Sleep apnea means that your breathing often is blocked or partly blocked during sleep. The problem can be mild to severe, based on how often your lungs don't get enough air. This may happen from 5 to more than 50 times an hour.
This topic focuses on obstructive sleep apnea, which is the most common type.
A less common type of apnea, called central sleep apnea, can occur in people who have had a stroke, have heart failure, or have a brain tumor or infection. Even though this topic isn't about central sleep apnea, some of the treatments discussed here may also help treat it. Talk with your doctor to find out more about central sleep apnea.
Blocked or narrowed airways in your nose, mouth, or throat can cause sleep apnea. Your airway can become blocked when your throat muscles and tongue relax during sleep.
Sleep apnea can also occur if you have large tonsils or adenoids or a large uvula. During the day, when you are awake and standing up, these may not cause problems. But when you lie down at night, they can press down on your airway, narrowing it and causing sleep apnea. Sleep apnea can also occur if you have a problem with your jawbone.
In children, the main cause of sleep apnea is large tonsils or adenoids.
Sleep apnea is more likely to occur if you are overweight, use certain medicines or alcohol before bed, or sleep on your back.
The main symptoms of sleep apnea that you may notice are:
Your bed partner may notice that while you sleep:
Children who have sleep apnea:
But children may not seem very sleepy during the day (a key symptom in adults). The only symptom of sleep apnea in some children may be that they do not grow as quickly as most children their age.
If you have sleep apnea, you may not be sleeping as well as you could. And you may be more likely to end up with serious problems such as:
Your doctor will probably examine you and ask about your past health. He or she may also ask you or your sleep partner about your snoring and sleep behavior and how tired you feel during the day.
Your doctor may suggest a sleep study. A sleep study usually takes place at a sleep center, where you will spend the night. Sleep studies find out how often you stop breathing or have too little air flowing into your lungs during sleep. They also find out how much oxygen you have in your blood during sleep. You may have blood tests and X-rays.
You may be able to treat mild sleep apnea by making changes in how you live and the way you sleep. For example:
If lifestyle changes don't help sleep apnea, you may be able to use an oral breathing device or other types of devices. These devices help keep your airway open while you sleep.
Sleep apnea is often treated with a machine that helps you breathe while you sleep. This treatment is called continuous positive airway pressure, or CPAP (say "SEE-pap"). Sometimes medicine that helps you stay awake during the day may be used along with CPAP. If your tonsils, adenoids, uvula, or other tissues are blocking your airway, your doctor may suggest surgery to open your airway.
Learning about obstructive sleep apnea (OSA):
Living with sleep apnea:
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Obstructive sleep apnea usually occurs when the throat muscles and tongue relax during sleep and partially or completely block the airway. When you stop breathing or have reduced flow of air into your lungs during sleep, the amount of oxygen in your blood decreases briefly.
Obstructive sleep apnea can also occur if you have bone deformities or enlarged tissues in your nose, mouth, or throat. For example, you may have enlarged tonsils. During the day when you are awake and standing up, this may not cause problems. But when you lie down at night, the tonsils can press down on your airway, narrowing it and causing sleep apnea.
In children, the main cause of sleep apnea is large tonsils or adenoids.
Other things that may contribute to sleep apnea include:
With sleep apnea, there are symptoms that you may notice and symptoms that others may notice when you're asleep.
Children who have sleep apnea nearly always snore. But they may not appear to be excessively sleepy during the day (a key symptom in adults).
Other conditions with symptoms similar to sleep apnea include other sleep disorders and an underactive thyroid.
Obstructive sleep apnea causes your airway to narrow or close off, reducing or stopping breathing for short periods during sleep.
If your breathing stops, you may make grunting, gasping, or snorting sounds and restless body movements. As breathing resumes, loud snoring starts. This may happen many times during a night.
The more often it happens, the more severe your sleep apnea is. Sleep apnea is called either mild, moderate, or severe.
When you stop breathing, the oxygen levels in your blood go down and carbon dioxide levels go up. This makes your heart and blood vessels work harder and can affect your heart rate and nervous system. That in turn may:
Because sleep apnea disturbs your sleep, it can make you very tired during the day. So if you have sleep apnea, you may:
Certain things make it more or less likely that you will have obstructive sleep apnea. Some of these you cannot change, while others you can.
Call your doctor if:
Watchful waiting is a wait-and-see approach. If you get better on your own, you will not need treatment. If you get worse, you and your doctor will decide what to do next. Watchful waiting may be right for you if you snore but are not excessively sleepy during the day.
Watchful waiting may not be right if you notice that your sleep partner snores loudly and heavily, is restless during sleep, and is sleepy during the day. If you think your sleep partner may have periods when breathing stops, suggest that he or she talk with a doctor.
