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Sleep Apnea

Sleep apnea is a potentially serious sleep disorder in which breathing repeatedly stops and starts. If you snore loudly and feel tired even after a full night's sleep, you might have sleep apnea.

The main types of sleep apnea are:

  • Obstructive sleep apnea (OSA), which is the more common form that occurs when throat muscles relax and block the flow of air into the lungs.
  • Central sleep apnea (CSA), which occurs when the brain doesn't send proper signals to the muscles that control breathing.
  • Treatment-emergent central sleep apnea, also known as complex sleep apnea, which happens when someone has OSA — diagnosed with a sleep study — that converts to CSA when receiving therapy for OSA

If you think you might have sleep apnea, see your health care provider. Treatment can ease your symptoms and might help prevent heart problems and other complications.

  • Obstructive sleep apnea affects at least 30 million Americans, but many cases go undiagnosed.
  • People with sleep apnea often experience daytime sleepiness and fatigue, as well as morning headaches and dry mouth.
  • Treatment options for sleep apnea include CPAP therapy, oral appliances, and, in some cases, surgery.

Symptoms

The symptoms of obstructive and central sleep apneas overlap, sometimes making it difficult to determine which type you have. The most common symptoms of obstructive and central sleep apneas include:

  • Loud snoring.
  • Episodes in which you stop breathing during sleep — which would be reported by another person.
  • Gasping for air during sleep.
  • Awakening with a dry mouth.
  • Morning headache.
  • Difficulty staying asleep, known as insomnia.
  • Excessive daytime sleepiness, known as hypersomnia.
  • Difficulty paying attention while awake.
  • Irritability.

Causes

Obstructive sleep apnea

This type of sleep apnea happens when the muscles in the back of the throat relax. These muscles support the soft palate, the triangular piece of tissue hanging from the soft palate called the uvula, the tonsils, the side walls of the throat and the tongue.

When the muscles relax, your airway narrows or closes as you breathe in. You can't get enough air, which can lower the oxygen level in your blood. Your brain senses that you can't breathe, and briefly wakes you so that you can reopen your airway. This awakening is usually so brief that you don't remember it.

You might snort, choke or gasp. This pattern can repeat itself 5 to 30 times or more each hour, all night. This makes it hard to reach the deep, restful phases of sleep.

Obstructive sleep apnea

Factors that increase the risk of this form of sleep apnea include:

  • Excess weight. Obesity greatly increases the risk of OSA. Fat deposits around your upper airway can obstruct your breathing.
  • Neck circumference. People with thicker necks might have narrower airways.
  • A narrowed airway. You might have inherited a narrow throat. Tonsils or adenoids also can enlarge and block the airway, particularly in children.
  • Being male. Men are 2 to 3 times more likely to have sleep apnea than are women. However, women increase their risk if they're overweight or if they've gone through menopause.
  • Being older. Sleep apnea occurs significantly more often in older adults.
  • Family history. Having family members with sleep apnea might increase your risk.
  • Use of alcohol, sedatives or tranquilizers. These substances relax the muscles in your throat, which can worsen obstructive sleep apnea.
  • Smoking. Smokers are three times more likely to have obstructive sleep apnea than are people who've never smoked. Smoking can increase the amount of inflammation and fluid retention in the upper airway.
  • Nasal congestion. If you have trouble breathing through your nose — whether from an anatomical problem or allergies — you're more likely to develop obstructive sleep apnea.
  • Medical conditions. Congestive heart failure, high blood pressure and type 2 diabetes are some of the conditions that may increase the risk of obstructive sleep apnea. Polycystic ovary syndrome, hormonal disorders, prior stroke and chronic lung diseases such as asthma also can increase risk.

Central sleep apnea

This less common form of sleep apnea occurs when your brain fails to send signals to your breathing muscles. This means that you make no effort to breathe for a short period. You might wake up with shortness of breath or have a difficult time getting to sleep or staying asleep.

Risk factors

Sleep apnea can affect anyone, even children. But certain factors increase your risk.

  • Being older. Middle-aged and older people have a higher risk of central sleep apnea.
  • Being male. Central sleep apnea is more common in men than it is in women.
  • Heart disorders. Having congestive heart failure increases the risk.
  • Using narcotic pain medicines. Opioid medicines, especially long-acting ones such as methadone, increase the risk of central sleep apnea.
  • Stroke. Having had a stroke increases the risk of central sleep apnea.