Have you ever dealt with the embarrassment of being told—be it by a friend, partner, or annoyed fellow passenger on a flight—that you snore loudly in your sleep? Do you usually wake up feeling exhausted no matter how many hours of shut-eye you get at night?
These problems aren't just embarrassing and frustrating. They can be a sign of something much more serious: sleep apnea.
It may seem like more of a nuisance than a serious problem, but sleep apnea can be deadly if left untreated. Here's everything you need to know about the condition, how to diagnose it, and your sleep apnea treatment options.
What is sleep apnea?
Most people know of sleep apnea as a serious sleep disorder in which breathing repeatedly stops and starts. The United States National Library of Medicine offers a more nuanced definition, explaining that sleep apnea can occur not just when breathing stops but also when it becomes very shallow. The pauses in breathing during a sleep apnea episode can last anywhere from a few seconds to full minutes, and these breaks in breathing can occur 30 or more times in an hour.
Let that sink in: This is a medical condition that literally makes you stop breathing and, worse still, during a time when you won't even be aware that you have stopped breathing. That's as scary as it sounds.
What's the difference between obstructive, central, and complex sleep apnea?
The three kinds of sleep apnea are obstructive sleep apnea, central sleep apnea, and complex sleep apnea syndrome. Here's what you need to know about each:
Obstructive sleep apnea is the most common kind of sleep apnea, and it causes breathing to stop and start over and over again during sleep. In obstructive sleep apnea, your throat muscles relax intermittently while you're asleep, blocking your airway. This form of sleep apnea is marked by loud snoring. "Populations where more processed foods are consumed have narrower jaws, and this may be contributing to increased incidence of snoring and obstructive sleep apnea," says Ellen Vora, M.D., a holistic psychiatrist practicing in NYC.
Central sleep apnea happens when your brain doesn't send the right signals to the muscles that control breathing. It's much less common than obstructive sleep apnea; in fact, the American Sleep Apnea Association (ASAA) estimates that central sleep apnea represents just 20 percent of all sleep apnea cases.
Finally, there's complex sleep apnea syndrome, also known as treatment-emergent central sleep apnea, which is a mix of both obstructive sleep apnea and central sleep apnea. It was discovered in 2006 by researchers from the Mayo Clinic. Patients with complex sleep apnea first seem to have obstructive sleep apnea, but their issues aren't totally alleviated by a CPAP (continuous airway pressure) machine. After using the CPAP, complex sleep apnea patients will see improvement to their obstruction, but they still won't breathe the way they should, at which time symptoms of central sleep apnea will appear. In other words, the patient will seem to have obstructive sleep apnea, but treatment will reveal an underlying central sleep apnea.
Signs and symptoms of sleep apnea.
Because there are different kinds of sleep apnea, there are also different signs and symptoms to look out for. Yet, obstructive and central sleep apnea also have some signs and symptoms in common, which are listed below. (We won't include complex sleep apnea in this section because it can only be diagnosed after treatment for obstructive sleep apnea has begun.)
It's worth noting that snoring is much more often a sign of obstructive sleep apnea than central sleep apnea. While both kinds of sleep apnea can cause snoring, obstructive sleep apnea is characterized by very loud snoring. If you've been sleeping with or near someone and they're nagging you about your snoring, it might not just be an annoying quirk to deal with. It could be a serious medical issue.
Observed episodes of breathing cessation during sleep
This is medical speak for "you (or someone who's seen you sleep) have actually noticed that you stopped breathing while sleeping." That's not just a sign; it's the definition of sleep apnea.
Waking up abruptly gasping for air
This one should be a no-brainer. Sleep apnea does make you stop breathing in your sleep, after all.
If you're waking up with headaches on the regular, keep an eye out for other signs and symptoms of sleep apnea.
In particular, you might notice increased depression or irritability if you're suffering from either obstructive or central sleep apnea.
