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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 30 or more 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, are on certain medicines (for example, opioids), or have a brain tumour 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 airways can become blocked when your throat muscles and tongue relax during sleep.
Sleep apnea can also occur if you have large tonsils or adenoids. 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, a common 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.
Having sleep apnea can lead to serious problems such as:
If you have sleep apnea, you also may not be sleeping as well as you could. If you feel sleepy during the day and it gets in the way of the normal things you do (like work, school, or driving), it's important to talk to your doctor. Be safe. Do not drive while you are drowsy.
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 behaviour and how tired you feel during the day.
Your doctor may suggest a sleep study. A sleep study may take place in your home or at a sleep centre, 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.
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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.
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).
In rare cases, sleep apnea in children can cause developmental delays and can cause failure of the right side of the heart (cor pulmonale).
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.
Your family doctor or general practitioner or your child's pediatrician can check people who have symptoms of obstructive sleep apnea.
If your doctor thinks you have sleep apnea, he or she may refer you to a sleep disorders specialist.
Other health professionals may be able to help you if you have other problems that are caused by sleep apnea. If you:
Your doctor will examine you and ask you and possibly your sleep partner some questions about your lifestyle, snoring, sleep behaviour, 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 that you have a sleep study in a lab or at your home.
Other tests that you may have include:
To diagnose sleep apnea in children, doctors follow similar steps.
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.
CPAP is nearly always the first medical treatment for sleep apnea. With CPAP, you use a breathing machine 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 and while you nap. If you don't use it, your symptoms will return right away.
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 out for them. A dentist will shape the device to fit your mouth.
Your doctor may suggest that you use nasal dilators (such as nose strips or disks) to help keep your airways open while you sleep. Nose strips widen the nostrils and improve airflow. Nasal disks have a valve that makes it harder for you to breathe out. This causes a little back-pressure in the airways that may help keep them open. You can get many of these devices without a prescription. Talk to your doctor or pharmacist about your options.
You may need to be treated for other health problems before you are treated for sleep apnea. For example:
You may also need treatment for problems that sleep apnea may cause, such as high blood pressure.
Children have most of the same treatment options as adults.
You can help prevent obstructive sleep apnea if you:
Home treatment for obstructive sleep apnea includes lifestyle changes and changing some sleeping habits.
One study found that people with sleep apnea who tend to have fluid collect in their lower legs and ankles may be helped by wearing compression stockings during the day.footnote 10 Keeping the fluid from collecting in the legs during the day may prevent the fluid from causing swelling of tissues in the nose and throat at night.
Your doctor may also suggest that you use a breathing device while you sleep. It helps keep your airway open. This could be a device that you put in your mouth. Other examples include strips or disks that you use on your nose.
Talk to your doctor if you are sleepy during the day and it gets in the way of the normal things you do. It's important that you do not drive or operate machinery while you are drowsy.
Doctors typically don't suggest using medicines to treat obstructive sleep apnea. Children may be given intranasal corticosteroid medicine for mild sleep apnea if surgery cannot be done or if the surgery did not work.footnote 11
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.footnote 12, footnote 13
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.footnote 15
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Adaptation Date: 8/18/2021
Adapted By: Alberta Health Services
Adaptation Reviewed By: Alberta Health Services
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