Obstructive Sleep Apnea: Symptoms, Causes, and Treatments

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Obstructive sleep apnea (OSA) is a common medical condition in which the muscles of the throat completely or partially collapse during sleep. This obstruction or narrowing of the upper airway makes it difficult to get a good night’s sleep. People with OSA often experience excessive daytime sleepiness and may notice changes in mood and concentration.

OSA affects up to a billion people worldwide, mostly adults between the ages of 30 and 69. The United States has the second-largest population of people who have OSA, with up to 15% of females and up to 30% of males affected. In addition, roughly 3% of children will develop OSA.

What Is Obstructive Sleep Apnea?

In OSA, the upper airway repeatedly collapses either partially or completely for at least 10 seconds at a time during sleep. Sometimes the airway obstruction can last longer than a minute.

For someone with OSA, a typical night’s sleep involves several episodes of both apneas and hypopneas. Hypopnea is the partial collapse or narrowing of the airway. Apnea occurs when the airway collapses or closes completely.

Symptoms

OSA is associated with a range of symptoms, but loud and habitual snoring is the most common. Research shows that people with more severe OSA tend to snore louder.

Other symptoms of OSA include:

Excessive daytime sleepiness
Gasping for air or choking
Disrupted sleep
Difficulty concentrating
Memory problems
Morning headaches
Insomnia
Mood swings
Strange dreams
Waking up frequently at night to urinate

OSA can be classified as mild, moderate, or severe based on the apnea-hypopnea index (AHI). The AHI is the average number of hypopneas and apneas you may experience each hour you sleep.

Mild: 5 to 15 events occur per hour. You may not notice any symptoms.
Moderate: 15 to 30 events occur per hour. Symptoms become noticeable, particularly daytime sleepiness.
Severe: More than 30 events occur per hour. Symptoms are very noticable and may be harmful when ignored.

When to Talk to Your Doctor

The decision to speak with your doctor is personal and may depend on the symptoms you experience. However, if left untreated, OSA can have significant impacts on your quality of life and may lead to other health problems.

Consider talking with a doctor if you are noticing changes in your health related to the quality of your sleep, including:

Feeling unusually tired or sleepy during the day
A bed partner or family member complaining that you disrupt their sleep
Finding yourself waking up frequently, sometimes gasping or choking

Causes

Obstructive sleep apnea is associated with medical conditions or differences in the structure of the head or neck that can make breathing more difficult. Oftentimes, these conditions overlap with risk factors, which are things that increase the chances of developing an illness.

Medical conditions associated with OSA include:

Diabetes
Hyperthyroidism
Stroke
Spinal cord injury
Congestive heart failure
Down syndrome
Irregular heartbeat

Variations in anatomy can be another cause of OSA. Some people are born with anatomical features of the skull that lead to obstructed airflow. These can include a lower jaw that is small or not aligned with the rest of the face or a hyoid bone that develops lower in the throat. The hyoid is a small bone that supports the tongue.

The most common cause of OSA in children is enlargement of the tonsils and adenoids. Up to 60% of children with Down syndrome have OSA, which is usually related to having a smaller upper airway space and decreased muscle tone.

Risk Factors

Risk factors are things that can make you more likely to develop a medical condition. If you have one or more of the following risk factors, you may be at a higher risk for developing OSA. However, just because you have risk factors does not mean you will definitely develop OSA.

Obesity: There is 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 affected by OSA is twice as likely to develop it themselves.

Diagnosing Obstructive Sleep Apnea

Your doctor can evaluate you for obstructive sleep apnea by asking questions about your symptoms, medical history, and family history. They may also perform a physical exam.

During a physical exam, the doctor will measure your neck and look inside your mouth and throat. With your mouth open and tongue sticking out, the doctor will check to see how visible certain parts of your throat are, including the tonsils and uvula. Since people with OSA tend to have larger neck circumferences, these parts of the throat are harder to see.

Your health care provider may ask a series of questions about your symptoms and how much they affect your ability to function. They will also consider your age, weight, and sex when determining your risk of OSA and your need for further testing.

Ultimately, doctors can only diagnose OSA after conducting a sleep study. The current gold standard for sleep studies is called polysomnography.

During a polysomnogram, a series of tests measure airflow in and out of the lungs, breathing patterns, and brain waves. Doctors and sleep specialists prefer to perform polysomnography in a laboratory setting, where they can carefully monitor equipment. But in some situations, a sleep apnea test may be performed at home.

Treatments

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.

Weight loss and exercise: Losing weight through a low calorie diet and regular exercise can lead to reduced daytime sleepiness, more fulfilling sleep, and overall better health for people with OSA.
Sleeping position: If you sleep on your back, you have a greater chance of snoring. Sleeping on your side instead can reduce your OSA symptoms. In some cases, it may even clear up OSA altogether.
Medications: Review the medications you are taking with your doctor. Some medications can affect the nervous system and worsen your sleep.
Alcohol: Limit or avoid drinking alcohol, especially at night, as it can make your OSA symptoms worse and interfere with your ability to get restful sleep.

Lifestyle changes may be enough to help control or improve mild symptoms of OSA. But 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 is not 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 does not 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 have not 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.

Complications

Getting adequate sleep or enough high-quality sleep can be difficult if you have undiagnosed or untreated obstructive sleep apnea. Daytime sleepiness from a lack of quality sleep can lead to serious problems, including car accidents. People with OSA are 2 to 3 times more likely to be involved in a car accident.

It’s also common for people with OSA to have other mental or physical health conditions. For example, individuals with OSA may experience depression, mood changes, irritability, and changes in memory or attention. In addition, OSA increases the risk of diabetes, heart failure, stroke, and irregular heartbeat.

Living With Obstructive Sleep Apnea

If you are 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 health care 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 health care 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 will not interfere with your treatment, like starting medications that could make your symptoms worse.