What obstructive sleep apnea is
While you sleep, the muscles of the throat relax. In obstructive sleep apnea (OSA) they relax so far that the soft tissue and the base of the tongue narrow or close the airway. Breathing stops or becomes shallow, oxygen falls, and the brain briefly rouses you to open the airway again, often with a gasp or a snort. You rarely remember these awakenings. They can happen a handful of times a night in mild apnea, and thirty or more times an hour in severe apnea, and each one fragments the deep sleep that repairs the body and the mind.
A landmark study of middle-aged adults found sleep-disordered breathing in about 24 percent of men and 9 percent of women, and most of them had never been diagnosed. The Centers for Disease Control and Prevention estimates that 50 to 70 million people in the United States live with a sleep or wakefulness disorder.
Symptoms
The person with apnea often notices the daytime half. The bed partner notices the night.
- Loud, regular snoring
- Pauses in breathing, then a gasp or choking sound, seen by a partner
- Waking unrefreshed, however long you slept
- Morning headaches, or a dry mouth and sore throat on waking
- Daytime sleepiness: falling asleep reading, watching television, in a meeting or at the wheel
- Trouble concentrating, irritability, low mood
- Waking often during the night, or to urinate
- Night sweats with no other cause
- High blood pressure that is hard to control
- Teeth worn flat or a jaw that clenches forward at night, which we often see at a dental visit before anything else is suspected
Two or three of these together are reason enough to be tested. Take the two-minute check below, or request an appointment.
Risk factors
- Weight. Extra tissue around the neck and airway narrows it. A body mass index above 35 is a recognized risk factor, and a larger neck size on its own. The BMI calculator below is here if you want to check.
- Age and sex. Risk rises after 50, and men are affected about twice as often as women, though women catch up after menopause.
- Family history and anatomy. A narrow airway, a small or set-back lower jaw, large tonsils, a long soft palate or chronic nasal congestion all run in families.
- Alcohol, sedatives and smoking. Alcohol and sedating medicines relax the throat further; even one drink before bed can worsen apnea. Smoking inflames the airway.
- High blood pressure, diabetes and asthma. Each one is more common in people with apnea, and apnea makes each one harder to control.
Read more: alcohol and sleep apnea, is sleep apnea hereditary, sleep apnea and weight gain, how common sleep apnea is.
Health risks
Untreated apnea is not only tiredness. Every pause drops oxygen and spikes stress hormones, hundreds of times a night, for years. The conditions linked to it in the research include:
- High blood pressure and heart disease, including atrial fibrillation
- Stroke
- Type 2 diabetes and weight gain
- Depression, anxiety and memory problems and dementia
- Headaches and migraines
- Chronic pain and fibromyalgia
- Car accidents: a drowsy driver is as dangerous as a drunk one
- Complications that, over years, shorten lives
The types of sleep apnea
Obstructive sleep apnea is by far the most common: the airway is physically blocked. Central sleep apnea is different: the brain briefly stops sending the signal to breathe, and it is treated differently, usually by a physician. Complex sleep apnea is a mix of the two. A sleep test tells them apart, which is one reason a diagnosis matters before any treatment. Read more about central sleep apnea and the types of sleep apnea.
How sleep apnea is diagnosed
A sleep test records your breathing, oxygen level and heart rate while you sleep. For most adults with suspected obstructive apnea, a home sleep test in your own bed is the first step. When symptoms suggest central apnea or another sleep disorder, an overnight study in a sleep laboratory (polysomnography) is the right test, and we help arrange it.
The result is scored as the apnea-hypopnea index, the number of pauses and shallow breaths per hour of sleep:
- 5 to 15 is mild
- 15 to 30 is moderate
- 30 or more is severe
How it is treated
Treatment depends on the severity and on you. Positive airway pressure (CPAP and its relatives) is effective when it is worn every night, and for some people it is the right choice. For adults with mild or moderate apnea, and for people with severe apnea who cannot tolerate CPAP, the sleep medicine guideline supports a custom oral appliance, made and fitted by a dentist, which holds the lower jaw forward and keeps the airway open. Lifestyle changes, positional therapy and, rarely, surgery round out the options. We tell you honestly which of these fits your results.
