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Quality sleep matters. And, for the more than 22 million Americans who live with sleep apnea, restful nights are few and far between. The condition occurs when the airway is blocked repeatedly during sleep, or the brain does not send a message to the muscles to breathe. Meaning, you'll likely wake with extreme fatigue, irritability, and headaches. It's a challenging condition to deal with, but there are effective treatments.
What is sleep apnea?
Sleep apnea is a common sleep disorder that affects millions of people in the U.S., ranging from mild sleep apnea to severe obstructive sleep apnea (OSA). Common sleep apnea symptoms include snoring or gasping during sleep, or “apnea events,” which occur when there is reduced or no breathing during sleep, and sleepiness.
Left untreated or undiagnosed, people with sleep apnea often experience extreme daytime fatigue. Unable to have a restful sleep, people with sleep apnea may experience other health complications including heart disease, heart attacks, high blood pressure, depression, and car/heavy machinery accidents.
“People suffering from sleep apnea tend to snore at night and may experience symptoms such as mood swings, trouble learning, sleepiness, and a low sex drive,” explains Chirag Shah, MD, co-founder of Push Health, an online healthcare platform.
Fortunately, there are treatment options available, the most common of which is a combination of lifestyle changes and the use of a continuous positive airway pressure machine (CPAP). New research into the specific causes of OSA is creating improved pathways for more effective, targeted therapy.
How is sleep apnea diagnosed?
To properly diagnose sleep apnea, it helps to understand the different types of the condition. There are three types of sleep apnea, each caused by different mechanisms. They are:
- Obstructive sleep apnea (OSA): This condition occurs when something physically blocks the airway. The most common cause of blockage is when the tongue collapses against the soft palate and the palate collapses against the back of the throat during sleep.
- Central sleep apnea: This type of sleep apnea is not a physical blockage, rather it occurs when the brain fails to signal to the relevant muscles how to breathe.
- Complex sleep apnea: This occurs when there is a combination of both a physical block and an issue with the brain signal for muscles to breathe.
In all cases of sleep apnea, when an apnea event (the complete absence of airflow) occurs, the brain partially wakes the sleeper to resume breathing. This waking throughout the sleep cycle is what causes fatigue, especially in people with severe sleep apnea, as they can be disturbed hundreds of times a night. Apnea events occur most commonly when a person has fallen into the rapid-eye-movement (REM) stage of the sleep cycle.
As there are a number of types of sleep apnea, there are also numerous potential causes. Understanding what is causing the sleep apnea is essential in forming a diagnosis and effective treatment plan.
“Obesity is the most common cause of obstructive sleep apnea,” explains Bernard Ashby MD, MPP, FACC, a vascular cardiologist at Comprehensive Vascular Care in South Florida.
“There are a number of possible causes for sleep apnea, including smoking, alcohol use, being overweight and having certain anatomical features such as a small upper airway/jaw or a large neck,” agrees Dr. Shah.
In order to be properly diagnosed, the best place to start is with a visit to your primary care physician. Your healthcare provider may be able to form an accurate diagnosis based on your medical history and physical exam. Or, your physician may refer you to a certified sleep medicine specialist or neurologist for a sleep study.
Questions your doctor may ask include:
- What are your symptoms?
- When did they start?
- Do you have a family history of sleep disorders?
- Are you taking any medications?
According to the National Heart, Lung, and Blood Institute (NHLBI), your physician may also perform a physical exam, looking for any signs of conditions that may increase your risk of sleep apnea. These physical signs include obesity, a large neck circumference, large tonsils, and a narrow upper airway.
Participating in either an at-home or in-clinic sleep center study, supervised by a sleep specialist, may be necessary to form an accurate diagnosis and to determine the severity of your condition. These studies are designed to monitor for apnea events, including how often they occur, and general breathing patterns. Your blood oxygen levels and muscle, brain, and heart activity are likely to also be monitored during the study.
According to NHLBI, the severity of your sleep apnea is determined based on the following number of apnea events per hour:
- Mild: Five to 14 apnea events in an hour
- Moderate: 15 to 29 apnea events in an hour
- Severe: 30 or more apnea events in an hour
Sleep apnea treatment options
Continuous positive airway therapy (CPAP) is the most common treatment device for sleep apnea according to the U.S. Food and Drug Administration (FDA). This is because it’s safe and effective.
“The optimal therapy is CPAP (continuous positive airway therapy). This involves wearing a nasal or face mask connected to a small machine that delivers air pressure to the throat, thereby keeping one's airway open during sleep,” explains Ashgan Elshinawy, DO, the director of the Center for Sleep and Breathing Disorders at Saint Peter’s University Hospital, New Brunswick, New Jersey.
However, some people struggle to stick with the CPAP therapy, as it requires sleeping with a mask or nasal cannula and being tethered to a machine. However, when properly adhered to, these CPAP machines are extremely effective sleep apnea treatments.
Aside from recommending a breathing device, your doctor may also suggest making some lifestyle changes to reverse sleep apnea. Most commonly this includes exercising regularly and eating a healthy diet, losing excess pounds, cutting back on alcohol, and quitting smoking.
