What Is Obstructive Sleep Apnea? Symptoms, Causes, Diagnosis, Treatment, and Prevention

There are three main types of sleep apnea. As the name suggests, obstructive sleep apnea occurs as a result of a physical blockage that interferes with normal breathing.

The individual is startled awake when the body senses an inability to breathe, which is why they may wake up gasping for air.

Most people associate sleep apnea with snoring. That link is accurate, though it’s important to note that not everyone who snores has sleep apnea.

• Gasping for air during the night
• Uneven breathing during sleep
• Sleepiness during the day
• Dry mouth
• Headaches
• Decreased libido
• Urinating frequently during the night

Children can also experience obstructive sleep apnea, though their signs of sleep apnea may be different and can include:

• Being overactive
• Excessive bed-wetting
• Asthma that seems to be getting worse
• Difficulty concentrating in school

Children are also at risk if they have enlarged tonsils or adenoids.

Sometimes the narrowed airway can be due to your anatomy, meaning that the structure of your face and mouth causes the tongue to sit further back in the mouth. Because of this, there is a genetic component to sleep apnea, since your face shape may be similar to that of your family members.

“One of the reasons for obstruction is the anatomical structure of the head and neck, which does have a relationship to the structure of the face,” says Colleen Lance, MD, a staff physician in the Sleep Disorders Center at the Cleveland Clinic in Willoughby Hills, Ohio.

The narrow airway could also be due to excess body weight. Most (though not all) of people with obstructive sleep apnea are overweight.

“Picture the airway like a building that does not have much in the way of scaffolding or support once you lie down and go to sleep at night,” says Dr. Lance. If the airway in your throat is already prone to compromise (say, due to the underlying anatomy of the airway, a change in muscle control, or a change in control of breathing once one falls asleep, which happens naturally), additional fatty tissue in people with more body weight will make that situation worse.

Often, someone might develop sleep apnea because they have several of these listed risk factors. “Apnea occurs for several reasons,” Lance says.

This sleep study can determine if you’re waking up throughout the night, but it cannot pinpoint where the obstruction is located. Further tests can do that, including a nasopharyngoscopy and a sleep endoscopy. Both of these tests use an endoscope to see why the airflow is being compromised. The sleep endoscopy involves light sedation.

The good news is that treatment can dramatically improve outcomes and reduce the risk of complications for people with obstructive sleep apnea.

Depending on your specific case and the severity of your issues, treatment can involve lifestyle changes, wearing a device that keeps your airway open while you sleep, medication, or even surgery.

Lifestyle Changes

A few lifestyle tweaks may be able to either reduce symptoms of sleep apnea or reverse the condition altogether.

• Changing Your Sleep Position Some people only experience symptoms when sleeping on their backs. Sleeping on your side could be better and reduce or resolve symptoms. Not sure how to teach yourself to reposition? Sew a tube sock stuffed with two or three tennis balls to the back of your shirt, making it uncomfortable to sleep on your back.
• Losing Weight Starting a new diet or exercise routine may seem daunting if you’re tired from the interrupted sleep you’ve been getting. But losing weight could improve your symptoms, though not if there are physical reasons you’re having trouble breathing.
• Avoiding Alcohol and Sedatives These can relax the muscles in the airway, leading them to collapse while you’re sleeping.

“These changes can definitely help — especially for those with mild sleep apnea,” says Safia Khan, MD, a sleep disorders specialist and assistant professor in the department of family and community medicine and the department of neurology at UT Southwestern Medical Center in Dallas.

CPAP Treatment

Medications

Complementary and Integrative Therapies

Your doctor may suggest one of these if your symptoms are mild to moderate and you have trouble using the CPAP. “Patient satisfaction is high with these,” Khan says.

Surgery and Other Procedures

If the issue stems from tonsils or adenoids blocking your airway, surgery may be done to take them out. Surgery may also be recommended to move the tongue forward or clear out tissue from the throat. Surgery is generally a last resort if other options have failed. “We typically reserve surgery for when people have already tried other treatment modalities and have not been successful,” Lance says. “Surgeries for apnea usually reduce apnea without curing it.”

Lance adds that individuals with moderate to severe apnea who have tried CPAP and failed, have a BMI less than 32, and have a particular pattern of collapse as determined by a sleep endoscopy may be candidates for hypoglossal nerve stimulation. “This is a surgically implanted device similar to a heart pacemaker,” Lance says. “It stimulates a nerve each time you breath while sleeping, moving the tongue forward with each breath.”

