What Is Sleep Apnea?

Sleep apnea is a com­mon dis­or­der in which you have one or more pauses in breath­ing or shal­low breaths while you sleep.

Breath­ing pauses can last from a few sec­onds to min­utes. They often occur 5 to 30 times or more an hour. Typ­i­cally, nor­mal breath­ing then starts again, some­times with a loud snort or chok­ing sound.

sleep_apnea

This results in poor sleep qual­ity that makes you tired dur­ing the day. Sleep apnea is one of the lead­ing causes of exces­sive day­time sleepi­ness.
Overview

Sleep apnea often goes undi­ag­nosed. Doc­tors usu­ally can’t detect the con­di­tion dur­ing rou­tine office vis­its. Also, there are no blood tests for the condition.

Most peo­ple who have sleep apnea don’t know they have it because it only occurs dur­ing sleep. A fam­ily mem­ber and/or bed part­ner may first notice the signs of sleep apnea.

The most com­mon type of sleep apnea is obstruc­tive sleep apnea. This most often means that the air­way has col­lapsed or is blocked dur­ing sleep. The block­age may cause shal­low breath­ing or breath­ing pauses.

When you try to breathe, any air that squeezes past the block­age can cause loud snor­ing. Obstruc­tive sleep apnea hap­pens more often in peo­ple who are over­weight, but it can affect anyone.

The ani­ma­tion below shows how obstruc­tive sleep apnea occurs. Click the “start” but­ton to play the ani­ma­tion. Writ­ten and spo­ken expla­na­tions are pro­vided with each frame. Use the but­tons in the lower right cor­ner to pause, restart, or replay the ani­ma­tion, or use the scroll bar below the but­tons to move through the frames.
The ani­ma­tion shows how air flow to the lungs can be blocked, caus­ing sleep apnea.

The ani­ma­tion shows how air flow to the lungs can be blocked, caus­ing sleep apnea.

Cen­tral sleep apnea is a less com­mon type of sleep apnea. It hap­pens when the area of your brain that con­trols your breath­ing doesn’t send the cor­rect sig­nals to your breath­ing mus­cles. You make no effort to breathe for brief periods.

Cen­tral sleep apnea often occurs with obstruc­tive sleep apnea, but it can occur alone. Snor­ing doesn’t typ­i­cally hap­pen with cen­tral sleep apnea.

Untreated sleep apnea can:

* Increase the risk for high blood pres­sure, heart attack, stroke, obe­sity, and dia­betes
* Increase the risk for or worsen heart fail­ure
* Make irreg­u­lar heart­beats more likely
* Increase the chance of hav­ing work-related or dri­ving accidents

Lifestyle changes, mouth­pieces, surgery, and/or breath­ing devices can suc­cess­fully treat sleep apnea in many peo­ple.

Other Names for Sleep Apnea

* Sleep-disordered breath­ing
* Cheyne-Stokes breathing

What Causes Sleep Apnea?

When you’re awake, throat mus­cles help keep your air­way stiff and open so air can flow into your lungs. When you sleep, these mus­cles are more relaxed. Nor­mally, the relaxed throat mus­cles don’t stop your air­way from stay­ing open to allow air into your lungs.

But if you have obstruc­tive sleep apnea, your air­ways can be blocked or nar­rowed dur­ing sleep because:

* Your throat mus­cles and tongue relax more than nor­mal.
* Your tongue and ton­sils (tis­sue masses in the back of your mouth) are large com­pared to the open­ing into your wind­pipe.
* You’re over­weight. The extra soft fat tis­sue can thicken the wall of the wind­pipe. This causes the inside open­ing to nar­row and makes it harder to keep open.
* The shape of your head and neck (bony struc­ture) may cause a smaller air­way size in the mouth and throat area.
* The aging process lim­its the abil­ity of brain sig­nals to keep your throat mus­cles stiff dur­ing sleep. This makes it more likely that the air­way will nar­row or collapse.

Not enough air flows into your lungs when your air­ways are fully or partly blocked dur­ing sleep. This can cause loud snor­ing and a drop in your blood oxy­gen levels.

When the oxy­gen drops to dan­ger­ous lev­els, it trig­gers your brain to dis­turb your sleep. This helps tighten the upper air­way mus­cles and open your wind­pipe. Nor­mal breaths then start again, often with a loud snort or chok­ing sound.

The fre­quent drops in oxy­gen lev­els and reduced sleep qual­ity trig­ger the release of stress hor­mones. These com­pounds raise your heart rate and increase your risk for high blood pres­sure, heart attack, stroke, and irreg­u­lar heart­beats. The hor­mones also raise the risk for or worsen heart failure.

Untreated sleep apnea also can lead to changes in how your body uses energy. These changes increase your risk for obe­sity and dia­betes.

