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Jun 09, 2021
6 min read

Obstructive sleep apnea (OSA): symptoms, risk factors, treatments

Obstructive sleep apnea (OSA) is a sleep disorder in which your breathing briefly stops and restarts during sleep. It’s also an underdiagnosed condition since healthcare providers often attribute its symptoms (loud snoring, daytime sleepiness) to other causes. With OSA, episodes of breathing pauses occur when your throat muscles relax and block your airway. The most effective treatment options for managing OSA are continuous positive airway pressure (CPAP), medical devices, and weight loss.

felix gussonePatricia Weiser PharmD

Reviewed by Felix Gussone, MD

Written by Patricia Weiser, PharmD

Disclaimer

If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.

Do you frequently wake up feeling groggy despite clocking eight hours of sleep? Do you struggle to stay awake while driving or working? Has your partner or roommate complained about your loud snoring, especially when you’re lying on your back? If this sounds like you, you might have a sleep disorder called obstructive sleep apnea.

Sleep apnea is a sleep disorder that involves abnormal breathing during sleep. Not all sleep apnea is obstructive sleep apnea. There’s also central sleep apnea, in which your brain doesn’t signal your body to breathe properly during sleep (Rundo, 2019). Some people have a mix of both central and obstructive sleep apneas.

What is obstructive sleep apnea (OSA)?

Obstructive sleep apnea (OSA) is a sleep disorder in which your breathing briefly stops and restarts while you’re sleeping. Each episode of paused breathing lasts 10 seconds or longer (Slowik, 2020). OSA occurs when your throat muscles relax, obstructing (blocking) your airway. 

This blockage can reduce the flow of oxygen to your brain and the rest of your body, possibly leading to an increased risk of cardiovascular problems.

With OSA, your sleep gets disturbed with each episode, but you may not fully wake up. As a result, breathing pauses may happen throughout the night. Five or more pauses per hour usually mean that you have OSA. With severe obstructive sleep apnea, airflow blockage episodes can occur up to 30 times or more per hour (Slowik, 2020).

Obstructive sleep apnea is a common medical condition, and it’s more prevalent in adults with obesity (a body mass index greater than 30). It’s diagnosed in 14% of men and 5% of women (Kapur, 2017). But, experts estimate that the actual prevalence of OSA is much higher. This probable underestimate is due to OSA symptoms such as daytime sleepiness sometimes being chalked up to other likely causes. As a result, you might be completely unaware that you stop breathing in your sleep. 

Experts also say that rates of OSA are on the rise, and they think that’s partly because of the obesity epidemic (Peppard, 2013).

Obstructive sleep apnea symptoms

Obstructive sleep apnea symptoms can vary from person to person. Symptoms can range from mild to severe and may include (Slowik, 2020; Strohl, 2020): 

  • Snoring
  • Sounds of choking, snorting, or gasping for breath during sleep
  • Waking up several times during the night
  • Morning headaches
  • Daytime sleepiness or low energy levels 
  • Falling asleep during the day
  • Low sex drive (Mun, 2018)

A note about snoring: just because someone snores doesn’t mean they have obstructive sleep apnea. In fact, most people who snore don’t have OSA. But, in those with OSA, most people (85%) are reported to have disruptive, heard-from-the-next-room snoring (Strohl, 2020).

OSA symptoms can lead to other problems. For example, daytime sleepiness can cause motor vehicle accidents, loss of employment, and reduced sexual desire. Relationships can also become strained due to disturbing the sleep of your bed partner or household members. They’ll probably notice OSA symptoms, such as loud snoring before you do.

Untreated OSA has been linked to poorly controlled high blood pressure, heart disease, and heart arrhythmias, among other medical conditions (Strohl, 2020).

What causes obstructive sleep apnea? 

Obstructive sleep apnea episodes occur when your upper airway is partially or completely blocked for at least 10 seconds (Slowik, 2020). 

This obstruction can happen if your airway becomes too narrow when your throat muscles relax during deep sleep. The shape of your airway, big tonsils, and a big tongue can also contribute to OSA. 

Risk factors for obstructive sleep apnea

Obstructive sleep apnea is more likely to occur in people with the following risk factors (Rundo, 2019, Slowik, 2020):

  • Obesity (a body mass index greater than 30). In one study, a 10 percent increase in weight was linked to a six-fold risk increase for OSA (Peppard, 2013).
  • Age 30 years and older
  • Male sex assigned at birth
  • Family history of OSA
  • Increased neck circumference
  • Alcohol or drug use
  • Sleeping on your back
  • Enlarged tonsils or adenoids
  • Having other medical conditions, such as underactive thyroid, high blood pressure, coronary artery disease, heart failure, depression, and type 2 diabetes

How is obstructive sleep apnea diagnosed?

If you have any symptoms of obstructive sleep apnea, the first step is to communicate with your healthcare provider. They may ask you more questions about your symptoms, sleep patterns, and energy level. Then, based on your symptoms and health history, your healthcare provider may recommend a sleep study. 

With a sleep study, you’ll either take a home sleep apnea test or a test called a polysomnogram. A polysomnogram is the recommended diagnostic test for OSA, especially if you have other risk factors or medical conditions (Kapur, 2017). With a polysomnogram, you’ll sleep overnight at a sleep study center or hospital.

The sleep study will record data while you sleep, such as your apnea episodes, brain and muscle activity, eye movements, and blood oxygen levels. Your healthcare professional will use the collected information to determine if you have OSA and confirm your diagnosis.

