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Sleep Apnea

Sleep apnea is a disorder in which breathing repeatedly stops and starts during sleep. Obstructive sleep apnea is the most common type. Common symptoms of sleep apnea include daytime fatigue, brain fog and dry mouth. Untreated, sleep apnea can lead to other health problems.

Last Modified: October 13, 2021
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What is Sleep Apnea?

Sleep apnea is a serious but common sleep disorder marked by extended pauses in breathing that occur multiple times during sleep. Lapses in breathing cause a dip in the body’s oxygen and lead to poor sleep quality. Sleep apnea can affect children and women, but it’s most common in men.

There are two main types of sleep apnea: obstructive sleep apnea (OSA) and central sleep apnea and mixed sleep apnea. People with both types have mixed sleep apnea.

Most people have obstructive sleep apnea which is caused by the tongue, jaw or uvula shifting position during sleep and blocking the airway. Central sleep apnea happens when the brain fails to send signals to muscles responsible for breathing.

Graphic showing the mouth in normal sleep versus sleep apnea
Obstructive sleep apnea is caused by the soft palate, tongue or uvula blocking the airway.

Symptoms of Sleep Apnea

Sleep apnea symptoms are caused by poor sleep quality and reduced oxygen in the body. Because these symptoms may mimic other health conditions, it’s important to check with your medical provider.

These symptoms may accompany signs — or evidence — of sleep apnea, such as reduced or absent breathing, loud snoring and choking or gasping for air while sleeping.

Breathing may stop for 10 seconds or more at a time, according to Dr. Jonathan Jun, a pulmonary and sleep medicine specialist at the Johns Hopkins Sleep Disorders Center.

You may have sleep apnea if you experience:
  • Decreased sex drive
  • Depression or anxiety in women
  • Dry mouth after waking up
  • Hyperactivity in children
  • Insomnia
  • Morning headaches
  • Problems with attention, concentration, memory and motor skills
  • Sexual dysfunction
  • Unusual sleepiness and fatigue during the day
  • Waking up to urinate frequently
Did you know?
Women and children may have different symptoms than men. Women report depression and anxiety as well as insomnia. Children experience asthma, hyperactivity and learning performance issues.

Though different things cause obstructive sleep apnea and central sleep apnea, they have many of the same symptoms and people need to see sleep specialists to get a proper diagnosis.

Left untreated, sleep apnea symptoms can get worse and lead to other health problems. Make sure you talk to your medical provider if you experience any signs or symptoms.

Causes and Risk Factors

Sleep apnea can be caused by various medical conditions or a person’s anatomy that lead to a blocked airway. People with OSA have blocked airways, while people with central sleep apnea have difficulty breathing during sleep because of faulty brain signals.

In addition, a person’s age, race, family history or lifestyle may increase the risk of developing sleep apnea.

Sleep apnea can be caused by:
  • Being born with conditions such as smaller facial bones, cleft lip or palate or Down syndrome
  • Certain medications that affect muscles or sleep patterns, such as opioids.
  • Fluid build-up in the neck from kidney or heart failure
  • Having large tonsils that narrow a person’s airway
  • Medical conditions that disrupt signals from the brain to the chest muscles or airway, such as stroke, myasthenia gravis or Chiari malformations
  • Obesity that increases neck fat deposits that obstruct the airway
  • Premature birth that increases the risk of breathing problems caused by the brain

The risk for sleep apnea increases with age, family history of sleep apnea or being black, Hispanic or Native American. Poor lifestyle habits such as drinking too much alcohol, smoking or being overweight or obese can also increase your risk.

Being obese can cause obesity hypoventilation syndrome (OHS), a condition where excess weight makes it difficult for the chest muscles to properly expand to take in air quickly enough. This makes it harder for the brain to control breathing.

Diagnosis

The gold standard for diagnosing sleep apnea is a sleep study. Patients will go to a special clinic that can monitor their breathing, brain function and muscle function while they sleep.

Before your medical provider will refer you to a sleep specialist or recommend a sleep study, they will examine you and ask you about your symptoms or any complications from untreated sleep apnea.

Make sure you come prepared to answer questions about your medical and family history.

Steps to Diagnose Sleep Apnea
  1. Medical History. Your doctor will review your medical history, such as family history, risk factors for sleep apnea and what signs and symptoms you are experiencing.
  2. Physical Exam. Your doctor will conduct a physical exam to check for conditions that can increase your risk, such as: Obesity, large neck circumference or a narrow airway.
  3. Sleep Study. If you have signs, symptoms and risk factors or sleep apnea, your doctor will recommend a sleep study to monitor blood oxygen levels, check brain activity, detect how many times your breathing stops or slows and check chest muscle function.
  4. Additional Tests. Tests to rule out other conditions such as hormone problems or medical conditions that could contribute to sleep apnea.

