Obstructive Sleep Apnea (OSA)

Obstructive sleep apnea (OSA) is a common but potentially serious sleep-related breathing disorder characterized by recurrent pauses in breathing during sleep. These interruptions, known as apneas, are caused by the temporary partial or complete collapse of the upper airway, which hinders the flow of air into the lungs. Over time, untreated OSA can disrupt sleep quality and increase the risk of serious health problems, including heart disease, stroke, and daytime impairment.

Below, we’ll explain what causes obstructive sleep apnea, how it’s diagnosed, common symptoms to watch for, and the treatment options available to help manage the condition.

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What Is Obstructive Sleep Apnea?

OSA is a type of sleep apnea primarily characterized by episodes of partial or complete obstruction of the upper airway. This obstruction occurs when the muscles at the back of the throat relax excessively, allowing soft tissues like the palate and uvula to collapse into the airway. This results in a temporary pause in breathing. 

During these pauses, an individual’s breathing may be significantly reduced or completely stopped for a period ranging from a few seconds to up to a minute. These episodes can occur multiple times a night, often leading to fragmented and non-restorative sleep. As a result, people with OSA often feel unrefreshed and excessively sleepy during the day.

Central vs. Obstructive Sleep Apnea

Obstructive sleep apnea and central sleep apnea both cause repeated pauses in breathing during sleep, but they occur for different reasons. OSA happens when the muscles and soft tissues in the throat relax and block the airway, even though the brain continues to signal the body to breathe.

In contrast, central sleep apnea (CSA) occurs when the brain doesn't consistently send the proper signals to the muscles that control breathing, meaning there's no physical airway blockage. Because the underlying causes differ, the evaluation and treatment approaches for OSA and CSA can also vary, making an accurate diagnosis essential.

What Are the Symptoms of Obstructive Sleep Apnea?

The hallmark symptoms of OSA are loud and habitual snoring, gasping, or choking sounds during sleep, and excessive daytime sleepiness. 

Other common symptoms of OSA include:

• Insomnia or disrupted sleep
• Difficulty concentrating and problems with memory 
• Morning headaches
• Irritability and mood swings
• Waking up frequently at night to urinate

Consider talking to your doctor if you have any of the symptoms above or if your bed partner notices that you have loud and chronic snoring.

What Causes Obstructive Sleep Apnea? 

Obstructive sleep apnea is primarily caused by the relaxation of tissues in the throat that result in partial or complete obstructions of the upper airway during sleep. 

Several factors can contribute to this condition, including: 

• Obesity: There's a strong link between obesity and OSA. Obesity can increase fatty tissue in the neck, which can affect airflow through the upper airway during sleep.
• Sex: OSA is more common in males and in females who are going or have gone through menopause. The risk of OSA in transgender people can depend on their sex assigned at birth and gender-affirming medical treatments they may receive.
• Smoking: Smokers may be up to three times more likely to develop OSA compared to those who never smoked or have already quit.
• Age: The risk of OSA increases with age until a person reaches about 60 or 70 years. Studies suggest that the risk levels off in older people.
• Nasal congestion: Nasal congestion may increase the risk of developing OSA. For people with OSA, nasal congestion can make it worse.
• Genetics: Someone with a close relative with OSA is twice as likely to develop it themselves.

How Is Obstructive Sleep Apnea Diagnosed?

Obstructive sleep apnea is diagnosed through a combination of clinical evaluation, medical history assessment, and sleep studies. 

During a clinical evaluation, your healthcare provider will ask about your medical history, including symptoms like snoring, excessive daytime sleepiness, and any choking or gasping during sleep. They may also ask about your lifestyle, risk factors, and any relevant family history. 

A physical evaluation may be performed to assess your overall health and check for any physical signs that could be related to OSA, such as the visibility of tissues in the back of your throat like the tonsils and uvula. Your doctor may also evaluate your weight and neck circumference, as a larger neck can be a risk factor for OSA. 

Ultimately, your doctor can only diagnose OSA after conducting a sleep study, also called polysomnography. Sleep studies measure breathing patterns, oxygen levels, heart rate, and sleep stages to identify how often breathing interruptions occur during the night. Testing may be performed in a sleep lab or, for some people, at home using an at-home sleep apnea test ordered by a physician.

