Updated on June 13, 2023.
Obstructive sleep apnea (OSA) is a condition characterized by heavy snoring and waking up repeatedly during the night. During each episode, people with sleep apnea stop breathing momentarily.
Not only does sleep apnea typically result in poor sleep at night and daytime drowsiness, but untreated sleep apnea puts you at increased risk for a host of chronic illnesses, including high blood pressure, stroke, irregular heartbeat, and heart failure. These may, in turn, contribute to a shorter life expectancy. In fact, research has shown that moderate and severe sleep apnea are associated with an increased risk of premature death.
What is sleep apnea exactly?
When you sleep, your throat muscles typically used for speaking, breathing, and swallowing become relaxed and the throat becomes narrower. If you already have a narrow throat, these relaxed muscles may partially or completely block the airway. Enlarged tonsils, a small mouth, large tongue, and obesity might compound the problem.
If the blockage is severe enough to cause a stop in breathing or to reduce your ability to breathe, you’ll come out of a deep sleep and into a light sleep. You’ll often start breathing again with a loud snore and you may wake up choking. In the most severe cases of sleep apnea, this may happen up to 30 times per hour.
Why sleep apnea is dangerous
In addition to interfering with quality sleep, sleep apnea places stress on the body and reduces the amount of nourishing oxygen the body receives. As a result, it raises your risk of a host of other conditions, including:
- Cardiovascular disease, including high blood pressure, heart attack, stroke, heart failure, and irregular heart rhythm
- Type 2 diabetes
- Asthma
- Eye problems, including glaucoma and dry eye
- Chronic kidney disease
- Cancers, including pancreatic, kidney, and skin cancer
You’re most at risk for sleep apnea if you’re male, overweight, age 40 or older, or if you smoke or drink alcohol. People who are older, overweight or obese, or have a family history of sleep apnea also have a higher risk of developing the condition, as do people who have heart failure or kidney failure.
Physical traits may also play a role, as people with large tonsils, large tongues, and large necks are at increased risk. These factors lead to narrowing of the upper airways.
Warning signs
As many as 26 percent of U.S. adults have sleep apnea, but many people don’t know they have it. In fact, up to 90 percent of those who have the condition are undiagnosed, according to some research. Often a spouse or partner will let you know that you’re snoring loudly and/or gasping for breath in the middle of the night.
Even if you don’t share a bed with someone, you may be able to look for clues. Snoring and daytime fatigue are two of the main signs. Others include:
- Headache upon waking
- Depression and irritability
- Frequent urination at night
- Dry mouth or sore throat upon waking
- Decreased libido or sexual dysfunction
How it’s diagnosed
The first step is to see a healthcare provider (HCP). They will take a medical history and may give you a physical examination, looking for a large uvula (the fleshy structure that hangs down at the back of the mouth just before the throat), soft palette, or tonsils that may be obstructing the flow of air.
A sleep study is typically the best way to diagnose sleep apnea. Sensors at a sleep study center record the amount of oxygen in your blood, air movement while you breathe, brain waves, chest movements, and heart rate.
Home sleep monitors are available, as well. While the measurements of a home-based monitor are typically more limited, a 2017 study published in Annals of Internal Medicine suggested that home studies may be just as accurate at diagnosing sleep apnea as those in sleep centers.
Your HCP reviews the results to determine how many times you either stopped breathing or your breathing was blocked. Having 5 to 15 of these breathing events per hour indicates mild sleep apnea, between 15 and 30 signals moderate sleep apnea, and having more than 30 breathing stoppages per hour is severe.
How sleep apnea is treated
People with sleep apnea have several options for treatment. For mild cases, lifestyle changes—such as weight loss, smoking cessation, and avoidance of drugs and alcohol—may help reduce symptoms. Sleeping on your side and keeping your nasal passages clear might help, too.
Another option for mild sleep apnea is a mouthpiece that pulls the jaw forward and keeps your tongue from blocking airflow down your throat. A dentist or orthodontist can make one for you.
A continuous positive airway pressure (CPAP) machine is the most common treatment for moderate to severe sleep apnea. A CPAP machine forces air through your nostrils and mouth to keep airways open while you sleep.
The machine has interchangeable masks, from full-face to low-profile nose pillows that sit over your nostrils. It may take some experimenting to find the one that’s right for you. Tell your HCP if you find the CPAP machine uncomfortable, or if there are side effects like dry mouth or headaches.
Research suggests that using a CPAP machine may do more than help you breathe better.
Results from a 2018 Journal of the American Heart Association study of 4.9 million Danish adults, including almost 40,500 with sleep apnea, suggested that use of a CPAP machine can decrease the risk of heart failure. The 13-year study revealed the risk of heart failure was 38 percent higher among people ages 60 and older who did not treat sleep apnea with a CPAP machine. No matter the subject’s age, those not using CPAP had a slightly increased risk of heart failure, according to the study.
Surgery is often a last resort, if you can’t or don’t want to wear a CPAP machine. It may involve resetting the lower jaw, shaving off parts of the uvula or soft palette, removing tonsils or adenoids, or some combination of these measures.
One new remedy that has shown promise in research is known as hypoglossal nerve stimulation therapy. Rather than surgically adjusting the physical aspects of the airway, the therapy involves implanting a small device under the skin beneath the clavicle with a wire leading to the hypoglossal nerve of the tongue. With each breath, the device sends an electrical signal to stiffen the tongue and prevent it from falling backward and blocking the airway.
