Key Points
-
Sleep apnea is when breathing during sleep briefly stops many times during the night.
-
The primary signs of sleep apnea are snoring, gasping during sleep, and feeling tired and headache-y during the day.
-
The condition worsens many health problems and can shorten life expectancy.
-
With proper treatment, sleep apnea is curable or at least manageable.
Do you wake up wondering why you don't feel rested? You might have sleep apnea. Odds are you already know someone diagnosed with it. The condition is becoming more common in the Western world, so pay attention to it because there are many long-term health dangers.
Fortunately, there are ways to manage and sometimes cure sleep apnea, so don't be afraid to talk to your doctor about it. Read on to learn the warning signs of sleep apnea, its causes, and how to treat it.
What Are the Warning Signs of Sleep Apnea?
There are many possible sleep apnea symptoms, but not all are definitive. If you have any of the following signs discussed below, it's worth investigating further. Even if you don't have sleep apnea, the listed symptoms can signal other problems that are harmful to health (and often annoying to whomever else is trying to sleep nearby).
Gasping or Interrupted Breathing During Sleep
The word "apnea" literally means "no breath," so the primary symptom of sleep apnea is gaps in breathing during sleep. The breathing stops for about 10 seconds before the body's alarm bells go off, frequently leading to a gasp for air. Sleep apnea makes you tired because you can't sleep soundly while this happens — even if you don't remember it.
A bed partner can tell you if they hear this pattern while you're asleep; if you don't have one, a home diagnostic device from a doctor also does the trick.
Snoring
Snoring is another form of obstructed breathing during sleep, often overlapping with sleep apnea. Not everyone who snores stops breathing, but if you snore loudly, it makes a sleep apnea diagnosis more likely.
Daytime Sleepiness
Many things can cause daytime sleepiness, but sleep apnea is a common culprit. The disturbance from interrupted breathing disrupts your sleep cycle, preventing you from reaching the deeper stages essential to physical and mental health.
Headache and Dry Mouth in the Morning
More than one thing can cause headaches and dry mouth when you wake up, such as excess drinking, but these are also possible sleep apnea symptoms. You've probably heard of "turtle headaches" that result from oxygen deprivation caused by covers pulled over the head at night. Sleep apnea headaches also come from a lack of oxygen due to interrupted breathing. The gasping action can also dry out your mouth.
Scalloped Tongue
Surprisingly, the first person to notice signs of sleep apnea could be your dentist. Obstructive sleep apnea frequently causes the tongue to press against the teeth during sleep, creating scallops around the edges. You can also observe this by sticking your tongue out at yourself in the mirror, which is entertaining if nothing else.
What Is the Main Cause of Sleep Apnea?
Sleep apnea has no single cause, but you can narrow down the possibilities by determining your type. Though one is a lot more common than the other, there are two main types: obstructive and central sleep apnea.
Delve into more about each type:
Obstructive Sleep Apnea
Obstructive sleep apnea is the more common kind. What happens to stop breathing is that the soft tissues of the throat relax and close up the airway. Snoring occurs for a similar reason, so the two conditions often go together, but the throat doesn't completely close up during a snore.
Why does this happen? There are a few possible reasons, which often work together to make things worse:
-
The shape of your mouth and throat is one risk factor that, unfortunately, you have no control over. Physicians can precisely measure this with the Mallampati score, which gauges the distance between the back of your tongue and roof of your mouth. The smaller the distance, the higher the risk of sleep apnea.
-
Obesity weighs down your neck with fat, which makes it easier for the airway to close up.
-
Alcohol consumption increases sleep apnea risk because it relaxes all your muscles, including the ones in your throat.
-
Nasal congestion due to allergies or infections can also clog up your airways for obvious reasons.
-
Smoking has a similar effect because of greater fluid retention and inflammation in the nose and throat.
-
Being old and male increases the risk of sleep apnea for reasons that aren't totally clear, but probably because older men are more likely to do all of the above. The fact that men mostly accumulate fat on their bellies and necks is also a factor, but women aren't immune to the problem. Dr. Jonathan Jun of the Johns Hopkins Sleep Disorders Medical Center says, "After menopause, hormones change and women tend to start looking like men in terms of where the weight gets put on […] It's a time to be paying attention to the risks of sleep apnea because women begin to catch up to men in the rates of apnea after menopause."
Central Sleep Apnea
With central sleep apnea, there's no physical obstruction to your breathing, but you have similar symptoms because of faulty signaling from your brain to your breathing muscles.
There are several possible causes of this one too. Heart disease, stroke, and kidney failure all increase central sleep apnea risk — so do high altitudes and opioid drugs. There's also "idiopathic" central sleep apnea, which is what the specialists call it when the cause is unclear.
Can Sleep Apnea Kill You?
