Sometimes snoring is more than just snoring. It can actually be a sign of obstructive sleep apnea (OSA), a condition that causes your airway to repeatedly collapse during sleep, briefly cutting off your breathing. It affects up to 32.4% of Americans (more than 80 million people), yet an estimated 80% of those with the condition don’t even know they have it.
Here are the subtle symptoms to look for, the best way to go about getting diagnosed, and the latest treatment options that can help you feel better—all day and all night.
This condition occurs when your airway collapses or becomes blocked (either partially or completely) while you’re asleep. “People with sleep apnea typically don’t have any trouble breathing while they’re awake,” says Jennifer Martin, MD, a professor at the Herbert Wertheim College of Medicine at Florida International University in Miami. “But as we fall asleep, our muscles relax, and their airway collapses.”
When that happens you stop breathing, which causes your oxygen levels to drop. That triggers your brain to wake you up so you’ll take a breath. “There can be an arousal from sleep, something in the 3-to-10-second range,” says James Rowley, MD, a professor of medicine at Rush University in Chicago. “You won’t even know it happened.”
As scary as this might sound—I’m sorry, did you say “stop breathing”?—Dr. Martin says it doesn’t get to the point where you could suffocate. “Your brain is really smart; it won’t let you die from not breathing.” Instead, you may just feel really, really tired the next day because you kept waking up.
Types
A quick note about the term sleep apnea: In this article it refers to obstructive sleep apnea, but there is actually another less common form of the condition called central sleep apnea (CSA).
With CSA your brain doesn’t always tell your muscles to breathe during sleep. “When you’re awake breathing is both voluntary and involuntary,” Dr. Martin explains. That means you can make yourself take a breath, but if you forget, you’ll keep breathing anyway. “When you’re asleep it’s only involuntary, and with central sleep apnea that signaling may not work the way it’s supposed to.”
There is also complex sleep apnea. This occurs when OSA becomes CSA while you’re receiving sleep apnea therapy.
Risk factors
What ups the chance of your airway closing while you’re sleeping? One major risk factor is having obesity. Carrying excess weight in the head and neck can mean “there’s less space for your airway, and it’s more likely to collapse,” Dr. Martin says. Abdominal fat can also contribute, making it hard for your chest to completely expand and relax when you’re asleep.
But sleep apnea can impact anyone, explains Dr. Rowley. That’s because the condition can also be brought on by the shape of your jaw or airway, your neck circumference, as well as a number of other factors. For example, Dr. Rowley says, “children and young adults with very large tonsils can get it.” Certain facial structures raise your risk, too, like having a recessed chin, which angles toward the neck instead of projecting forward.
Being postmenopausal is another potential contributor. Your risk for sleep apnea is two to three times higher after you go through menopause than it was before. “Estrogen and progesterone can protect women from sleep apnea,” Dr. Martin says. As levels of those hormones drop after menopause, you lose that protection. “You also tend to lose lean muscle mass and gain more fat [after menopause], so all those things can increase your risk,” Dr. Martin adds.
Symptoms
One of the tricky things about sleep apnea is that some of the symptoms—especially the arousals—happen when you’re, well, asleep. “The quality of sleep is poor because your brain wakes you up 5, 15, 20 times an hour,” says Dr. Martin. “But for a lot of people, the awakenings are just a few seconds, so you don’t remember you’re waking up.”
What you will notice is you rarely feel like you’re getting a good night’s sleep. You may wake up exhausted and not refreshed even though you were in bed for a solid eight hours. But fatigue is easy to normalize and can be somewhat subtle. “It may not be that you want to fall asleep in meetings at work; it’s just lethargy and low energy,” Dr. Martin says.
If you share a bed with someone, they can help spot the signs of sleep apnea. Maybe they see you take a big gasp for air while you’re sleeping or notice that you snore. “The snoring is the uvula flopping in the small airway,” says Dr. Rowley, adding that the majority of people with the condition snore.