In addition to being tired and irritable, you might notice that you have trouble concentrating during the day if your sleep quality is affected by sleep apnea.
Signs and symptoms unique to obstructive sleep apnea.
Other symptoms people suffering from obstructive sleep apnea might notice include:
- High blood pressure
- Sweating at night
- Loss of interest in sex
- Waking up with dry mouth and/or sore throat
Signs and symptoms unique to central sleep apnea.
Other symptoms people suffering from central sleep apnea might notice include:
- Shortness of breath when lying down that gets better as you sit up
- Insomnia and/or difficulty staying sleep
- Chest pain at night
What causes sleep apnea?
"There are so many factors that can contribute to sleep apnea risk," says Dr. Vora, "including being overweight, having a large neck circumference or a narrow throat, alcohol or sedative use, and smoking."
And, just as with signs and symptoms, the causes of obstructive and central sleep apnea can vary. (Once again, complex sleep apnea won't be addressed directly in this section because it's a mix of the other two kinds of sleep apnea.)
Obstructive sleep apnea is caused by the muscles in the back of your throat relaxing so much that your airway narrows—or, in some cases, closes completely—and normal breathing is impossible. This typically lasts for 10 to 20 seconds, which can lower the level of oxygen in the blood. In people with obstructive sleep apnea, the airways can become blocked five to 30 times an hour all night long. In some cases, the airway blockage can repeat even more.
Central sleep apnea starts in the brain, not in the throat. Basically, if you have central sleep apnea, your brain isn't telling your breathing muscles what they need to work. There are several things that can impair your brain's ability to send those messages properly.
In some cases, central sleep apnea can be the result of another health issue, like congestive heart failure or a stroke. In these cases, breathing will get gradually weaker (and then stronger again) throughout the night, and sleep apnea will occur during the weakest point in that breathing cycle.
Other causes of central sleep apnea include drugs, specifically opioids, which can cause irregular breathing, and exposure to high altitudes, which can cause hyperventilation due to the change in oxygen levels.
Risk factors for obstructive sleep apnea.
So what makes you more at risk for sleep apnea? Again, it varies depending on the kind of sleep apnea. Here's what you need to know about the risk factors for obstructive sleep apnea and central sleep apnea.
Being obese or overweight. Roughly half of people with obstructive sleep apnea are overweight. The reason excessive weight is associated with a higher risk of obstructive sleep apnea is that fat deposits can obstruct the airways.
Inherited predisposition. Sometimes your genes are to blame for naturally narrow airways that cause sleep apnea.
Enlarged tonsils and adenoids. If your tonsils or adenoids (the glands found on the roof of your mouth, behind the soft palate) become enlarged, your airways may become blocked.
High blood pressure. Obstructive sleep apnea is pretty common among people with high blood pressure.
Diabetes. Research has found a significant link between obstructive sleep apnea and diabetes, but it's not yet clear why that is.
Sex. Across the board, researchers agree that men are more vulnerable to the condition than women. According to the National Sleep Foundation, about eight times as many men have obstructive sleep apnea than do women.
Family history. Like many conditions, a family history of sleep apnea increases your own risk of having the condition.
Risk factors for central sleep apnea.
Sex. As with obstructive sleep apnea, men are more likely to develop central sleep apnea than women.
Age. Because central sleep apnea is often caused by other health conditions, like heart issues and stroke, it's more likely to strike older people who are at increased risk for those problems, particularly people over 65.
Living at a high altitude. Live somewhere like Colorado? The views might be amazing, but the high altitude puts you at a higher risk of developing central sleep apnea.
How sleep apnea can affect your health.
If left untreated, sleep apnea is potentially very dangerous. Sleep apnea brings with it an increased risk of stroke, heart attack, and dementia. Sleep apnea can even be fatal in some cases. Case in point: Sleep apnea was reported as a contributing cause of death for actress Carrie Fisher. Even if sleep apnea doesn't kill you, it definitely increases your risk of dying younger than you would otherwise. A 2015 study found that people with untreated sleep apnea are 86 percent more likely to die at a younger age than people who don't have sleep apnea.
