What is sleep apnea?
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.
What causes obstructive sleep apnea?
narrowed airways in your nose, mouth, or throat can cause sleep apnea. Your
airway can become blocked when your throat muscles and tongue relax during
Sleep apnea can also occur if you have large
tonsils or adenoids or a large
uvula. 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
See pictures of
normal and blocked airways during sleep.
What are the symptoms?
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.
Should you worry about sleep apnea?
If you have
sleep apnea, you may not be sleeping as well as you could. And you may be more
likely to end up with serious problems such as:
How is sleep apnea diagnosed?
Your doctor will probably examine you and ask about your past health. He
or she may also ask you or your sleeping 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.
How is it treated?
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 do not help sleep apnea, you
may be able to use an oral breathing device. These devices help keep your
airway open while you sleep.
If you have moderate to
severe sleep apnea, you may be able to use 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
Frequently asked questions
Learning about obstructive sleep apnea (OSA):
Living with sleep apnea:
Health Tools help you make wise health decisions or take action to improve your health.
A blockage or narrowing of the
airways in your nose, mouth, or throat generally causes obstructive
sleep apnea (OSA). This 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
Other factors that may
contribute to sleep apnea include:
In children, the main cause of sleep apnea is large
tonsils or adenoids.
The most common symptoms of obstructive
sleep apnea (OSA) that you may notice include:
Symptoms of sleep apnea that others may notice
In children, symptoms of
sleep apnea depend on how old the child is:
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). The only symptom of sleep apnea in some children may be that they do
not grow as quickly as they should for their age.
in children sleep apnea 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 an underactive thyroid (hypothyroidism)
and other sleep disorders, such as suddenly falling asleep (narcolepsy) or an intense urge to move the legs (restless legs syndrome).
sleep apnea (OSA) 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
your breathing is interrupted while you sleep
severity of sleep apnea.
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. This in turn may lead to
other problems including
high blood pressure (hypertension) and
coronary artery disease (CAD). Sleep apnea can also
make these diseases worse and more difficult to treat. Sleep apnea also raises
your risk of having a stroke.12
sleep apnea disturbs your sleep, it can make you very tired during the day. If
you have sleep apnea, you may:
Certain factors make it more
or less likely that you will have obstructive
sleep apnea (OSA). Some of these you cannot change,
while others you can.
Factors that you cannot
change and that may make it more likely you will have sleep apnea
you may be able to change that will reduce your chances of having sleep apnea
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 sleeping
partner snores loudly and heavily, is restless during sleep, and is sleepy
during the day. If you think your sleeping 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 (OSA) include:
If your doctor thinks that you may have sleep apnea, he
or she may have you see a specialist who treats sleep disorders. The specialist
can help arrange and interpret a
sleep study and prescribe treatment for the disease,
continuous positive airway pressure (CPAP).
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 sleeping
partner questions about your lifestyle, snoring, sleep behavior, 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 obstructive
sleep apnea (OSA), he or she may suggest sleep studies
or other tests.
Other tests that you may have include:
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:
To diagnose sleep apnea in children, doctors follow similar
steps. According to the American Academy of Pediatrics:6
You may need sleep tests after your treatment begins, to
see how well it is working.
Treatment for obstructive
sleep apnea (OSA) includes lifestyle changes,
continuous positive airway pressure (CPAP) (to prevent
the airway from closing during sleep), the use of dental devices (oral breathing devices) to help keep your airway open, medicine to help you
stay awake during the day, and surgery. The goals of treatment are to relieve
symptoms such as snoring and
excessive daytime sleepiness and prevent
other problems, such as
high blood pressure. Your doctor will base your
treatment on how
severe your sleep apnea is.
your doctor will 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
You may need to be treated for other health problems
before you are treated for sleep apnea. For example, people who also have
inflammation of the nasal passages (rhinitis) may
need to use nose spray to reduce the inflammation. People who have an
underactive thyroid gland (hypothyroidism) need to take thyroid
Children have the same treatment options as adults. But
surgery (tonsillectomy and adenoidectomy) typically is the
first choice because enlarged tonsils or adenoids cause most cases of sleep
apnea in children. If surgery is not possible
or does not work, children are treated using CPAP.
