Obstructive Sleep Apnea (OSA)
Last Updated 11/02/2020
Authors:Aneesa Das, MD, FCCP; Bernardo Selim, MD, FCCP; Jeremy Weingarten, MD, FCCP
About Obstructive Sleep Apnea (OSA)
- Obstructive sleep apnea (OSA) is a common condition.
- Sometimes, blood clotting can be an abnormal condition.
- Your risk of increases with increasing body weight.
- Because they wake up frequently during sleep, people with OSA usually feel sleepy during the day and may have issues with alertness, memory, concentration, and mood (irritability).
- OSA is associated with heart disease and other major medical problems.
Obstructive sleep apnea (OSA) is a sleep disorder. When people have OSA, their airway becomes too relaxed while they sleep. This blockage causes their breathing to stop while they are asleep. It also frequently causes snoring and choking or gasping for air during sleep. This results in poor sleep quality and daytime sleepiness.
OSA is a common disorder. In the United States, 10% to 30% of adults have OSA. Negative effects of OSA include reduced ability to function at work or while driving. OSA is also associated with developing heart and vascular disease. Motor vehicle accidents are at least twice as likely to occur in people with OSA compared to those without OSA. People with severe untreated OSA have 2-3 times the risk of heart attack and stroke.
OSA isn’t the only type of sleep apnea that a person can have. Central sleep apnea, the other major type of sleep apnea, occurs when a person’s brain does not tell the body to breathe repeatedly through the night. A sleep study can easily determine which type of sleep apnea you may have.
If you think you might have sleep apnea, see your provider. Treatment can ease your complaints and may help prevent heart problems or other complications from occurring.
How OSA affects your body
OSA can have many effects on your health and well-being. Because you wake up often during the night, you may complain of poor sleep and daytime sleepiness. This is because even though you may spend 7 to 9 hours asleep per night, you are waking up frequently. You may feel as if you haven’t slept at all. In addition, not getting enough sleep because of OSA will result in many other issues in addition to sleepiness. These may include daytime fatigue, poor concentration, poor memory, and mood instability (irritability). In children with OSA, instead of getting sleepy, they often become hyperactive.
OSA can have negative long-term effects on other conditions. OSA is associated with high blood pressure, stroke, coronary artery disease, congestive heart failure, cardiac rhythm disturbances, and difficulty controlling blood sugar. Because of this, treatment of OSA, especially severe OSA, is essential.
Symptoms of Obstructive Sleep Apnea
Different people have different symptoms related to OSA. Some people have significant issues related to OSA, while others have minimal symptoms. This is why a sleep study is needed to diagnose sleep apnea.
Common symptoms related to OSA include:
- Snoring. which is a common symptom of OSA. Most people with sleep apnea snore, although not everyone who snores has sleep apnea.
- Because sleep apnea results in poor sleep quality, people with sleep apnea are often sleepy during the day and may doze off or take daytime naps. Car accidents may also occur in people with sleep apnea because they can fall asleep at the wheel.
- Pauses in breathing followed by abrupt awakenings with snoring, gasping, or choking. This symptom may be observed by a bed partner.
- Difficulties with memory and concentration.
- Changes in mood or irritability.
- Frequent trips to the bathroom at night.
- Morning headaches and dry mouth.
What are the risk factors for OSA?
- Overweight/obesity. Obesity increases a person’s risk for sleep apnea because fatty tissue in the airway results in a smaller opening for air to pass. This fatty tissue is more likely to block the airway. However, those who have a healthy weight can have sleep apnea.
- Gender. Men have a 2 to 3 times higher risk of sleep apnea than women. Older women have a similar risk for OSA as men.
- Age. Sleep apnea becomes more frequent as a person ages, starting in young adulthood until the 60s and 70s. After this time, the risk of sleep apnea appears to level off.
- Upper airway crowding. People with small chins, large tongues, or large tonsils have a higher risk for sleep apnea.
Diagnosing Obstructive Sleep Apnea
If you or your bed partner thinks that you may have sleep apnea, contact your health care provider to talk about testing and treatment. This may include a referral to a sleep specialist.
When you see a sleep specialist, that provider will ask you about your health history and do a physical examination. The specialist may ask questions about:
- Your family history of sleep problems (OSA may run in your family.)
- Medicines you are currently taking to see how they might affect your sleep
- Sleep-related complaints
- Your sleep and work schedule to determine if you are getting enough sleep and have good sleep habits
- Other sleep problems, such as how long it takes to fall asleep, whether or not you have movements during your sleep, or sleep walk or sleep talk
How is OSA diagnosed?
OSA is diagnosed with either sleep test in a laboratory, called a polysomnogram (PSG), or a portable sleep apnea test that can be done at home, called a home sleep apnea test, or HSAT. The most common test is the HSAT.
If you have questions about these tests, ask your physician or sleep specialist. Your health care team will decide which test is best for you.
Contact your provider if you have:
- Loud, disruptive snoring
- Pauses in breathing during sleep
- Daytime sleepiness
- Difficulty controlling medical problems, such as blood pressure or blood sugar
Treating Obstructive Sleep Apnea
The treatment of OSA usually falls into one of four categories below. You work with your health care team to determine the right treatment for you.
