IT'S ESTIMATED THAT more than 18 million adults in the U.S. have obstructive sleep apnea, according to the National Sleep Foundation, and for the majority who suffer from the most common form of sleep-disordered breathing, it goes undiagnosed.
Throat muscles, which are usually tense while awake, relax during sleep, allowing the airway to collapse or become plugged by the tongue. As with a kinked hose, the flow stops, sometimes for 10 seconds or more. As the brain senses distress, people may bolt upright and gasp for air, or they may simply snort and go back to sleep, experts say. This can go on hundreds of times a night, without the person realizing it. And it can erode health, says Michael Twery, director of National Center on Sleep Disorders Research within the National Heart, Lung, and Blood Institute.
Untreated, sleep apnea has been linked to high blood pressure, heart disease, stroke, memory loss, obesity, parasomnias (or involuntary behaviors like sleepwalking) and insulin resistance, a precursor to Type 2 diabetes. And research shows a link between severe sleep apnea, the repeated drops in blood oxygen levels, and premature death. What's more, the ensuing daytime sleepiness can also be a "public health hazard, if you happen to be an airline pilot or a 16-wheel truck driver who is sleeping at the wheel," says Dr. Alex Chediak, a past president of the American Academy of Sleep Medicine.
Snore loudly? Feel exhausted despite a "good night's rest?" It might be time to discuss symptoms with a doctor, says Twery, adding: "The initial detection of this condition often stems from things that the patient can tell their physician – there's no blood test." Those deemed at risk may be referred to a sleep specialist for a sleep study to evaluate for obstructive sleep apnea, although home-based testing options are available as well.
Treatment options may include a continuous positive airway pressure, or CPAP, machine, which creates a column of air that keeps the airway open, an oral device or surgery, Chediak says.
Meantime, here's what sleep doctors say can exacerbate obstructive sleep apnea or put people at risk for the nighttime breathing disorder:
Weight gain. “The main factor that contributes to sleep apnea is obesity, ” says Dr. Asha Singh, director of the OHSU Sleep Medicine Program in Portland, Oregon. Excess pounds can bulk up tissues in and around the airway, says Chediak, making the airway more vulnerable to collapse as muscles relax during sleep. Likewise, heavier people tend to have thicker necks, which can also be a factor, says Dr. David Schulman, a sleep medicine specialist with Emory Healthcare in Atlanta. Although thin folks can develop apnea, more than 50 percent of people who have the condition are overweight, according to the NHLBI.
You can have two people of the same weight, and the same body mass index, and one may have sleep apnea, and one may not, says Dr. Amy Guralnick, an assistant professor of medicine at the University of Chicago, and a member of the faculty at the university’s Sleep Disorders Center. "But if somebody has sleep apnea and they gain [weight], almost certainly their sleep apnea will get worse," she says.
Frustratingly, sleep apnea may also contribute to weight gain. There is evidence to suggest that it may lead to an increase in appetite for unhealthful foods. A study in the Journal of Clinical Sleep Medicine found that people with severe forms of the disorder, especially women, were more likely to make poor food choices than those unaffected or with mild cases. Additionally, sleep deprivation, a hallmark of sleep apnea, seems to tinker with hormones that normally suppress appetite, Chediak says. While shedding pounds may alleviate or eliminate sleep apnea if weight is the root cause – weight loss surgery, for example, has been shown to ease it in the morbidly obese – there's "no compelling evidence" that treating sleep apnea will make people melt pounds, Chediak says.
Alcohol. “Alcohol increases muscle relaxation, and that’s true for the muscles of the throat – and actually the tongue muscle," says Dr. Kathleen Yaremchuk, chair of otolaryngology and a sleep specialist at Henry Ford Health System in Detroit. This makes the airway more vulnerable to obstruction during sleep. Though alcohol's effect usually dissipates as it clears the body throughout the night, cutting down may help.
Medications. Prescription medications can also create a double whammy. "If you're taking muscle relaxants, you're going to expose yourself to greater snoring and sleep apnea," Chediak says, and "the vast majority of sleeping medications have a muscle relaxant property." In addition, sleeping pills make it harder to arouse from sleep. A noise must be louder. A pain must be sharper. Likewise, an episode of sleep apnea must last longer because "more respiratory compromise" is needed to wake the brain up to restore normal breathing, he says. Painkillers can also be problematic, experts say, particularly opioids, which cause respiratory suppression and add to breathing difficulties a person may face overnight.
Other medical problems. Most significantly these include diabetes and high blood pressure, which raise a person's cardiovascular risk and are associated with higher rates of sleep apnea. "About 30 to 40 percent of adults with high blood pressure also have sleep apnea, which is more prevalent in those with drug-resistant hypertension. So approximately 80 percent of patients that don’t respond to hypertensive medication have some apnea," Singh says. "Adhering to sleep apnea treatment is a proven means of decreasing blood pressure." About 7 in 10 people with Type 2 diabetes also have obstructive sleep apnea, she says. The severity of the sleep disorder directly impacts diabetes symptoms; and, conversely, poor glucose control is linked with more severe sleep apnea.
Sleep position. Typically, sleeping on your back makes sleep apnea worse, and sleeping on your side makes it better, Schulman says. That has to do with how and where weight falls on the airway. "Sleeping on your back makes the tongue relax back further, and that tends to make sleep apnea worse," Singh adds.
Using positional therapy devices that make you sleep on your side can help with treating sleep apnea, she says. Options like slumberBUMP, which is essentially a belt with a pillow attached to the back, make it uncomfortable for individuals to sleep on their back, so they stay in a lateral position during their sleep, Singh explains.
Sleep deprivation. It is thought that the body craves the deepest kind of sleep when sleep deprived and will launch into it to make up for lost shuteye, Schulman says. But sleep apnea tends to be worse during that deep-sleep period, called rapid eye movement (REM) sleep, owing to its heightened state of relaxation, he explains. Thus, carving out adequate time for a night's rest is important, he says. On the other hand, sleep deprivation is often a consequence of sleep apnea, which may create a cruel cycle.