Understanding Sleep Apnea – FAQ

Sleep apnea is a sleep 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).

If you're interested in learning more about sleep apnea, check out our comprehensive guide to sleep apnea.

Yes, sleep apnea is very common. Studies suggest that 1 in 5 adults has at least mild sleep apnea, and many remain undiagnosed. It affects both men and women, though men are at higher risk. Because it is often underdiagnosed, awareness and sleep apnea testing are important for protecting long-term health.

If you think you have symptoms of sleep apnea, learn how our home sleep test works.

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.

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.

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.

Learn more about the differences of obstructive and central 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.

Obstructive Sleep Apnea (OSA) Causes

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.

Central Sleep Apnea (CSA) Causes

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.

If you're at high risk for sleep apnea and are curious to know more about sleep apnea symptoms, testing and treatment, read our blog.

Common sleep apnea symptoms include:

• Loud snoring
• Gasping or choking during sleep
• Pauses in breathing noticed by a bed partner
• Excessive daytime sleepiness
• Morning headaches
• Difficulty concentrating

If you notice these signs, you may benefit from a sleep apnea study at home or in a sleep lab to confirm a diagnosis.

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 marked by gradual increases and decreases in breathing effort, often followed by pauses (apneic episodes). This is commonly seen in people with CSA and certain heart conditions.
2. Interrupted Breathing Without Effort – Unlike OSA, where the airway is blocked, CSA occurs because the brain temporarily fails to send signals to the breathing muscles. These pauses in breathing happen without physical effort to breathe.
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.

If you suspect you or a loved one has sleep apnea, learn how to support someone with sleep apnea.

Sleep apnea is typically diagnosed through a combination of a medical evaluation and a sleep study. Your doctor may first review your medical history, ask about symptoms like loud snoring, daytime fatigue, or pauses in breathing during sleep, and perform a physical examination.

Sleep apnea is then confirmed using either an in-lab sleep study (polysomnography) or using a home sleep apnea test (HSAT). An in-lab study is the gold standard, but a home sleep test can be a convenient option for many people. Devices like the FDA and Health Canada approved WatchPAT One home sleep study provide results with up to 95% accuracy compared to a sleep lab.

If you’re interested in learning more, our guide to home sleep apnea testing explains how these tests work, what to expect, and how results are reviewed by licensed sleep physicians.

Sleep apnea can be treated in several ways, depending on your symptoms and diagnosis. The most common and effective option is using a CPAP machine, which delivers constant air pressure to keep your airway open while you sleep. Many people find that starting CPAP therapy greatly improves their sleep quality, energy levels, and overall health.

Other treatment options for sleep apnea:

Oral Appliances – Custom dental devices that reposition the jaw to help keep the airway clear.

Lifestyle Changes – Weight loss, reducing alcohol use, quitting smoking, or adjusting sleep position.

Positional Therapy – Avoiding back-sleeping with special devices or techniques.

Surgical Options – In select cases, surgery may help remove or reduce airway blockages.

Most patients begin treatment with CPAP therapy for sleep apnea or an oral appliance, as these are proven first-line therapies. Your doctor or sleep specialist will help determine the best option for your needs.

If you're interested in learning more about treatments for sleep apnea, read our blog.

There is no universal “cure” for sleep apnea, but treatments like CPAP therapy effectively manage symptoms. Some people experience improvement or even remission with weight loss, surgery, or by treating underlying conditions. Regular follow-ups with a sleep specialist help ensure you receive the best care for long-term results.

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

Health risks from untreated sleep apnea:

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. Explore more about how sleep apnea affects the heart by reading our blog.
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.

If Sleep apnea is not addressed, it can cause havoc on the boy over time. For more information on the health effects of sleep apnea, see Johns Hopkins Medicine’s article on the dangers of uncontrolled sleep apnea.

Yes, sleep apnea can run in families. 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.

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?

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.

Yes. A home sleep apnea test offers a convenient way to check for sleep apnea from the comfort of your own bed. Devices like the WatchPAT One measure oxygen levels, heart rate, and sleep patterns to provide accurate results. Many patients find at-home sleep testing more comfortable and accessible than visiting a sleep lab.