Who Is At Risk for Sleep Apnea?

It’s esti­mated that more than 12 mil­lion Amer­i­can adults have obstruc­tive sleep apnea. More than half of the peo­ple who have this con­di­tion are overweight.

Sleep apnea is more com­mon in men. One out of 25 middle-aged men and 1 out of 50 middle-aged women have sleep apnea.

Sleep apnea becomes more com­mon as you get older. At least 1 out of 10 peo­ple over the age of 65 has sleep apnea. Women are much more likely to develop sleep apnea after menopause.

African Amer­i­cans, His­pan­ics, and Pacific Islanders are more likely to develop sleep apnea than Caucasians.

If some­one in your fam­ily has sleep apnea, you’re more likely to develop it.

Peo­ple who have small air­ways in their noses, throats, or mouths also are more likely to have sleep apnea. Smaller air­ways may be due to the shape of these struc­tures or aller­gies or other med­ical con­di­tions that cause con­ges­tion in these areas.

Small chil­dren often have enlarged ton­sil tis­sues in the throat. This can make them prone to devel­op­ing sleep apnea.

Other risk fac­tors for sleep apnea include smok­ing, high blood pres­sure, and risk fac­tors for stroke or heart fail­ure.

What Are the Signs and Symp­toms of Sleep Apnea?

One of the most com­mon signs of obstruc­tive sleep apnea is loud and chronic (ongo­ing) snor­ing. Pauses may occur in the snor­ing. Chok­ing or gasp­ing may fol­low the pauses.

The snor­ing usu­ally is loud­est when you sleep on your back; it may be less noisy when you turn on your side. Snor­ing may not hap­pen every night. Over time, the snor­ing may hap­pen more often and get louder.

You’re asleep when the snor­ing or gasp­ing occurs. You will likely not know that you’re hav­ing prob­lems breath­ing or be able to judge how severe the prob­lem is. Your fam­ily mem­bers or bed part­ner will often notice these prob­lems before you do.

Not every­one who snores has sleep apnea.

Another com­mon sign of sleep apnea is fight­ing sleepi­ness dur­ing the day, at work, or while dri­ving. You may find your­self rapidly falling asleep dur­ing the quiet moments of the day when you’re not active.
Other Signs and Symptoms

Oth­ers signs and symp­toms of sleep apnea may include:

* Morn­ing headaches
* Mem­ory or learn­ing prob­lems and not being able to con­cen­trate
* Feel­ing irri­ta­ble, depressed, or hav­ing mood swings or per­son­al­ity changes
* Uri­na­tion at night
* A dry throat when you wake up

In chil­dren, sleep apnea can cause hyper­ac­tiv­ity, poor school per­for­mance, and aggres­sive­ness. Chil­dren who have sleep apnea also may have unusual sleep­ing posi­tions, bed­wet­ting, and may breathe through their mouths instead of their noses dur­ing the day.

How Is Sleep Apnea Diagnosed?

Doc­tors diag­nose sleep apnea based on your med­ical and fam­ily his­to­ries, a phys­i­cal exam, and results from sleep stud­ies. Usu­ally, your pri­mary care doc­tor eval­u­ates your symp­toms first. He or she then decides whether you need to see a sleep specialist.

These spe­cial­ists are doc­tors who diag­nose and treat peo­ple with sleep prob­lems. Such doc­tors include lung, nerve, or ear, nose, and throat spe­cial­ists. Other types of doc­tors also can be sleep spe­cial­ists.
Med­ical and Fam­ily Histories

Your doc­tor will ask you and your fam­ily ques­tions about how you sleep and how you func­tion dur­ing the day. To help your doc­tor, con­sider keep­ing a sleep diary for 1 to 2 weeks. Write down how much you sleep each night, as well as how sleepy you feel at var­i­ous times dur­ing the day.

You can find a sam­ple sleep diary in the National Heart, Lung, and Blood Institute’s “Your Guide to Healthy Sleep.”

Your doc­tor also will want to know how loudly and often you snore or make gasp­ing or chok­ing sounds dur­ing sleep. Often you’re not aware of such symp­toms and must ask a fam­ily mem­ber or bed part­ner to report them.

If you’re a par­ent of a child who may have sleep apnea, tell your child’s doc­tor about your child’s signs and symptoms.

Let your doc­tor know if any­one in your fam­ily has been diag­nosed with sleep apnea or has had symp­toms of the disorder.

Many peo­ple aren’t aware of their symp­toms and aren’t diag­nosed.
Phys­i­cal Exam

Your doc­tor will check your mouth, nose, and throat for extra or large tis­sues. The ton­sils often are enlarged in chil­dren with sleep apnea. A phys­i­cal exam and med­ical his­tory may be all that’s needed to diag­nose sleep apnea in children.