Untreated sleep apnea also leaves you open to a variety of other side effects and complications. Researchers have found a strong link between obstructive sleep apnea and depression, for example, although the relationship between the two isn't fully understood at this time. Another study found that sleep apnea might be associated with erectile dysfunction in men.
Diagnosing sleep apnea.
At this point, you might be way more worried about your snoring than you were at the beginning of this article! So, Dr. Vora says, "if you snore loudly, wake up with a headache or very dry mouth, experience insomnia or excessive daytime sleepiness, feel irritable, have been told by a bed partner that you gasp for air at night, or have any reason to believe you might have sleep apnea, it's a good idea to raise this topic with your primary care doctor and consider going for a sleep study."
At your initial appointment, it's important to explain your symptoms, family history, and anything else that you think might be relevant to your diagnosis. If your doctor believes there's reason to be concerned about sleep apnea, they will refer you to a sleep specialist for a full evaluation.
Usually, the evaluation for sleep apnea will require that you stay overnight at a sleep center for monitoring. The primary test used to detect sleep apnea is a nocturnal polysomnography, which entails being hooked up to all kinds of medical equipment to monitor everything from your heart and brain activity to your breathing patterns and blood oxygen levels.
There are also home sleep test options available, which can be simpler and, of course, don't require you to spend a night at a sleep center. Home tests are less reliable, however, and sleep center testing might still be required down the line.
Testing for sleep apnea can be expensive, however, especially if your health insurance plan doesn't cover it. According to the American Sleep Apnea Association, the cost of diagnosing and treating sleep apnea is usually more than $1,000 and can be even more if ongoing treatment is required. This shouldn't stop you from getting treatment, however, since sleep apnea can be very dangerous if left untreated.
Sleep apnea treatment options.
The first step in alleviating obstructive sleep apnea is to make lifestyle changes. Since excess weight is a known cause of this kind of sleep apnea, your doctor will likely recommend weight loss and exercise if you're overweight or obese. You can also avoid alcohol and medications that relax the throat muscles and change your sleeping position (sleeping on your side or your stomach is better for the condition than sleeping on your back). If you smoke, your doctor will also encourage you to stop right away.
Your doctor might also recommend that you use a special device called a CPAP machine to help treat your sleep apnea. CPAP stands for "continuous positive airway pressure," and it's administered by a machine that helps do the work of keeping your airways open while you sleep. This will involve wearing a mask that pumps air through your airways. CPAP machines are effective at treating moderate to severe sleep apnea (and they're the primary treatment for central sleep apnea), but it can be uncomfortable for some people to sleep in.
Finally, if other treatments aren’t working, your doctor might recommend surgery. According to the Mayo Clinic, surgical solutions for sleep apnea include:
Tissue removal. Specifically, the surgeon would remove tissue from the back of your mouth and top of your throat. Usually, this would include a tonsillectomy.
Tissue shrinkage. Using energy (radiofrequency ablation), doctors can shrink the tissues in the back of the mouth and top of the throat, but this is only effective for mild to moderate sleep apnea.
Jaw repositioning. This is a big one and involves moving the jaw forward to increase the amount of space behind the tongue to make obstruction less likely.
Nerve stimulation. In this surgery, a stimulator is inserted into the nerve that controls tongue movement to keep the tongue in the right position so the airway stays open.
Tracheostomy. This surgery is an extreme option reserved for life-threatening cases of sleep apnea that haven't responded to other treatments. It involves a surgeon creating an opening in your neck and inserting a tube that you would breathe through.
Bottom line: If you think you might have sleep apnea, the best course of action is to talk to your doctor and proactively make lifestyle changes that can help alleviate the symptoms, like snoring. The process of diagnosing and treating sleep apnea might seem daunting, but it's well worth the health benefits of treating the condition as soon as possible.