Treatment for Sleep Apnea

Treatments for sleep apnea include: continuous positive airway pressure (CPAP) or bi-level positive airway pressure (BiPAP) machines, lifestyles changes, oral devices or surgery. Sleep apnea treatment options depend on how severe sleep apnea is.

Specialists measure severity by how many apnea events — times you stop or have slow breathing — a person has per hour while sleeping. This measurement comes from a sleep study.

How Severe is Your Sleep Apnea?
Sleep Apnea SeverityNumber of Apnea EventsTreatment Options
Mild5 to 14 apnea events per hourCPAP, BiPAP, lifestyle changes, oral devices
Moderate15 to 29 apnea events per hourCPAP, BiPAP, oral devices
Severe30 or more apnea events per hourCPAP, BiPAP, surgery

CPAP and BiPAP Machines

Continuous positive airway pressure (CPAP) or bi-level positive airway pressure (BiPAP) machines are machines that use pressurized air to keep airways open and help people breathe better during sleep. CPAP machines use the same air pressure when people breathe in and out, and BiPAP machines use less pressure when a person breathes out. CPAP devices are one of the main treatments for people with OSA and central sleep apnea. These machines are effective, but they take some time to get used to and some people quit using the machines.

Millions of people use Philips CPAP machines, and they are the largest CPAP maker in the world. But in June 2021, the FDA announced a Philips CPAP recall because sound abatement foam in the devices could degrade, enter the body and potentially cause cancer and other serious risks.

People who used recalled devices filed Philips CPAP lawsuits against the device maker because of cancer and other injuries.

Not all of Philips’ CPAP machines were recalled and other CPAP companies make machines that are still considered safe and effective.

Philips CPAP & Cancer
Philips recalled their CPAP machines after discovering the sound abatement foam can degrade, releasing toxic chemicals and particles that can be ingested and cause serious health problems.
Learn More

Surgery

Doctors don’t typically recommend surgery for sleep apnea unless sleep apnea hasn’t responded to more conservative treatments such as CPAP. Possible complications include infection, bleeding, additional breathing problems and allergic reactions to anesthesia.

Surgeons can implant devices that keep the tongue, uvula or soft palate from blocking the airway. They can also remove tissue that blocks the airway or correct facial abnormalities that contribute to airway obstruction, such as part of the back of the tongue or the tonsils.

One 2021 article by Dr. Charles E. Morgan and colleagues suggests that surgical procedures have shown short-term benefits. But many studies suggest that the benefits vary by procedure and patient, especially in people with a higher body mass index.

Lifestyle Changes

Lifestyle changes are most effective for people with mild sleep apnea and can help reduce symptoms. Changes include: losing weight, reducing alcohol consumption and quitting smoking.

For example, one 2020 study published in Otolaryngology — Head and Neck Surgery showed that alcohol consumption was associated with worsening of snoring and low oxygen saturation in patients with OSA.

Another 2020 study in The Clinical Respiratory Journal found patients with severe OSA were heavy smokers and smoking increased OSA severity by reducing oxygen in the blood and increasing the apnea index.

Oral Devices

Oral devices are custom-made dental implants that help the jaw move forward and keep the tongue from blocking the airway. Patients insert them into their mouths when they go to sleep.

Examples of oral devices include mouth guards and tongue retaining devices. These devices are more effective for people with less severe sleep apnea.

What Are the Risks of Untreated Sleep Apnea?

Complications of untreated sleep apnea

Left untreated, sleep apnea can lead to more health problems. Lack of oxygen sends your body in high alert and increases heart rate and blood pressure.

“It’s very similar to that type of stress response. I would liken sleep apnea to something like that happening on a nightly basis,” explains Jun.

Constant oxygen fluctuations can lead to blood vessel and organ inflammation. If you have symptoms of sleep apnea, your doctor may check for these health conditions to help diagnose sleep apnea.

Sleep apnea increases the risk of:
  • Asthma
  • Behavioral and cognitive disorders such as dementia in older adults and learning disabilities in children
  • Cancer
  • Glaucoma, dry eye and other eye disorders
  • Heart attack or heart failure
  • High blood pressure
  • Irregular heartbeat called atrial fibrillation
  • Kidney problems
  • Mental health issues, such as depression
  • Stroke, hardening of the arteries
  • Type 2 diabetes, glucose intolerance and other metabolic disorders
Please seek the advice of a medical professional before making health care decisions.