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.
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
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.
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:
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
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
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.
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 sleep studies
or other tests.
Other tests that you may have include:
Most doctors follow these guidelines from the American Academy of Pediatrics:4
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
You may need to be treated for other health problems
before you are treated for sleep apnea. For example:
sleep apnea gets worse, talk to your doctor:
Children have the same treatment options as adults. But
surgery (removing tonsils or adenoids) typically is the
first choice, because enlarged tonsils or adenoids cause most cases of sleep
apnea in children. If surgery isn't possible
or doesn't work, children are treated using CPAP.
You can help prevent obstructive
sleep apnea if you:
Home treatment for obstructive
sleep apnea includes lifestyle changes and changing some sleeping habits.
Some people use nasal
strips, which widen the nostrils and improve airflow. Although these strips may
decrease snoring, they cannot treat sleep apnea.
Doctors typically don't suggest using medicines to treat obstructive
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.8, 9
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.11, 12
CPAP is nearly always the first medical treatment for sleep
apnea. With CPAP, you use a breathing device 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.
If CPAP isn't 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.
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 for them.
The U.S. Food and Drug Administration has approved nasal disks for treating sleep apnea and snoring. The disks attach to the outside of your nose. One disk is attached over each nostril. A valve positioned over the nostril makes it harder to breathe out, which causes a little back-pressure in the airways. This back-pressure may help keep the airways open during sleep.
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 College of Physicians (ACP) is
a national organization of internists. Doctors of internal medicine focus on
adult medicine and have had special study and training focusing on the
prevention and treatment of adult diseases. The ACP provides information for
patients and families on the organization's website, including information on
diseases and conditions, end-of-life care, women's issues, and immunizations.
The site also offers video news stories, health tips, special reports, and a
link to the ACP diabetes webpage.
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.
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Kushida CA, et al. (2006). Practice parameters for the indications for polysomnography and related procedures: An update for 2005. Sleep, 28(4): 499–521.
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June 17, 2011
Anne C. Poinier, MD - Internal Medicine
& Mark A. Rasmus, MD - Pulmonology, Critical Care Medicine, Sleep Medicine
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