What Is Obstructive Sleep Apnea?
Obstructive sleep apnea (OSA) is a relatively common condition, especially in obese adults. It refers to obstruction (blockage) of the airway during sleep. This obstruction is usually caused by the back of the tongue and the muscles of the palate relaxing and falling backward, which blocks the trachea (windpipe).
A blocked airway can lead to decreased oxygenation of the blood. The body senses this, and you will wake up and resume breathing normally before falling back asleep again. This cycle can repeat itself many times throughout the night, resulting in poor quality sleep, which can result in excessive sleepiness during the daytime and other significant medical problems .
The primary treatment for OSA is to keep the airway open through the night by using a continuous positive airway pressure (CPAP) device.
You should visit your primary care physician within a few weeks to discuss your symptoms. The physician will likely order a sleep test to confirm the diagnosis.
How common is Obstructive Sleep Apnea?
Symptoms that always occur with Obstructive Sleep Apnea:
- Snoring or apneas
Obstructive Sleep Apnea is also known as
- Obstructive sleep apnea syndrome
Obstructive Sleep Apnea Symptoms
These symptoms occur during the nighttime and are often reported by a partner who sleeps in the bed with you:
- Loud snoring
- Stopping of breathing during sleep
- A snorting sound after breathing has stopped
- Worsening of snoring during dream (REM) sleep
Symptoms during the daytime
The daytime symptoms of OSA are mainly related to the lack of efficient sleep at night:
- Decreased daytime alertness
- Increased pressure to take a nap
- Lack of attention/concentration
Complications of untreated OSA
If you have OSA and it is not treated it can result in serious problems, such as:
- Motor vehicle accident: Due to falling asleep at the wheel
- High blood pressure (hypertension) 
- Increased anesthetic risk: If you need surgery, your risk of complication is higher if you have OSA.
- Heart disease, including heart attack
- Liver disease
- General increased risk of death
Obstructive Sleep Apnea Causes
During sleep, the airway (passageway from your nose and throat to your lungs) relaxes just like the rest of your body. When the airway relaxes, it has a narrower space to pass air into your lungs. This narrowing is responsible for the snoring sound some people make during sleep. In OSA, the airway relaxation is severe, and the airway can become completely closed off. This results in a complete lack of breathing. After some time, the body detects that there is no lung ventilation and the brain automatically wakes you up to reopen the airway and improve ventilation. However, the same thing can happen again a few moments later. Most people do not remember waking up during the night. This results in a cycle of constant falling asleep and waking back up, which leads to inefficient sleep.
Strong risk factors
Ultimately, the cause of OSA is not well known, but some risk factors are strongly associated with OSA:
- Obesity: This can increase the amount of soft tissue around the airway, increasing its likelihood of collapse.
- Older age
- Male gender
- Structural abnormalities: If your airway has a construction that favors collapse, you may be more likely to develop OSA.
- Previous surgery on the airway
- Brain injury
- Drugs and alcohol: These can increase airway relaxation and decrease your brain’s drive to respond to decreased ventilation.
Lesser risk factors
The following factors are moderately associated with the risk of developing OSA.
- Sinus congestion
- Family history of OSA
The following congenital syndromes are associated with structural abnormalities to the airway.
- Down’s syndrome
- Cleft palate
Treatment Options and Prevention
Before treatment of OSA begins, an appropriate diagnosis of OSA must be made. Historically, the best way to diagnose OSA was to undergo a sleep study in a sleep lab. This requires you to have a night of sleep in a sleep lab center under the monitoring of various medical devices that detect your brain waves, breathing, heart rhythm, and blood pressure. The sleep medicine doctor reviews the results of your brain waves and determines if you are waking up excessively throughout the night. The downside to this test is that sleeping in a foreign environment may be unrestful and may not mimic a normal night of sleep.
Increasingly, a home sleep apnea test (HSAT) can be used to diagnose OSA . In this test, you sleep in your home as usual but with some sensors on your body. These sensors perform many of the same functions as the sleep lab sensors and can assist a doctor in diagnosing OSA.
Your doctor should also check you for some of the complications of OSA, including high blood pressure.
The most important treatment for OSA is continuous positive airway pressure (CPAP) . CPAP is a device that you wear over your nose and mouth through the night, which feels like a breeze blowing into your nose and mouth. This pressure acts to keep your airway open and prevents episodes of stopping to breathe. Some people may find a CPAP uncomfortable, but most people get used to it after some time. You must use the CPAP regularly for a significant benefit.
The following can further treat OSA:
- Bilevel positive airway pressure (BiPAP)
- Expiratory positive airway pressure (EPAP)
- Using an oral appliance: This is a device that looks like a mouthguard, which sits in your mouth to keep the airway open.
- Hypoglossal nerve stimulation: This provides electrical stimulation of the nerve that supplies the tongue muscle to prevent it from falling backward toward your throat
- Surgery: This is reserved for difficult to treat cases. Surgery may remodel the airway and remove excess tissue to prevent airway collapse.
- Weight loss (if you are overweight)
- Stopping smoking
- Sleep on your side as opposed to your back: This helps the airway stay open because gravity is not pulling the airway backward toward the throat .
Prevention of OSA relies on curbing the risk factors listed above. Below is a list of activities to work on to decrease the chance of developing OSA. These recommendations can also serve to treat OSA once it has developed.
- Weight loss (if you are overweight)
- Stopping smoking
- Exercise regularly
- Avoid alcohol: Especially in the hours leading up to bedtime
- Avoid sedating drugs: Such as medicine that makes you sleepy
- Sleep on your side as opposed to your back
- Elevate the head of the bed: This means propping up the head of your bed, not using more pillows.
- Open nasal passages: Use a decongestant or anti-allergy medication or a neti pot to increase airflow in the upper airway.
- Play a wind instrument: Some studies suggest that playing a wind instrument can increase the resistance of your airway and better prevent collapsing.
When to Seek Further Consultation
You should see a doctor if you have the symptoms described above. If you notice that you feel tired and can’t concentrate or that you fall asleep easily when idle during the day, for example. If you notice that you wake up out-of-breath or gasping for air, this may indicate OSA or another problem. Additionally, if a partner who sleeps in the bed with you notes that you snore very loudly, stop breathing occasionally, or make other abnormal breathing noises during the night, it may be time to seek care.
Questions Your Doctor May Ask to Diagnose
To diagnose this condition, your doctor would likely ask about the following symptoms and risk factors.
- Any fever today or during the last week?
- Do you have trouble sleeping?
- Are you having difficulty concentrating or thinking through daily activities?
- Is your fatigue getting any better or worse?
- How fatigued are you?
The above questions are also covered by our A.I. Health Assistant.
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