There are three types of sleep apnea: obstructive sleep apnea, central sleep apnea, and mixed sleep apnea. This topic focuses on obstructive sleep apnea.

What causes obstructive sleep apnea?

Obstructive sleep apnea (OSA) usually is caused by a blockage (obstruction) in the nose, mouth, or throat (airway) from a structural problem, such as an enlarged tongue or tonsils. Other factors, such as smoking or obesity, often contribute to OSA. For example, you may have enlarged tonsils that partially block the airway. During the day when you are awake and upright, this may cause no problems. However, when you lie down at night, fatty tissue in the neck can press down on your airway, narrowing it and causing OSA.

See illustrations of normal and blocked airways during sleep.

The main symptoms of OSA are loud snoring and sleepiness during the day. Your bed partner may notice periods when you stop breathing during sleep. Other symptoms may include:

• Tossing and turning during sleep.
• Feeling suffocated during sleep.
• Feeling tired all the time.
• Morning headaches.
• Feeling irritated and unrested.
• Falling asleep at inappropriate times, such as while eating, driving, or talking.
• Problems on the job.

What happens in OSA?

During an apnea episode, your blood oxygen level may drop because you stop breathing. Over time, low blood oxygen levels can lead to serious health problems and early death. If you have OSA, you may be at increased risk for developing high blood pressure (hypertension), high blood pressure in the lungs (pulmonary hypertension), depression, difficulty with concentration, abnormal heart rate, heart failure, coronary artery disease (CAD), and stroke.

If you have OSA, you may feel tired throughout the day. You may fall asleep at inappropriate times, such as while driving or working, which can lead to a higher-than-average rate of automobile- and work-related accidents.

A medical history and physical examination are the first steps in diagnosing OSA. If these suggest you have this condition, a sleep study (polysomnographic study) is recommended. A sleep study is usually done at a sleep center, where you will spend the night. Sleep studies identify:

• How often you stop breathing or have slower breathing during sleep.
• How low your blood oxygen levels drop during sleep.
• How often your sleep is disturbed and you wake up.

A number of other tests, such as measuring your eye movement, may also be done during the sleep study.

How is OSA treated?

If you have mild OSA, losing weight, developing good sleep habits, and avoiding alcohol and certain medications may cure the condition. If you have moderate to severe OSA, you may need to use a breathing device (continuous positive airway pressure [CPAP]) that prevents your airway from closing during sleep. If CPAP is not effective, or if enlarged tissues are causing the blockage, surgery may be needed.

Undiagnosed and untreated obstructive sleep apnea (OSA) can interfere with your quality of life. If you have OSA, you may be at risk for excessive daytime sleepiness and complications such as high blood pressure, high blood pressure in the lungs (pulmonary hypertension), depression, irregular heart rhythms, heart failure, coronary artery disease, and stroke.

Consider the following when making your decision:

• You should try continuous positive airway pressure (CPAP) before trying more invasive treatments. Most experts do not recommend surgery for obstructive sleep apnea (OSA) unless you have done so.
• You may consider surgery as initial treatment if a blockage is clearly reversible, such as from having overly large tonsils, or if you are at high risk for developing complications, such as high blood pressure.
• You might still need CPAP after uvulopalatopharyngoplasty surgery. There is no good evidence on the outcome of using this for OSA. About 40% to 60% of people who have UPPP have an improvement in their symptoms, but it is difficult to say who will benefit from the surgery and who will not.
• Tracheostomy almost always cures sleep apnea caused by blockage of the upper airway. However, you are at risk for many complications and you may have cosmetic concerns. Other, less invasive treatments also are available and nearly as effective as tracheostomy in most people.