Obstructive Sleep Apnea
One of the more well-known sleep disorders is called sleep apnea. There are two main types of sleep apnea -- central sleep apnea (CSA) and obstructive sleep apnea (OSA) -- and this article will focus on OSA.
An apnea is a temporary pause in breathing, and in OSA, this can happen dozens of times during the night. This happens because of the restriction of airflow through the airway.
In this guide, we’ll introduce you to OSA. We’ll cover all the key information that you need to know: what it is, what causes it, its symptoms, its consequences, and how it is diagnosed and treated.
What is Obstructive Sleep Apnea?
Obstructive sleep apnea is a condition that is marked by halted or interrupted breathing during sleep. Though the condition is called sleep apnea, each individual pause in breath is known as an apnea.
Because this happens during sleep, many people with OSA do not realize that they have this condition. Despite this, OSA can have serious health implications because of how it affects sleep quality and how it affects the body.
With OSA, breathing problems are caused by a blockage or obstruction of the airway. Another type of sleep apnea is central sleep apnea (CSA), which is caused by problems in the brain’s system for signaling and controlling the muscles that regulate breathing. Complex sleep apnea is the term used when a person has both OSA and CSA. OSA is more common and is generally what is being referred to when someone mentions “sleep apnea” without any further explanation.
What Are the Symptoms of Obstructive Sleep Apnea?
There are a number of symptoms that are regularly experienced by people with OSA. An overview of these symptoms is below:
- Snoring: heavy snoring is very common in patients with OSA as it is estimated that up to 85% of people with OSA snore. However, this does not mean that all people who snore have OSA. While most people with OSA snore, it is not the case that most people who snore have OSA.
- Gasping during sleep: in addition to just snoring, people with sleep apnea may sound at times as though they are choking. When they fail to get enough air, this can be very pronounced and may even wake the person up.
- Trouble sleeping: even when they are tired, people with OSA may struggle to stay asleep through the course of the night. The persistent problems breathing can be enough to limit the amount and quality of their sleep.
- Dry throat and mouth: because of the intensity of their snoring and gasping, many people with OSA find that they have issues related to a very dry mouth and/or sore throat.
- Morning headaches: it is common for people with OSA to report having issues with serious headaches, especially in the mornings.
- Daytime sleepiness: as a result of their reduced amount of sleep, a common symptom of OSA is daytime sleepiness and a tendency to doze off during regular day-to-day activities.
- Fatigue: in addition to feeling sleepy, people with OSA may lack energy and suffer from a more generalized fatigue.
- Impaired thinking and mood: lack of sleep can also directly affect the cognition and mood of people with OSA. This can manifest itself with things like forgetfulness, limited attention, irritability, frustration, and more.
What Are the Causes of Obstructive Sleep Apnea?
There are a number of different factors that can contribute to a person having OSA. It is not always exactly clear why one person has OSA and another person doesn’t, but these are the factors most clearly related to this condition:
- Certain anatomical features: apneas happen when the airway is blocked, and this can be a function of anatomy. People with a shorter lower jaw, a larger neck size, a larger tongue, larger tonsils, and certain shapes of the top of the mouth have a higher propensity for their airway to become restricted. When sleeping, the muscles and soft tissue near the airway relax, which makes it easier for those with these anatomic features to find that their airway is obstructed.
- Obesity: obesity has been found to be a very significant risk factor for sleep apnea. Being overweight can make the tissue near the airway larger, making it easier for them to restrict airflow. More research is being conducted to further our understanding of the relationship between obesity and OSA.
- Sleeping on your back: when you sleep on your back, it is much easier for the muscles and soft tissue in the back of the throat to sink down toward the airway. For this reason, sleeping on your back puts you at greater risk for both snoring and OSA compared to other sleeping positions.
- Family history: having one or more family members who have had OSA can increase your risk for having this condition. It is estimated that 25-40% of people with OSA have a family history of this disorder.
- Age: people who are older are at a higher risk of developing OSA. This is largely because of the way that muscles and soft tissues relax and soften with age, making them more prone to block the airway.
- Use of alcohol and/or sedatives: using alcohol or sedatives (such as opiates) can also accelerate the relaxing of the anatomy near the airway, so people who use these, especially close to bedtime, have higher rates of of OSA.
- Significant nasal congestion: people who have persistent or ongoing issues with nasal congestion may be at higher risk of OSA because of how this contributes to breathing difficulties. Asthma may also be a risk factor.
- Smoking: some research has found that people who smoke are at a higher risk for developing OSA than people who don’t smoke.
In recent years, the amount of people diagnosed with OSA has increased significantly. As obesity rates have increased, more people have developed this problem. In addition, awareness of OSA has increased causing more people to realize that they may have this condition. If you have noticed that you have the symptoms that we’ve described in this guide, make sure to talk to your doctor about whether any further testing or evaluation is necessary.
What Are the Health Risks of Obstructive Sleep Apnea?
The health consequences from OSA can be severe. Problems with fatigue and excessive daytime sleepiness can have major effects on a person’s day-to-day life. Tiredness may affect performance at work, for example, plus people with chronic sleepiness are at much higher risk of automobile accidents, falls, and other injuries of that nature.