Adults with the con­di­tion may have an enlarged uvula or soft palate. The uvula is the tis­sue that hangs from the mid­dle of the back of your mouth. The soft palate is the roof of your mouth in the back of your throat.
Sleep Studies

A sleep study is the most accu­rate test for diag­nos­ing sleep apnea. It cap­tures what hap­pens with your breath­ing while you sleep.

A sleep study is often done in a sleep cen­ter or sleep lab, which may be part of a hos­pi­tal. You may stay overnight in the sleep cen­ter.
Polysomnogram

A polysomno­gram (poly-SOM-no-gram), or PSG, is the most com­mon study for diag­nos­ing sleep apnea. This test records:

* Brain activ­ity
* Eye move­ment and other mus­cle activ­ity
* Breath­ing and heart rate
* How much air moves in and out of your lungs while you’re sleep­ing
* The amount of oxy­gen in your blood

A PSG is pain­less. You will go to sleep as usual, except you will have sen­sors on your scalp, face, chest, limbs, and fin­ger. The staff at the sleep cen­ter will use the sen­sors to check on you through­out the night.

A sleep spe­cial­ist reviews the results of your PSG to see whether you have sleep apnea and how severe it is. He or she will use the results to plan your treatment.

How Is Sleep Apnea Treated?

The goals of treat­ing obstruc­tive sleep apnea are to:

* Restore reg­u­lar breath­ing dur­ing sleep
* Relieve symp­toms such as loud snor­ing and day­time sleepiness

Treat­ment may help other med­ical prob­lems linked to sleep apnea, such as high blood pres­sure. Treat­ment also can reduce your risk for heart dis­ease, stroke, and dia­betes.
Spe­cific Types of Treatment

Lifestyle changes, mouth­pieces, breath­ing devices, and/or surgery are used to treat sleep apnea. Cur­rently, there are no med­i­cines to treat sleep apnea.

If you have sleep apnea, talk to your doc­tor or sleep spe­cial­ist about the treat­ment options that are most appro­pri­ate for your spe­cific condition.

Lifestyle changes and/or mouth­pieces may be enough to relieve mild sleep apnea. Peo­ple who have mod­er­ate or severe sleep apnea may need breath­ing devices or surgery.
Lifestyle Changes

If you have mild sleep apnea, some changes in daily activ­i­ties or habits may be all that you need.

* Avoid alco­hol and med­i­cines that make you sleepy. They make it harder for your throat to stay open while you sleep.
* Lose weight if you’re over­weight or obese. Even a lit­tle weight loss can improve your symp­toms.
* Sleep on your side instead of your back to help keep your throat open. You can sleep with spe­cial pil­lows or shirts that pre­vent you from sleep­ing on your back.
* Keep your nasal pas­sages open at night with nose sprays or allergy med­i­cines, if needed. Talk to your doc­tor about whether these treat­ments might help you.
* Stop smoking.

Mouth­piece

A mouth­piece, some­times called an oral appli­ance, may help some peo­ple who have mild sleep apnea. Your doc­tor also may rec­om­mend a mouth­piece if you snore loudly but don’t have sleep apnea.

A den­tist or ortho­don­tist can make a custom-fit plas­tic mouth­piece for treat­ing sleep apnea. (An ortho­don­tist spe­cial­izes in cor­rect­ing teeth or jaw prob­lems.) The mouth­piece will adjust your lower jaw and your tongue to help keep your air­ways open while you sleep.

If you use a mouth­piece, it’s impor­tant that you check with your doc­tor about dis­com­fort or pain while using the device. You may need peri­odic office vis­its so your doc­tor can adjust your mouth­piece to fit better.

Breath­ing Devices

Con­tin­u­ous pos­i­tive air­way pres­sure (CPAP) is the most com­mon treat­ment for mod­er­ate to severe sleep apnea in adults. A CPAP machine uses a mask that fits over your mouth and nose, or just over your nose. The machine gen­tly blows air into your throat.

The air presses on the wall of your air­way. The air pres­sure is adjusted so that it’s just enough to stop the air­ways from becom­ing nar­rowed or blocked dur­ing sleep.

Treat­ing sleep apnea may help you stop snor­ing. But stop­ping snor­ing doesn’t mean that you no longer have sleep apnea or can stop using CPAP. Sleep apnea will return if CPAP is stopped or not used correctly.

Usu­ally, a tech­ni­cian will come to your home to bring the CPAP equip­ment. The tech­ni­cian will set up the CPAP machine and adjust it based on your doctor’s orders. After the ini­tial setup, you may need to have the CPAP adjusted on occa­sion for the best results.

