What Exactly Is Sleep Apnea?

Sleep apnea is the second most common sleep disorder after insomnia. (It is also referred to sometimes as a sleep-related breathing disorder.) With sleep apnea, involuntary pauses in breathing are caused by either a blocked airway or a signaling problem in the brain. Your throat muscles can collapse, your tongue can fall back into your airway, or your tongue or other obstruction can impede air flow. When your airway is cut off, the brain must wake itself to tell the respiratory system to take over, which can lead to gasps or snorts when breathing is resumed.

Most people with a blocked airway have obstructive sleep apnea (OSA). Less common is central sleep apnea (CSA), which occurs when the brain fails to properly control breathing during sleep. Perhaps the best-known trait of obstructive sleep apnea is snoring, which is most prevalent in those who sleep on their back, and sleep apnea can cause you to wake up numerous times a night.

The major symptoms of sleep apnea include:

• Loud or frequent snoring

• Silent pauses in breathing

• Choking or gasping sounds

• Non-restorative sleep

• Daytime sleepiness or fatigue

• Insomnia

• Memory loss

One thing to note: snoring can occur without sleep apnea, and sleep apnea can be present without snoring. Sometimes it’s hard to tell whether the problem is obstructive or central sleep apnea because the symptoms between them overlap.

It is now estimated that 26 percent of adults between the ages of 30-70 have obstructive sleep apnea. Older, overweight men are more prone to it than other groups, but anyone, including babies, can have it. While it’s true that more men than women suffer from sleep apnea, “that gender disparity is mostly seen with premenopausal women,” says Harly E. Greenberg, MD, medical director of Northwell Health Sleep Disorder Center. “It’s thought that progesterone and estrogen act as a stimulant in premenopausal women, and those hormones decline after menopause.”

The most common cause of sleep apnea is obesity, but researchers have discovered others as well. “The causes of obstructive sleep apnea are multifactorial,” says Dr. Greenberg, “and obesity is just one particular manifestation. It’s a complex condition.” For instance, people with these particular attributes are more susceptible to developing sleep apnea: men with a collar size of 17 inches or more; women with a collar size of 16 inches or more; people with large tonsils or a large tongue; and those with a narrow palate or airway that collapses more easily are all possible victims of OSA. In addition, family history, smoking, and nasal congestion can contribute to sleep apnea.

If your symptoms line up and you or your doctor suspect you may have OSA or CSA, your doctor will likely refer you to a sleep specialist or recommend that you spend a night in a sleep clinic, during which time your breathing and other bodily functions will be evaluated by a nocturnal polysomnography. This test monitors your heart, breathing patterns, limb movements, lung and brain activity, and blood oxygen levels while you are asleep.

Or your doctor may provide an at-home sleep test, which measures your heart rate, airflow, and breathing patterns. These tests are generally less conclusive than tests in a sleep disorder center. Obstructive apnea can also be diagnosed by an ear, nose and throat doctor, who will look for blockages in your nose and throat. Because cardiovascular issues are sometimes at the root of central sleep apnea, CSA is sometimes treated by cardiologists.

If you are overweight or obese, losing weight can help diminish or even eradicate sleep apnea. If obesity is not your health challenge, there are three main treatments for sleep apnea, including continuous positive airway pressure (CPAP) therapy; oral appliance therapy; and surgery.

A CPAP machine increases air pressure in your throat so that your airway doesn’t collapse when you breathe in. You use CPAP at home at night, usually with a mask that covers your nose (or sometimes a mask that covers your nose and mouth or otherwise a set of prongs that fit into your nose).

Oral appliances are also used for sleep apnea, such as a dental device like a mouth guard that positions the lower jaw slightly forward and down. These devices are most effective in mild to moderate cases.

There is also a relatively new therapy that shows promise, according to Dr. Greenberg, for those with moderate to severe sleep apnea who can’t tolerate CPAP. “We are now working with a device that stimulates the nerve that controls tongue movement when there is a pause in breathing,” says Dr. Greenberg. This is called hypoglossal nerve stimulation (HGNS). The device is implanted in the chest and can be turned on at bedtime and off in the morning. The results show an 84 percent reduction in breathing pauses and an 11 percent increase in blood oxygen levels, which indicates that HGNS is an effective alternative to CPAP.

Sleep apnea can have longer-term negative effects on your health, too, including high blood pressure, cardiovascular disease, diabetes, and depression.

Sleep apnea and mental health issues go hand in hand. Anxiety is common, both in the form of “nocturnal panic attacks” and as part of a general feeling of unease and discontent. Mental health conditions such as mood disorders, depression, and post-traumatic stress syndrome have been found to be highly comorbid with sleep apnea. According to one study from the National Survey of Drug Use and Health, those with sleep apnea have increased risk for suicidal ideation and severe psychological distress.