Sleep Apnea: Symptoms, Causes, Diagnosis, and Treatments

Sleep apnea is when a person’s breathing repeatedly stops and starts during sleep. These pauses, called apneas, last 10 seconds or more and occur multiple times per hour. Sleep apnea disrupts sleep quality, leading to daytime sleepiness and increased health risks. The National Council on Aging (2024) states that the disorder affects approximately 40 million adults in the United States, with 80% of moderate to severe cases remaining undiagnosed.

The symptoms of sleep apnea are loud snoring, gasping for air during sleep, and daytime sleepiness. The causes of sleep apnea are anatomical factors, neurological issues, and lifestyle factors.

Types of sleep apnea include obstructive sleep apnea (OSA), central sleep apnea (CSA), and complex sleep apnea syndrome, as highlighted by Suni, Eric (2024) in the Sleep Foundation article- “Sleep Apnea: What it is, its risk factors, its health impacts, and how it can be treated.”

Diagnosis of sleep apnea encompasses sleep studies like polysomnography (PSG) and monitoring for apneas during sleep. Treatment of sleep apnea consists of lifestyle changes, positive airway pressure therapy, oral appliances, and surgery.

What Is Sleep Apnea?

Sleep apnea is a sleep-related breathing disorder in which breathing repeatedly stops and starts during sleep. These pauses in breathing last at least 10 seconds and occur five or more times per hour. These interruptions, lasting at least 10 seconds each, occur five or more times per hour, leading to shallow breathing, a choking sound, or a snorting sound. The resulting drop in blood oxygen levels causes the brain to briefly awaken the individual to restore normal breathing. This cycle disrupts restful sleep, causing terrible sleepiness and feeling tired during the day.

A new study presented at the SLEEP annual meeting, led by Troxel, Wendy, et al. (2024), reveals that consistent use of positive airway pressure (PAP) therapy by individuals with obstructive sleep apnea improves their relationship with their partners. The research “0569 Breathing Easy Together: How Positive Airway Pressure Adherence Benefits Both Patients and Partners” shows that greater adherence to PAP therapy is linked to higher relationship satisfaction and reduced conflict.  Additionally, better sleep efficiency among patients correlates with increased relationship satisfaction for patients and their partners. 

Troxel emphasized the relevance of sleep in maintaining healthy relationships, noting that addressing sleep disorders like sleep apnea prevents issues such as “sleep divorces.” The study, supported by a National Institutes of Health grant, involved 36 couples over three months, tracking PAP therapy adherence, sleep quality, and relationship dynamics. 

Sobering statistics from the National Council on Aging disclose that approximately 40 million Americans (almost 20% of the population) suffer from sleep apnea, making it a common affliction. 

What Are the Types of Sleep Apnea?

The types of sleep apnea include obstructive sleep apnea (OSA), central sleep apnea (CSA), and complex sleep apnea syndrome. The most important types of sleep apnea are given below as highlighted by Suni, Eric (2024) in the Sleep Foundation article- “Sleep Apnea: What it is, its risk factors, its health impacts, and how it can be treated”:

• Obstructive Sleep Apnea (OSA): OSA occurs when throat muscles relax and block the flow of air during sleep.. Causative factors of OSA include obesity, enlarged tonsils, or structural abnormalities in the throat.

According to Ling, Vanessa (2024) in the article “Sleep Apnea Statistics and Facts You Should Know,” published by the National Council on Aging, nearly 44% of men and 28% of women snore regularly. 

Symptoms include loud snoring, choking or gasping sounds during unconscious breath, and excessive daytime sleepiness.

However, the American Academy of Sleep Medicine’s (2021) article “Is it more than a snore? Recognizing sleep apnea warning signs,” suggests that the prevalence might be even higher, with about 70% of bed partners reporting that their partner snores. While snoring alone doesn’t always indicate obstructive sleep apnea (OSA), it is a key symptom, with up to 94% of individuals with OSA reporting loud snoring.

Common treatments are positive airway pressure (PAP) therapy and lifestyle changes such as weight loss.

• Central Sleep Apnea (CSA): CSA happens when the brain fails to send proper signals to the breathing muscles. Causes include neurological conditions such as stroke or heart failure, or it can occur idiopathically.

