Is obstructive sleep apnea causing you to snore?

Have you been told that you snore? It’s a common problem — approximately 57 percent of men and 40 percent of women persistently snore, according to the Sleep Foundation.

However, snoring shouldn’t be dismissed as a mere annoyance. It can be a sign of obstructive sleep apnea, a condition that affects approximately 39 million U.S. adults.

Obstructive sleep apnea occurs when the muscles of the upper airway become so relaxed during sleep that the airway collapses or narrows, blocking the flow of air into the lungs. These breathing disruptions can last for 10 seconds or longer and may happen multiple times a night.

“Sometimes people wake up gasping for air, and other times they may not know it’s happening,” says Kimberly Mebust, MD, a sleep medicine specialist at MultiCare Health System. “When untreated, obstructive sleep apnea can lead to poor-quality sleep and can increase the risk for high blood pressure, strokes, heart attacks, diabetes and other serious health conditions.”

Continuous positive airway pressure (CPAP) machines are a common treatment for sleep apnea, but there are other options. Learn more about how this condition is diagnosed and what new treatments are available.

How is obstructive sleep apnea diagnosed?

Loud snoring, gasping or choking during sleep are hallmark symptoms of obstructive sleep apnea, but other common symptoms of this condition include:

• Excessive daytime sleepiness or fatigue
• Chronic morning headaches
• Chronic mouth dryness or throat discomfort upon waking
• Frequent waking to urinate at night
• Mood changes, such as increased irritability, anxiety or depression

“Sometimes I see people who think that they have insomnia or a urologic problem because they think that they’re waking up frequently at night to go the bathroom when it turns out that obstructive sleep apnea is actually what’s disturbing their sleep,” Dr. Mebust says.

In addition to increasing a person’s risk for serious medical events like strokes and heart attacks, untreated sleep apnea can also lead to cognitive problems.

“Sleep apnea causes recurrent drops in oxygen levels — known as hypoxia — which can damage parts of the brain,” Dr. Mebust says. “Over time, this damage can lead to memory loss and Alzheimer’s disease.”

If you experience symptoms of sleep apnea, talk to your primary care provider. Following a physical exam and review of your medical history, your doctor or other health care provider may refer you for a sleep study.

Sleep studies, conducted either at home or in a medical setting, are a painless way to measure brain waves, heart rate, oxygen rate and other bodily activity while you sleep. A sleep study can detect how many episodes of disrupted breathing you experience per hour, which — among other metrics — helps confirm a diagnosis of obstructive sleep apnea and its severity.

“Some obstructive sleep apnea is considered normal,” Dr. Mebust says. “It starts to become a concern when you have five or more episodes of disrupted breathing an hour. Those with severe sleep apnea can experience anywhere from 30 to more than 100 disruptions an hour.”

Risk factors for obstructive sleep apnea

Several factors contribute to a person’s risk of developing obstructive sleep apnea. Here are a few:

• Age. As we grow older, the soft tissues in our mouth and throat tend to become floppier, increasing the likelihood they will constrict or narrow the airway.
• Sex. It is more common for men to have obstructive sleep apnea; however, when women reach menopause, they are just as likely to experience it.
• Structural features. People can have certain anatomical features that increase their likelihood of experiencing obstructive sleep apnea. Those include large tonsils and adenoids, a small airway, a small lower jaw or a lower jaw that is set far back, a large tongue, or large neck circumference.
• Family history. If you have family members who have obstructive sleep apnea, then you are more likely to develop it, too.
• Lifestyle factors. Sedatives, alcohol use and smoking can worsen obstructive sleep apnea.

Treatments for obstructive sleep apnea

Treatments for sleep apnea are designed to eliminate breathing disruptions while you sleep, which resolves symptoms like snoring and improves the quality of your rest. A variety of treatment options are available depending on the severity of your condition and other factors — and more are in development.

Positive airway pressure therapy. CPAP machines have been the gold standard for treating sleep apnea for many years. This device works by drawing in air and then pressurizing it. You then breathe in the pressurized air through a mask that fits over the nose. This continuous flow of air keeps the airway from collapsing while you sleep.

“People aren’t born to wear CPAP devices, so it takes some practice and time to get used to them,” Dr. Mebust says. “Over the years, there have been improvements — there are different types of masks available now and they take up less real estate on the face. People with moderate to severe sleep apnea tend to have the most success with using CPAP machines.”

Some people may have difficulty tolerating the pressurized air, particularly when it comes to breathing out. A bilevel positive airway pressure (BiPAP) machine is another option. It blows air out at a lower pressure than it sucks air in, which can be easier for those who are pressure sensitive.

Oral appliances. Also known as mandibular advancement devices, oral appliances are worn while you sleep. They help keep your airway open by holding your lower jaw forward. Ideal for those with mild to moderate sleep apnea, these devices tend to work best when they are custom made and fitted by a dentist. (However, they still qualify as medical devices.)

“Oral appliances have between a 50 to 80 percent success rate,” Dr. Mebust says. “Once you get fitted for one, we recommend that you get a follow-up sleep study to make sure it’s working.”

Hypoglossal nerve stimulation. A newer treatment for obstructive sleep apnea, hypoglossal nerve stimulation (also known as the Inspire® device) works similarly to a pacemaker — it involves the surgical implantation of a device inside the body. However, instead of stimulating the heart, it gently stimulates the hypoglossal nerve — which controls the muscles of the tongue — and prevents the tongue from blocking your airway during sleep.

“The success rate of the Inspire device is about 80 percent,” Dr. Mebust says. “To qualify for it, a person must have moderate to severe obstructive sleep apnea, be unable to benefit from a CPAP machine and meet other criteria as well.”

Weight management. Maintaining a healthy weight can lessen the severity of sleep apnea and sometimes resolve it completely. This is because those who are overweight often have excess throat tissue that can obstruct the airway.

“A real game changer has been the advent of diabetes-related medications that have also demonstrated success in helping people lose weight,” Dr. Mebust says. “In fact, one of these medications is being used in a clinical trial specifically for the treatment of obstructive sleep apnea in those who are overweight.”

Surgery. When sleep apnea is severe and other treatments aren’t working, surgery may be an option. Surgeries may include removal of the tonsils or adenoids; removal of excess tissue in the throat; or craniofacial surgeries that address tongue or jaw abnormalities.

“Surgeries can be invasive and painful, and they may not be all that effective at resolving sleep apnea,” Dr. Mebust says. “It’s become much less common to treat sleep apnea with surgery.”

Bongo Rx. This device has gained popularity for those with mild to moderate obstructive sleep apnea who cannot tolerate a CPAP machine. Rather than using pressurized air, it harnesses your own exhalations to help keep the airway open. It involves the use of two small cones that fit in your nose while you sleep.

While approved by the U.S. Food and Drug Administration, the Bongo Rx requires a prescription and is not covered by most insurance plans yet.