Your Complete Guide to Sleep Apnea: Symptoms, Diagnosis, and Management

Overview

Sleep apnea is a common sleep disorder characterized by repeated pauses in breathing during sleep. These pauses can last 10 seconds or longer and happen dozens or even hundreds of times per night. The two most common types are obstructive sleep apnea (OSA), caused by relaxed throat muscles blocking the airway, and central sleep apnea, which occurs when the brain fails to send proper signals to the muscles that control breathing. Many people have a mix of both, called mixed sleep apnea. If left untreated, sleep apnea increases the risk of high blood pressure, heart disease, type 2 diabetes, and other serious health conditions.

Signs & Symptoms

Symptoms of sleep apnea often go unnoticed by the person experiencing them, as they occur during sleep. Family members or bed partners are often the first to spot signs of the condition.

• Loud, chronic snoring
• Gasping or choking for air during sleep
• Pauses in breathing observed by a bed partner
• Excessive daytime sleepiness, even after a full night of rest
• Waking up with a dry mouth or sore throat
• Morning headaches
• Difficulty concentrating or memory problems
• Irritability or mood changes
• Waking up frequently to urinate during the night

Causes & Risk Factors

Obstructive sleep apnea (OSA) occurs when the muscles in the back of your throat relax too much to allow normal breathing. These muscles support the soft palate, the triangular piece of tissue hanging from the uvula, the tonsils, the side walls of the throat, and the tongue. When these muscles relax, your airway narrows or closes as you breathe in, cutting off oxygen for 10 seconds or longer. This lowers the oxygen level in your blood and triggers your brain to briefly wake you up to reopen your airway. Most people don't remember these awakenings, but they can prevent you from reaching the deep, restful phases of sleep. Central sleep apnea, a less common type, occurs when your brain fails to send signals to the muscles that control breathing. It is often linked to brainstem conditions like stroke or amyotrophic lateral sclerosis (ALS), opioid use, or sleeping at high altitudes.

• Excess weight or obesity (the most common risk factor for OSA)
• A thicker neck circumference (more than 17 inches for men, more than 16 inches for women)
• A narrowed airway, often due to enlarged tonsils or adenoids, especially in children
• Being male (men are 2-3 times more likely to develop OSA than premenopausal women; risk for women rises after menopause)
• Older age (risk increases as you get older)
• Family history of sleep apnea
• Use of alcohol, sedatives, or tranquilizers (these relax throat muscles)
• Smoking (increases inflammation and fluid retention in the upper airway)
• Nasal congestion or chronic allergies
• Hormonal disorders, such as hypothyroidism or acromegaly

Diagnosis

If your healthcare provider suspects sleep apnea, they will first review your symptoms, medical history, and perform a physical exam, including checking your throat, neck, and mouth for extra tissue or abnormalities. The only way to confirm a sleep apnea diagnosis is with a sleep study, called a polysomnography. This test records your brain waves, oxygen levels, heart rate, breathing patterns, and body movements during sleep. Sleep studies can be done in a specialized sleep lab or, for some people, with a home sleep apnea test that measures fewer metrics.

Treatment & Management

Treatment for sleep apnea depends on the type and severity of your condition. The goal of treatment is to restore normal breathing during sleep, relieve symptoms like daytime fatigue, and prevent long-term health complications.

• Lifestyle changes: Losing weight if you are overweight, avoiding alcohol and sedatives before bed, sleeping on your side instead of your back, and quitting smoking can reduce mild sleep apnea symptoms.
• Positive airway pressure (PAP) therapy: The most common and effective treatment for moderate to severe OSA is a CPAP (continuous positive airway pressure) machine, which delivers a steady stream of air through a mask to keep your airway open during sleep. BiPAP (bilevel positive airway pressure) machines, which deliver different air pressures for inhaling and exhaling, are often used for central sleep apnea or people who struggle with CPAP.
• Oral appliances: Custom-fitted dental devices that reposition your lower jaw and tongue to keep your airway open can be effective for mild to moderate OSA.
• Surgery: In some cases, surgery may be recommended to remove excess tissue from the throat (a procedure called uvulopalatopharyngoplasty, or UPPP), implant devices to stimulate the nerve that controls tongue movement, or correct structural issues like a deviated septum. For children with enlarged tonsils or adenoids, tonsillectomy or adenoidectomy is often the first-line treatment.

Living With It

With consistent treatment, most people with sleep apnea see significant improvement in sleep quality, daytime energy, and overall health. It may take a few weeks to adjust to PAP therapy, but many people find that the benefits far outweigh the initial discomfort. Regular follow-up appointments with your sleep specialist or healthcare provider are important to adjust your treatment as needed and monitor for any related health conditions like high blood pressure and type 2 diabetes.