Health professionals who can check people who have symptoms of obstructive sleep apnea include:
Other health professionals may be able to help you if you have other problems that are caused by sleep apnea. If you:
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Your doctor will examine you and ask you and possibly your sleep partner some questions about your lifestyle, snoring, sleep behavior, and how tired you feel during the day (this is called a medical history).
Your doctor may ask you to complete a questionnaire, such as the Epworth Sleepiness Scale. The answers to questions in this questionnaire can help the doctor find out if you have sleep apnea. If your doctor thinks that you may have sleep apnea, he or she may suggest sleep studies or other tests.
Other tests that you may have include:
Most doctors follow these guidelines from the American Academy of Pediatrics:4
To see how well your treatment is working, you may need sleep tests after treatment begins.
If your sleep apnea has not improved after initial treatment, and if enlarged tissues in your mouth and throat are causing it, your doctor may do one or more tests before suggesting surgery to remove the excess tissue. These tests may include:
Treatment for obstructive sleep apnea may include:
Your doctor will probably have you try lifestyle changes and CPAP first. Surgery might be a first choice only if the sleep apnea is caused by a blockage that is easily fixed.
You may need to be treated for other health problems before you are treated for sleep apnea. For example:
If your sleep apnea gets worse, talk to your doctor:
Children have the same treatment options as adults. But surgery (removing tonsils or adenoids) typically is the first choice, because enlarged tonsils or adenoids cause most cases of sleep apnea in children. If surgery isn't possible or doesn't work, children are treated using CPAP.
You can help prevent obstructive sleep apnea if you:
Home treatment for obstructive sleep apnea includes lifestyle changes and changing some sleeping habits.
Some people use nasal strips, which widen the nostrils and improve airflow. Although these strips may decrease snoring, they cannot treat sleep apnea.
Doctors typically don't suggest using medicines to treat obstructive sleep apnea.
But medicine can help reduce daytime sleepiness when continuous positive airway pressure (CPAP) is reducing the number of times you stop breathing at night but you still feel sleepy during the day.8, 9
People with sleep apnea who take these medicines to reduce daytime sleepiness should keep using CPAP to treat sleep apnea.
Surgery for obstructive sleep apnea usually isn't done unless other treatments have failed or you are unable or choose not to use other treatments.
If you are thinking about having surgery to treat sleep apnea, talk with your doctor about having a sleep study done first.
Experts typically suggest that you try continuous positive airway pressure (CPAP) before considering surgery.
Laser-assisted uvulopalatoplasty uses a laser to perform surgery. It is sometimes used to treat mild to moderate sleep apnea, although not all people benefit. This surgery is not recommended by the American Academy of Sleep Medicine to treat sleep apnea.11, 12
CPAP is nearly always the first medical treatment for sleep apnea. With CPAP, you use a breathing device that prevents your airways from closing during sleep.
Research shows that:
It may take time for you to be comfortable using CPAP. You may find that you want to take off the mask, or you may find it hard to sleep. If you can't get used to CPAP, talk to your doctor. You might be able to try another type of mask or make other adjustments.
Some CPAP devices automatically adjust air pressure or use different air pressures when you breathe in or out. They are easier and more comfortable for some people to use.
If you use CPAP to treat sleep apnea, you need to use it every night. If you don't use it, your symptoms will return right away.
If CPAP isn't working, you may need another sleep study to find out whether your CPAP machine needs to be adjusted. You may also need to think about surgery.
Oral breathing devices reposition your tongue and jaw during sleep, which opens up your airways. They may be used for people who have mild to moderate sleep apnea. They may also be used for people with severe sleep apnea who try CPAP but find out that it does not work for them.
The U.S. Food and Drug Administration has approved nasal disks for treating sleep apnea and snoring. The disks attach to the outside of your nose. One disk is attached over each nostril. A valve positioned over the nostril makes it harder to breathe out, which causes a little back-pressure in the airways. This back-pressure may help keep the airways open during sleep.
|National Institute of Neurological Disorders and Stroke|
|NIH Neurological Institute|
|P.O. Box 5801|
|Bethesda, MD 20824|
The National Institute of Neurological Disorders and Stroke (NINDS), a part of the National Institutes of Health, is the leading U.S. federal government agency supporting research on brain and nervous system disorders. It provides the public with educational materials and information about these disorders.
|American College of Physicians|
|190 North Independence Mall West|
|Philadelphia, PA 19106-1572|
The American College of Physicians (ACP) is a national organization of internists. Doctors of internal medicine focus on adult medicine and have had special study and training focusing on the prevention and treatment of adult diseases. The ACP provides information for patients and families on the organization's website, including information on diseases and conditions, end-of-life care, women's issues, and immunizations. The site also offers video news stories, health tips, special reports, and a link to the ACP diabetes webpage.