Complications
If treated properly and managed well, OSA is unlikely to affect other aspects of your health. But if it’s untreated, things can start to go wrong. There are two main reasons for this: the drop in oxygen you experience each night and the poor quality of your sleep. “Those things together are not good for the brain or the heart,” says Dr. Martin. As a result untreated sleep apnea raises your chances of experiencing stroke, heart disease, high blood pressure, memory and cognition problems, and more.
There is also the danger that comes with being extremely tired as you tackle daily tasks like driving a car. “If you’re sleepy, you’re at a higher risk for motor vehicle accidents,” Dr. Rowley says. In fact, having sleep apnea means you’re 2.4 times more likely to get in a crash than others, and the risk increases the more severe your condition is.
Getting a diagnosis
To get a diagnosis you’ll need to meet with a sleep specialist and undergo a sleep test. This can be done one of two ways. The first option is going to a sleep lab, where they’ll hook you up with sensors to monitor details like your brain waves and oxygen levels while you sleep there overnight, Dr. Martin says. “But a lot of the tests can be done at home,” Dr. Martin adds. The sleep specialist will guide you toward which approach you should take.
You will then receive a score on what’s known as the apnea-hypopnea index, which counts how many times per hour you have an “event,” a.k.a. an airway collapse that causes you to stop breathing. “If it’s more than five times an hour, that’s considered abnormal, and we start to consider treatment options,” Dr. Martin says.
Your apnea-hypopnea index number indicates how serious your sleep apnea is.
- 5 to 15: Mild sleep apnea
- 15 to 30: Moderate sleep apnea
- 30 or more: Severe sleep apnea
Hearing that you have sleep apnea, no matter the severity, can be frightening, but receiving that diagnosis is a key step on the journey to feeling better. “You have to know what you’re dealing with,” says Dr. Martin. “And with effective treatment a lot of people’s sleep quality gets better, daytime symptoms improve, they are less sleepy during the day, and they have more energy to do what they want.”
Treatment
When it comes to treating your condition, you’ve got options. The one you’re probably already familiar with is a CPAP (continuous positive airway pressure) machine. This device features a mask that fits over your nose and/or mouth alongside a tube that helps deliver air and stop your airway from collapsing.
If the idea of sleeping with a mask strapped to your face weirds you out, know that the designs have improved a lot in recent years. “There are more minimal [options] these days,” says Dr. Rowley. And if you don’t like the first mask you try, ask your doctor for a different option. “It’s a matter of finding the right [one],” Dr. Rowley says, adding that once someone does, “a lot of people say they can’t sleep without it. Putting on their CPAP is just part of their bedroom routine.”
If you have mild or moderate sleep apnea, another treatment option is oral appliance therapy. “It holds the tongue and lower jaw in a different position that creates more space in your airway,” Dr. Martin explains.
If you only experience sleep apnea when you’re on your back, your doctor may recommend a wearable vibrating device (called a positional trainer) that buzzes when you roll onto your back. This should gently nudge you to change positions, and in turn, keep your airway open.
There are other treatments as well, including an implantable device that stimulates the nerve under your tongue to keep your airway open and a GLP-1 that treats sleep apnea by helping you lose weight. Your sleep specialist can go over the pros and cons of each approach and advise you on the best option for your situation.
Because sleep apnea does have a link to weight, your clinician may encourage you to lose a few pounds. “It doesn’t always lead to complete resolution, but it can reduce the severity,” Dr. Martin says. However, it’s important to remember that you have other treatment options if you don’t want to lose weight or find it difficult to do so. This might also be a good time to test out a sober-curious lifestyle. “Alcohol suppresses breathing in general, which can make sleep apnea worse,” Dr. Martin says.
By finding a treatment that works, you’re investing in your well-being. “One of my good friends described it as getting glasses for the first time,” says Dr. Martin. “You don’t know how bad your vision is until you put on glasses. You don’t know how bad you feel until you get your sleep apnea treated.”
Related:
- Is Your Constant Fatigue Actually a Sign of This Common Sleep Disorder?
- Is Sleep Apnea Genetic?
- Why You Shouldn’t Just Accept Being Tired All the Time
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