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Understanding Sleep Apnea

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What is Sleep Apnea

Sleep Apnea

Sleep apnea is a sleep-related disorder characterized by pauses (apnea) in breathing or shallow breathing (hypopnea) during sleep. These events may occur many times throughout the night, each time leading to lowered blood oxygen levels. This triggers the body's stress response, increasing heart rate and blood pressure. If left untreated, the condition can have long-term health impacts, including cardiovascular problems and other serious complications.

There are two main types of sleep apnea:

1.Obstructive Sleep Apnea (OSA)

2. Central Sleep Apnea (CSA).

What is Obstructive Sleep Apnea (OSA)?

Obstructive Sleep Apnea

Obstructive sleep apnea (OSA) is a common sleep disorder characterized by repetitive episodes of partial or complete obstruction of the upper airway during sleep.

These obstructions, often caused by relaxation of the throat muscles, and extra weight on the throat, lead to interruptions in breathing that result in lower oxygen levels. These episodes increase the stress response as a mechanism to wake up the body and restore airflow. As a result, individuals with obstructive sleep apnea experience fragmented sleep, oxygen desaturation, and increased stress on the body that if is not treated can lead to long-term health complications.

What is Central Sleep Apnea (CSA)

Central Sleep Apnea

Central sleep apnea (CSA) is a sleep disorder characterized by pauses in breathing during sleep that occur when the brain fails to send signals to the muscles responsible for breathing.

During episodes of central sleep apnea, the individual may experience brief periods of no airflow (apnea) or shallow breathing (hypopnea). These pauses in breathing can lead to fragmented sleep, frequent awakenings, and fluctuations in oxygen levels.

Central sleep apnea can occur as a primary condition or may be associated with other underlying health problems, such as heart failure, stroke, brainstem injury, or certain medications.

What is the Difference Between Central and Obstructive Sleep Apnea?

The Difference between Obstructive and Central Sleep Apnea

The difference between obstructive and central sleep apnea is, unlike obstructive sleep apnea (OSA), where the airway becomes blocked, CSA involves a disruption in the brain's respiratory control centers.

Both central and obstructive sleep apnea cause a disruption to normal breathing that puts stress on the body and if left untreated, overtime will cause health issues.

What Causes Sleep Apnea?

What Causes Sleep Apnea?

Sleep apnea occurs when your breathing is repeatedly interrupted during sleep. The causes and risk factors depend on the type of sleep apnea: obstructive sleep apnea (OSA) or central sleep apnea (CSA). While both conditions share some risk factors, they also have distinct causes.

Causes and Risk Factors for Obstructive Sleep Apnea (OSA)

Obstructive sleep apnea is caused by the physical collapse of the upper airway during sleep. Several factors can increase the risk of developing OSA, including:

  1. Excess Weight or Obesity: Fat deposits around the neck can narrow the airway, making it more likely to collapse during sleep.
  2. Age: The risk of OSA increases with age, particularly in middle-aged and older adults.
  3. Gender: Men are more likely to develop OSA than women, although postmenopausal women face an increased risk due to fluctuating hormone levels that increase swelling.
  4. Family History: Genetics can play a role, with a family history of OSA increasing your likelihood of developing the condition.
  5. Anatomy of the Upper Airway: Structural issues like enlarged tonsils, a small jaw, or a deviated septum can contribute to airway obstruction.
  6. Alcohol and Sedatives: These relax throat muscles, increasing the chances of airway collapse.
  7. Smoking: Inflammation and fluid retention caused by smoking can narrow the airway.
  8. Nasal Congestion: Chronic nasal congestion or allergies can restrict airflow, increasing breathing effort.
  9. Sleep Position: Sleeping on your back may worsen OSA by allowing the tongue and soft tissues to block the airway.
  10. Ethnicity: Studies show African Americans, Hispanics, and Pacific Islanders have a higher prevalence of OSA compared to Caucasians.

Causes and Risk Factors for Central Sleep Apnea (CSA)

Central sleep apnea is caused by a disruption in the brain’s ability to control breathing. The following factors can increase the risk of developing CSA:

  1. Heart Failure: CSA is commonly associated with heart conditions, particularly those affecting ejection fraction or heart rhythm.
  2. Stroke or Neurological Conditions: Damage to the brainstem, which regulates breathing, can lead to CSA.
  3. Opioid Use: Certain medications, especially opioids, can suppress the brain’s respiratory drive.
  4. High Altitude: Exposure to high altitudes can interfere with breathing patterns, particularly in individuals with pre-existing medical conditions.
  5. Cheyne-Stokes Respiration: A specific breathing pattern characterized by cycles of shallow and deep breathing is strongly linked to CSA.
  6. Kidney Disorders: Chronic kidney disease and renal failure can lead to fluid retention and imbalances that contribute to CSA.
  7. Age: Older adults, particularly those with underlying health conditions, are at a higher risk of CSA.

Symtoms of Sleep Apnea (OSA and CSA)

Common symptoms of sleep apnea include:

  1. Daytime Sleepiness: Excessive daytime sleepiness, fatigue, and a general feeling of tiredness during waking hours.
  2. Poor Concentration: Difficulty concentrating, memory problems, and impaired cognitive function due to disrupted sleep patterns.
  3. Morning Headaches: Due to oxygen deprivation and stress during sleep.
  4. Mood Changes: Mood swings, irritability, and feelings of depression can occur due to lack of restorative sleep.

Distinct Symptoms of Obstructive Sleep Apnea:

  1. Loud Snoring: Loud, persistent snoring, which may be accompanied by choking or gasping sounds as breathing resumes.
  2. Witnessed Pauses in Breathing: Bed partners or family members may observe episodes where breathing stops or becomes shallow during sleep.
  3. Dry Mouth or Sore Throat: Due to mouth breathing or snoring is more common in OSA.
  4. Frequent Nighttime Urination: Needing to urinate frequently during the night is often associated with OSA due to sleep disruption.

