What is OSA?
OSA stands for obstructive sleep apnea
One of the most common sleep disorders in people with sleeping difficulties is obstructive sleep apnea (OSA).
OSA is diagnosed with a test called an overnight sleep study that records the activity of the body during sleep.
A sleep study can provide doctors with important information about a person’s sleep cycle, including how often and how long their breathing pauses (called apnea).
One of the most important measurements is a person’s oxygen level during the different stages of sleep. When the level falls below what the body needs to function normally, it is called oxygen desaturation. This not only tells the doctor how severe OSA is but is also an indication of future health concerns.
What Is Obstructive Sleep Apnea?
Obstructive sleep apnea occurs when your throat muscles relax and block your airway during sleep. When this happens, breathing can stop for anywhere from 10 seconds to over a minute in some cases.1
People with OSA experience frequent, repeated pauses in breathing during sleep. Some experience hundreds of these in a night.2 And, while the person may be completely unaware of these gaps, their partner will often notice and become alarmed.
During these breathing gaps, people receive less air, which causes their blood oxygen levels to drop. While these levels will generally return to normal once regular breathing starts again, frequent breathing gaps can pose serious health concerns. This is why OSA is something you can’t ignore.
Based on the findings, the doctor may recommend an overnight sleep study, also known as level 1 polysomnography or a home sleep test. Considered the gold standard for the diagnosis of OSA, the test involves connecting you to sensors that monitor your temperature, heart rate, brain waves, breathing rate and depth, nasal and mouth airflow, and body movements during sleep.
The sleeper who suffers from Obstructive Sleep Apnea (OSA) periodically struggles to breathe but is unable to inhale effectively because his or her airway has become blocked or collapsed. The sleeper whose problem is central sleep apnea (CSA) periodically doesn’t breathe at all so oxygen intake is ineffectual. In either type of sleep apnea, the lack of oxygen usually causes the patient to wake up or arouse, at least briefly. The Obstructive Sleep Apnea patient has a mechanical problem, one that almost always can be corrected by a continuous positive airway pressure (CPAP) device.
OSA Obstructive Sleep Apnea symptoms
People with OSA experience frequent, repeated pauses in breathing during sleep. Some experience hundreds of these in a night. And, while the person may be completely unaware of these gaps, their partner will often notice and become alarmed.
During these breathing gaps, people receive less air, which causes their blood oxygen levels to drop. While these levels will generally return to normal once regular breathing starts again, frequent breathing gaps can pose serious health concerns. This is why OSA is something you can’t ignore.
Depending on the severity of the condition, other symptoms may occur, including:
Loud snoring, snorting, gasping, or choking during sleep
Night sweats
Nocturia (nighttime urination)
Nighttime acid reflux
Dry mouth when awakening
Insomnia
Headaches
Irritability
Memory problems
Depression
Low sex life
Weight gain
If you have OSA, a person sleeping with you may notice you snore loudly, snort or make a choking sound when you start breathing again after a breathing pause. These symptoms may happen less often or go unnoticed in women with OSA. Other symptoms include:
More than usual daytime sleepiness
Waking up with a dry throat or headache
Waking up often during the night
Difficulty concentrating or mood changes during the day
Talk to your doctor if you experience symptoms of sleep apnea. The diagnosis of a sleep disorder such as OSA requires a sleep study done in a sleep lab or at home. A diagnosis will determine if your OSA is mild, moderate, or severe based on the average number of times you stop breathing each hour during sleep.
Studies suggest that having OSA raises the heart rate and increases blood pressure, placing stress on the heart. This may be because apneas frequently reduce blood oxygen levels, activating the branch of the nervous system responsible for increasing heart performance. In addition, levels of chemicals in the blood that cause inflammation and promote elevations in blood sugar rise. Such inflammation can damage the heart and blood vessels. 1, 2 Both hypertension and diabetes increase the risk for heart disease, and the likelihood of being diagnosed with one of these illnesses increases as a result of OSA.
Hypertension
High blood pressure is a common chronic medical condition. It afflicts over 40% of people between the ages of 50 and 60 years of age in the United States. OSA is a risk factor for the development of hypertension.3 Approximately 50% of those with sleep apnea have hypertension. In fact, elevated blood pressure might be the only clue that a person has OSA. Fortunately, treatment of OSA may result in better control or even resolution of hypertension.
Heart Disease
Coronary artery disease occurs in 67% of the adult population of the United States. It frequently results in heart attacks and premature death. Evidence indicates that OSA might be a risk factor for future heart attacks or angina pectoris (chest pain related to blockage of blood vessels supplying the heart), and middle-aged men might be at particular risk
Stroke
Having a stroke can be a devastating event, with the potential for severe disability or death. OSA might be a risk factor for having a stroke (see Figure 4), and recovery after a stroke might be delayed in people with OSA.5 Conversely, people who have had a stroke are more at risk of developing OSA.