Other treatment options include:
- Mouthpieces: Worn while you sleep, these are designed to keep your upper airway open.
- Implants: Used in severe cases of OSA and Central Sleep Apnea, implants require surgery. They deliver mild stimulation to throat muscles during sleep to keep your airway open.
- Orofacial therapy: Some children and adults find this therapy an effective treatment. Physical therapy for the mouth and face, it helps strengthen muscles that contribute to a closed airway.
- Removal of obstructions: This requires surgery. Some patients have their tonsils removed, have their upper airway enlarged by moving their lower jaw, or have a tracheostomy. A tracheostomy is when a hole is cut into your windpipe (trachea), and a breathing tube is inserted to allow airflow.
Sleep apnea medications
Sleeping pills and medication like benzodiazepines are rarely recommended for the treatment of sleep apnea, a surprising fact for many patients. This is because many prescriptions work by relaxing the airway tissue. As sleep apnea is often caused by airway blockages due to already relaxed throat muscles, the use of sleeping pills is likely to block a person's airway even more.
Breathing devices and lifestyle changes are the recommended treatment options for sleep apnea.
Some medications—like Nuvigil (armodafinil) and Provigil (modafinil)—are prescribed to ease daytime sleepiness caused by obstructive sleep apnea, however, they do not treat sleep apnea itself.
Side effects of sleep apnea
Some side effects of sleep apnea can be snoring, dry mouth and headache upon awakening, trouble staying asleep, high blood pressure, depression, and possible heart failure. (Source 1, 2).
This is not a complete list. Talk to your healthcare provider to learn more about the complications associated with sleep apnea.
What are the best home remedies for sleep apnea?
There are a number of things people can do at home to either treat or prevent sleep apnea. This includes making some lifestyle changes, as well as changing your sleep position. However, the effectiveness of these at-home treatments will depend upon the cause of your sleep apnea.
1. Lose weight
Obesity is a common cause of sleep apnea, so maintaining a healthy weight through diet and regular exercise may reverse your symptoms. Studies show that losing weight can help patients with OSA avoid surgery or prolonged use of CPAP devices.
2. Sleep on your side
Changing your sleep position can also help prevent a blocked airway during sleep. “Ways to help prevent apneas include sleeping on the side,” explains Dr. Elshinawy.
This is backed up by a 2004 study that indicated that sleeping on your back is related to more severe and frequent apneas. However, more research is required into the effect of other sleep positions on apneas.
3. Reduce alcohol and smoking
Alcohol is known to relax throat muscles, thereby potentially contributing to your sleep apnea condition.
Likewise, smoking can cause inflammation to these same muscles, reducing the size of the airway opening. Cutting back on both these habits may help decrease the severity and frequency of apnea.
4. Use mouthpieces
For some people, oral appliance therapy can be helpful in treating their sleep apnea. The mouthpieces reposition your tongue and jaw to avoid having your airway close while you sleep.
There are two main types of oral appliances—mandibular advancement devices and tongue stabilizing devices. Both of these are available over-the-counter, generally at a low cost.
Frequently asked questions about sleep apnea
What is the best treatment for sleep apnea?
The best treatment for sleep apnea depends on the individual, however, the most common treatment is a combination of lifestyle changes like weight loss, and the use of a continuous positive airway therapy (CPAP) device while sleeping.
What is the main cause of sleep apnea?
Sleep apnea occurs when you stop breathing momentarily while you sleep because there is a blockage of the airway. This blockage is most commonly caused by obesity and excess weight.
What are the warning signs of sleep apnea?
Common warning signs of sleep apnea include waking with headaches, or a very sore, dry throat. Snoring, extreme fatigue, mood swings, irritability, frequent urination during sleep, and gasping while asleep are also signs of sleep apnea.
Can sleep apnea be cured completely?
Depending on its cause, sleep apnea can be cured. Commonly this is achieved through weight loss or surgery.
How do you treat sleep apnea at home?
Some things to try at home to treat sleep apnea include sleeping on your side, avoiding alcohol and smoking, and losing weight through a healthy diet and exercise.
Is CPAP the only treatment for sleep apnea?
No. Other treatments include behavioral modification such as weight loss, quitting smoking and alcohol, and changing your sleep position. The use of mouthpieces while sleeping and some surgeries can also be effective.
What are permanent treatments for sleep apnea?
Permanent treatments for sleep apnea vary depending on the root cause. For some patients, losing weight is an effective solution. For others, surgery may be required, or the long term use of breathing devices.
Can sleep apnea be treated with medication?
At this time there is no medication that has been shown to help resolve or improve sleep apnea.
Some patients use medications, like Nuvigil (armodafinil) and Provigil (modafinil), to ease excessive sleepiness caused by their obstructive sleep apnea. However, these do not treat sleep apnea itself.
What is the best way to sleep to avoid sleep apnea?
The best way to avoid sleep apnea is to maintain a healthy weight, avoid sleeping on your back, quit smoking, and reduce the amount of alcohol you consume.
Are there any natural ways to treat sleep apnea?
Yes. Patients can avoid sleeping on their backs, maintain a healthy weight through a good diet and regular exercise, and avoid smoking and excessive alcohol consumption.