Sleep Apnea - Symptoms, Causes & Treatment Options

What is Sleep Apnea?

Sleep apnea is a condition that causes a person to stop breathing for short periods while sleeping. Because it starves the body of oxygen, sleep apnea can lead to serious health problems, including high blood pressure, heart disease, and stroke. 

What Causes Sleep Apnea?

The causes of sleep apnea depend on the type:¹

• Obstructive sleep apnea (OSA) — this is the most common type of sleep apnea and is caused by airway obstructions. Often this occurs when the tongue falls backward and blocks the throat. It can also be due to relaxed throat muscles.
• Central sleep apnea (CSA) — if someone has problems with the nerves and muscles that control breathing, they may develop this form of sleep apnea.
• Mixed sleep apnea syndrome — this involves a mixture of OSA and CSA.

Anyone can experience sleep apnea, but there are certain risk factors, including:

• Older age  
• Male sex  
• Being overweight or obese
• Having a family history of sleep apnea
• Having heart, kidney, or hormone problems  
• Drinking alcohol and smoking
• Having certain anatomic traits like large tonsils or a thick neck

Symptoms of Sleep Apnea

Common sleep apnea symptoms include:

• Gasping for air
• Breathing that starts and stops suddenly 
• Snoring frequently

Some people also experience:

• Daytime tiredness
• Dry mouth
• Headaches
• Sexual dysfunction
• Waking during the night to urinate

Children with sleep apnea may have difficulty concentrating in school, experience bedwetting, or have worsening asthma symptoms. 

How Doctors Diagnose Sleep Apnea

A sleep specialist or doctor diagnoses sleep apnea by asking about your symptoms, family history, and medication use. Then, they may order tests to rule out other medical conditions and request a sleep study to help with their diagnosis.

Sleep studies may take place during an overnight stay at a specialized sleep center. Alternatively, people can use portable monitoring devices in their home.²

The study involves placing sensors on the face, eyelids, chest, limbs, and fingers. The sensors measure brainwaves, heart and breathing rates, oxygen levels, and muscle movements. The results may help diagnose sleeping disorders like OSA or CSA. 

9 Treatments for Sleep Apnea

Here are some common treatment options for sleep apnea: 

1. CPAP (continuous positive airway pressure) machine

CPAP machines are the first-line treatment for OSA. As you sleep, you’ll wear a specialized mask that fits over the nose and mouth. The mask attaches to a machine that provides constant air pressure and keeps your airway open.³

Many people notice immediate improvements when they start using a continuous positive airway pressure machine. CPAP therapy can improve sleep quality and reduce or eliminate snoring. However, some people may experience side effects such as a congested or runny nose, dry mouth, or nosebleeds.

Although CPAP therapy is effective, approximately 50% of users become nonadherent over time or may refuse treatment. Often, this is because most people don’t tolerate forced air in their noses and find the device uncomfortable to sleep with.⁴

Doctors may suggest using a different device, like an auto-CPAP machine, which automatically adjusts the pressure as you sleep. Alternatively, bilevel positive airway pressure (BiPAP) machines use two air pressure settings that provide more pressure on inhalation and less on exhalation.

2. Adaptive servo-ventilation (ASV)

This airflow device has a built-in computer that learns and stores your normal breathing pattern. While you sleep, the machine uses pressure to normalize your breathing and prevent interruptions.

ASV might be more effective than other types of positive airway pressure devices in treating complex sleep apnea. ASV is not a suitable option for people with predominantly CSA and/or advanced heart failure.⁵

3. Oral appliances

Dentists can make custom-fit oral appliances that you wear in your mouth while sleeping. Although CPAP machines are more effective, some people find oral devices easier to use.

There are two primary types and some hybrid devices that have the features of both:

•  Mandibular repositioning mouthpieces — cover the upper and lower teeth, positioning the jaw forward so it cannot block the airway
• Tongue retaining devices — hold the tongue forward to prevent it from blocking the airway

You'll need to follow up with your dentist regularly when using such a device to ensure the fit remains optimal.

The US Food and Drug Administration (FDA) has also recently approved an appliance that uses electrical stimulation on the tongue to prevent it from collapsing backward during sleep. It must be worn for 20 minutes daily for 6 weeks to see results.⁶

4. Rapid maxillary expansion (RME)

RME is an effective orthodontic treatment for OSA, primarily in children. It's a technique used to widen or expand the upper jaw if it's too narrow. This enlarges the size of the nasal cavity and can substantially increase the airflow through the nose.