Diabetes Mellitus
Coinciding with the increase in obesity in the United States, more and more people are developing type 2 diabetes. Research indicates that blood sugar (glucose) levels are higher among people with OSA. However, it appears that treatment of OSA may improve blood sugar levels.
Premature Death
Because OSA is associated with a number of chronic medical conditions, not surprisingly, several studies have shown an association between OSA and increased likelihood of premature death.
Middle-aged men appear to be at greatest risk, with the cause of death most commonly related to cardiovascular disease.
Sleepiness
Many people with OSA are excessively sleepy during the daytime. This can make it difficult to work, and can even lead to job loss. If you have OSA you might fall asleep while driving a car, watching television, reading, talking on the telephone, or even while eating a meal. People with OSA might not complain of sleepiness; they just think that they are “slowing down” and getting more tired as they get older.
Depression and Memory Problems
Depression is very common in people with untreated OSA. Frequently, people are treated for depression for years before anyone realizes that OSA is causing the depression. People with OSA can also have memory problems, difficulty concentrating, amnesia of events, and slower reaction times.
Impact on Family and Friends
OSA can have a major impact on family and friends. Depression makes it hard to maintain relationships, and people with OSA are less likely to engage in social activities, especially physical exercise, because they are too tired. Because of the loud, bothersome snoring associated with OSA, spouses or bed partners might choose to sleep in separate bedrooms. For men, OSA can also lead to problems with impotence, although this can be the motivation for getting a physical evaluation.
Diagnosis Sleep Apnea
Based on the findings, the doctor may recommend an overnight sleep study, also known as level 1 polysomnography or a home sleep test. Considered the gold standard for the diagnosis of OSA, the test involves connecting you to sensors that monitor your temperature, heart rate, brain waves, breathing rate and depth, nasal and mouth airflow, and body movements during sleep.1
Risk Factors
You should also suspect OSA if you have risk factors for the disorder. People of any age, sex, or weight can have OSA, but it is much more common in people who:
Are obese
Are male
Are over 50 years of age
Smoke cigarettes
Sleep on their back
Regularly use alcohol or sedatives (medications for sleep and anxiety)
Have enlarged tonsils or adenoids
Have hypothyroidism (underactive thyroid gland)
Have had a stroke
Have certain head and face features contributing to narrow upper airway”
Have a neck circumference of 17 inches or more for a male or 16 inches or more for a female
Treatment for Obstructive Sleep Apnea (OSA)
Getting treatment for OSA is key because OSA not only affects your sleep but increases your risk of serious health problems and even death. OSA may increase your risk of heart attack, stroke, type 2 diabetes, glaucoma, and some types of cancer along with other serious health conditions. Lifestyle behavior changes such as losing weight, drinking less alcohol, stopping smoking, and using devices that help you sleep in a certain position may help improve OSA, but may not make it go away entirely. Taking certain medicines, such as sedatives or sleep aids, that slow or lessen breathing can also contribute to OSA. Talk to your doctor before stopping or starting any medicine.
OSA treatments can work well to manage OSA, but not every treatment is right for everyone. Some treatments work best for people with mild OSA while others are best for people with more severe OSA. Sometimes you must try a specific treatment before you can move on to a different treatment. Some treatments involve surgery to correct a narrow airway or a specific part of the airway that may collapse during sleep. Any type of surgery has risks, so talk with your doctor about all of your options before you decide.
The U.S. Food and Drug Administration evaluates the safety and effectiveness of certain medical devices before they can be marketed to the public, including the device most often used for OSA. Depending on your health status and the type of OSA you may have, your doctor may prescribe one of these OSA treatments.
CPAP Machine
The most common OSA treatment is using a continuous positive airway pressure machine, commonly known as a CPAP machine, every night during sleep. CPAPs use mild air pressure to keep your airways open during sleep. The air is delivered through a mask that fits over your nose and mouth, or only your nose. CPAPs are considered the standard treatment for OSA, but you may need to work with a doctor or technician for a few weeks to find the best combination of settings and CPAP accessories for you.
Nasal Expiratory Positive Airway Pressure (EPAP)
This alternative treatment uses disposable or reusable valves inserted into or over the nostrils during sleep. The valves limit your exhalations or breaths out, which helps maintain pressure to keep your airway open during sleep. Unlike a CPAP machine, EPAP valves do not need power from an electrical outlet or batteries.
