changes and medical options.

Lifestyle Changes as Sleep Apnea Treatment

Avoiding Alcohol and Certain Medicines

Some of our favorite habits can unfortunately worsen sleep apnea and its side effects. For example, it’s best to avoid alcohol and medicines that make you sleepy, which can sometimes make apnea symptoms worse. 

Sleep Positions

Sleeping on your back gives gravity a leg up — this sleeping position can let more tissue fall back into your airway, making sleep apnea symptoms worse. Side sleeping is considered the best position for sleep apnea, often in conjunction with CPAP or other measures. Try to get used to sleeping on your side or with your head elevated on a pillow, and you may be able to lessen symptoms. 

Weight Loss

Some providers recommend weight loss for sleep apnea, and it certainly can’t hurt. While it may not be the complete cure, many studies suggest losing weight can lessen the severity and reduce side effects in the long-term. 

Non-Surgical Sleep Apnea Treatment

CPAP

“CPAP is the most common treatment for OSA,” says Dr. Raj Dasgupta, a sleep science expert and quadruple-board-certified pulmonologist. A CPAP machine works by blowing a pressurized column of air into your airway all night, which keeps your breathing and sleeping uninterrupted. 

To use CPAP, you wear a mask over your nose and mouth (or just your nose) at night while you sleep. This mask connects to a machine near your bed via a hose, which pumps pressurized air in while you sleep.

“Unfortunately, it relies on a mask that a patient wears over their nose and/or mouth during sleep to keep airways open, which can cause discomfort,” adds Dr. Dasgupta. Studies show that as low as 50% of sleepers with OSA can stick with CPAP therapy for an extended period of time.

Dental Device

Another option is a dental device designed to pull the jaw forward and keep the airways open. These may be more comfortable than CPAP machines, but still a bit invasive for light sleepers. 

Weight Loss Medications

Sometimes, treating the underlying cause may help with OSA symptoms.  “Weight loss drugs like GLP-1 medications can target the subset of patients where OSA is predominantly caused by excess weight,” Dr. Dasgupta explains. “But it’s important to remember that patients who use these medications to treat their OSA will take time because weight loss takes time — versus CPAP devices that provide relief immediately.”

Surgical Sleep Apnea Treatment

Over the years, experts have searched for various sleep apnea surgical fixes, and hypoglossal nerve stimulation (HNS) is often touted as an effective surgical treatment option. 

During this procedure, a surgeon places a device under the skin of your chest (similar to a pacemaker) and threads connected sensors that deliver electrical impulses to your hypoglossal nerve, AKA the nerve that makes your tongue tense up. With this gadget running, you stay asleep, but your tongue can’t relax back into your throat. Though the procedure is largely effective, some report discomfort or malfunctioning equipment as a common side effect.

Though not overly common, other surgeries combat sleep apnea by removing extra throat tissue or adjusting your palate and other facial structures. One popular surgery for both adults and children is the removal of the tonsils or adenoids, glands that can swell and block the airway.

Another surgical option, called maxillomandibular advancement (MMA) surgery, removes portions of your jawbone. It may sound intense, but research says it’s also an effective surgical treatment for OSA, with an 85 percent success rate.

For those who have tried CPAP and other treatments, surgery may be a good option — under the direction of your provider. But keep in mind that surgery doesn’t guarantee a cure, and most doctors consider CPAP therapy the best and least invasive option.

What Can You Do to Treat Sleep Apnea Symptoms?

If your provider gives you the go-ahead, you may be able to reduce sleep apnea symptoms with at-home self-care. Here are some small changes you can make to hopefully start sleeping better:

• Exercise: Aerobic exercise and strength training (with resistance bands or weights) can help you feel better when you have sleep apnea. Shoot for 150 minutes per week for the best results.
• Avoid alcohol: The alcohol in your favorite drink can relax your throat muscles and lead to blocked airways as you sleep.
• Double-check your medications: Some anti-anxiety medications and even sleeping pills can make sleep apnea worse.
• Don’t sleep on your back: When you sleep on your side or stomach, your tongue has less opportunity to fall back into your throat.
• Clear out nasal congestion: Use saline nasal spray, decongestants, or antihistamines to keep your sinuses clear.
• Use an adjustable base: While on the expensive side, if you can’t quite quit back sleeping, an adjustable bed can help elevate your head while you rest in this position, reducing the risk of obstruction. 

While these tips may improve your sleep apnea, it’s still always a good idea to check with your healthcare provider to make sure you don’t need more in-depth intervention.

Frequently Asked Questions About Sleep Apnea

Sources