Sleep apnea is a medical condition that is best described as insidious. It typically develops slowly and often without people noticing. But it’s not a benign condition; its presence can cause so many other medical conditions.

When broken down, sleep apnea means a lack of breathing during sleep. And it’s just as scary as it sounds. 

It’s categorized into two types:

• Obstructive sleep apnea (OSA)

• Central sleep apnea (CSA)

The difference between OSA and CSA is what causes the lack of breathing during sleep. In CSA, the lungs and breathing muscles stop working, and this causes breathing to temporarily stop while asleep. In OSA, the lungs and breathing muscles are still working, but the flow of air becomes obstructed due to temporary collapse of the airway.

OSA is the most common type of sleep apnea, and it affects around one billion people worldwide. CSA isn’t nearly as common, and it’s only estimated to affect around five to ten percent of people with sleep apnea.¹ And for that reason, this article is going to focus solely on OSA.

Even though people don’t typically have obvious symptoms of sleep apnea, the recognition and treatment of sleep apnea is critical. What can seem like a simple sleeping disorder has been linked to many common and life-threatening medical conditions. 

Sleep apnea is typically treated with breathing machines that are worn during sleep, but advances in medicine have provided people with other treatment options. 

But OSA isn’t typically a condition that humans are born with – it’s something that develops over time. And depending on the cause, there are lifestyle modifications that can be made to improve or sometimes completely reverse the disease. 

What Causes Sleep Apnea?

The risk of developing OSA is influenced by factors that are either things that we’re born with or things that happen or change throughout our lives. 

The four main risk factors for developing OSA include:²

• Sex: Men are at a higher risk of OSA when compared to premenopausal women. However, once women go through menopause, they then have the same risk of OSA as men. Plus, even in men and women with the same body mass index (BMI), men still have a higher risk of having OSA compared to women. Men and women with OSA also have different symptoms. Men are more likely to have symptoms of snoring and episodes of apnea, while women tend to have symptoms of insomnia and daytime sleepiness. The vagueness of symptoms women experience can cause a delay in diagnosis for women compared to men. 

• Age: The risk of developing OSA increases with age. This is thought to be due to several factors, with the main one being a decrease in the amount of deep sleep we get as we get older. Deep sleep has been found to be protective against sleep apnea and airway collapse. So the less deep sleep you get causes a greater risk of having OSA. Also, elderly adults typically don’t report as many symptoms compared to young or middle-aged adults, which leads to a delay in diagnosis. 

• Race: The presence of OSA in different racial groups varies. The overall presence of OSA is 30% in caucasians, 32% in African Americans, 38% in Hispanics, and 39% in Chinese individuals. Compared to caucasian adults, African American and American Indian adults have a 20% and 23% increased risk of having sleep apnea, respectively. These variations in risk for OSA among different racial groups is likely due to differences in the structure of people’s skulls, facial bones, sinus passages, and airways.

• Weight: There is a strong correlation between increased weight and increased risk of OSA in adults. For every 10% increase in body weight, the risk of developing OSA is six times higher AND there’s a 32% increase in the amount of apnea episodes during sleep.

As mentioned before, there are things we can and cannot change that can increase the risk of developing OSA. We can’t change how we’re born, and we can’t make time stop. So the main thing that can be done to decrease the risk of OSA is weight loss, which is discussed a bit more later on.

What Are the Symptoms of Sleep Apnea?

The symptoms of OSA are a result of periods of lack of breathing and airway collapse and the poor sleep that is associated with it. For that reason, the symptoms of OSA are broken down into two groups: nighttime and daytime symptoms.

Nighttime symptoms of OSA include:³

• Snoring

• Gasping

• Snorting

• Periods of not breathing during sleep

• Broken sleep

• Inability to stay asleep 

• Inability to return to sleep during the night after waking

• Using the bathroom during the night

• Bedwetting

• Night sweats 

Daytime symptoms of OSA include:³

• Excessive sleepiness 

• Fatigue

• Headaches in the morning

• Memory or concentration difficulties

• Changes in mood

• Irritability

• Decreased libido

As mentioned before, OSA is insidious, and the symptoms of it aren’t always recognized. Because of this, many people with OSA haven’t been diagnosed. 

How Is Sleep Apnea Diagnosed?

OSA is diagnosed with a sleep study, which can be ordered by a healthcare professional like a primary care provider. Oftentimes, diagnosis is delayed because the symptoms of OSA can be vague and difficult to recognize.

However, if you suspect that you have sleep apnea, make sure you see your primary care provider. Depending on the clinician and your symptoms, they may either start by completing screening tools, or they may initially order a sleep study. 

Screening tools that are recommended to determine the risk of sleep disorders such as OSA include the Epworth Sleepiness Scale and the STOP-BANG questionnaire.² These tools are the most accurate when completed with a healthcare provider, but you can complete the questionnaires to see if you’re at an increased risk of having a sleep disorder such as OSA.