CSA is less common, affecting less than 1% of people. In a cross-sectional study, “Prevalence and Characteristics of Central Compared to Obstructive Sleep Apnea: Analyses from the Sleep Heart Health Study Cohort,” by Donovan, Lucas M. & Kapur, Vishesh K. (2016) published in the Sleep Research Society, central sleep apnea (CSA) was found to have a prevalence of 0.9% among adults aged 40 and older, based on the largest sleep cohort available.  

Symptoms include periods of no breathing, Cheyne-Stokes respiration patterns, and waking up with a dry mouth due to a reduced percentage of oxygen and hypoxia.

The study highlighted that obstructive sleep apnea (OSA) is much more common than CSA, especially among individuals with heart failure. The Sleep Heart Health Study (SHHS), conducted from 1995 to 2006, involved 6,441 participants aged 40 and older. At baseline, data were collected through polysomnography (PSG), EKG, blood pressure measurements, and health questionnaires. 

The PSG data were scored centrally using standardized criteria, with data from 5,804 participants available through the National Sleep Research Resource (NSRR). The study was conducted with approval from the NSRR and institutional review boards with informed consent obtained from all participants.

Treatment options are positive airway pressure (PAP) therapy and lifestyle modifications such as weight loss.

• Complex Sleep Apnea: Complex sleep apnea syndrome, also known as treatment-emergent central sleep apnea, is characterized by the development of central sleep apnea in individuals already receiving treatment for obstructive sleep apnea. This condition arises from persistent hypoxia and hypercapnia despite treatment for OSA.

Symptoms are recurring apneas, fluctuating breathing patterns such as Cheyne-Stokes respiration, and daytime fatigue due to persistent sleep disturbances.

CSA is where central apneas (more than 5 per hour) persist or emerge even after obstructive events are treated with positive airway pressure (PAP). This type combines features of both OSA and CSA. It occurs in about 15% of sleep apnea cases. 

Treatments are adaptive servo-ventilation (ASV), bilevel positive airway pressure (BiPAP) therapy, and treatment of underlying medications.

In the journal Sleep Disorders, Muhammad Talha, Khan and Rose, Amy Franco (2014) discuss their research on “Complex Sleep Apnea Syndrome.” Unlike other causes of central apneas, such as narcotics or systolic heart failure, this syndrome is driven by ventilatory instability related to fluctuations in arterial CO2 levels, increased CO2 elimination due to CPAP, and the activation of airway and pulmonary stretch receptors. The prevalence of this condition varies widely, ranging from 0.56% to 18%, with no clear predictive characteristics distinguishing it from simple obstructive sleep apnea. 

The prognosis is similar to obstructive sleep apnea, with most patients experiencing resolution of central apneas during follow-up with CPAP therapy. For those whose central apneas persist, alternative treatments include bilevel PAP, adaptive servo-ventilation, permissive flow limitation, and medication.

What Are the Symptoms of Sleep Apnea?

The most common symptoms of sleep apnea are loud snoring, gasping for air during sleep, and daytime sleepiness. Loud snoring is when the airway becomes partially obstructed, causing vibrations in the throat as air flows over the narrowed passage. Excessive daytime sleepiness is attributed to a steady need to sleep during the day, despite having had a full night’s sleep. Repeated pauses in breathing, or apneas, ensue when breathing stops for at least 10 seconds during sleep because of an obstructed airway. The most common symptoms of sleep apnea are given below as spotlighted by the American Academy of Sleep Medicine’s (2021) article “Is it more than a snore? Recognizing sleep apnea warning signs”:

• Loud, Chronic Snoring: Loud, chronic snoring is the persistent, noisy breathing that occurs during sleep due to partially blocked airways. It can disrupt sleep for both parties and is a frequent occurrence in people with sleep apnea, in 94% of cases. Triggers are lying on the back or consuming alcohol before bedtime while alleviating factors that help are sleeping on one’s side or using a CPAP machine.

According to the study “Objective Relationship Between Sleep Apnea and Frequency of Snoring Assessed by Machine Learning” published in the Journal of Clinical Sleep Medicine (2019) by Alshaer, Hiram, et al., the connection between sleep apnea and snoring frequency has been analyzed using machine learning techniques, and found to be the primary indicator of obstructive sleep apnea (OSA), occurring in 94% of cases. 

• Excessive Daytime Sleepiness: Excessive daytime sleepiness is a condition characterized by persistent tiredness and difficulty concentrating during the day. 