The procedure involves placing a fixed metal appliance on the upper teeth. The metal framework attaches to metal bands or a plastic splint cemented to the back teeth. In the parts that run across the palate, there's an expansion screw that gradually widens the upper jaw.

RME is more effective in children since the bone is softer than in older people. 

5. Orofacial therapy

This effective therapy consists of specific exercises for the facial muscles. The aim is to increase and strengthen muscle tone, endurance, and movement. Training the muscles decreases the likelihood of airway collapse and improves sleep quality.

Studies also found that orofacial therapy helps adherence to CPAP treatment.

6. Supplemental oxygen

Using supplemental oxygen while you sleep may help if you have CSA. It can also help people who don't want to use CPAP machines.

Supplemental oxygen can prevent hypoxemia or low oxygen levels. However, it doesn't prevent obstructive events or improve daytime sleepiness.⁷

7. Uvulopalatopharyngoplasty (UPPP)

Uvulopalatopharyngoplasty (UPPP) is one of the most common, yet invasive, OSA surgical options. It involves removing soft tissue, including the tonsils, uvula, and part of the soft palate to enlarge the airways.

Doctors may not always recommend UPPP to treat sleep apnea, as it doesn't consistently help. It primarily benefits people with enlarged tonsils and a relatively normal palate.

Alternatively, doctors can use radiofrequency ablation to shrink the tissues at the rear of the mouth instead of removing them. This avoids the risk of surgery and has similar benefits to UPPP.

8. Jaw advancement surgery

Maximum mandibular advancement surgery (MMA) is successful in 75 to 100% of cases. It involves moving the upper jaw (maxilla) and lower jaw (mandible) forward, enlarging the airways, and reducing airflow resistance.³

Many experts now consider MMA the gold standard in surgical orthodontic treatment for OSA. However, the surgery is not without risks. Some people experience temporary hearing changes and temporary or permanent facial numbness. Also, the jaw can return to its original position following surgery.

9. Hypoglossal nerve stimulation (HGNS)

A surgeon inserts a small electrical stimulation device into the chest wall during this procedure. The device stimulates the hypoglossal nerve that controls muscles in the tongue. The stimulation rhythm synchronizes with a person's breathing to relieve upper airway construction.

This approach doesn't require permanent alteration of the airway tissues. Research also shows that it's effective and can decrease OSA symptom scores by 68% following 1 year of use.⁸

Other Ways to Manage Sleep Apnea 

Some people may be able to manage mild sleep apnea with lifestyle changes. Doctors may recommend these options for treating OSA before trying other treatments.

• Lose weight if you're overweight or obese — weight loss helps reduce fatty tissue that blocks the airways.
• Increase physical activity levels — exercise boosts oxygen levels and improves sleep quality, improving energy levels.
• Reduce alcohol consumption — alcohol reduces the tone of the upper airway breathing muscles and can lead to weight gain.
• Quit smoking — research shows that smoking increases OSA symptoms and daytime sleepiness.¹⁰
• Avoid strong pain relievers — medications such as opioids and high-dose benzodiazepines can increase OSA symptoms. These powerful drugs relax the breathing muscles and slow the breathing rate.
• Change sleeping position — some people breathe easier lying on their side. Beds that elevate the head may also help.

Outlook and Prognosis

Untreated sleep apnea stresses the heart, reduces life expectancy by several years, and can directly lead to death. However, effective treatment can control symptoms so that you can lead a normal life without long-term health effects.

Risks of Untreated Sleep Apnea

Without treatment, sleep apnea can cause serious health problems, including:

• High blood pressure
• Stroke
• Cardiac arrhythmias
• Enlargement of the heart muscle
• Heart failure and/or heart attacks
• Diabetes
• Obesity

Many people with heart failure or an abnormal heart rate have sleep apnea, as sleep apnea can have serious effects on the body.

Additional serious effects include:

• Hypoxia or low oxygen levels
• Altered carbon dioxide levels
• Pressure changes in the chest that affect the heart
• Increased levels of inflammation

Therefore, anyone experiencing symptoms should seek urgent advice from their doctor.  

Summary

Sleep apnea is a potentially serious sleep disorder in which breathing repeatedly stops and restarts. Obstructive sleep apnea (OSA) involves blockages of the airways, while central sleep apnea (CSA) involves problems with nerve signals.

Treatments such as continuous positive airway pressure (CPAP) machines, oral devices, and surgery are effective. Lifestyle changes such as weight loss, quitting smoking, and reducing alcohol consumption can also help.

Sleep apnea can cause serious health problems such as high blood pressure, stroke, and heart failure without treatment. Therefore, seeking medical help is important if you're experiencing sleep apnea symptoms.