The first treatment for
sleep apnea (OSA) consists of making lifestyle
changes. Your sleep apnea may be helped if you:
All people who have sleep apnea should make these
lifestyle changes. They may be all that is needed to relieve
mild sleep apnea.
Some people use nasal
strips, which widen the nostrils and improve airflow. Although these strips may
decrease snoring, they cannot treat sleep apnea.
Continuous positive airway pressure (CPAP) is nearly always the first medical treatment for sleep
Other medical treatment includes
oral breathing devices. These devices reposition your tongue and jaw during
sleep, which opens up your airways.
Surgery might be the
first treatment only when a blockage can be fixed easily,
such as when you have overly large tonsils.
Ongoing treatment for
sleep apnea (OSA) includes using
continuous positive airway pressure (CPAP) or an
oral breathing device and making changes in your lifestyle. Lifestyle changes
include losing weight (if needed), improving sleep habits (such as sleeping on
your side and waking up at the same time every morning),
avoiding the use of alcohol and certain medicines (especially sleeping pills
sedatives) before bed, and stopping smoking. Sometimes
medicine to help you stay awake during the day is used along with CPAP.
If CPAP is not working, you may need
sleep study to find out whether your CPAP machine
needs to be adjusted. You may also need to think about surgery. Surgical
sleep apnea (OSA) gets worse, talk to your doctor. You
may need another complete
sleep study, and you may need to adjust your
continuous positive airway pressure (CPAP) machine.
You may be able to take medicine to help you stay awake during the day. You may
also need treatment for
problems that sleep apnea may cause, such as
high blood pressure.
In some cases, you
may need surgery. Surgical options include:
Research shows that continuous
positive airway pressure (CPAP) decreases daytime sleepiness, especially in
people who have moderate to severe sleep apnea.1, 9 But CPAP may not work as well
for people who have mild sleep apnea.9
CPAP can lower daytime and nighttime blood pressure.10
If you use CPAP to treat sleep apnea, you need
to use it every night. If you do not use it, your symptoms will return right
Treatment of obstructive sleep apnea in people with coronary
artery disease lowers the risk of some heart problems.11
You can help prevent obstructive
sleep apnea (OSA) and snoring if you:
You can treat obstructive
sleep apnea (OSA) at home if you have
mild sleep apnea (5 or fewer apnea episodes an hour).
Home treatment for sleep apnea includes:
If you are using a
continuous positive airway pressure (CPAP) machine to
help you breathe, use it every night. If you don't use it all night, every
night, your symptoms will return right away.
Doctors typically do not suggest medicines
for the treatment of obstructive
sleep apnea (OSA). But medicine can help reduce
daytime sleepiness when
continuous positive airway pressure (CPAP) is reducing
apneas—the number of times you stop breathing at night—but daytime sleepiness
The U.S. Food and Drug Administration (FDA) has approved
wakefulness-promoting medicines for people who are using CPAP but still have
excessive daytime sleepiness:
People with sleep apnea who take
wakefulness-promoting medicines should continue using CPAP to treat sleep
Surgery for obstructive
sleep apnea (OSA) is usually not done unless other
treatments have failed or you are unable or choose not to use other
Tonsillectomy and/or adenoidectomy usually is the
first choice for children, because enlarged tonsils or adenoids cause most
cases of sleep apnea in children. Other types of surgery may be needed to
correct birth defects that can cause sleep apnea symptoms.
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. CPAP is a machine that increases air pressure in the
throat and prevents tissues in the airway from collapsing when you breathe
In adults, uvulopalatopharyngoplasty (UPPP) is the most common
surgery used to treat sleep apnea.
Tracheostomy is used only when all other treatments for
severe sleep apnea have failed or when you cannot
tolerate other treatments.
A rarely used option is repositioning
facial bones (maxillofacial reconstruction) if CPAP or UPPP do not work. This
surgery is designed to increase the size of the bones around the tongue and to
create pull (traction) on the base of the tongue, which enlarges the airway.
