Sometimes mentioned interchangeably with snoring, sleep apnea is an all-too-common condition that causes a person to stop breathing for brief but frequent periods of time during sleep. It can sound or look like shallow breathing, gasping, or loud snoring. To a bed partner, it can also appear rather alarming.
Approximately 22 million adults suffer from sleep apnea. Men are more than twice as likely as women to have the condition, though it can affect anyone of any age, including between 1 and 4% of children in the U.S. Though these numbers look high, they’re likely even higher, because sleep apnea is both underdiagnosed and underrecognized due to the nature of the condition.
Sleep apnea can be hard to diagnose — or even suspect — due to the nature of its onset. When something happens only while you’re sleeping, and one of its primary symptoms is the more innocuous snoring, it can be hard to recognize that there’s something more going on. But there are other signs and factors that help clue you — or an attentive partner — in on. Here is what you need to know about how to understand, manage, and treat sleep apnea.
Types of sleep apnea
Sleep apnea can be a major disruption to your sleep architecture, leading to fragmented, unrefreshing sleep and decreased wellbeing.
There are three types of sleep apnea:
- Obstructive sleep apnea (OSA) is the most common type of sleep apnea. It happens when the muscles and tissues at the back of the throat relax, causing your airways to narrow or collapse — or, become obstructed — during sleep. The obstruction prevents easy breathing throughout the night. As a result, your body wakes you up so that you can begin breathing again.
- Central sleep apnea (CSA) is when there is an issue between your respiratory muscles and your brain (your central nervous system) that prevents you from breathing properly. Your respiratory system either never receives the signals or never responds to the signals to intake oxygen — so there are periods of time where your body isn’t even trying to breathe. CSA is associated with severe fatigue and cardiovascular problems.
- Complex sleep apnea is a combination of obstructive and central sleep apnea.
Despite the assorted causes, each type of sleep apnea causes:
- low oxygen levels in the blood
- paused breathing during sleep
- frequent waking (often hundreds of times per night) with disrupted rest
How sleep apnea affects sleep
Those low blood-oxygen levels, breathing issues, and frequent wake-ups can cause major disruption to your sleep architecture. People with severe sleep apnea can stop breathing for 10 to 30 seconds at a time while they’re sleeping — and these short cessations of breathing can happen nearly 400 times every night.
SleepScore Labs, our partner in sleep data and science expertise, analyzed data from more than 3,000 people to explore the relationship between sleep apnea and sleep quality. According to the analysis, sleep apnea negatively affected numerous key sleep metrics. Individuals with sleep apnea experienced less total sleep time and significantly poorer sleep efficiency — the ratio between total time in bed and total time asleep — than those without the condition.
According to SleepScore Labs, people with sleep apnea also had a more difficult time getting up in the morning, had significantly poorer alertness within the first half hour of waking up, and reported lower sleep quality overall. Those who reported having sleep apnea also had more nights of poor sleep each week than individuals who didn’t report having the condition.
Signs and symptoms of sleep apnea
Though snoring is the most audible and recognizable symptom of sleep apnea, it doesn’t always mean that you have apnea, and it doesn’t paint the full picture.
“Snoring is the most common, but pauses in breathing (sometimes with choking or gasping), unrefreshing sleep (waking up still feeling tired, fatigued, etc.), or medical problems like high blood pressure that are not responding well to standard treatment are also common signs,” says Eric Kezirian, MD, MPH, a leading snoring and sleep apnea surgeon and a professor of clinical otolaryngology, head, and neck surgery, at the University of Southern California. It’s important to take stock of how you feel each morning, to better assess if there’s more to your snoring. “All signs and symptoms of sleep disordered breathing are important,” he says.
Other sleep apnea symptoms include:
- Excessive daytime sleepiness
- Insomnia (difficulty falling or staying asleep)
- Dry mouth when you wake up
- Morning headache
- Difficulty paying attention while awake
- Irritability and other mood changes
Risk factors for sleep apnea
You’re also more likely to have sleep apnea if you have these risk factors:
- Male: Men are two to three times more likely than women to have sleep apnea.
- Age: Sleep apnea is more prevalent among older adults. In fact, the difference drastically narrows, with statistics showing sleep-disordered breathing affecting up to 70% of older men and 56% of older women.