CPAP treat­ment may cause side effects in some peo­ple. These side effects include a dry or stuffy nose, irri­tated skin on your face, sore eyes, and headaches. If your CPAP isn’t prop­erly adjusted, you may get stom­ach bloat­ing and dis­com­fort while wear­ing the mask.

If you’re hav­ing trou­ble with CPAP side effects, work with your sleep spe­cial­ist, his or her nurs­ing staff, and the CPAP tech­ni­cian. Together, you can take steps to reduce these side effects. These steps include adjust­ing the CPAP set­tings or the size/fit of the mask, or adding mois­ture to the air as it flows through the mask. A nasal spray may relieve a dry, stuffy, or runny nose.

There are many dif­fer­ent kinds of CPAP machines and masks. Be sure to tell your doc­tor if you’re not happy with the type you’re using. He or she may sug­gest switch­ing to a dif­fer­ent kind that may work bet­ter for you.

Peo­ple who have severe sleep apnea symp­toms gen­er­ally feel much bet­ter once they begin treat­ment with CPAP.

Surgery

Some peo­ple who have sleep apnea may ben­e­fit from surgery. The type of surgery and how well it works depend on the cause of the sleep apnea.

Surgery is done to widen breath­ing pas­sages. It usu­ally involves remov­ing, shrink­ing, or stiff­en­ing excess tis­sue in the mouth and throat or reset­ting the lower jaw.

Surgery to shrink or stiffen excess tis­sue in the mouth or throat is done in a doctor’s office or a hos­pi­tal. Shrink­ing tis­sue may involve small shots or other treat­ments to the tis­sue. A series of such treat­ments may be needed to shrink the excess tis­sue. To stiffen excess tis­sue, the doc­tor makes a small cut in the tis­sue and inserts a small piece of stiff plastic.

Surgery to remove excess tis­sue is only done in a hos­pi­tal. You’re given med­i­cine that makes you sleep dur­ing the surgery. After surgery, you may have throat pain that lasts for 1 to 2 weeks.

Surgery to remove the ton­sils, if they’re block­ing the air­way, may be very help­ful for some chil­dren. Your child’s doc­tor may sug­gest wait­ing some time to see whether these tis­sues shrink on their own. This is com­mon as small chil­dren grow.

Key Points

* Sleep apnea is a com­mon breath­ing dis­or­der in which you have one or more pauses in breath­ing or shal­low breaths while you sleep.
* Sleep apnea usu­ally is a chronic (ongo­ing) con­di­tion that dis­rupts your sleep 3 or more nights each week.
* Sleep apnea often goes undi­ag­nosed. Doc­tors usu­ally can’t detect the con­di­tion dur­ing rou­tine office vis­its. Also, there are no blood tests for the con­di­tion. Most peo­ple who have sleep apnea don’t know they have it because it only occurs dur­ing sleep.
* The most com­mon type of sleep apnea is obstruc­tive sleep apnea. This most often means that the air­way has col­lapsed or is blocked dur­ing sleep. This may cause shal­low breath­ing or breath­ing pauses.
* Sleep apnea can cause day­time sleepi­ness, increase the risk for or worsen some med­ical con­di­tions, and increase the chance of hav­ing a work– or driving-related acci­dent.
* It’s esti­mated that more than 12 mil­lion Amer­i­can adults have sleep apnea. More than half of the peo­ple who have this con­di­tion are over­weight.
* The most com­mon signs of sleep apnea are loud snor­ing and chok­ing or gasp­ing dur­ing sleep and being very sleepy dur­ing the day.
* Doc­tors diag­nose sleep apnea based on your med­ical and fam­ily his­to­ries, a phys­i­cal exam, and results from sleep stud­ies.
* Treat­ment is aimed at restor­ing reg­u­lar breath­ing dur­ing sleep and reliev­ing symp­toms. Treat­ment also may help other med­ical prob­lems linked to sleep apnea.
* Lifestyle changes, mouth­pieces, breath­ing devices, and/or surgery are used to treat sleep apnea. Con­tin­u­ous pos­i­tive air­way pres­sure (CPAP) is the most com­mon treat­ment for mod­er­ate to severe sleep apnea.
* Sleep apnea can be very seri­ous. How­ever, fol­low­ing an effec­tive treat­ment plan can often improve your qual­ity of life quite a bit. Fol­low up with your doc­tor reg­u­larly to make sure your treat­ment is work­ing. Tell him or her if the treat­ment causes side effects that you can’t han­dle.
* Fam­ily mem­bers can help a per­son who snores loudly or stops breath­ing dur­ing sleep by encour­ag­ing him or her to get med­ical help.
* Treat­ment may improve your over­all health and hap­pi­ness as well as your qual­ity of sleep (and pos­si­bly your family’s qual­ity of sleep).