You will usually need more than one 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 approved by the American
Academy of Sleep Medicine to treat sleep apnea.3
Other treatment choices for
sleep apnea (OSA) include:
If you use CPAP to treat sleep apnea, you need to use it every night. If you do
not use it, your symptoms will return right away.
It may take time
for you to be at ease when you use CPAP. You may find that you want to take off
the mask, or you may find it difficult to sleep while using it. If you cannot
get used to it, talk to your doctor. You might be able to try another type of
mask or make other adjustments.
Nasal strips to decrease snoring
are available in most pharmacies. Nasal strips widen the nostrils and improve
airflow. Although these strips may decrease snoring, they cannot treat sleep
If you are overweight and have sleep apnea, think about
getting nutritional counseling to help you lose weight.
The National Institute of Neurological Disorders and
Stroke (NINDS), a part of the National Institutes of Health, is the leading
U.S. federal government agency supporting research on brain and nervous system
disorders. It provides the public with educational materials and information
about these disorders.
The American Sleep Apnea Association provides education and support
for people who have sleep apnea.
The U.S. National Heart, Lung, and Blood Institute
(NHLBI) information center offers information and publications about preventing
The National Sleep Foundation, an independent nonprofit
organization, can provide you with brochures on sleep disorders and a list of
accredited sleep disorder clinics.
Giles TL, et al. (2006). Continuous positive
airways pressure for obstructive sleep apnoea in adults. Cochrane Database of Systematic Reviews
Malhotra A, White DP (2002). Obstructive sleep apnea.
Lancet, 360(9328): 237–245.
Littner M, et al. (2001). Practice parameters for the
use of laser-assisted uvulopalatoplasty: An update for 2000. Sleep, 24(5): 603–619.
Sundaram S, et al. (2005).
Surgery for obstructive sleep apnoea in adults.
Cochrane Database of Systematic Reviews (4).
Silverberg DS, et al. (2002). Treating obstructive
sleep apnea improves essential hypertension and quality of life.
American Family Physician, 65(2): 229–236.
American Academy of Pediatrics (2002). Clinical
practice guideline: Diagnosis and management of childhood obstructive sleep
apnea. Pediatrics, 109(4): 704–712.
Schwartz JRL, et al. (2003). Modafinil as adjunct
therapy for daytime sleepiness in obstructive sleep apnea: A 12-week,
open-label study. Chest, 124(6): 2192–2199.
Guilleminault C, Abad VC (2004). Obstructive sleep
apnea syndromes. Medical Clinics of North America,
Hensley M, Ray C (2006). Sleep apnea. Clinical Evidence (15): 1–18.
Norman D, et al. (2006). Effects of continuous
positive airway pressure versus supplemental oxygen on 24-hour ambulatory blood
pressure. Hypertension, 47(5): 840–845.
Milleron O, et al. (2004). Benefits of obstructive
sleep apnoea treatment in coronary artery disease: A long-term follow-up study.
European Heart Journal, 25(9): 728–734.
Arzt M, et al. (2005). Association of sleep-disordered
breathing and the occurrence of stroke. American Journal of Respiratory and Clinical Care Medicine, 172(11): 1447–1451.
Hirshkowitz M, et al. (2007). Adjunct armodafinil
improves wakefulness and memory in obstructive sleep apnea/hypopnea syndrome.
Respiratory Medicine, 101(3): 616–627.
Buchwald H, et al. (2004). Bariatric surgery: A
systematic review and meta-analysis. JAMA, 292(14):
Other Works Consulted
Caples SM, et al. (2005). Obstructive sleep
apnea. Annals of Internal Medicine, 142(3):
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.
Kushida CA, et al. (2006). Practice parameters for the
indications for polysomnography and related procedures: An update for 2005.
Sleep, 28(4): 499–521.
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,
Morgenthaler TI, et al. (2006). Practice parameters
for the medical therapy of obstructive sleep apnea. Sleep, 29(8): 1031–1035.
July 9, 2009
E. Gregory Thompson, MD - Internal Medicine
& Mark A. Rasmus, MD - Pulmonology, Critical Care Medicine, Sleep Medicine
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