How to treat sleep apnea and prevent long-term health complications
- Sleep apnea is a common sleep disorder that can lead to serious health complications if left untreated.
- To treat sleep apnea, you may need to use a CPAP machine, a special oral appliance, or make a few key lifestyle changes.
- Here's how to identify the symptoms of sleep apnea and get the proper treatment.
- This article was medically reviewed by Raj Dasgupta, MD, an associate professor of clinical medicine in the division of pulmonary, critical care, and sleep medicine at Keck School of Medicine of USC.
Sleep apnea is a condition where people stop breathing, fully or partially, while they are sleeping. There are two main types of sleep apnea: obstructive sleep apnea and central sleep apnea.
Obstructive sleep apnea is the most common type, affecting 26% of American adults ages 30 to 70 and nearly 1 billion people worldwide. If left untreated, it can increase your risk of long-term health problems, such as heart disease and type 2 diabetes.
This article will focus on obstructive sleep apnea and teach you how to recognize the warning signs and seek proper treatment.
What is obstructive sleep apnea?
Obstructive sleep apnea (OSA) is the most common type of sleep apnea. It occurs when the tongue falls back onto the soft palate (the area at the back of the mouth and top of the throat). The soft palate pushes to the back of the throat, fully or partially blocking the airway.
OSA is associated with poor long-term health outcomes. This includes a higher risk of many health complications, such as high blood pressure, heart attacks, strokes, depression, and early death. And it can also pose short-term health dangers.
"The increased sleepiness from OSA can also lead to increased motor vehicle accidents and work-related injuries," says Kelli Randell, MD, a medical advisor for Aeroflow Healthcare, a medical equipment manufacturer.
Obstructive sleep apnea symptoms
The main symptoms of OSA include:
- Loud snoring
- Choking during the night
- Daytime sleepiness because of sleep interruptions
- Morning headaches
- Trouble sleeping all night
You might also notice other medical conditions like high blood pressure getting worse, says Steven Holfinger, MD, a sleep medicine expert at The Ohio State University Wexner Medical Center. For example, your blood pressure readings may increase as a result of OSA.
If you're experiencing these symptoms, "You should talk with your primary care doctor or see a sleep specialist for further care," Holfinger says.
In most cases, physicians will conduct a sleep study to diagnose sleep apnea. During the sleep study your breathing will be monitored and doctors will measure two main factors:
1. Apneas where you do not breath for at least 10 seconds.
2. Hypopnea where you have restricted breathing for at least 10 seconds at a time.
If you have five or more apneas or hypopneas per hour, you will likely be diagnosed with sleep apnea. If you have 30 or more you'll be considered to have severe sleep apnea.
How to treat sleep apnea
After diagnosis, you should work with your doctor to learn how best to treat your sleep apnea. Treatment commonly includes a mix of lifestyle changes, therapies, appliances, or surgeries, such as:
Lifestyle changes
A few key lifestyle changes can help lessen the symptoms of sleep apnea. In most cases, your doctor may recommend these steps on top of other medical treatment:
- Losing weight. Sleep apnea is closely linked with obesity: about 70% of people with OSA are obese. In fact, losing 10% of your body weight is linked to a 20% reduction in OSA symptoms.
- Reducing alcohol intake. Consuming alcohol is associated with an increased risk for sleep apnea, and avoiding alcohol can help reduce OSA symptoms and prevent it from getting worse.
- Changing sleep position. Specifically, you'll want to avoid sleeping horizontally on your back to help keep your airway clear and treat OSA. Elevating your head and upper body during sleep — or even taping a tennis ball to the back of your shirt to avoid sleeping on your back — can lead to significant short-term improvements for sleep apnea.
CPAP therapy
A continuous positive airway pressure (CPAP) machine is a mask that fits over your face and lightly blows air into your soft palate as you sleep.
This gentle pressure is enough to keep the airway from falling closed in patients with OSA, and sometimes, it's the only treatment you'll need.
"It's the most effective, nonsurgical treatment for patients. CPAP is considered first-line treatment," Randell says. "Most patients will experience better sleep and quality of life with use of CPAP by itself."
Since CPAPs are currently the best treatment for OSA, people with the condition should ideally use this machine diligently until their sleep troubles resolve.
However, many people do not use CPAPs as prescribed because they find the machines bothersome or uncomfortable. A scientific review from 2016 found that more than 34% of people with a CPAP machine didn't adhere to the use their doctor had prescribed.
Oral appliances
Oral appliances are worn like a mouth guard or a retainer while sleeping. These can push the lower jaw forward and help keep the airway open.
"A moderate number of patients have successful treatment with these devices," Randell says. "The biggest complaint about oral appliances is discomfort." However, some people may find them more comfortable than CPAP machines.
There are more than 100 of these appliances approved by the FDA for sleep apnea treatment. Your doctor will be able to guide you best when selecting and getting fitted for one of these oral appliances.
Surgical treatments
Surgical treatments for sleep apnea can be effective, especially for those who have tried a CPAP machine or oral appliances and found that they were too uncomfortable to use consistently.
Surgery — which usually includes removing the tonsils — is a common treatment for sleep apnea in children, Holfinger says.
"For adults, surgery is much less common but may be necessary when sleep apnea is severe and other treatments have failed," Holfinger says. "The surgical options are meant to either remove or reposition tissue to further open the airway."
Here are common surgical options, according to Randell:
- Nasal surgeries are used for patients who have a nasal obstruction contributing to OSA, but they are not considered effective for patients without that specific contributing factor.
- Upper airway surgeries, like uvulopalatopharyngoplasty (UPPP), removes extra tissue from the upper airway, while a tonsillectomy removes the tonsils. The effectiveness of these surgeries depends on the patient, and can range from 30% to 80%, Randell says.
- Lower pharyngeal and laryngeal procedures, such as tongue reduction or advancement, mandibular advancement, or epiglottis replacement change the structure of the mouth and palate to prevent blockage of the airway. These often require more than one procedure and are effective in 35% to 65% of patients, Randell says.
- Tracheostomy allows the lungs to access air from a hole in the throat, bypassing the airway. This is an extreme but very effective surgery, usually reserved for the most severe cases of sleep apnea.
The bottom line
Learning to treat and manage your OSA is an important step for protecting your long-term health.
If you suspect you have sleep apnea, you should speak with your doctor and find a treatment that works for you to avoid the more serious health complications of sleep apnea, like high blood pressure or heart disease.
"Generally, sleep apnea should be considered a treatable condition, as there are multiple approaches available to control it on a nightly basis," says Holfinger.