Results from a sleep study are used to calculate the apnea-hypopnea index (AHI), which represents the average number of breathing interruptions per hour of sleep. The AHI helps determine both the presence and severity of obstructive sleep apnea.

• Mild obstructive sleep apnea: an AHI of 5 to 14 events per hour
• Moderate obstructive sleep apnea: 15 to 29 events per hour
• Severe obstructive sleep apnea: 30 or more events per hour

What Are the Treatments for Obstructive Sleep Apnea?

A variety of treatment options are available for obstructive sleep apnea. The treatment plan your doctor recommends may depend on how long you have had symptoms and how much they bother you.

Doctors may begin treatment by recommending lifestyle changes. These can include altering daily habits or routines to help reduce your symptoms.

For moderate or severe symptoms, the most common and recommended treatment is positive airway pressure (PAP). PAP can be delivered through different types of machines, but each one requires you to wear a mask over your nose, mouth, or both.

• Continuous positive airway pressure (CPAP): CPAP works by delivering a constant flow of air while sleeping to reduce the chances of airway collapse. Some CPAP devices called auto-adjusting PAP (APAP) machines automatically adjust the air flow to your breathing patterns.
• Bilevel positive airway pressure (BiPAP): Doctors may prescribe BiPAP if CPAP isn't working well for you. It works by delivering two different levels of airflow, one for breathing in and the other for breathing out.

While PAP machines are helpful, they may not work for everyone. In some cases, other treatment options may be offered.

• Oral appliances: If PAP therapy doesn't improve your OSA, then oral appliances could be an option. Many patients find oral appliances more comfortable than wearing PAP equipment at night. Appliances work by stabilizing your mouth to improve airflow.
• Surgery: Though surgery is a less-common treatment, it may be appropriate for people who haven't benefited from PAP therapy or oral appliances. Surgery may also help people with large adenoids, enlarged tonsils, and other physical features that make it hard to breathe.
• Implantable devices: If you have moderate to severe OSA that hasn't responded to other treatments, implantable devices may be an option. These devices are implanted in the chest and monitor your breathing, delivering a pulse to keep your airway open during sleep. 

Can Obstructive Sleep Apnea Be Cured?

Obstructive sleep apnea is generally considered a chronic condition, meaning it typically cannot be permanently cured in most adults. However, it can often be effectively managed and controlled with the right treatment.

In some cases—such as when OSA is caused primarily by excess weight or enlarged tonsils in children—addressing the underlying cause may lead to long-term resolution. Even when symptoms improve, ongoing monitoring is important, as sleep apnea can return if risk factors change over time.

Living With Obstructive Sleep Apnea

If you're diagnosed with obstructive sleep apnea, it can take time to adjust to the lifestyle changes and treatment options your doctor recommends. Keep in mind that your doctor and healthcare team are there to answer any medically related questions.

There are several steps you can take to manage your OSA and improve the quality of your sleep.

• Follow the treatment plan: Treatment works best when used as recommended. Whether you have been prescribed a CPAP machine or another device, do your best to follow the instructions carefully.
• Take care of your device: PAP machines and oral devices typically include instructions for cleaning and maintenance. Cleaning your equipment regularly will keep it free of germs that could cause harm.
• Follow up regularly with your doctor: Your doctor can help you use your CPAP machine or other devices, address any difficulties you may have with your treatment, and answer your questions about coping with OSA.
• Keep all members of your healthcare team updated: If you see different doctors for other health conditions, discuss your OSA treatment plan with all of them. That way, they can make decisions that won't interfere with your treatment, like starting medications that could make your symptoms worse.

Written by

Tochukwu Ikpeze, MD, Contributing Writer

Tochukwu grew up in New York and has a passion for creative and scientific writing. Tochukwu holds an undergraduate degree in Biology and Psychology, a Master’s degree in Biomedical Science, and a Medical Degree as well. In his free time, Tochukwu enjoys reading, learning, exploring various topics pertaining to the human condition and conveying that information to the public through writing.

Reviewed by

David Rosen, MD, Senior Medical Advisor

Dr. David Rosen’s passion to help improve America’s sleep led him to launch renumasleep.com, a digital health platform focused on providing streamlined and accessible care for obstructive sleep apnea, in August 2022.