Home sleep tests for OSA have gained popularity because they’re convenient and done right in the comfort of your home. You’ll do the test on your own, without the assistance of a sleep technician. However, this so-called “unattended sleep study” isn’t for everyone. Ask your healthcare provider if they think this test is right for you.

Types of obstructive sleep apnea 

Based on your test results, your OSA will be diagnosed as mild, moderate, or severe. OSA severity is determined by the average number of apnea episodes (breathing pauses of 10 seconds or longer) that you have per hour (Rundo, 2019; Slowik, 2020).

  • Mild OSA: 5–14.9 obstructive breathing pauses per hour
  • Moderate OSA: 15–29.9 obstructive breathing pauses per hour
  • Severe OSA: 30 or more obstructive breathing pauses per hour

Obstructive sleep apnea treatment

The most effective treatment for OSA is continuous positive airway pressure (CPAP). It’s highly effective, and it’s recommended that all patients diagnosed with OSA should be offered CPAP as initial therapy (Qaseem, 2013; Spicuzza, 2013). It’s a device that keeps your airway open while you sleep.

When you see images of CPAP and similar devices, it’s natural to feel concerned about comfort. However, you can get a custom-fitted CPAP, and it can make a huge difference. CPAP could help wake up refreshed and energized and enjoy an overall higher quality of life (Strohl, 2020). And controlling your OSA can help improve your other medical conditions, such as high blood pressure (Strohl, 2020).

Other options include nasal or oral appliances that help hold your airway open. Positioning devices are also available that prevent you from sleeping on your back (Strohl, 2020).

There are no medications that are effective for treating or curing OSA. However, certain medication types could worsen OSA. This includes muscle relaxers and benzodiazepines, such as diazepam (Valium). So, your healthcare provider may recommend changes to your current medications as part of managing your OSA. They may also advise you to limit your alcohol intake (Simou, 2018). 

If you have nasal congestion due to allergies, your healthcare provider may suggest a steroid nasal spray, such as fluticasone (Flonase). This won’t directly treat OSA, but it may help if nasal stuffiness contributes to your symptoms (Slowik, 2020). 

Obesity is a leading risk factor for obstructive sleep apnea. Losing some weight, even 15% of your body weight, can help make your OSA symptoms less severe (Strohl, 2020). Effective weight loss strategies include regular exercise along with better food choices. If you’ve been diagnosed with OSA, now’s the time to focus on your health, fitness, and improving your diet. 

Surgery is sometimes an option for severe OSA in adults, especially if your throat is narrow due to enlarged tonsils or adenoids (Slowik, 2020). But, for most people with OSA, surgery is a last resort if CPAP, weight loss, and other strategies aren’t helping.

If you have symptoms of obstructive sleep apnea, reach out to a healthcare professional. Or, if you’re struggling with your CPAP treatment or weight loss plan, don’t give up. Your healthcare provider can work with you to identify the problems and find solutions that work to manage your obstructive sleep apnea.

References

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  2. Mun, J. K., Choi, S. J., Kang, M. R., Hong, S. B., & Joo, E. Y. (2018). Sleep and libido in men with obstructive sleep apnea syndrome. Sleep Medicine, 52, 158–162. doi: 10.1016/j.sleep.2018.07.016. Retrieved from https://pubmed.ncbi.nlm.nih.gov/30340202/
  3. Peppard, P. E., Young, T., Barnet, J. H., Palta, M., Hagen, E. W., & Hla, K. M. (2013). Increased prevalence of sleep-disordered breathing in adults. American Journal of Epidemiology, 177(9), 1006–1014. doi: 10.1093/aje/kws342. Retrieved from https://pubmed.ncbi.nlm.nih.gov/23589584/
  4. Qaseem, A., Holty, J. E., Owens, D. K., Dallas, P., Starkey, M., Shekelle, P., & Clinical Guidelines Committee of the American College of Physicians (2013). Management of obstructive sleep apnea in adults: A clinical practice guideline from the American College of Physicians. Annals of Internal Medicine, 159(7), 471–483. doi: 10.7326/0003-4819-159-7-201310010-00704. Retrieved from https://pubmed.ncbi.nlm.nih.gov/24061345/
  5. Rundo J. V. (2019). Obstructive sleep apnea basics. Cleveland Clinic Journal of Medicine, 86(9 Suppl 1), 2–9. Retrieved from https://www.ccjm.org/content/86/9_suppl_1/2.long
  6. Simou, E., Britton, J., & Leonardi-Bee, J. (2018). Alcohol and the risk of sleep apnoea: a systematic review and meta-analysis. Sleep Medicine, 42, 38–46. doi: 10.1016/j.sleep.2017.12.005. Retrieved from https://pubmed.ncbi.nlm.nih.gov/29458744/
  7. Slowik, J.M. & Collen, J.F. (2020). Obstructive sleep apnea. [Updated 2020 Dec 3]. In: StatPearls [Internet]. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK459252/
  8. Spicuzza, L., Caruso, D., & Di Maria, G. (2015). Obstructive sleep apnoea syndrome and its management. Therapeutic Advances in Chronic Disease, 6(5), 273–285. doi: 10.1177/2040622315590318. Retrieved from https://pubmed.ncbi.nlm.nih.gov/26336596/
  9. Strohl, K. P. (2020). Obstructive sleep apnea. Retrieved from https://www.msdmanuals.com/professional/pulmonary-disorders/sleep-apnea/obstructive-sleep-apnea