- Overweight: Those with weight issues or obesity are more at risk because excess fat deposits in the neck may contribute to narrowing of the airways.
- Use of alcohol or sedatives: These substances can relax the muscles in the throat and interfere with your ability to breathe well at night.
- Smoking: Current smokers are 2.5 times more likely to have OSA than people who have never smoked or former smokers.
- Sleeping on your back: Gravity means your tongue and other tissues rest toward the back of your throat and block the airway.
- Certain medical disorders: Many conditions — such as stroke, hypothyroidism, metabolic syndrome, asthma, diabetes, high blood pressure, and neurological disorders — can increase the risk of sleep apnea.
- Certain structural abnormalities: Enlarged tonsils or a large tongue can also increase your risk for sleep apnea.
Lifestyle therapies for sleep apnea
Before you start working on an anti-snore strategy, it’s important to check in with your medical provider. There are lifestyle therapies that may help open your airways, such as breathing exercises and nasal products, but the ideal solution for your symptoms and situation may differ.
“Conservative treatments for obstructive sleep apnea are very important,” notes Kezirian, citing overall life changes that can improve the condition. “These include avoiding sleeping on your back, losing weight, and avoiding alcohol or sedatives before bedtime.”
Don’t sleep on your back
“About half of all patients with obstructive sleep apnea have notably worse sleep apnea when they are on their back versus their sides or stomach,” says Kezirian. To breathe better, switch your sleep position, ideally to sleeping on your side.
Pro-tip: If you’re finding that old habits die hard, consider stitching a small ball between the shoulder blades of your sleepwear. The trick may seem strange, but it’s research-backed and shown to work.
Keep your head elevated
Besides the ball hack, look for products specifically designed to help keep your head and neck in a position for better breathing. Adjustable beds, for example, allow you to elevate your upper body or head area, and some options can even monitor your breathing and snoring throughout the night, then adjust the bed’s position accordingly.
For a smaller investment, try sleep apnea pillows. These are responsive, inflatable pillows and wedge pillows that keep your head elevated. Other contoured pillows can encourage you to sleep on your side for better positioning. Even the firmness of your mattress can determine which sleep position is most comfortable.
Avoid alcohol and sedatives before bed
If you drink at all, the American Lung Association recommends having your last beverage at least four hours before bedtime. Similarly, you should avoid taking sedatives like sleeping pills and muscle relaxants if you have sleep apnea. Talk to your doctor if you think prescribed medications (especially those for pain or anxiety) are contributing to your breathing problems.
If you’re missing something to help you relax and unwind, swapping out alcohol for soothing tea may be the right pre-bedtime ritual that won’t risk narrowing your airways.
Incorporate more exercise
If you are overweight, your doctor may recommend weight management as a strategy. Research has shown that in overweight men, weight loss was an effective strategy for treating and even curing sleep apnea, especially in severe cases. Poor sleep and weight do have a complicated relationship, so ask your doctor first about most effective strategies for the short-term as well.
Pro-tip: Practicing mouth and throat exercises can help reduce sleep apnea severity. Known as oropharyngeal muscle exercises, throat, tongue, and facial muscle stimulation is shown to reduce snoring and improve sleep quality in people who have experienced stroke and moderate OSA and mild to moderate OSA.
Track your sleep
One of the biggest first steps to working with your sleep apnea is understanding how it impacts your sleep. Tracking your sleep can give you objective insights into your wake-ups and your sleep quality. “While home solutions from consumer sleep technologies cannot yet replace clinical sleep diagnostic tests, certain features currently available may help guide users to better understanding their own sleep patterns and take decisive action to get the help that they need,” explains Elie Gottlieb, PhD, applied sleep scientist at SleepScore Labs.
Pro-tip: Make note of how your sleep changes based on other behavioral or in-bed changes you make, whether cutting out alcohol, sleeping in an elevated position, or notching 30 minutes of exercise, to determine the impact on your sleep quality.
Medical treatment for sleep apnea
For many cases of sleep apnea, treatment is a multi-pronged approach that also includes medical care. Here are some of the medical treatments for apnea.