Research has also found that OSA can contribute to serious problems related to the cardiovascular system including high blood pressure and the risk of having a stroke or a heart attack. It can also cause emotional problems including depression.
From the perspective of both general wellness and potentially major health events, OSA is a serious condition that poses a range of risks if it is not diagnosed and addressed.
How is Obstructive Sleep Apnea Diagnosed?
If you are concerned that you may have sleep apnea, it is important to talk with a doctor or nurse. A health professional will usually start by doing a general physical exam and conducting a health history. During this health history, they will ask about any other health issues that you have or have had, and they will also ask for details about what you’ve noticed with regard to your sleep. If you keep a sleep journal, this may be useful. The physical exam likely will examine your airway and the anatomy around it.
Based on this examination, a doctor may suspect OSA, but a sleep study (called polysomnography) is necessary to confirm a diagnosis of OSA. Often these sleep studies are conducted with an overnight stay in a special facility. During the study, a sleep technician can use equipment to monitor for apneas and other interruptions of the body’s systems during sleep. Measurement of the amount of oxygen in your blood can also be used to determine how significant your apneas are since the interrupted breathing can reduce oxygen levels.
The results of your sleep study are usually available within a few days and may be reviewed with you by your doctor and/or the sleep technician. Based on these results, the doctors can discuss different avenues for potential treatment if you have been diagnosed with OSA.
How is Obstructive Sleep Apnea Treated?
When a person is diagnosed with OSA, beginning treatment is necessary to reduce the potential health impacts of the condition. Most people find that with treatment the quality and quantity of their sleep improves, and they often feel better. The type of treatment that is prescribed depends on the situation, including the severity of OSA, but the most common treatments include:
This is the most common and well-known of the treatments for OSA. CPAP stands for continuous positive airway pressure, and CPAP therapy is the use of a machine that uses pressurized air to keep the airway open through the night. A machine (known as a CPAP) takes in ambient air, pressurizes it, and then pumps it through a hose and into the mouth and airway.
Using a CPAP requires wearing a mask during the entire night. Some people find the CPAP mask to be uncomfortable to wear, but most people grow accustomed to it with time. For people who can tolerate wearing the mask and using the CPAP, these machines are generally quite effective at eliminating apneas and improving sleep.
Like CPAP therapy, this approach uses a machine to pump pressurized air into the airway through a hose and a mask. The difference between CPAP and BIPAP (or BPAP) is how the pressure is regulated. In a CPAP machine, the amount of pressure is different when a person inhales and exhales. This is why BPAP stands for bi-level positive airway pressure while CPAP is continuous positive airway pressure.
Provent is an FDA-approved therapy for OSA that does not require wearing a mask or using a machine like a CPAP or a BIPAP. Provent is a small device that is put into the nostrils where it is held in place with a light adhesive. In the middle of each device is a valve that opens and closes with your breathing. These valves put pressure into the airway that keeps it open and limits apneas. Each Provent device is small and disposable, which makes this an option preferred by people who do not want to wear a mask or who travel often and need an easily portable option for managing OSA. A prescription is required to get Provent.
Oral appliance therapy (OAT)
For people whose OSA is caused mainly by their anatomy and how it blocks the airway, a dental device may be an option. These are often called anti-snoring mouthpieces or mouthguards. These are generally available over-the-counter, but a dentist can help to make sure that the proper fit is obtained and without a risk of damage to the teeth or jaw. Mandibular advancement devices (MADs) works by pushing the lower jaw forward, and tongue retaining devices (TRDs) hold the tongue in place so that it doesn’t slip backward to the airway. These devices are typically less expensive than CPAP, BIPAP, or Provent, but their overall effectiveness is not as well established.
One way of trying to treat OSA is by controlling the risk factors that contribute to it. For example, because obesity can cause OSA, a doctor may recommend changes with regard to diet and exercise in order to promote weight loss. Reducing use of alcohol or sedatives and avoiding sleeping on your back are other possible lifestyle changes that can decrease airway obstruction. While lifestyle changes can have a big effect, they may not be able to completely resolve OSA without the use of other methods and treatments mentioned here.
In certain cases, surgery may be able to eliminate the anatomical causes of airway obstructions. Types of surgeries can include uvulopalatopharyngoplasty (UPPP) and tracheostomy. UPPP removes soft tissue near the airway to make it wider. Tracheostomy creates an airway through an incision in the throat and is only a last resort in very rare and extreme cases that cannot be remedied by other treatments. Other surgical treatments -- like radiofrequency ablation and laser surgery -- may be used but do not generally create durable cures to OSA. In general, surgery is not a common first-line therapy because of its potential for complications and because of the availability of other therapies that are often effective.
What Medications Are Available for Obstructive Sleep Apnea?
There is no proven medical therapy for OSA. Some medications may be prescribed in order to supplement BIPAP or CPAP therapy, for example, but drugs in-and-of-themselves are not able to cure or resolve OSA.
Examples of drugs that may be prescribed are those that are designed to counteract sleepiness (such as modafinil). Supplemental oxygen has been used but is not a long-term solution and can come with side effects. Drugs can also be prescribed to help with underlying conditions, such as chronic nasal congestion, that can exacerbate OSA.
It is important for anyone with OSA or who is concerned about OSA or excessive sleepiness to talk with a doctor before beginning to use any medication.