Overcoming Obstructive Sleep Apnea

Treatment for obstructive sleep apnea usually includes continuous positive airway pressure devices. These appliances keep the airway open so the body can retain normal blood oxygen levels and avoid serious conditions related to sleep apnea.

If you wake up feeling groggy or lethargic, or your spouse or partner complains that you snore, you may be suffering from obstructive sleep apnea (OSA). Millions of Americans have this condition. The National Institutes of Health breaks down the numbers further, showing that sleep apnea affects:

  • 1 out of every 25 middle-aged men
  • 1 out of every 50 middle-aged women
  • 1 out of every 10 people over the age of 65

What Is Obstructive Sleep Apnea?

People with obstructive sleep apnea have some type of airway obstruction that causes them to stop breathing or to take shallow breaths for brief periods throughout the night — this is called apnea. An apnea episode results in the person taking a sudden, deep, and usually loud breath or gasp, upon which normal breathing resumes. These episodes may occur anywhere from five to 100 times an hour. Snoring is also common as the airway tissues vibrate from the air fighting to get through.

As a result of sleep apnea, blood oxygen levels drop until the brain perceives the problem and arouses the sleeper enough to take a deep breath but not enough to wake up. “This leads to severe sleep fragmentation and daytime sleepiness, because the restorative nature of sleep depends on the continuity of sleep,” explains neurologist Mark Mahowald, MD, medical director of the Minnesota Regional Sleep Disorders Center in Minneapolis. Dr. Mahowald says that a history of loud snoring and daytime sleepiness are the two most common signs of OSA.

What Triggers Obstructive Sleep Apnea?

The most obvious symptom of obstructive sleep apnea is heavy snoring and gasping during sleep. Other symptoms include waking up with a headache or a dry throat.

A variety of issues can cause the airway obstruction that produces OSA, such as:

  • Excessive relaxation of the tongue or throat muscles
  • A large tongue or tonsils that block the airway
  • An unusually narrow airway
  • Being overweight. This can cause a narrow airway due to excessive fatty tissue around the neck. However, Mahowald says the association between weight and obstructive sleep apnea is greatly overstated.

Some people have a milder form of airway obstruction known as upper airway resistance syndrome (UARS). These patients exhibit an increased effort to breathe but no actual apnea episodes (although they do snore and deal with daytime sleepiness).

Left untreated, OSA can have serious consequences, Mahowald warns. Over the long term, the fluctuations in blood oxygen levels typical of this condition may increase your risk of diabetes, stroke, high blood pressure, and heart arrhythmias. OSA may also contribute to the 100,000 motor vehicle accidents that occur each year due to driver sleepiness.

Some people have a different, rarer form of sleep apnea called central sleep apnea, which occurs when the brain temporarily stops telling the respiratory muscles to work. These people make no attempt to breathe during an apnea episode. Central sleep apnea usually accompanies other serious neurological disorders, such as Parkinson’s disease, stroke, and complications of cervical spine surgery. It also may occur in patients with congestive heart failure. Sometimes a person has both central and obstructive sleep apnea.

How Is Obstructive Sleep Apnea Treated

The best treatment for both types of sleep apnea is continuous positive airway pressure (CPAP). CPAP devices include a mask that fits over the nose, or mouth and nose, and is attached to a tube. The other end of the tube attaches to a generator, which blows air through the tube and into the throat. This pressurized air keeps the airway open and allows the patient to breathe easily and sleep through the night. Mahowald says that whenever possible, CPAP is the way to go.

However, not everyone can tolerate sleeping while wearing a mechanical mask. Avoiding lying on your back may help OSA since the tongue and other tissue won’t collapse and block the airway. Patients can buy special devices and pillows that prevent them from falling asleep on their backs; the homemade version involves placing a tennis ball into the back of your pajama shirt, between your shoulder blades. The ball will wake you up if you end up rolling on your back in the middle of the night.

Other ways to treat obstructive sleep apnea include avoiding alcohol and depressants that can excessively relax the airway muscles; using oral devices that keep the tongue out of the airway; electing surgery to stabilize the soft palate or get rid of excess tissue near the palate or uvula; and losing weight (though sleep apnea may remain).

By Norra MacReady – Medically reviewed by Christine Wilmsen Craig, MD