A beginner’s guide to sleep apnea
There’s nothing worse than getting a terrible night’s sleep. Tossing and turning. Feeling restless. Moving through a fog the next day. It happens to the best of us. But for some people, this frustration can become a regular occurrence.
If you consistently have trouble sleeping, wake up feeling unrested and irritable, or still feel tired after a full night’s sleep, it may be a sign of sleep apnea. In fact, it’s one of the most common sleep disorders in America, according to the American Academy of Sleep Medicine.
The thing is, many people with sleep apnea don’t know they have it. Here’s what you need to know about the condition — and how to get the restful sleep you deserve.
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What is sleep apnea?
The more common form of sleep apnea (SA) is called obstructive sleep apnea (OSA). It’s a condition that causes airways to collapse during sleep. This can prevent effective breathing for more than 10 seconds at a time, according to the National Institutes of Health. And it can happen repeatedly during the night: People with severe OSA may have upward of 30 breathing disruptions per hour.
Each time this happens, the person is forced to awaken to breathe again. These awakenings are so brief that the person may not even remember them.
What are the symptoms of sleep apnea?
One of the classic signs is excessive sleepiness during the day, says Sheila Tsai, MD. She’s a pulmonologist and the head of sleep medicine at National Jewish Health in Denver. Some of the other most common symptoms include:
- Loud snoring
- Morning headaches
- Restless sleep
- Witnessed pauses in breathing
- Memory or concentration issues, such as forgetfulness
These symptoms can mimic other common sleep disorders such as insomnia. People with insomnia have difficulty falling and staying asleep. (Learn more about insomnia – and how to treat it safely — here.) So if you or a loved one is experiencing some of these issues, it might be time to have a conversation with your doctor.
What causes sleep apnea?
Unfortunately, experts aren’t sure what causes sleep apnea. But there are several common factors that put you at greater risk. These include:
- Weight. Having extra weight can put more pressure on your upper airway, which can obstruct breathing.
- Genetics. Sleep apnea may run in families. One study published in the journal Sleep estimated that obstructive sleep apnea is 40% attributable to genetics.
- Mouth and upper airway. Large tonsils, a large tongue or a small airway can make blocked breathing more likely during sleep.
- Gender. “Men have higher rates of sleep apnea than women, and we think part of that is related to female sex hormones being somewhat protective,” says Dr. Tsai.
- Smoking. This can inflame the upper airway, which can contribute to OSA, says Dr. Tsai.
- Sleep position. Sleep apnea is often worse in the supine (lying on your back) position, since it cuts off your airway, says W. Christopher Winter, MD. He’s a neurologist, sleep specialist and author of The Rested Child.
- Medications. Some can worsen or contribute to sleep apnea, says Dr. Tsai. These can include narcotics and benzodiazepines, which are sometimes taken for anxiety.
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Why is sleep apnea harmful?
These breathing disruptions aren’t just a nighttime nuisance (to you or your partner). They can also contribute to a plethora of health issues.
For starters, chronic sleep deprivation can lead to falling asleep at dangerous times, such as when you’re driving. And it’s connected to changes in mood, too.
Untreated sleep apnea is also linked to a host of chronic diseases, such as coronary artery disease and diabetes. That’s because the on-again, off-again loss of oxygen during the night can mess with your metabolism. For example: “When you have sleep apnea, the factors involved in clotting and inflammation are increased,” says Dr. Winter. It may also change how your body processes lipids (such as cholesterol) and insulin, he adds.
Sleep apnea can also increase your risk for obesity. A study from Johns Hopkins Medicine found that sleep apnea led to an increase in blood sugar and fat levels, which can play a role in putting on pounds. “When we sleep poorly, we also tend to secrete more of the hormone ghrelin that makes us feel hungry,” notes Dr. Tsai. “This increases our cravings for fatty, unhealthy food and consequently can result in weight gain.”
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How is sleep apnea treated?
If you suspect you have sleep apnea, talk to your doctor. You may be referred to a sleep medicine specialist. These experts will start with a thorough history and physical examination, which includes learning more about you and your habits. They’ll also assess your body mass index, neck circumference, facial features and upper airway anatomy.
“Taking all these data together helps us evaluate the symptoms and determine likelihood for sleep apnea,” says Dr. Tsai. “Then a sleep study is performed to confirm the diagnosis of sleep apnea.” Think of this exam as a high-tech sleepover. You’ll spend the night in a sleep lab so that doctors can monitor what is happening in your body and your brain.
There are no medications available that successfully treat OSA. But your doctor may suggest one of the following treatments:
CPAP stands for continuous positive airway pressure. “With CPAP therapy, a machine will generate pressure that is delivered through a mask that the patient wears during sleep,” says Dr. Tsai. “The pressure keeps the upper airway open during sleep so that it cannot close or narrow. In that way, the oxygen does not drop frequently, and the sleep is more sound and there is less stress to the body.”
Oral appliance therapy
In certain people with OSA, a mandibular advancement device (or oral appliance therapy) can be used to treat sleep apnea when it is worn overnight.
“It is made by a dentist and worn in the upper and lower teeth like retainers,” says Dr. Tsai. “The lower portion is anchored to the top such that the jaw is somewhat protruded to open up the upper airway space.”
If CPAP therapy or other treatments aren’t successful, your doctor may recommend more invasive options that help open your airway.
Some examples include removing the tonsils or adenoids (glands that sit up high in the throat). There’s also a device called the hypoglossal nerve stimulator. It is implanted under the skin, and an electrode is surgically placed around a nerve that causes the tongue to contract and move forward in the mouth.
Making changes to your everyday habits may also help reduce your sleep apnea symptoms.
“I always encourage lifestyle modifications to help manage sleep apnea. For example, exercising and maintaining a healthy weight are important,” says Dr. Tsai. “Limiting alcohol, cigarettes and medications that can worsen sleep apnea are helpful measures. I also usually recommend people try not to sleep on their backs and to sleep with the head of their bed slightly elevated, if possible, if sleep apnea is a concern.”
These are just some of the common strategies that can help you reap more restful sleep. When in doubt, talk to your doctor about how you can take charge of your sleep habits once and for all.
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Sleep apnea overview: National Institute of Neurological Disorders and Stroke
Common sleep disorders: Cleveland Clinic
How sleep apnea impacts health: Physiological Reviews (2010). “Pathophysiology of Sleep Apnea”
Sleep apnea and genetics: Sleep (2011). “Genetic Underpinnings of Obstructive Sleep Apnea: Are We Making Progress?”