Do you find yourself tossing and turning, snoring, with difficulty breathing at night? It’s estimated that obstructive sleep apnea affects between 2-9% of adults in the United States, though the majority of cases go undiagnosed.
Many people who suffer from obstructive sleep apnea (OSA) awake not feeling rested from the night before, which can snowball into additional unwanted side effects. While obstructive sleep apnea is typically a long-term disease, it can be managed through a wide variety of treatments. On this page, we’ll walk you through what obstructive sleep apnea is, including common symptoms and causes, with information to learn more about diagnosis and treatment.
What is Obstructive Sleep Apnea?
Obstructive sleep apnea is a respiratory disorder that is found in both children and adults. Those who exhibit it, experience either complete or partial collapse of the upper airway during sleep. This makes it hard to breathe, and can be very disruptive to a full night’s sleep, in addition to disturbing your bed partner. It’s analogous to breathing through a straw. When you’re awake it is not so difficult as you are aware and you can increase your breathing rate, however at night you do not have this same compensatory mechanism, so it wakes you up. Obstructive sleep apnea most frequently affects older men, but can also affect women and children as well.
What Are the Symptoms of Obstructive Sleep Apnea?
Obstructive sleep apnea can have a series of negative side effects on day-to-day life, often resulting in lower levels of energy and sleepiness during the day. Those who experience obstructive sleep apnea may also exhibit the following symptoms:
- Loud snoring
- Nocturnal restlessness
- Insomnia with frequent awakenings
- Awakening with choking or gasping
- Vivid or threatening dreams
- Daytime sleepiness
- Lack of concentration
- Morning headaches
- Cognitive deficits
- Changes in mood
What Causes Obstructive Sleep Apnea?
Several studies have shown strong correlations between gender, age, and weight to increase your risk of experiencing obstructive sleep apnea. In particular, the most common risk factors include:
- Age and Gender: Men are up to two to three times more likely to have obstructive sleep apnea than women, though risk factors appear to balance out once women become postmenopausal. As one ages from young adulthood to 50’s and 60’s the risk increases, but levels off after that.
- Obesity: Several studies have found a strong correlation between higher body mass index (BMI – a measure of body fat based on height and weight) and obstructive sleep apnea. One study found that people who increased only 10% in weight were six times more likely to be at risk for obstructive sleep apnea. Additionally, 90% of people who suffer from hyperventilation syndrome (OHS) also have obstructive sleep apnea.
- Upper airway and craniofacial abnormalities: People are more likely to have obstructive sleep apnea if they exhibit abnormalities such as short mandibles, enlarged tonsils, or abnormally sized upper jaw bones.
- Neck size: Those with a larger neck (over 17 inches in men and 16 inches in women), tongue, or tonsils and adenoids may be more likely to experience a blocked airway.
Additional Risk Factors
Certain potential risk factors are still being studied, but have a less established correlation. Some of these include:
- Family history: Genetic predispositions like craniofacial structure and having family members who snore and/or have OSA likely increase individual risk.
- Smoking: Heavy smokers are almost three times more likely to have obstructive sleep apnea than non-smokers.
- Nasal congestion: People who have nasal congestion are approximately twice as likely to have obstructive sleep apnea. However, it’s not yet clear whether obstructive sleep apnea improves when nasal congestion is corrected.
Pre-existing conditions may also play a factor. The following conditions have also been associated with an increased risk of exhibiting obstructive sleep apnea:
- Type II diabetes
- Gastroesophageal reflux
- Cardiovascular disease
- Polycystic ovarian syndrome (PCOS)
- Parkinson’s disease
- Obesity hypoventilation syndrome
- Chronic lung disease
If you experience symptoms consistent with OSA, you should speak to your doctor or another fully credentialed physician about treatment options. Depending on your symptoms, the doctor may recommend an overnight sleep study, also known as a polysomnogram, a painless and non-invasive procedure. These studies typically take place at a sleep center or lab.
Depending on what type of results this study yields, the doctor may recommend one or more of the following treatment options for OSA:
- Continuous positive airway pressure (CPAP) therapy: CPAP is considered the standard form of therapy for most people with OSA, as well as those showing mild sleep apnea symptoms. Sleepers wear a face mask and receive pressurized air from the CPAP machine through a connective hose. Some machines are also equipped with humidifiers to ease breathing. Bi-level positive air pressure (BiPAP) therapy, which delivers pressure at a more variable rate, may be recommended for people who don’t respond to CPAP or are CPAP-intolerant.
- Oral appliance: A mouthpiece or mouthguard may be recommended for light to moderate OSA symptoms, as well as snoring. These appliances fall into two general categories. Mandibular advancement devices (MADs) physically reposition the jaw forward to expand the airway. Tongue-retaining devices (TRDs) grip the tongue and prevent it from blocking the airway. Most of these appliances are sold over the counter and do not require a prescription, but check with your doctor just in case.
- Surgery: Doctors may recommend surgery (7) if non-invasive methods like CPAP and oral appliances do not alleviate OSA symptoms. In many cases, surgery is needed to correct anatomical deformities that contribute to airway blockage. Removing tissue from the soft palate, uvula, tonsils, adenoids, and/or tongue can also be effective. Many children who experience OSA will have their tonsils and adenoids removed during a procedure known as an adenotonsillectomy.