Oral Appliance
A prescription-only oral appliance is worn during sleep and fits like a sports mouth guard or an orthodontic retainer but is for both the top and bottom teeth. It keeps your jaw positioned forward so that your airway stays open while you sleep. A dentist takes impressions of your teeth so a custom device can be made and fitted for you.
Tongue Retaining Device
This type of oral appliance is worn in the mouth during sleep and includes a part that prevents your tongue from falling back into the airway during sleep.
Neuromuscular Tongue Muscle Stimulator
A neuromuscular tongue muscle stimulator is a prescription-only device you put in your mouth for 20 minutes a day while you are awake. The device delivers mild electrical currents to your tongue muscle, strengthening it so that it does not relax and block your airway as much during sleep.
Implantable Nerve Stimulator
The FDA approved a medical device for OSA that can be surgically implanted during an outpatient procedure. A surgeon implants the device, which is similar to a pacemaker, on the upper chest below the collarbone. During surgery the doctor places wires from the implant near the nerves that control your tongue and nearby muscles. The implant sends mild electrical impulses through the wires to nerves in your tongue muscles during sleep. The nerve stimulation prevents your tongue and the muscles around it from collapsing and blocking your airway during sleep.
Most implants have a remote control you use to turn the device on before going to sleep and off after waking up.
Position Therapy Device (a pillow or similar device)
A special pillow or other bed device may help mild to moderate positional OSA. Positional obstructive sleep apnea is caused by lying on your back (face-up) during sleep. A special pillow or similar bed device can help you stay sleeping on your side where gravity does not cause your tongue or throat to block your airway.
Before purchasing a device, some people try homemade positional methods such as a special pillow or bumpers for the bed.
Position Monitoring Device/Stimulation
A positional monitoring device can treat mild to moderate OSA caused by sleeping on your back. It is worn on the body (usually around the neck or chest) and monitors your sleeping position with a position accelerometer. When you are lying on your back, or face-up, during sleep the device vibrates in increasing intensity until you turn over to sleep on your side.
Medicines May Not Mix With OSA
There are no FDA-approved drugs to treat sleep apnea. Elisabeth Boulos, M.D., at the FDA’s Center for Drug Evaluation and Research, says that doctors sometimes prescribe medicines that help keep you awake if you have OSA and persistent daytime sleepiness despite treatment with a CPAP machine. These medicines may help manage some symptoms but do not fix the nighttime breathing problem.
Moreover, Dr. Boulos recommends that if you’ve been diagnosed with sleep apnea and are taking other medicines, you should let your doctor know what those medicines are. “A number of prescription drugs—in addition to alcohol and tobacco products—can actually make sleep apnea worse, including many for insomnia, anxiety or severe pain,” she says.
There are a lot of benefits to ongoing CPAP treatment such as:
Uninterrupted sleep
Successful CPAP therapy means less constant nighttime awakening when you stop breathing.
More energy during the day
Rather than feeling exhausted, you may wake up energized, ready to tackle the day.
Fewer headaches
CPAP therapy can help reduce headaches caused by lack of oxygen when you stop breathing.
Reduced snoring
Less snoring means a more peaceful sleep experience and happier bed partner.
OSA Self evaluation
These four yes-or-no “STOP” questions can help you determine your risk for sleep apnea:
S: Do you snore loudly (louder than talking or loud enough to be heard through closed doors)?
T: Do you often feel tired, fatigued, or sleepy during the day?
O: Has anyone observed you not breathing during sleep?
P: Do you have or have you been treated for high blood pressure?
You have a high risk of sleep apnea if you answered “yes” to two or more of these questions. You are strongly encouraged to discuss these results with your medical provider.
The questionnaire has an even higher predictive value when you answer four more questions:
B: Is your Body Mass Index more than 35 kg/m2?
A: Is your age more than 50 years old?
N: Is your neck circumference greater than 40 cm?
G: Is your gender male?
You have a high risk of sleep apnea if you answered “yes” to three or more of the eight STOP-BANG questions. You are strongly encouraged to discuss these results with your medical provider.
Most people with OSA usually have one or more of the following symptoms.
Excessive and inappropriate daytime sleepiness
Loud snoring occurring virtually every night
Apneas (pauses in breathing) witnessed by bed partner
Episodes of waking at night feeling short of breath or gasping for air
Insomnia
Problems with memory and/or concentration
Impotence
Changes in mood, particularly depression
Fatigue
In order to get a proper diagnosis, you must see a healthcare practitioner—either a primary care physician/clinician or a sleep specialist. He or she will obtain additional information and determine whether there are alternative explanations for your symptoms. Your doctor will decide whether further evaluation is necessary.