Sleep apnea rarely kills people directly; your instinct to breathe is strong enough to kick in even when you're asleep, so apnea patients who die in their beds usually have other conditions that compound the problem. However, the sleep disruption and accompanying stress cause problems that can lead to a shorter life expectancy.
Daytime Sleepiness
Sleep deprivation is common enough not to seem like a big deal. You survived college despite it, right? According to the National Highway Traffic Safety Administration, sleep-deprived driving caused at least 633 fatal car accidents in the U.S. in 2020. The slowdown in your reaction time also increases the risk of death from household accidents.
Poor sleep also degrades your quality of life, even if it doesn't kill you that dramatically. Sleep is crucial to your body's and brain's self-repair processes. The deep sleep stage that apnea sufferers so often miss is when your body engages most intensively in deep tissue repair. REM sleep, when your dreams are most intense, is surprisingly important to your mental health. Anxiety, depression, OCD, and PTSD can worsen when you don't get enough sleep.
Diabetes
Obesity and diabetes increase the risk of sleep apnea, but sleep apnea might also cause diabetes, according to research.
"Our lab and others have shown that sleep apnea is associated with higher risks of diabetes, independent of obesity, and that sleep apnea can increase blood sugar levels,” says Hopkins' Dr. Jun.
Diabetes, in turn, leads to a whole host of health risks: heart disease, stroke, kidney disease, and non-fatal but still unpleasant symptoms like loss of eyesight, pain and numbness in the limbs, and nasty ulcers.
Heart Arrhythmias
"Arrhythmia" means erratic rhythm, meaning your heart sometimes skips a beat. Many people live with heart arrhythmias of some sort, but the low oxygen levels that untreated sleep apnea brings can aggravate the problem. This is likely the cause of sleep apnea sufferers dying from sudden heart attacks in bed.
Diagnosing Sleep Apnea
If you suspect you have sleep apnea, your primary care physician is the first stop. They either diagnose you themselves or send you to a sleep clinic specializing in that.
The easiest way to diagnose sleep apnea is to take an at-home sleep test. These involve attaching sensors to yourself that monitor your breathing and oxygen levels, which are a little awkward but relatively unobtrusive. Then you go to sleep as normal and take the device back to the clinic the next day for analysis.
If the diagnosis is unclear, the clinic calls you in for an on-site test, where they hook you up to a bunch of sensors that track activity in your brain, heart, lungs, and limbs as you sleep. You'll likely go through this if you have central sleep apnea, but home testing alone often detects obstructive sleep apnea.
How Do You Fix Sleep Apnea?
Because there are multiple sleep apnea causes, sleep apnea treatments come in many forms too. Once you've got an official diagnosis, you can work with your doctor on the best treatment plan for your life. Such plans usually involve one or more of the following.
Lifestyle Changes
Here is yet another reason to lose weight, quit smoking, and cut drinking. It's not fun, but such changes help with sleep apnea and many other health problems.
Another more specific change to sleep apnea is changing your sleeping position. Obstructive sleep apnea is more likely if you're lying on your back, so learning to sleep on your side can offer improvement.
Devices
The most common device to treat obstructive sleep apnea is the continuous positive airway pressure (CPAP) machine. To use it, you put a mask over your nose and mouth connected by tube to a gizmo that increases the pressure on the air you breathe in, keeping your airway open.
These are usually quite effective, but getting used to sleeping while hooked up to one takes some time. If you can't get comfortable with a CPAP machine, less intrusive devices, and oral appliances are also available. They aren't always as effective, though.
Central sleep apnea sufferers also often use CPAP machines but can benefit from machines delivering oxygen to the lungs.
Surgery
Surgery is a last-resort option for sleep apnea. As noted earlier, some people are just unluckily born with a mouth and throat shape that makes them vulnerable to obstructive sleep apnea.
Depending on precisely what the issue is, such surgeries might involve paring back or shrinking throat tissue, repositioning the jaw, and in the extreme case opening a breathing hole in your neck. Some promising implants are under development, but they're still unproven treatments.
Medications
There are no medications for obstructive sleep apnea, but central sleep apnea sometimes benefits from drugs that seem to help stimulate the dormant breathing impulses in the brain. Your doctor might adjust medications you're already taking that worsen sleep apnea, such as opioids.
Dreaming of a Cure
If your sleep apnea is mild to moderate, lifestyle changes alone might take it out of your life for good. Don't avoid treatment just because you're afraid that you won't be able to lose weight or quit smoking — everyone in medicine knows how incredibly difficult that is. Sometimes, it's not due to your behavior at all. Central sleep apnea is especially tricky because the cause is often an incurable or unknown disease.
However, it's possible to manage sleep apnea and lead a normal life even if you can't make it completely go away. Management through CPAP devices and other treatments that improve your sleep boosts your mental and physical health in many ways. If you think you might have sleep apnea, don't hesitate — go check it out!
Want to know more about sleep disorders and how to fix them? Subscribe to Snooze!
