9 Things You Need to Know About Sleep Apnea
What is sleep apnea?
Think of sleep apnea as trying to scuba dive when you only have a snorkel. While your partner with full scuba gear descends gently into the ocean, you have to splash to the surface every 30 seconds for air. Only you’re not underwater, you’re asleep. And the faulty breathing apparatus is your own body.
Sleep apnea is a chronic disorder that causes pauses in your breathing while you sleep. "Your brain is having to make a decision between breathing and sleeping," explains W. Chris Winter, MD, author of The Sleep Solution: Why Your Sleep is Broken and How to Fix It ($15; amazon.com).
If you have sleep apnea, your breathing may stop as many as hundreds of times a night, which can make it extremely difficult to achieve a state of deep sleep. You may even wake up multiple times. The result? You’re probably not getting enough sleep, or at least enough good sleep. Sleep apnea is a serious condition, and over time it can increase your risk for heart disease, stroke, and more. But the good news is that there are treatments available. Here, nine things everyone should know about sleep apnea.
There’s more than one type of sleep apnea
Obstructive sleep apnea (OSA) is the most common type of sleep apnea, and occurs when the muscles in your throat become blocked ("obstructed") while you sleep. Another type of sleep apnea, central sleep apnea, happens when there’s a disconnect between your brain and muscles. As a result, your brain doesn’t send the correct signals to the muscles that control your breathing. Sometimes obstructive and central sleep apnea can occur at the same time, which is called complex sleep apnea syndrome.
Obesity is a major risk factor
While central sleep apnea may be triggered by medical conditions (such as heart disorders) and certain medications (such as opioids), obstructive sleep apnea often affects people who are overweight. In fact, as many as half of people with OSA are overweight, according to the National Heart, Lung, and Blood Institute. Some experts think that overweight people have extra tissue in the mouth and throat area, which can block the airway as they sleep. Although not everyone with sleep apnea is overweight, losing excess weight may help ease symptoms for some.
Other factors that may up your risk of obstructive sleep apnea: having naturally larger tonsils or narrow airways, having a family member with sleep apnea, smoking, alcohol, and nasal congestion.
Snoring is not the only symptom
Loud snoring may be the most noticeable symptom of sleep apnea (especially for the person who shares your bed), but it’s not the only sign. Feeling excessively sleepy (or even falling asleep) during the day is another common symptom. “It’s falling asleep during work and important meetings,” says Dr. Winter. Most people don’t connect feeling sleepy with sleep apnea because they may not know they’ve been waking up during the night. Snoring is a better tip-off—not only is it loud, but it’s usually followed by choking and gasping sounds. This snoring and gasping occurs when the tissue in the back of your throat vibrates. However, not all snorers have sleep apnea. Morning headaches, dry mouth, mood swings, and trouble focusing may also point to sleep apnea.
More men than women have sleep apnea
Middle-aged men are more likely to develop sleep apnea than women. Charles Dickens identified the most common sleep apnea patient back in 1837 when he wrote The Pickwick Papers: The main character was "middle-aged and overweight and snored like a banshee and had excessive daytime sleepiness," says Mark Eric Dyken, MD, professor of neurology and director of the University of Iowa College of Medicine Sleep Disorder Center. (This is why sleep apnea used to be called “Pickwickian syndrome.”) But women can develop sleep apnea, too; their risk is greater after they reach menopause.
Sleep apnea can be life threatening
Left untreated, sleep apnea can lead to dangerous complications, including high blood pressure, diabetes, irregular heartbeat, heart attack, heart failure, stroke, and more. "It becomes this very intricate web," says Dr. Winter. "Sleep apnea makes you gain weight because a lot of people eat to stay awake, the weight gain [can cause you] to have a heart attack. You’re also more likely to have diabetes and metabolic syndrome." Metabolic syndrome refers to a collection of health risk factors that raise your risk for heart disease and diabetes: stomach fat, high triglycerides, low "good" HDL cholesterol, high blood pressure, and high fasting blood sugar.
Sleep apnea can also up your risk of developing depression and may impact your relationships, both at home (if your partner is feeling sleep-deprived from your snoring) and at work (if you are constantly feeling tired and underperforming).
Sleep apnea is often undiagnosed
“[Sleep apnea] is very under-diagnosed because a lot of people find that they get in bed and fall asleep immediately, and to some people that signifies good sleep," says Dr. Winter. “They think ‘I can sleep anywhere—I can fall asleep in a canoe.’ That indicates something is wrong with your sleep, not that you’re good at it."
Another reason for sleep apnea’s under-diagnosis is that it happens with you’re unconscious, and often people don’t make the connection between feeling sleepy during the day and having sleep apnea. That’s why snoring is an important clue, which someone else usually comments on. "Unless you come in with partner, you have no idea," says Dr. Dyken.
You can be diagnosed at home
Once upon a time, you had to spend an uncomfortable night at a sleep lab hooked up to wires and monitors to get an accurate sleep apnea diagnosis. Now, many people can pinpoint a diagnosis at home. After a physical exam, your doctor may recommend a home-based portable monitor, which looks at sleep stats such as your heart rate and chest movements. It can also be helpful to keep a sleep diary for a few weeks to note when you sleep and wake up.
The downside of the home approach is that it usually only diagnoses sleep apnea and won’t tell you if you have another sleep condition, says Dr. Winter. If you don’t have sleep apnea, you may need to head to a sleep lab or visit a sleep specialist to find out what’s wrong.
There are treatment options
Sleep apnea is a serious condition, but the good news is that there are treatment options available. Smart lifestyle changes can help too, especially for people with mild sleep apnea (more on this later).
Wearing a CPAP (continuous positive airflow pressure) mask at night is the main treatment for people with moderate to severe sleep apnea. This machine helps keep the upper airway passages open so you can breathe easier while you sleep. But many people don’t like using a CPAP mask. "It’s probably the most effective treatment, but it’s definitely not convenient or sexy," says Dr. Winter. Side effects such as congestion and dry mouth can also be frustrating for CPAP users.
If CPAP isn’t right for you, there are other options, as well, such as mouthpieces (oral appliances) that move your tongue or jaw forward and away from your airway. For people who do not get relief from these treatments, surgeries to open the breathing passages (such as jaw repositioning or removing tonsils and tissues from the back of the mouth) may be an option.
Lifestyle changes may help
Smart lifestyle changes can make a difference in the quality of your sleep if you have sleep apnea. "Anything that can disrupt sleep can make apnea worse," says Dr. Dyken. People with sleep apnea should avoid sleeping on their backs (to keep the tongue away from the breathing passages), cut out soft drinks, quit smoking, and avoid using sleeping pills and alcohol (both can slow down your breathing even further). "Heavy drinking predisposes you to the condition because of muscle relaxation," explains Dr. Winter.
It’s also especially important for people with sleep apnea to practice good sleep hygiene. Reserve the bedroom for sleep and sex only, make sure the temperature is comfortable, and turn off all lights. Limiting screen time before bed can also help.