If results of one or both of these screening tools are increased, then a sleep study is indicated. A sleep study, also called polysomnography (PSG), is the best study for the evaluation of OSA. This test is eight hours long and is conducted at an outpatient facility. During the test, breathing and oxygen levels are closely monitored. It’s required that you sleep overnight at the facility, which can be difficult for some people.² 

In certain instances, a home sleep apnea test (HSAT) can be performed, but this isn’t common. A HSAT also isn’t as accurate as PSG and may underestimate the severity of sleep disorders such as OSA.² 

As inconvenient as a sleep study may be, it’s the best way to diagnose OSA. And once the diagnosis is made, treatment can begin, which can decrease the risk of other medical conditions. 

Is Obstructive Sleep Apnea Associated With Other Medical Conditions?

Not only does OSA affect aspects of sleep, it affects the heart, blood vessels, lungs, and mind. OSA is associated with several serious and life-threatening conditions including:²

• Stroke

• Heart attack 

• High blood pressure 

• High cholesterol 

• Elevated blood sugar levels 

• Diabetes

• Abnormal heart rhythms

• Elevated pressure in arteries connected to the lungs (pulmonary hypertension)

• Congestive heart failure

• Depression

The heart arrhythmia that is often associated with OSA is atrial fibrillation. Because of OSA’s significant effects on the heart, it’s been shown to directly cause atrial fibrillation. And if OSA isn’t properly treated, the treatment for atrial fibrillation isn’t nearly as effective.⁴ Read more about atrial fibrillation in my article: Diagnosed With Atrial Fibrillation? What You Need to Know.

How Is Sleep Apnea Treated?

Because OSA is associated with several serious medical conditions, treatment is crucial. 

The treatment of OSA is focused on keeping the airway open during sleep. Doing so prevents the episodes of apnea that put so much stress and strain on the body. Treatment options for OSA are broken down into non-surgical treatments, surgical treatments, and lifestyle modifications. 

In order to decrease the risk of unnecessary complications, non-surgical treatments are trialed first. The most common options include:⁵

• Continuous positive airway pressure (CPAP): This is administered by a mask that goes around the nose or the nose and mouth. It helps to keep the airway from collapsing in those with OSA by blowing air into the airway. CPAP is the preferred treatment for OSA, but many people cannot tolerate it. Due to this, it’s estimated that 46-83% of people prescribed CPAP don’t use it as advised.

• Oral appliances (OAs): These devices are inserted into the mouth during sleep, and they help to open the airway by keeping the tongue and other structures in the mouth out of the airway. The two most common devices used are tongue-retaining devices and mandibular advancing appliances. While OAs are more comfortable to wear at night, they aren’t as effective in treating OSA as CPAP. However, patients have been found to be more compliant with them when compared to CPAP.

Surgical treatments for OSA include:⁵

• Uvulopalatopharyngoplasty (UPPP): OSA can sometimes be caused by obstruction of the airway by certain structures in the mouth. If this is the case, this surgery may improve episodes of apnea in some people with OSA. UPPP involves the removal of the tonsils, uvula (the pink structure in the back of the throat), and the posterior velum (a part of the roof of the mouth).

• Maxillomandibular advancement surgery (MMA): If other surgical efforts fail, MMA is typically considered. It’s deemed to be one of the most effective surgical treatments for OSA. It involves surgical reconstruction of the upper and lower jawbones to decrease airway obstruction.

• Inspire implantable device: This is a more recent treatment for OSA, and it involves the surgical implantation of a device that stimulates muscles in the airway to keep the airway from collapsing. The device is controlled with a remote, and the battery life of the device is about 11 years. In order to qualify for the device, people have to meet certain criteria. You can read more about it here. 

Lifestyle modifications that can be made to decrease the severity of OSA include:

• Weight loss: As mentioned above, being overweight is one of the four main risk factors for OSA, and if you’ve been diagnosed with OSA, losing weight can help decrease the severity of it. If you’re planning to lose some weight, it’s been found that a 10% decrease in weight results in a 26% decrease in apnea episodes during sleep.²

• Sleep position: Even the position in which you sleep can affect the severity of OSA. Avoiding sleeping on your back can help decrease the frequency of apnea episodes.⁵

It’s important to note that even if you require non-surgical or surgical treatment for OSA, implementing lifestyle modifications will still improve the severity of OSA and the associated symptoms. 

Do You Think You Have Sleep Apnea?

If you have symptoms of sleep apnea and think that you may have it, see your primary care provider right away. They can complete the OSA risk questionnaires and order a sleep study if needed. 

However, sleep studies are in high demand, and there aren’t an abundance of places that do them. So getting a sleep study usually takes a white. That’s why it’s important to tell your primary care provider about your symptoms sooner rather than later. 

In the meantime, you can focus on making changes to your sleeping positions and losing weight, as these things have been proven to help decrease episodes of apnea during sleep. 

Stay informed, stay healthy. 

Works cited

1. Estimation of the global prevalence and burden of obstructive sleep apnoea: a literature-based analysis – (nih.gov)

2. Obstructive sleep apnea basics – (ccjm.org)

3. Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults – (nih.gov)

4. Sleep Apnea and Atrial Fibrillation: Role of the Cardiac Autonomic Nervous System – (nih.gov)

5. Obstructive sleep apnea treatment in adults – (wiley.com)

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