What is sleep apnea? Experts share common signs, symptoms and treatments

Imagine snuggling in your favorite PJs and into bed, ready to drift into a peaceful slumber, when suddenly you’re jolted awake, gasping for air. While it sounds more like a nightmare, it's the frequent reality for about 30 million Americans with sleep apnea. According to the American Medical Association, only 6 million people, though, have been properly diagnosed with the condition.

But while many people have at least heard of the condition — especially after this week's reports that President Biden has begun using a CPAP (continuous positive airway pressure) machine to treat sleep apnea — they might be unclear about the details. Yahoo Life asked sleep experts to explain what it all means.

1. Sleep apnea involves interrupted breathing

As defined by the National Heart, Lung and Blood Institute, sleep apnea is a condition in which “breathing stops and restarts many times while you sleep,” due to partial or complete closure of the upper airway, through which air travels to reach the lungs. This includes sections in the mouth, nose, pharynx (the throat) and larynx (the vocal box).

There are two types of the condition: Obstructive sleep apnea (OSA) is the most common form and, as described above, occurs when your upper airway becomes blocked during sleep. The second type is central sleep apnea (CSA), which is less about blockage and more about brain receptors. It happens when your brain isn't sending signals to the muscles that control breathing, causing interruptions during sleep.

As Dr. Andrew Varga, neuroscientist and physician at the Mount Sinai Integrative Sleep Center, explains to Yahoo Life, with OSA, upper airway closures result in the body not getting enough oxygen, which can trigger an immediate reaction from our body to wake up.

"Your pharynx feels increased pressure, and mechanical receptors send a reflex to the brain to say, ‘Hey! Wake up and open the airway!’” he explains of the body's natural response.

2. Symptoms include snoring, headaches and mood changes

"Loud, disruptive snoring" is a common symptom of sleep apnea, Dr. Bhanu Kolla, professor of psychiatry and psychology at the Center for Sleep Medicine, tells Yahoo Life. But while snoring is often associated with the condition, it's important to know that not everyone who snores has sleep apnea.

Other signs include “choking or gasping spells” during sleep, suffering from headaches in the morning due to a lack of oxygen throughout the night, and sleepiness or fatigue during the day, notes Kolla. More often than not, these episodes are reported by other people, such as partners who share the bed, since the person with sleep apnea is typically unaware of them.

Mood changes, such as depression or irritability due to a lack of sleep, and dry mouth or sore throat in the morning due to open-mouth breathing, are also common symptoms associated with OSA.

3. To be properly diagnosed, a sleep study is required

Following an evaluation — starting with a primary-care doctor and then typically moving to a sleep medicine specialist, who could be an internist, pulmonologist, cardiologist, otolaryngologist (ear, nose, throat) or neurologist — the physician will administer a sleep study, also known as a polysomnogram, to diagnose and treat sleep apnea.

During the study, performed on a sleeping patient in a sleep lab, multiple physiological parameters are measured, including brain activity, eye movements, heart rate, breathing patterns, oxygen levels and body positions. As Kolla explains, this helps physicians “detect pauses or cessation of breathing during sleep” and potential "drops in oxygen saturation and brain-wave activity."

Those results are then interpreted by the specialist, who evaluates the number of times these breathing events occur. "If these occur frequently, usually more than five times per hour, a diagnosis of sleep apnea is made," says Kolla.

While at-home sleep apnea tests do exist, they require a telemedicine appointment and prescription and are less-complete evaluations than those administered in sleep labs, according to Johns Hopkins Medicine.

4. Treatments range from the CPAP machine to surgeries

Kolla describes the CPAP machine as the "gold standard and most effective way of treating sleep apnea.”

"It works like a glorified hair dryer," Varga says of the machine. “It’s air from the room that’s been warmed and humidified — it’s not extra oxygen or anything like that — then it uses that air pressure to keep the airway open.”

By blowing air through a tube that’s connected to a mask, which is placed over the nose and mouth, the CPAP machine shoots the air into your upper airway to stent open the soft tissue causing partial or complete closure. If done correctly, the machine can also eliminate snoring and other breathing abnormalities, notes Kolla, as well as improve sleep quality and daytime functioning.

But the CPAP is not the only treatment method out there.

“Other treatment options could include an oral appliance device like a mouth guard," prescribed by a dentist, "that moves the lower jaw forward by a few millimeters to create additional space at the back of the throat,” adds Kolla. “Weight loss, sleeping on the side and some upper airway surgeries can also help alleviate or eliminate sleep apnea,” as can using so-called “positional devices,” such as Styrofoam pillows to prop the airway to a more comfortable breathing position.

Surgical options also exist, including an "easy 15-minute procedure" that “removes the uvula and some of the soft palate,” to open up the airway for better breathing, says Varga.

While there are currently no Food and Drug Administration-approved medications for sleep apnea, in February, the FDA fast-tracked what will be the first oral treatment for OSA, likely to hit the market by 2024.

5. Gender, age and pre-existing conditions all play a role

According to data from the Mayo Clinic, men are two to three times more likely to have sleep apnea than women. However, women do increase their risk if they’re overweight or post-menopausal.

Even after menopause, the incidence in women is still slightly lower than the incidence in men, says Varga. “There’s a generalized increase in severity with aging [for all genders] up until roughly mid-60s or so. Then it plateaus after that.”

Particularly when it comes to OSA, Varga notes that conditions like obesity, nasal congestion, use of alcohol or sedatives, neck size (those with thicker necks may have narrower airways), smoking, as well as enlarged tonsils or adenoids, can be common causes.

As for CSA, Varga says health conditions that control your airway and/or chest muscles may also be the culprit, including neurological diseases like Parkinson’s, Alzheimer’s and congestive heart failure. The condition may also affect those taking opioid painkillers, smokers, or people exposed to high-altitude environments that may trigger what's called periodic breathing.

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