Sleep Apnea Causes and Treatments

What would you do if you suddenly stopped breathing right in the middle of an afternoon meeting? Or with your kids at a park? You would likely be alarmed, to say the least. But when you have sleep apnea, you sleep right through short pauses in breath multiple times each hour.

During a sleep apnea episode, your breathing pauses throughout the night. Your body catches on to the problem pretty quick and gets you breathing again, but these pauses can make your oxygen levels dip and disrupt healthy sleep patterns. (1)

For some, these pauses are obvious thanks to loud gasps, while others may show no outward signs this is happening. (1) Either way, sleep apnea is very common: almost 40 million Americans have a sleep apnea diagnosis, and experts think many go undiagnosed. (2)

Wondering if you’re one of those who have undiagnosed sleep apnea may induce some anxiety, but you have plenty of options for treatment to keep your breathing and slumber steady all night.

Note: The content on Sleepopolis is meant to be informative in nature, but it shouldn’t be taken as medical advice, and it shouldn’t take the place of medical advice and supervision from a trained professional. If you feel you may be suffering from any sleep disorder or medical condition, please see your healthcare provider immediately.

What Is Sleep Apnea?

Let’s get down to the nitty gritty: what is sleep apnea, exactly? “Sleep apnea is a breathing disorder,” says Audrey Wells, MD, sleep expert and founder of Super Sleep MD. But not all sleep apnea is the same — there are a few different types.

Sleep Apnea Episodes 

Obstructive sleep apnea episodes typically last from 10 to 120 seconds and happen when your muscles relax during sleep and let floppy tissues 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 an hour or more. (4) (1)

These episodes block air from getting through, says Joel Provenzano, M.D., a pulmonary care and critical care physician based in Marion, OH. “Your body then has to wake you up to open up your airway to start breathing again.” This wake-up can involve loud gasps, grunts, and snorts. (1)

Types of Sleep Apnea 

Experts categorize sleep apnea into two distinct categories, with a third type describing a mashup of the other two. 

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. (1) 

Central Sleep Apnea

When you have central sleep apnea, your brain periodically stops sending messages to your breathing muscles, causing pauses in breathing. (5)

Complex Sleep Apnea

Complex sleep apnea is a mix of the two types, and the most common pattern is developing CSA while being treated for the obstructive type. (6)

Obstructive sleep apnea, or OSA, is by far the most common type of the three, so we’ll spend most of our time talking about it over the others. (5) (6) 

Sleep Apnea Symptoms

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

Most people with sleep apnea (94 percent) snore in their sleep. (2) Beyond that, the most common symptoms of sleep apnea are fatigue and excessive daytime sleepiness, says Provenzano. “This is because even in mild sleep apnea you are waking up every 8 to 10 minutes and are not maintaining sleep long enough to get into the deep, restful, restorative stages of sleep.” 

Sleep apnea symptoms: (1)

• Very loud snoring
• Snoring interrupted by long periods of silence followed by a loud snort or gasp
• Irritability
• Forgetfulness
• Waking up feeling unrefreshed
• Falling asleep easily through the day
• Drowsiness while driving
• High blood pressure (hypertension)
• Depression
• Hyperactive behavior (most common in children)
• Persistent headaches

While snoring and sleepiness are common, you can have sleep apnea without these symptoms, says Wells. 

Central sleep apnea (CSA) symptoms look mostly the same as those experienced in OSA, but snoring can be less common.(5)

What Causes Sleep Apnea?

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

Obstructive Sleep Apnea Causes and Risk Factors

Obstructive sleep apnea is caused by muscle relaxation during sleep. (1) But everyone gets sleep-induced floppy muscles, so why doesn’t everyone have this problem? Because people with OSA usually have some other risk factors at play, like: (1)

• 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. (1) (7)

Central Sleep Apnea Causes and Risk Factors

Central sleep apnea is caused by inadequate communication between your brain and breathing muscles. Quite a few conditions can cause this, including: (5)

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

Certain risk factors can also make you more likely to develop either type of sleep apnea: (5)

• Current heart disorders like atrial fibrillation
• History of stroke or brain tumors
• High altitude
• Opioid medications
• CPAP use (You read that right — sometimes CPAP therapy can lead to complex sleep apnea)

Diagnosing Sleep Apnea

Whether your partner shoves you all night for your raucous snores, or you feel sleepy all day after a “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. (1) Sleep apnea runs in families, says Provenzano, so your provider will also want to know if anyone in your family has sleep apnea. After this, for all types of sleep apnea, the go-to method for diagnosis is a sleep study. (8)

Nocturnal polysomnography

In a sleep lab 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. (9)

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. (10)

Home Sleep Study

Home sleep studies have fewer bells and whistles, and typically measure just your breathing and oxygen levels on a portable device. (11) These more simple studies can be convenient, but they’re only helpful if they come back positive, says Wells. “If the home sleep apnea test is done for a person who has symptoms of sleep apnea but it comes back negative, I would prefer to call that inconclusive because it may not be sensitive enough to pick up the condition.”

In other words, if you get a “no sleep apnea” result from a home sleep study, Wells recommends getting a sleep lab study to be sure.

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. (1) (5)

Short-term effects of sleep apnea: (1) (5)

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

Long-term effects of sleep-apnea: (1)

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

Some people can go years with sleep apnea before they notice any symptoms or long-term effects, says Wells, but typically you’ll see the signs within a year.

