Sleep Apnea: Snoring, Daytime Sleepiness and When to Be Evaluated

What it involves

MedlinePlus describes obstructive sleep apnea, or OSA, as a problem in which breathing pauses during sleep because of narrowed or blocked airways. During sleep, the throat muscles relax and, in some people, the tissues close in and block the airway. Loud snoring is a telltale symptom, but MedlinePlus notes that not everyone who snores has sleep apnea.

Who this is for

• Patients whose partner hears loud snoring, snorts, gasping, or pauses in breathing during the night
• Patients who wake unrefreshed or feel sleepy during the day
• Patients with high blood pressure that is hard to control or morning headaches
• Patients who fall asleep at work or feel drowsy while driving

What to expect

• Questions about snoring, sleep quality, bedtime habits, and daytime sleepiness
• A look at your mouth, neck, and throat, plus a review of weight and blood pressure
• A plain explanation of whether sleep apnea is likely and what confirms it
• A referral for a sleep study when the history points to it

What sleep apnea sounds like

MedlinePlus says people with OSA usually begin snoring heavily soon after falling asleep, and the snoring often becomes very loud. It may be interrupted by a long silent period when breathing stops, followed by a loud snort and gasp, and the pattern repeats through the night. Most people with OSA do not know this is happening, and some wake up gasping for air.

How it shows up in the day

MedlinePlus lists several daytime signs:

• Waking up unrefreshed, with morning headaches
• Feeling sleepy or drowsy throughout the day
• Being grumpy, impatient, forgetful, or irritable
• Falling asleep at work, while reading, or while watching TV
• Feeling sleepy while driving, or even falling asleep behind the wheel
• Difficult-to-treat headaches or high blood pressure

Who is more at risk

MedlinePlus names several risk factors for OSA: obesity, a large neck or collar size of 17 inches or more in men and 16 inches or more in women, a large tongue, large tonsils or adenoids, a lower jaw that is short compared to the upper jaw, and sleeping on your back. The obesity and BMI guide explains how weight is assessed at a visit, and the blood pressure readings guide covers the numbers MedlinePlus ties to this condition.

Why it is worth sorting out

MedlinePlus says untreated OSA may cause anxiety and depression, poor performance at work or school, and daytime sleepiness that raises the risk of car and workplace accidents. It adds that untreated OSA may lead to or worsen heart disease, including arrhythmias, heart failure, heart attack, high blood pressure, and stroke. The heart disease risk guide explains how a provider looks at that bigger picture.

How it is confirmed

MedlinePlus says a provider takes a history, examines the mouth, neck, and throat, and asks about daytime sleepiness and bedtime habits. It also says a sleep study is needed to confirm OSA and that it can be done at home or in a sleep lab. This practice does not list sleep studies as a service, so the study would be arranged by referral. MedlinePlus adds that other tests, such as a thyroid function check or pulse oximetry, may be performed.

Treatment and what you can start now

MedlinePlus says mild cases may improve with lifestyle changes: avoiding alcohol or sleep-inducing medicines before bed, avoiding sleeping on your back, and losing excess weight. It says CPAP devices work well for most people, dental devices help some, and surgery is often a last resort. Because sleepiness, headaches, and low energy overlap with other problems, the fatigue and tiredness guide and the insomnia guide cover the neighboring causes.

Sources

• MedlinePlus — Obstructive sleep apnea - adults
• MedlinePlus — Sleep Apnea health topic