CPAP machines
The gold standard for sleep apnea treatment is generally CPAP (continuous positive airway pressure) machines. CPAP treatment involves wearing a mask fitted over your nose that forces air through the nasal passages to help keep the airways open. However, equating apnea treatment with CPAP can be a problem, Kezirian cautions.
“The misconception that CPAP is the only treatment available for obstructive sleep apnea leads many people to avoid getting an evaluation and sleep study and, even if they are diagnosed, leaves many patients who cannot tolerate CPAP without effective treatment,” he says. “People with obstructive sleep apnea who are not doing well with CPAP should at least consider other options, including surgery and oral appliances.”
If you are unable to use a CPAP mask, there are many other options.
Oral appliances
Oral appliances are mouthguard-like devices that hold your jaw in a forward position, keeping the tongue away from the back of your throat.
The success of these treatments depends on the cause or pattern of your obstruction: “If you have a small lower jaw, you tend to do better with oral appliances, as long as you can sleep comfortably with them in place. If you have large tonsils, you will generally do much better with surgery than an oral appliance,” Kezirian says.
Surgical treatment
There is no single surgery for sleep apnea. Rather, doctors evaluate each case to determine the underlying cause or location of the obstruction — such as a deviated septum in the nose, a small jaw, or large tonsils or other excess tissue in the soft palate — and then work to correct that. Some common surgical approaches include:
- tissue removal or shrinkage
- jaw surgery
- implants
- nerve stimulation
- airway surgery
Some of these therapies may be best used in combination, too. "Surgery can be essential to treat nasal obstruction (blockage of breathing through the nose), which can be very important to improving comfort and success with CPAP and oral appliances," says Kezirian.
What happens if sleep apnea goes untreated?
Complications from sleep apnea go further than just feeling unrested for a day, says Michael J. Breus, Ph.D., a clinical psychologist and fellow of the American Academy of Sleep Medicine.
"Currently we know that when you have an apnea, your heart rate slows down to conserve the oxygen in your system. Next your brain says, 'Oh crap, we need more air,' and it tells your heart to speed up to wake you up to breathe," explains Breus. "When the heart does this over and over, what happens is that the muscles of the heart will grow irregularly." This growth can lead to cardiovascular complications like irregular heartbeat, high blood pressure, atrial fibrillation, heart attack, stroke, and even death, he notes.
Untreated sleep apnea is also associated with:
- Decreased productivity: Excessive daytime sleepiness can lead to decreased productivity at work, plus problems with learning and memory.
- Increased chance of accidents: There’s a greater risk of injury, especially when driving. In fact, people with sleep apnea are at twice the risk of being in a car accident.
- Increased inflammation: The lack of oxygen from sleep apnea can lead to chronic inflammation and oxidative stress, which may contribute to the development of other complications.
- Metabolic syndrome, which is associated with glucose intolerance, diabetes, and kidney disease, is linked to untreated sleep apnea.
- Eye disease, such as glaucoma
- Asthma
- Some cancers
The key word here is untreated, however — with treatment, the risk of these complications can be reduced or avoided altogether. “There’s a misconception that apnea cannot be cured, which is not true,” says Breus.
How will a doctor diagnose sleep apnea?
If you share a bed with a partner, you can clue one another in on potential issues. If you notice loud snoring, gasping for air, or halted breathing in a partner, or a partner mentions them to you about your own sleep habits, it’s worth consulting a doctor about potential sleep apnea.
The first step is compiling a medical history and conducting a physical exam. If your doctor thinks you may have sleep apnea, sleep specialists could perform a polysomnography (sleep study) to help confirm a diagnosis. As part of a sleep study — which can sometimes be done at home instead of in a sleep clinic — you’ll be hooked up to sensors so doctors can monitor your brain waves, breathing, oxygen levels, and heart rate while you sleep. This test may involve sleeping in the clinic overnight, in a room that’s similar to a hotel room.
You may also be referred to a neurologist or an ENT (ear, nose, and throat) specialist who can further evaluate central or obstructive sleep apnea.
All told, it can take several weeks or longer to diagnose sleep apnea. If your partner is also experiencing sleepless nights from your snoring, consider anti-snoring devices or a white noise machine, which can help the brain refocus on sleep. In the meantime, it’s important to take what steps you can at home to ensure that your brain and body are getting the oxygen they need to function — because treating your sleep apnea is nothing to sleep on.
