There are approximately 18 million adults in the U.S. who have obstructive sleep apnea, according to the National Sleep Foundation. Among those who suffer from the most common form of sleep-disordered breathing, it often goes undiagnosed.
While sleeping, the throat muscles are usually relaxed and allow the airway to collapse or become plugged by the tongue, which causes the flow of air to stop, sometimes for 10 seconds or more. When the brain senses the distress, people may bolt upright in a panic gasping for air, or they can simply snort and go right back to sleep. This breathing pattern can repeat numerous times during the night without the person realizing it. And it can erode health, according to Michael Twery, director of the National Center of Sleep Disorders Research within the National Heart, Lung, and Blood Institute.
When left untreated, sleep apnea has been linked to high blood pressure, heart disease, stroke, memory loss, obesity, parasomnias (involuntary behaviors like sleepwalking) and insulin resistance, a precursor to type 2 diabetes. Research has also shown a link between severe sleep apnea, the repeated drop in blood oxygen levels, and premature death. The ensuing daytime sleepiness can cause a “public hazard if you happen to be an airline pilot or an 18-wheel truck driver who is sleeping at the wheel,” said Dr. Alex Chediak, a past president of the American Academy of Sleep Medicine.
Do you snore loudly? Or feel exhausted even though you’ve had a good night’s sleep? It might be time to visit your doctor to discuss these symptoms, said 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 who are at a high risk of sleep apnea may be referred to a sleep specialist for a sleep study evaluation for obstructive sleep apnea, although a home-based testing option is possible.
Treatment options can include a continuous positive airway pressure (CPAP) machine, which creates a column of air that keeps the airway open, an oral device, or surgery. In the meantime, sleep doctors say that the following behavior and health issues can exacerbate obstructive sleep apnea or put people at risk for this nighttime breathing disorder.
8. Weight Gain
“The main factor that contributes to sleep apnea is obesity,” said Dr. Asha Singh, director of the OHSU Sleep Medicine Program in Portland, Oregon. Excess weight can bulk up tissues in and around the airway, which cause the airway to become vulnerable to collapse as the muscles relax during sleep. Also, heavier people tend to have thicker necks, which can also be a factor, said Dr. David Schulman, a sleep medicine specialist with Emory Healthcare in Atlanta. Although thin people are also susceptible to developing apnea, more than 50 percent of people who have the condition are overweight, according to the NHLBI.
There can be two people who weigh the same and have the same body mass index, and one of them has sleep apnea and the other doesn’t, according to 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 said.
“Alcohol increases muscle relaxation, and that’s true for the muscles of the throat–and actually the tongue muscle,” said Dr. Kathleen Yaremchuk, chair of otolaryngology and a sleep specialist at Henry Ford Health System in Detroit. This makes the airway a lot more vulnerable to obstruction during sleep.
Prescription medications can often have a negative effect on sleep apnea. “If you’re taking muscle relaxants, you’re going to expose yourself to greater snoring and sleep apnea,” Chediak said, adding that “the vast majority of sleeping medications have a muscle relaxant property.” Sleeping medications make it much more difficult to wake from a deep sleep. A noise must be louder. A pain must be sharper. An episode of sleep apnea must last longer in order for “more respiratory compromise” to wake the brain and restore normal breathing. Painkillers can also cause problems, according to experts, as opioids and other medications can cause respiratory suppression and add to the breathing difficulties a person may face overnight.
5. Other Medical Problems
Diabetes and high blood pressure are known to raise a person’s cardiovascular risk and are also 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 said. The magnitude of the sleep disorder directly impacts diabetes symptoms, and poor glucose control is linked with more severe sleep apnea.
4. Sleep Position
Sleeping on your back further intensifies sleep apnea, and by sleeping on your side you lessen the symptoms, said Schulman, which correlates to the weight distribution on the airway. “Sleeping on your back makes the tongue relax back further, and that tends to make sleep apnea worse,” Singh added.
The use of positional therapy devices that make you sleep on your side help serve as a sleep apnea treatment. Options like slumberBUMP, which is a belt with a pillow attached to the back, make it uncomfortable for individuals to sleep on their back, and force them to stay in a lateral position during sleep.Related: Fix Your Health Problems by Sleeping Correctly
3. Sleep Deprivation
When you are sleep deprived, it is believed that your body craves the deepest kind of sleep and will automatically launch into it to make up for lost sleep time, says Schulman. However, sleep apnea tends to worsen during the deep sleep period of REM, rapid eye movement, owing to its heightened state of relaxation. Sleep deprivation is often a consequence of sleep apnea, which may create a vicious cycle.
Adding to the long list of reasons to quit, smoking can raise your risk of developing sleep apnea and compound breathing problems for those who suffer from it. Cigarettes are direct irritants to the upper airway, the throat, the uvula, the soft palate and the tongue, and over time can make those areas swell. Smoking is also the leading cause of chronic obstructive pulmonary disease and is a severe trigger for symptoms of asthma.
For certain people, an anatomic abnormality may be the source. Enlarged tonsils, a deviated septum or a smaller-than-normal airway are some of the most common issues. The problem area is at the back of the mouth and beginning of the throat, and “whether or not somebody’s posterior pharynx is very crowded when you look inside their mouth,” Guralnick said. Although adults most commonly have these issues, children are often faced with them too, such as having enlarged tonsils or enlarged adenoids (glands found in the roof of the mouth). “All those things can increase your risk of having sleep apnea,” he said.Related: Sleep Facts and Myths