Obstructive Sleep Apnea (OSA)

What Is Obstructive Sleep Apnea?

Obstructive sleep apnea is when something blocks part or all of your upper airway while you sleep. Your diaphragm and chest muscles have to work harder to open your airway and pull air into your lungs. Your breath can become very shallow, or you may even stop breathing briefly. You usually start to breathe again with a loud gasp, snort, or body jerk. You may not sleep well, but you probably won't know that it’s happening.

The condition can also lower the flow of oxygen to your organs and cause uneven heart rhythms.

Obstructive Sleep Apnea Symptoms

Common obstructive sleep apnea warning signs include:

• Daytime sleepiness or fatigue
• Dry mouth or sore throat when you wake up
• Headaches in the morning
• Trouble concentrating, forgetfulness, depression, or crankiness
• Night sweats
• Restlessness during sleep
• Problems with sex, like a low sex drive
• Snoring
• Waking up suddenly and feeling like you're gasping or choking
• Trouble getting up in the mornings
• Waking up often in the middle of the night to pee
• High blood pressure
• Gastroesophageal reflux disease (GERD)

If you share a bed with someone, they'll probably notice your sleep apnea before you do.

Symptoms in children may not be as clear. They may include:

• Bed-wetting
• Choking or drooling
• Sweating a lot at night
• Ribcage moves inward when they breathe out
• Learning and behavior problems
• Problems at school
• Sluggishness or sleepiness (often seen as laziness)
• Snoring
• Teeth grinding
• Restlessness in bed
• Breathing that pauses or stops
• Unusual sleeping positions, such as sleeping on their hands and knees, or with their neck bent far back

Many other medical conditions can also cause these symptoms. Talk to your doctor to rule them out.

Obstructive Sleep Apnea Causes

Obstructive sleep apnea usually happens when the muscles that control your airway relax too much, narrowing your throat. You wake up for a moment to reopen your airway, but you probably won’t remember doing it. This might happen dozens of times each hour.

Other things that block your throat can cause obstructive sleep apnea, like obesity, swollen tonsils, and health problems like endocrine disorders or heart failure.

Obstructive Sleep Apnea Risk Factors

Anyone can have obstructive sleep apnea. It’s more likely if you:

• Are male
• Are older
• Are black, Hispanic, or Native American
• Have a family history of sleep apnea
• Have asthma
• Smoke
• Have diabetes
• Have high blood pressure
• Have a higher risk of heart failure or stroke
• Are overweight or obese
• Have a large or thick neck
• Have smaller airways in your nose, throat, or mouth
• Have too much tissue at the back of your throat that hangs down to block your airway
• Have a large tongue

Obstructive Sleep Apnea Complications

Complications of obstructive sleep apnea can include:

• Sleepiness during the day and trouble concentrating. Adults may have a higher risk of accidents, and children may have a hard time at school.
• Cardiovascular problems such as heart attack, high blood pressure, unusual heart rhythms, or stroke
• Eye problems such as glaucoma and dry eye
• Metabolic disorders like type 2 diabetes
• Problems with pregnancy like gestational diabetes or low-birth-weight babies
• Complications after surgery

Obstructive Sleep Apnea Diagnosis

Your doctor will give you a physical exam and ask about your sleep. They may also want to ask people who live with you about your sleep habits.

You may need to spend a night in a sleep lab or have a sleep study done at your house. You’ll wear monitors to measure things such as:

• Air flow
• Blood oxygen levels
• Breathing patterns
• Electrical activity in your brain
• Eye movement
• Heart rate or rhythm
• Muscle activity and movement of your arms and legs

The study will track how many times you had breathing problems while you slept.

Obstructive Sleep Apnea Treatment

Possible treatment options for obstructive sleep apnea include:

Weight loss, if needed. Losing even 10% of your weight can make a difference.

Not drinking alcohol or taking sleeping pills. These make your airway more likely to close during sleep and keep you from breathing like you should for longer periods.

Sleeping on your side. This can help if you get mild sleep apnea only when you sleep on your back.

Nasal sprays. These can help if sinus problems or nasal congestion make it harder to breathe while you sleep.

CPAP machine. This device includes a mask that you wear over your nose, mouth, or both. An air blower forces constant air through your nose or mouth. The air pressure is just enough to keep your upper airway tissues from relaxing too much while you sleep. A similar device is the BPAP, which has two levels of air flow that change when you breathe in and out.

Oral devices. If you have mild sleep apnea, you might get dental appliances or oral "mandibular advancement" devices that keep your tongue from blocking your throat or bring your lower jaw forward. That may help keep your airway open while you sleep. A trained dental expert can decide which type of device may be best for you.

Surgery. This is for people who have extra or uneven tissue that blocks airflow through the nose or throat. For example, if you have a deviated nasal septum, swollen tonsils, and adenoids, or a small lower jaw that causes your throat to be too narrow, surgery might help you. Doctors usually try other treatments first.

Types of surgery for obstructive sleep apnea include:

Upper airway stimulator. This device, called Inspire, has a small pulse generator that your surgeon puts under the skin in your upper chest. A wire leading to your lung tracks your natural breathing pattern. Another wire, leading up to your neck, delivers mild signals to nerves that control your airway muscles, keeping them open. You can use a remote to turn it on before bed and turn it off in the morning.

Somnoplasty. Your doctor uses radiofrequency energy to tighten the tissue at the back of your throat.

UPPP, or UP3. This procedure takes out soft tissue in the back of your throat and palate, making your airway wider at your throat opening. (UPPP stands for uvulopalatopharyngoplasty.)

Nasal surgery. These operations correct obstructions in your nose, such as a deviated septum (when the wall between your nostrils is off-center).

Mandibular/maxillary advancement surgery. Your doctor moves your jawbone and face bones forward to make more room in the back of your throat. It’s a complex procedure used only for people who have severe sleep apnea and problems with their head or face.

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