|American Sleep Apnea Association (ASAA)|
|1424 K Street NW|
|Washington, DC 20005|
The American Sleep Apnea Association provides education and support for people who have sleep apnea.
|National Heart, Lung, and Blood Institute (NHLBI)|
|P.O. Box 30105|
|Bethesda, MD 20824-0105|
The U.S. National Heart, Lung, and Blood Institute (NHLBI) information center offers information and publications about preventing and treating:
|National Sleep Foundation|
|1010 North Glebe Road|
|Arlington, VA 22201|
The National Sleep Foundation, an independent nonprofit organization, can provide you with brochures on sleep disorders and a list of accredited sleep disorder clinics.
- Malhotra A, White DP (2002). Obstructive sleep apnea. Lancet, 360(9328): 237–245.
- Guilleminault C, Abad VC (2004). Obstructive sleep apnea syndromes. Medical Clinics of North America, 88(3): 611–630.
- Arzt M, et al. (2005). Association of sleep-disordered breathing and the occurrence of stroke. American Journal of Respiratory and Clinical Care Medicine, 172(11): 1447–1451.
- Marcus CL, et al. (2012). Diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics, 130(3): 576–584.
- Johansson K, et al. (2009). Effect of a very low energy diet on moderate and severe obstructive sleep apnoea in obese men: A randomised controlled trial. BMJ. Published online December 3, 2009 (doi:10.1136/bmj.b4609).
- Hensley M, Ray C (2009). Sleep apnoea, search date May 2008. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.
- Silverberg DS, et al. (2002). Treating obstructive sleep apnea improves essential hypertension and quality of life. American Family Physician, 65(2): 229–236.
- Schwartz JRL, et al. (2003). Modafinil as adjunct therapy for daytime sleepiness in obstructive sleep apnea: A 12-week, open-label study. Chest, 124(6): 2192–2199.
- Hirshkowitz M, et al. (2007). Adjunct armodafinil improves wakefulness and memory in obstructive sleep apnea/hypopnea syndrome. Respiratory Medicine, 101(3): 616–627.
- Buchwald H, et al. (2004). Bariatric surgery: A systematic review and meta-analysis. JAMA, 292(14): 1724–1737.
- Aurora RN, et al. (2010). Practice parameters for the surgical modifications of the upper airway for obstructive sleep apnea in adults. Sleep, 33(10): 1408–1413.
- Littner M, et al. (2001). Practice parameters for the use of laser-assisted uvulopalatoplasty: An update for 2000. Sleep, 24(5): 603–619.
- Giles TL, et al. (2006). Continuous positive airways pressure for obstructive sleep apnoea in adults. Cochrane Database of Systematic Reviews (3).
- Norman D, et al. (2006). Effects of continuous positive airway pressure versus supplemental oxygen on 24-hour ambulatory blood pressure. Hypertension, 47(5): 840–845.
Other Works Consulted
- Collop NA, et al. (2007). Clinical guidelines for the use of unattended portable monitors in the diagnosis of obstructive sleep apnea in adult patients. Journal of Clinical Sleep Medicine, 3(7): 737–747.
- Kushida CA, et al. (2006). Practice parameters for the indications for polysomnography and related procedures: An update for 2005. Sleep, 28(4): 499–521.
- Kushida CA, et al. (2006). Practice parameters for the treatment of snoring and obstructive sleep apnea with oral appliances: An update for 2005. Sleep, 29(2): 240–243.
- Kushida CA, et al. (2006). Practice parameters for the use of continuous and bilevel positive airway pressure devices to treat adult patients with sleep-related breathing disorders. Sleep, 29(3): 375–380.
- Kushida CA, et al. (2008). Clinical guidelines for the manual titration of positive airway pressure in patients with obstructive sleep apnea. Journal of Clinical Sleep Medicine, 4(2): 151–171.
- Marcus CL, et al. (2012). Diagnosis and Management of Childhood Obstructive Sleep Apnea Syndrome, Pediatrics, 130(3): e714–e755.
- Morgenthaler TI, et al. (2006). Practice parameters for the medical therapy of obstructive sleep apnea. Sleep, 29(8): 1031–1035.
|Primary Medical Reviewer||Anne C. Poinier, MD - Internal Medicine|
|Specialist Medical Reviewer||Mark A. Rasmus, MD - Pulmonology, Critical Care Medicine, Sleep Medicine|
|Last Revised||February 19, 2013|
Last Revised: February 19, 2013
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