We’ll dig into this more below, but it’s important to remember that sleep apnea is extremely treatable, meaning you can very likely avoid any of the above symptoms by getting proper treatment. 

Sleep Apnea in Children

Your brain needs oxygen to function well, but in a child’s developing brain, oxygen is even more important, says Wells. Between two and three percent of children have diagnosed sleep apnea, but experts think the actual number could be up to 10 percent in children who snore. (12) Sleep apnea in children looks slightly different from adults. (13) 

Children three to ten years old have softer airways and are more prone to blockage by tonsils, says Wells. “And so just the volume of the tonsils is enough to obstruct a small and flexible airway,” she adds, whereas adults rarely have blockage from tonsils.

In one shared risk factor, weight can play a role in childhood sleep apnea. (13) The rate of childhood obesity has increased steadily over the past 20 years, with childhood OSA also on the rise. (14)

Wells says sleep apnea treatment in children typically involves having their tonsils removed, which can be very effective. If the child is overweight, however, they may need a follow up sleep study to see if further treatment is needed, she adds.

Sleep Apnea Treatment

​​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. (8)

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

Lifestyle Changes as Sleep Apnea Treatment

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

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. (1) If you can get used to sleeping on your side or with your head elevated on a pillow, you may be able to lessen symptoms, although these changes can’t replace other treatments. (15)

Some providers recommend weight loss for sleep apnea, and it certainly can’t hurt. “Studies have shown that significant weight loss can only ‘cure’ very mild sleep apnea, though losing weight can make sleep apnea less severe,” says Provenzano.

Non-Surgical Sleep Apnea Treatment

“The mainstay and gold standard of treating sleep apnea is PAP (positive airway pressure) therapy,” says Provenzano, which is usually offered via a CPAP (continuous positive airway pressure) device. About 33 million U.S. adults use a CPAP machine. (2)

A CPAP machine works by blowing a pressurized column of air into your airway all night, which keeps your breathing and sleeping uninterrupted. (16) To use CPAP, you wear a mask over your nose and mouth (or just your nose) at night while you sleep. This mask connects via a hose to a machine near your bed, which pumps the pressured air while you sleep. (16)

Providers recommend CPAP as a first line treatment because it’s non-invasive and can be customized, says Wells. “It works more than 95 times out of 100. But the trick is you have to use it,” she adds. That may sound simple, but compliance rates aren’t historically super high, often because of discomfort. (17) Luckily, CPAPs have changed quite a bit in recent years. 

“CPAP therapy has come a long way over the last several years to where the machines are smaller, quieter, and now even can auto-adjust through the night so you never get too much or too little air,” says Provenzano, who says you have a lot more options for mask styles and headgear now, so you can find the one that fits most comfortably. 

These positive changes in CPAP gear are important because they help people stick with it. “It really can change lives,” says Provenzano.

If you can’t tolerate a CPAP no matter how hard you try, Wells recommends using a dental device, which pushes your lower jaw forward and pulls tissues away from your throat. Although not as effective as CPAP, Wells says, custom-fit devices offered by a healthcare provider can help decrease sleep apnea episodes.

Surgical Sleep Apnea Treatment

Over the years, experts have searched for various sleep apnea surgical fixes, and hypoglossal nerve stimulation (HNS) is an effective surgical treatment option, says Wells. (18)

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. (19)

Though not overly common, other surgeries combat sleep apnea by: (1)

• Removing extra throat tissue
• Adjusting your palate or other facial structures
• Removing your tonsils and adenoids (a patch of tissue high in the throat) (20)

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. (21)

For those who have tried CPAP and other treatments, surgery can be a good option, under the direction of your provider. But keep in mind, surgery doesn’t guarantee a cure, and CPAP therapy remains the best option if possible. (1)

Self-Care for Sleep Apnea

If your provider gives you the okay, you may be able to lessen sleep apnea symptoms through-self care at home. 

Self-care for sleep apnea can include: (22)

• 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 your best results.
• Lose some weight: Even moderate weight loss can make more room in your airways.
• Avoid alcohol: The alcohol in your favorite drink can relax your throat muscles and lead to blocked airways as you sleep.
• Re-think some 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 or provider-approved decongestants or antihistamines to keep your sinuses clear.

While these tips may make a big difference for you, it’s still always a good idea to check with your healthcare provider to make sure you don’t need other treatments.

When to See a Doctor

As you’ve read, sleep apnea isn’t something you want to ignore. A healthcare provider can help you figure out if you have sleep apnea, which type you have, and how best to treat it. 

With that in mind, be sure to contact your provider if you snore regularly while sleeping, you wake up gasping through the night, or you feel exhausted and sleepy during the day, even after getting “enough” sleep. (1)

FAQs

The Last Word From Sleepopolis

Sleep apnea may sound scary, but consistent treatment can have you back on track and sleeping great! Some report difficulty getting used to CPAP, but once they do, they say they’ve never felt better, says Wells. No matter your treatment path, stick with it, let your provider know about any new symptoms, and enjoy better rest and a healthier you!

Sources

Abby McCoy

Abby McCoy is an RN of 16 years who has worked with adults and pediatric patients encompassing trauma, orthopedics, home care, transplant, and case management. She has practiced nursing all over the world from San Fransisco, CA to Tharaka, Kenya. Abby loves spending time with her husband, four kids, and their cat named Cat.