There is also a new option called eXciteOSA, Khan says. It’s available through medical professionals and is not covered by most insurance plans. “It stimulates the muscles in the tongue and upper airway, and it works out the muscles,” Khan says. You use it while awake for 30 minutes, and it opens the airway enough for it to help with mild sleep apnea.

You don’t have control over some obstructive sleep apnea risk factors, such as the physical anatomy of your mouth and airways, but there are some that you can change. Minimizing those risk factors is the best way to prevent obstructive sleep apnea.

Lance suggests:

• Eating a healthy diet and exercising to maintain a healthy weight
• Avoiding sleeping on your back
• Treating underlying nasal allergies
• Avoiding alcohol, sedatives, and painkillers near bedtime

“If there is suspicion, testing is key in order to guide therapy or prevention,” Lance says.

However, if you use CPAP to manage your sleep apnea, chances are that you will always need to use it. Khan says individuals who struggle with CPAP may opt for another treatment.

To cure obstructive sleep apnea, something would need to change with the anatomy of the airway, Lance says. “For adults, the most effective way to change airway anatomy would mean weight loss or possibly surgery.”

She adds, however, that these usually result in an improvement in sleep apnea symptoms rather than a complete cure.

Unfortunately, obstructive sleep apnea can lead to serious complications, particularly if left untreated.

• Hypertension stroke
• Heart failure
• Arrythmias
• Cardiomyopathy
• Diabetes
• Obesity
• Heart attack

The link between obstructive sleep apnea and heart trouble is because people with sleep apnea typically have higher blood pressure because pauses in breathing cause lowered oxygen levels at night, change pressure in the heart, and increase inflammation.

There haven’t been many studies on obstructive sleep apnea and ethnicity, but available research states that it’s more common among specific Black, Indigenous, and People of Color (BIPOC) groups.

Though these disparities exist, they are not well understood and require further research.

Black Americans and Obstructive Sleep Apnea

Some physical reasons contribute to the increased risk of obstructive sleep apnea among Black Americans, including face shape and tongue size. Khan notes that Black Americans may be more likely than people of other races to have larger tongues with a high arch.

Hispanic Americans and Obstructive Sleep Apnea

The prevalence of obesity among Hispanic Americans is high, which may contribute to why they experience obstructive sleep apnea in higher numbers.

Hispanic Americans may also be more likely to have larger tongues that can interfere with the open airway, Khan says.

Native Americans and Obstructive Sleep Apnea

Native Americans are more likely than white Americans and Asian Americans to have obesity and therefore are at an increased risk of developing obstructive sleep apnea.

Obstructive sleep apnea is connected to several other conditions and health factors:

• Cardiovascular Disease The prevalence of obstructive sleep apnea is between 40 to 80 percent among patients with high blood pressure, heart trouble, or stoke.

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  Obstructive sleep apnea (particularly when poorly managed) can increase the risk of several heart problems.
• Type 2 Diabetes People with type 2 diabetes were 48 percent more likely to have obstructive sleep apnea than those without diabetes.

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   The relationship isn’t well understood. The researchers said it could be due to the increased obesity rates among people with type 2 diabetes; obesity, diabetes-related foot disease, and insulin treatment were all predictors of obstructive sleep apnea among people with type 2 diabetes.
• Reduced Cognitive Functioning This association is debated among experts, but a review found that obstructive sleep apnea resulted in poor cognitive performance.

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   CPAP use can improve these deficits, though. There isn’t conclusive evidence, but researchers have postured that untreated sleep apnea could raise the risk of dementia, given this link to cognitive deficits.

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  Researchers continue to investigate the connection.
• COVID-19 A meta-analysis found that people with COVID-19 who had obstructive sleep apnea experienced more severe cases and higher mortality rates.

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   These patients should be closely monitored.
• Opioid Use Nearly 60 percent of people taking opioids to manage chronic pain also experienced sleep apnea, with obstructive sleep apnea being the most common type experienced by 72 percent of those individuals.

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   The researchers noted this could be due to relaxed airways and weaker breathing while on the drugs.
• Increased Accidents Research found that a diagnosis of obstructive sleep apnea was associated with a 17 percent increase of risk of a motor vehicle accident when compared with those without it.

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• Obstructive sleep apnea means that you have a physical blockage that interferes with normal breathing.
• Most people with obstructive sleep apnea are overweight or have obesity.
• If left untreated, obstructive sleep apnea can lead to heart attacks, hypertension, diabetes, and other complications.
• Obstructive sleep apnea can be managed and treatment may include lifestyle changes, medication, and devices such as CPAP machines. In more severe cases, surgery might be necessary.