By Vera Caldwell
Most people only learn they snore when someone else tells them. And while, yes, the sawing or freight train-like noise can bother others, there’s another reason to care about snoring: it can sometimes be a sign of an underlying medical issue, like sleep apnea.
But Dr. Faisal Zahiruddin, a pulmonologist and sleep medicine specialist at Houston Methodist, notes that snoring isn’t the only sleep apnea symptom that should be on your radar.
(Related: What Causes Snoring And When to See a Doctor About It)
What is sleep apnea?
The word apnea is derived from Greek — “a” means “without” and “pnea” means “air.” So apnea means “without air,” and sleep apnea is a condition characterized by brief interruptions in breathing during sleep. There are two kinds of sleep apnea, obstructive and central.
Obstructive sleep apnea (OSA) is more common, affecting an estimated 80.6 million people in the U.S. and 1 billion people worldwide. It happens when the airways relax too much during sleep, partially collapsing. This can lead to snoring but, more concerningly, it prevents the lungs from both receiving adequate oxygen and eliminating carbon dioxide. As a result, oxygen levels drop in the bloodstream, causing blood pressure to shoot up and placing strain on the heart.
Central sleep apnea, on the other hand, is much less common. It happens when the brain fails to send signals to the breathing apparatus. This type of sleep apnea is less symptomatic and more difficult to detect and treat.
(Related: 5 Signs to See an Ear, Nose & Throat (ENT) Specialist)
Sleep apnea risk factors to be aware of
Though obstructive sleep apnea can occur in childhood, it’s much more common with increasing age. Specifically, adults older than 50 have a significantly higher risk of developing it.
Family history can also increase the likelihood of sleep apnea, though specific genetic markers associated with the condition haven’t yet been identified. Its tendency to run in families could be due to shared habits or environments. Anatomy plays a role as well. If someone's parents have a narrow upper airway, then they can inherit some of that anatomy from them, which could put them at risk for sleep apnea.
Aside from age and family history, the main risk factors of sleep apnea are:
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Poor diet
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Sleep position
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Being overweight
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Neck circumference
Sleep apnea symptoms you shouldn’t ignore
Though snoring is the most well-known symptom of sleep apnea, it isn’t necessarily a direct indicator of the condition.
“Sometimes a snore is just a snore,” says Dr. Zahiruddin. “And while it can be a symptom of obstructive sleep apnea, it’s not the root problem. The real issue is the dynamic airway collapse and inadequate ventilation that occurs.”
The most common symptom of sleep apnea is excessive daytime tiredness due to disruption of sleep. Other symptoms include waking up in the night — either for no clear reason or due to difficulty breathing — as well as morning headaches and not feeling well-rested. Mood changes like depression and irritability can also be signs of sleep apnea.
(Related: Why Am I So Tired?)
What happens if sleep apnea isn’t treated?
Obstructive sleep apnea can have severe consequences if left untreated. Most concerningly, it’s correlated with a higher rate of sudden cardiac death, and heart attacks and congestive heart failure are also more common — especially for people with moderate to severe sleep apnea.
One study has even found that apnea-induced sleep disruptions may accelerate biological aging.
The good news, though, is that these risks can be reduced with treatment, which is why it’s important to speak to your doctor if you think you might have sleep apnea.
(Related: Understanding Your Heart Attack Risk Profile)
How is sleep apnea diagnosed?
Sleep apnea is diagnosed through a sleep study, typically a polysomnogram. This test takes place in a sleep lab and measures breathing, EKG, brain waves, muscle activity and effort of breathing. These measurements help determine what’s called an “apnea hypopnea index,” which is defined as the number of times per hour that breathing stops. Experiencing less than five incidents is considered normal, while 5 to 15 incidents is indicative of mild sleep apnea. A number above 15 signals moderate sleep apnea and a number above 30 signals severe.
While the idea of sleeping in a medical building may sound unpleasant, sleep labs do their best to mimic a home environment and make patients comfortable.
“Our sleep lab has top of the line mattresses, cable TV — all the things you might have in your own bedroom,” says Dr. Zahiruddin.
Another diagnostic option is a home sleep test, which provides less detail but is a more convenient option if the likelihood of obstructive sleep apnea is high. However, a home sleep study can only confirm a diagnosis, not rule one out. If home test results are negative, a polysomnogram in a sleep lab will be needed to officially rule out obstructive sleep apnea.
(Related: Sleep Trackers: How Accurate Are They Really?)
Can lifestyle changes help reduce sleep apnea?
Addressing risk factors, such as being overweight, smoking and sleeping in poor positions, can help relieve sleep apnea symptoms. For instance, some people can reduce their symptoms by sleeping on their sides.
“The lifestyle change that is most impactful in obstructive sleep apnea is weight gain and loss,” says Dr. Zahiruddin. “Though people who are in great shape can have obstructive sleep apnea, the condition becomes more prominent and more likely with increasing weight.”.
How is sleep apnea treated?
Watch out for false advertising. Over-the-counter treatments like nose strips and nasal decongestants may claim to help with sleep apnea, but they can only help reduce snoring.
Instead, your doctor will recommend one of the following sleep apnea treatments:
(Related: Can Mouth Tape During Sleep Be Dangerous?)
CPAP
The most effective and widely known sleep apnea treatment is continuous positive airway pressure, or CPAP, which involves wearing a mask attached to a small machine that uses gentle pressure to open the airways as you sleep. This allows breathing and oxygen levels to remain normal, reducing the strain on the heart and blood vessels.
“The more the CPAP machine is used, the greater the health benefit,” adds Dr. Zahiruddin.
This means it should be used every night — and even when taking naps. And not to worry, CPAP machines are more comfortable and quieter in recent years, as companies work to improve the wearer’s experience.
“Most people don't have trouble acclimating to the CPAP device,” says Dr. Zahiruddin. “In fact, many patients come back to me and say they’ll never sleep without it again.”
Alternatives to CPAP
One alternative treatment option is a dental appliance called a mandibular advancement device, which moves the lower jaw forward to open the airway. This is generally only recommended for people who can’t use CPAP, since the device comes with a risk of jaw and dental problems. It’s also only effective for people who have mild obstructive sleep apnea.
Surgeries to address the airway obstruction can also help alleviate symptoms. For example, if someone has a deviated septum, then a surgery called a septoplasty can be done to correct it. Large tonsils or adenoids may also cause an obstruction that contributes to sleep apnea, so having them removed may improve symptoms.
Some patients with moderate to severe sleep apnea may be unable to use CPAP but also be intimidated by surgery. In these cases, a newer, less-invasive treatment called a hypoglossal nerve stimulator may be a good fit. The hypoglossal nerve stimulator is a device implanted in the chest using two small incisions. It’s powered on during sleep and works by stimulating the hypoglossal nerve, which controls the muscles in the tongue, inducing the nerve to move the tongue forward with each breath, opening the airway.
To be eligible for this treatment, you must be diagnosed with moderate or severe sleep apnea, have an obstruction at the palate or base of the tongue and have a BMI under 40.
