Sleep Apnea: Causes, Symptoms & Treatment

Sleep apnea is a serious sleep disorder in which breathing repeatedly stops and starts during sleep. The most common type, obstructive sleep apnea (OSA), occurs when the muscles in the back of the throat relax excessively during sleep, causing the airway to narrow or close. This leads to repeated drops in blood oxygen levels and fragmented sleep.

An estimated 30 million Americans have OSA, but approximately 80% remain undiagnosed. It is more common in men, people who are overweight, and those over age 50.

Nighttime symptoms:

• Loud, chronic snoring (often reported by a bed partner)
• Observed episodes of breathing cessation during sleep
• Gasping, choking, or snorting during sleep
• Restless sleep
• Frequent nighttime urination (nocturia)

Daytime symptoms:

• Excessive daytime sleepiness
• Morning headaches
• Difficulty concentrating and memory problems
• Irritability and mood changes
• Decreased libido

Untreated sleep apnea significantly increases the risk of:

• Hypertension (present in ~50% of OSA patients)
• Heart attack and heart failure
• Stroke
• Atrial fibrillation
• Type 2 diabetes
• Motor vehicle accidents (due to excessive sleepiness)
• Depression

• Polysomnography (sleep study): The gold standard -- overnight monitoring in a sleep lab records brain waves, blood oxygen, heart rate, breathing, and eye/leg movements
• Home sleep apnea test: Simplified monitoring at home; suitable for patients with high clinical suspicion and no significant comorbidities
• Apnea-Hypopnea Index (AHI): Number of breathing interruptions per hour of sleep -- mild (5-14), moderate (15-29), severe (30+)

Continuous positive airway pressure (CPAP) -- the gold standard:

• A machine delivers constant air pressure through a mask to keep the airway open during sleep
• Most effective treatment for moderate to severe OSA
• Adherence is the main challenge; proper mask fitting and acclimatization are key

Alternative treatments:

• Oral appliances (mandibular advancement devices): Push the lower jaw forward to keep the airway open; effective for mild to moderate OSA
• Positional therapy: For patients whose apnea occurs mainly when sleeping on their back
• Weight loss: Can significantly reduce or even cure OSA; a 10% weight loss can reduce AHI by 26%
• Surgery: Uvulopalatopharyngoplasty (UPPP), maxillomandibular advancement, hypoglossal nerve stimulation (Inspire device)
• Lifestyle changes: Avoid alcohol and sedatives before bed, maintain regular sleep schedule

See a doctor if you have loud snoring (especially with witnessed breathing pauses), excessive daytime sleepiness, morning headaches, or difficulty concentrating. A bed partner's observations are particularly valuable -- ask them about your snoring and breathing during sleep.