Sleep Apnea

Sleep apnea is a sleep disorder in which breathing repeatedly stops and starts.

Signs and symptoms

The most common signs and symptoms of sleep apnea include:

• Awakening with a dry mouth
• Difficulty paying attention while awake
• Difficulty staying asleep (insomnia)
• Episodes in which you stop breathing during sleep — which would be reported by another person
• Excessive daytime sleepiness (hypersomnia)
• Gasping for air during sleep
• Loud snoring
• Morning headache

Sleep apnea occurs when the muscles in the back of your throat relax. These muscles support the soft palate, the triangular piece of tissue hanging from the soft palate (uvula), the tonsils, the side walls of the throat and the tongue.

When the muscles relax, your airway narrows or closes as you breathe in. You can't get enough air, which can lower the oxygen level in your blood. Your brain senses your inability to breathe and briefly rouses you from sleep so that you can reopen your airway. This awakening is usually so brief that you don't remember it.

You might snort, choke or gasp. This pattern can repeat itself five to 30 times or more each hour, all night, impairing your ability to reach the deep, restful phases of sleep.

Risk factors

Factors that increase the risk of sleep apnea include:

• A narrowed airway. You might have inherited a narrow throat. Tonsils or adenoids also can enlarge and block the airway, particularly in children.
• Being male. Men are two to three times more likely to have sleep apnea than are women. However, women increase their risk if they're overweight, and their risk also appears to rise after menopause.
• Being older. Sleep apnea occurs significantly more often in older adults.
• Excess weight. Obesity greatly increases the risk of sleep apnea. Fat deposits around your upper airway can obstruct your breathing.
• Family history. Having family members with sleep apnea might increase your risk.
• Medical conditions. Congestive heart failure, high blood pressure, type 2 diabetes and Parkinson's disease are some of the conditions that may increase the risk of obstructive sleep apnea. Polycystic ovary syndrome, hormonal disorders, prior stroke and chronic lung diseases such as asthma also can increase risk.
• Nasal congestion. If you have difficulty breathing through your nose — whether from an anatomical problem or allergies — you're more likely to develop obstructive sleep apnea.
• Neck circumference. People with thicker necks might have narrower airways.
• Smoking. Smokers are three times more likely to have obstructive sleep apnea than are people who've never smoked. Smoking can increase the amount of inflammation and fluid retention in the upper airway.
• Use of alcohol, sedatives, or tranquilizers. These substances relax the muscles in your throat, which can worsen obstructive sleep apnea.

Treatment

Sleep apnea is treated with lifestyle changes, mouthpieces, breathing devices and surgery. Medicines typically aren't used to treat the condition.

The goals of treating sleep apnea are to restore regular breathing during sleep and to relieve symptoms, such as loud snoring and daytime sleepiness.

Treatment may improve other medical problems linked to sleep apnea, such as high blood pressure. Treatment also can reduce your risk for heart disease, stroke and diabetes.

For milder cases of obstructive sleep apnea, your doctor may recommend lifestyle changes, such as:

• Avoiding sleeping on your back
• Drinking alcohol moderately, if at all, and not drinking several hours before bedtime
• Exercising regularly
• Losing weight if you're overweight
• Using a nasal decongestant or allergy medications

If these measures don't improve your sleep or if your apnea is moderate to severe, then your doctor may recommend other treatments. Certain devices can help open up a blocked airway. In other cases, surgery may be necessary.