Your provider may request a follow-up sleep study to ensure your treatment is working.
Continuous Positive Airway Pressure (CPAP)
A CPAP is a machine that gently blows air into your airway to keep it open during sleep. It uses a mask that can either fit into the nostrils or over the nose and/or mouth. CPAP is highly effective when used regularly. It is usually the first treatment that people with OSA try. CPAP should be used on a nightly basis for the best treatment.
Oral appliances are a treatment option for mild to moderate OSA or if you cannot use a CPAP device. These are dental appliances designed to open your throat by bringing your jaw forward when sleeping.
If other treatment options do not work for you, you might consider surgical options. Surgeries for sleep apnea include removing or stiffening the tissue in the back of the throat. This includes the back part of the roof of the mouth, tonsils, and uvula.
There are other surgical options that are more invasive. These procedures are usually the last options a person will try. If you have questions about surgical treatments, ask your physician.
Lifestyle changes may be done in combination with the other forms of treatment for sleep apnea.
- Lose weight or maintain a healthy weight. If you lose weight, it will improve your OSA. Losing just 10% of your body weight can improve your sleep apnea. In some cases, losing a significant amount of weight can even cure the disease.
- Avoid alcohol and certain medications. Drinking excessive alcohol or taking some pain medicines or sleeping pills before bedtime can worsen OSA.
- Quit smoking. Cigarette smoking can increase swelling in your airway making snoring and OSA worse.
- Use positional therapy. Some people have worse sleep apnea when they lay on their back. Instead, try sleeping on your side to see if it reduces OSA symptoms.
There is often an adjustment period when getting used to nightly CPAP use. Sleeping with a mask on is a new experience for most. If you find it difficult to use your CPAP, it is important to contact your provider. Treating OSA typically improves many of the symptoms.
While some symptoms, such as snoring, will improve the first night you are on treatment, other issues may take longer to change. Daytime sleepiness and memory recall improve more when your CPAP is used for the entire night. Some of your OSA symptoms may continue to improve over several weeks to months of use. Morning headaches, dry mouth, and difficulty waking up in the morning improve once OSA is treated. Many people often feel more alert during the day and are less likely to take naps.
If you have issues that continue after treatment, discuss this with your provider. Sometimes, this may be due to other sleep or medical disorders, medications or not getting enough sleep.
Managing your OSA has two parts. First, make sure your treatment is working properly. Second, make healthy lifestyle choices and changes.
To make sure your treatment works as well as possible, care for your devices. Keep your CPAP supplies clean and replace parts regularly. Many CPAP machines have the ability to determine how well therapy is working. Seeing a health care provider once a year to review the information on your machine can help keep you healthy and ensure everything is working properly.
Keep your oral appliance clean. If you use an oral appliance, it is important to follow up with both a sleep specialist and a dentist. These appliances have the potential to cause misalignment of the teeth, so close follow up is important.
Making healthy choices can help you improve sleep apnea. Things you can do include:
- Lose weight or maintain a healthy weight.
- Have a sleep routine.
- Avoid tobacco.
- Avoid alcohol before bed.
If surgery is done to treat OSA, it is important have a follow-up sleep study to ensure that your OSA is resolved. Over time, scar tissue or relaxation of the muscles can cause OSA to return, so discussing sleep complaints with your provider each year is important. If complaints of OSA start to return, a repeat evaluation may be needed.
Finding support is important with any disorder. Ask your provider about any local support groups in your area. Educate your family and friends about OSA so that they can better support you. Additional resources can be found at:
Questions to ask your health care provider
In preparation for your appointment with your health care provider or sleep specialist, write down a list of questions ahead of time. These are some questions for you to ask:
- What is the most likely explanation on how I feel and my complaints?
- Other than obstructive sleep apnea, are there other explanations about what I am experiencing?
- What is obstructive sleep apnea?
- Why do I have obstructive sleep apnea?
- Is it temporary or permanent?
- What test do I need to do to confirm obstructive sleep apnea?
- How do I prepare for this test?
- What are my treatment options?
- Which treatment is best for me?
- Are all treatment options equally effective to treat my obstructive sleep apnea?
Please consider asking additional questions during your appointment.
Questions your provider may ask
Your health care provider or sleep health specialist will ask you questions about your health and medical history, so this information will help you to be ready for your appointment:
- Make a list of your sleep and nonsleep-related complaints.
- Request your bed partner or a trusted friend come along, as they may provide valuable additional information about your sleep or help you take notes about your condition.
- Bring a complete list of all prescription, over-the-counter medications and supplements that you are taking.
- Bring copies of your medical history, including medical records and sleep tests performed at another clinician’s office. You can ask other provider’s offices to fax/mail this information to your current health care provider in advance of your visit.
- Be aware of any pre-appointment requirements. At the time you make the appointment, please ask if there’s a sleep questionnaire or a sleep diary to fill out in advance.
Please consider bringing any additional medical information or documentation to your appointment.