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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
more than 50 times an hour.
This topic focuses on obstructive sleep apnea, which is the most common
A less common type of apnea, called central sleep apnea,
can occur in people who have had a stroke, have heart failure, or have a brain
tumor 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.
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 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.
children, the main 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
The main symptoms of sleep apnea that you may
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 this 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
behavior and how tired you feel during the day.
Your doctor may
sleep study. A sleep study usually takes place at a
sleep center, 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
airways 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
Learning about obstructive sleep apnea (OSA):
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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
In children, the main cause of sleep apnea is large
tonsils or adenoids.
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
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.
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
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
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:
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.
Health professionals who can check people who have
symptoms of obstructive
sleep apnea include:
Other health professionals may be able to help
you if you have other problems that are caused by sleep apnea. If you:
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Your doctor will
examine you and ask you and possibly your sleep
partner some questions about your lifestyle, snoring, sleep behavior, and how tired
you feel during the day (this is called a
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.
are a series of tests that record what happens to your body during sleep. Polysomnography is the main way to detect sleep apnea. This test records
electrical activity of your brain, eye movement, muscle activity, heart rate,
breathing, airflow through your nose and mouth, and blood oxygen levels (saturation).
Other tests that you may have include:
Most doctors follow these guidelines from the American Academy of Pediatrics:3
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
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:
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.
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. 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:
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.8 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 airways 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 this 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.3
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.9, 10
People with sleep apnea who take
these medicines to reduce daytime sleepiness should keep using CPAP to treat sleep
Surgery for obstructive
sleep apnea usually isn't done unless other
treatments have failed or you are unable or choose not to use other
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
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.12
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Other Works Consulted
Adult Obstructive Sleep Apnea Task Force for the American Academy of Sleep Medicine (2009). Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. Journal of Clinical Sleep Medicine, 5(3): 263–276. http://www.aasmnet.org/Resources/clinicalguidelines/OSA_Adults.pdf. Accessed October 10, 2013.
Campos-Rodriguez F, et al. (2012). Cardiovascular mortality in women with obstructive sleep apnea with
or without continuous positive airway pressure treatment: A cohort study. Annals of Internal Medicine, 156(2): 115–122.
Collop NA, et al. (2007). Clinical
guidelines for the use of unattended portable monitors in the diagnosis of
obstructive sleep apnea in adult patients. Journal of Clinical Sleep Medicine, 3(7): 737–747.
Holley AB, et al. (2011). Efficacy of an adjustable oral appliance and comparison with continuous positive airway pressure for the treatment of obstructive sleep apnea syndrome. Chest, 140(6): 1511–1516.
Kushida CA, et al. (2006). Practice parameters for the
treatment of snoring and obstructive sleep apnea with oral appliances: An
update for 2005. Sleep, 29(2): 240–243.
Kushida CA, et al. (2006). Practice parameters for the
use of continuous and bilevel positive airway pressure devices to treat adult
patients with sleep-related breathing disorders. Sleep,
Kushida CA, et al. (2008). Clinical guidelines for the manual titration of positive airway
pressure in patients with obstructive sleep apnea. Journal of Clinical Sleep Medicine, 4(2): 151–171.
Qaseem A, et al. (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. Accessed October 7, 2013.
U.S. Department of Health and Human Services, et al. (2005, revised 2011). Your Guide to Healthy Sleep
(NIH Publication No. 11-5271). Available online:
Current as of:
March 17, 2014
Anne C. Poinier, MD - Internal Medicine & Mark A. Rasmus, MD - Pulmonology, Critical Care Medicine, Sleep Medicine
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