Distinct Symptoms of Central Sleep Apnea:

  1. Cheyne-Stokes Respiration: A distinctive breathing pattern characterized by cyclic changes in breathing effort, often accompanied by apneic episodes, is typical of CSA.
  2. Interrupted Breathing: Pauses in breathing during sleep due to the brain failing to send signals to the respiratory muscles are a hallmark feature of CSA.
  3. Less Common Snoring: While snoring can occur in CSA, it is typically less prominent and may not be as loud or persistent as in OSA.

Is Sleep Apnea Dangerous?

Is Sleep Apnea Dangerous?

Untreated sleep apnea—whether obstructive (OSA) or central (CSA)—can cause serious health problems by placing chronic stress on the body through repeated disruptions in breathing and poor sleep quality.

Health complications from untreated sleep apnea include:

  1. Hypertension (High Blood Pressure): Sleep apnea is strongly associated with hypertension, as the repeated episodes of oxygen deprivation and arousal from sleep can lead to increased stress response and resulting blood pressure spikes during the night.
  2. Cardiovascular Disease: Untreated sleep apnea significantly increases the risk of heart disease, including coronary artery disease, heart attack, heart failure, and arrhythmias. The combination of oxygen desaturation, blood pressure fluctuations, and systemic inflammation can contribute to cardiovascular damage over time.
  3. Stroke: Sleep apnea is a significant risk factor for stroke, particularly ischemic stroke, due to its effects on blood pressure regulation, vascular endothelial function, and cerebral blood flow.
  4. Type 2 Diabetes: Sleep apnea is associated with insulin resistance, glucose intolerance, and an increased risk of developing type 2 diabetes mellitus. The metabolic disturbances and systemic inflammation associated with sleep apnea can exacerbate insulin resistance and contribute to the progression of diabetes.
  5. Neurocognitive Impairment: Chronic sleep fragmentation and intermittent hypoxia associated with sleep apnea can lead to cognitive dysfunction, memory impairment, decreased concentration, and daytime sleepiness. Untreated sleep apnea is also linked to an increased risk of developing neurodegenerative diseases such as Alzheimer's disease.
  6. Motor Vehicle Accidents: Excessive daytime sleepiness and impaired vigilance resulting from untreated sleep apnea increase the risk of motor vehicle accidents and workplace injuries. Individuals with sleep apnea are more likely to experience drowsy driving episodes and have a higher accident rate compared to the general population.
  7. Depression and Mood Disorders: Sleep apnea is associated with an increased risk of depression, anxiety, and mood disorders, possibly due to the chronic stress of disrupted sleep, alterations in neurotransmitter function, and changes in brain structure and function.
  8. Decreased Quality of Life: Untreated sleep apnea can significantly impact quality of life, leading to decreased energy levels, impaired daytime functioning, relationship problems, and diminished overall well-being.

Is Sleep Apnea Genetic or Hereditary?

Is Sleep Apnea Genetic or Hereditary?

Yes, sleep apnea can have a hereditary component. A family history of sleep apnea increases your likelihood of developing the condition. Genetics can influence several factors that may predispose individuals to sleep apnea, including:

1. Anatomical Features and Obstructive Sleep Apnea (OSA):

Certain inherited anatomical traits, such as a naturally narrow throat, enlarged tonsils, or a recessed jaw, can increase the risk of OSA by contributing to airway obstruction during sleep.

2. Respiratory Control Mechanisms and Central Sleep Apnea (CSA):

Genetic factors may also play a role in how the brain regulates breathing. This can increase susceptibility to central sleep apnea, where pauses in breathing occur due to a lack of respiratory effort.

3. Shared Lifestyle and Health Factors:

While not purely genetic, families often share lifestyle habits that influence sleep apnea risk, such as dietary choices, exercise routines, and body weight. Obesity, a significant risk factor for OSA, can run in families due to both genetic predisposition and shared behaviors.

4. Ethnicity and Genetic Risk:

Certain ethnic groups, such as African Americans, Hispanics, and Pacific Islanders, have a higher prevalence of sleep apnea, suggesting a genetic predisposition in combination with environmental factors.

Mild vs. Moderate vs. Severe Sleep Apnea

Mild vs. Moderate vs. Severe Sleep Apnea: Understanding Severity

The severity of sleep apnea is determined using the Apnea-Hypopnea Index (AHI), which measures the number of breathing disruptions (apneas and hypopneas) per hour of sleep. Here's how sleep apnea is classified:

Apnea-Hypopnea Index (AHI) Classifications:

  • AHI < 5: Normal (No sleep apnea)
  • AHI 5 - 15: Mild Sleep Apnea
  • AHI 15 - 30: Moderate Sleep Apnea
  • AHI > 30: Severe Sleep Apnea

What does a Higher AHI Mean?

What Does a Higher AHI Mean?

A higher Apnea-Hypopnea Index (AHI) score indicates more frequent and severe breathing disturbances during sleep. These disruptions can result in:

  • Daytime Sleepiness: Frequent interruptions in sleep lead to chronic fatigue and reduced alertness.
  • Fatigue: Poor sleep quality impacts physical and mental energy levels.
  • Health Risks: Severe sleep apnea is associated with a greater risk of heart disease, stroke, diabetes, and other complications.
  • Home Sleep Apnea Testing

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  • Terminology

    Sleep Apnea Lingo

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  • Sleep Apnea Treatment

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  • Optimizing CPAP Therapy

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