Sleep apnea is a type of sleep-related breathing disorder. People with sleep apnea experience shallow breathing or repeatedly have pauses in breathing while they sleep. Unfortunately, many sleepers go unaware that their nighttime breathing is abnormal and up to 80% of people with sleep apnea go undiagnosed.

Sleep apnea can also reduce the quality of your sleep while increasing your risk of serious health consequences. If you think you may have sleep apnea, it's important to seek the necessary testing and treatment as soon as possible.

There are two main types of sleep apnea:

• Obstructive Sleep Apnea (OSA): Obstructive sleep apnea occurs when the airway at the back of the throat becomes constricted or obstructed during sleep, air is prevented from passing through normally. In response to the obstruction, a person usually takes several gasps or deep breaths, and may make sounds like snorting or choking. Approximately 10% to 30% of adults in the United States have OSA.
• Central Sleep Apnea (CSA): Central sleep apnea is caused by a miscommunication between the brain and the muscles that control breathing, leading to temporary pauses or periods of shallow breathing. It is estimated that less than 1% of people have CSA.

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Symptoms of Sleep Apnea

The effects of restless and poor sleep may be compounded by how sleep apnea affects oxygen levels in the body. If left undiagnosed or untreated, it accompanies a higher risk of health problems, including metabolic disorders, mood disorders, and high blood pressure. Frequent symptoms of sleep apnea to watch out for include:

• Excessive daytime sleepiness
• Loud snoring or gasping
• Headaches after waking up
• Dry mouth
• Irritability or difficulty concentrating
• Abnormal breathing, such as breathing that slows down, speeds up, or pauses
• Sudden shortness of breath or chest pain

Certain symptoms may not be immediately noticeable to a sleeping individual. For example, abnormal breathing and snoring may only be noticed by a partner, family member, or caregiver. In adolescents, OSA is much more common than CSA. It is estimated that 1% to 5% of children have OSA, typically caused by enlarged tonsils and adenoids in the throat.

Causes of Sleep Apnea

In people with OSA, the muscles in the back of the throat relax during sleep, reducing space for air to pass through. Snoring occurs as the airway narrows, and when the airway is obstructed, a person fails to get enough oxygen. The lack of oxygen causes partial or complete awakenings in order to restore airflow, repeatedly disrupting the sleep cycle.

Multiple factors affect a person’s chances of developing OSA.

• Age
• Sex
• Head and neck anatomy
• Body weight
• Alcohol and cigarette use
• Hormone abnormalities
• Sleeping position
• Family history of sleep apnea
• Certain medical conditions

For people with CSA, when the brain stem fails to properly recognize carbon dioxide levels in the body during sleep it can cause repeated episodes of breathing that is slower and shallower than it should be. CSA most often occurs as a consequence of another medical problem, such as a stroke, infection, or injury affecting the brain.

How Is Sleep Apnea Diagnosed?

An evaluation for sleep apnea typically starts with a review of a person’s symptoms and overall health, as well as a physical exam. Although testing is required to confirm that someone has sleep apnea, the presence of symptoms can factor into the diagnosis and help determine the severity of the condition.

A sleep study, also called polysomnography, is conducted at a specialized sleep laboratory where multiple sensors are used to track breathing, awakenings, oxygen levels, muscle movement, sleep stages, and other aspects of sleep. An in-lab sleep study can differentiate between obstructive and central sleep apnea. An at-home sleep study for OSA may be more convenient, but the results must still be interpreted by a health professional.

Treatments for Sleep Apnea

Treatment for CSA often focuses on addressing the medical issue causing abnormal breathing. If sleep disruptions are mild, treatment for the underlying cause may be all that is required. For symptoms of CSA that are persistent or severe, additional treatment, including medication or supplemental oxygen therapy, may be advised.

Sleep environment changes as well as behavioral changes can effectively prevent or resolve mild symptoms of OSA. These may include losing weight, getting regular exercise, altering sleeping position, and limiting alcohol consumption. However, if the condition persists, doctors may recommend additional treatment plans involving PAP or oral devices, or even surgery.

• PAP Therapy: Positive airway pressure (PAP) therapy is a treatment offered to almost all people with sleep apnea. PAP therapy keeps the airway open with pressurized air that is pumped from a machine through a hose and a mask worn on the face. The “gold standard” is continuous positive airway pressure (CPAP) which sends a stream of air that is always at the same pressure level, however other types of PAP devices are available that can provide variability in the amount of air pressure.
• Oral Appliances: For people with certain anatomical features, oral appliances that can hold the jaw or tongue in a specific position may reduce the severity of OSA. These oral appliances often do not improve breathing as much as PAP therapy, but may be preferred by people who have difficulties or discomfort when using PAP devices.
• Surgery: Surgery to expand the airway can be a treatment option for patients who have tissue obstructing their airway. Another type of surgical treatment requires implanting a device to stimulate a nerve that helps control breathing. Surgery is usually the last treatment option and only advised after trying less invasive treatments first.

It is important to stay in touch with your sleep specialist and report any ongoing symptoms, challenges, or other concerns that may require an adjustment to your treatment plan.

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