This symptom is severe and persistent, stemming from fragmented sleep due to repeated apneas. It affects daily functioning, and cognitive performance, and increases the risk of accidents. Triggers include insufficient nighttime sleep or irregular sleep patterns while alleviating factors are adhering to a consistent sleep schedule and use of CPAP therapy.

A cross-sectional study titled “Evaluation of Sleep Quality and Risk of Obstructive Sleep Apnea in Patients Referred for Aesthetic Rhinoplasty” by Miyahara, Lucas, Kenzo, et al. (2019) found that among 44 participants, 18 (41%) were male and 26 (59%) were female. The study revealed that 82% of the participants experienced poor sleep quality, while 46% reported excessive daytime sleepiness. Additionally, 27% were identified as being at high risk for Obstructive Sleep Apnea (OSA). The average score for nasal symptoms, measured by the Nasal Obstructive Symptoms Evaluation, was 66.25±25.38. Comparisons between participants with good and poor sleep quality showed a significantly higher risk for OSA (p=0.05) in those with poor sleep quality. Furthermore, participants at high risk for OSA had considerably higher scores on both the Nasal Obstructive Symptoms Evaluation (p=0.001) and the analog snoring scale (p<0.001) in comparison to those at low risk.

These p-values indicate the statistical significance of the differences observed. A p-value of 0.05 suggests a borderline sizeable difference in the risk of OSA between those with good and poor sleep quality. A p-value of 0.001 expresses a big distinction in nasal obstruction symptoms between high-risk and low-risk OSA groups. A p<0.001 on the analog snoring scale means a huge difference in snoring severity between participants at high risk for OSA and those at low risk.

• Morning Headaches: Morning headaches are frequent headaches that happen upon waking. According to the study “Prevalence and Risk Factors of Morning Headaches in the General Population” by Maurice M. Ohayon (2004), between 18% and 41% of patients with Obstructive Sleep Apnea Syndrome (OSAS) recounted experiencing morning headaches. Triggers of sleep apnea morning headaches are poor sleep quality and oxygen deprivation during sleep while alleviating factors require proper management of sleep apnea with CPAP therapy. 

These headaches spring from oxygen deprivation during sleep. A study by Suzuki, Keisuke, et al. (2015), titled “Sleep Apnoea Headache in Obstructive Sleep Apnoea Syndrome Patients Presenting with Morning Headache: Comparison of the ICHD-2 and ICHD-3 Beta Criteria,” reveals that these headaches typically present as a pressing sensation on both sides of the forehead and last about 30 minutes.

• Mood Changes: Mood changes refer to alterations in emotional states, including irritability, depression, and anxiety. These changes stem from poor sleep quality, which negatively impacts mental health.  Triggers of mood changes in sleep apnea are consistent poor sleep and chronic fatigue. Boosting sleep quality through treatment helps alleviate mood disturbances.

In the study “Mood, Behavioral Impairment, and Sleep Breathing Disorders in Obstructive Sleep Apnea Syndrome Patients Treated with Maxillomandibular Advancement: Reflection on a Case Series and Review of Literature” by Stilo, Giovanna, et al. (2023), the correlation between depressive and cognitive symptoms in patients with Obstructive Sleep Apnea Syndrome (OSAS) ranges from 5% to 63%. This wide berth spells that in diverse studies, between 5% and 63% of individuals with OSAS also exhibit depressive and cognitive symptoms. The variation implies that while some patients with OSAS have mild or no symptoms, others experience more serious mental health impairments.

The study brings into focus two cases of severe OSAS patients who were intolerant to continuous positive airway pressure (C-PAP) and subsequently underwent maxillomandibular advancement (MMA) surgery. The gravity of their depressive and cognitive symptoms was evaluated through validated questionnaires, medical observation, and patient self-reports, with pre- and post-treatment polysomnography conducted. Six months post-surgery, the apnea–hypopnea index (AHI) normalized, depressive symptoms remarkedly went down, and quality of life rose. The study concluded that marked progress was observed in physical and mental functioning, as well as in depression and anxiety levels.

• Night Sweats: Night sweats are episodes of excessive sweating during sleep, affecting about 30% of people with sleep apnea. Night sweats are due to strained breathing effort and elevated body temperature. These night sweats are frequent, exasperating further discomfort and disturbed rest. Triggers of night sweats are because apneas and the body’s reaction to greater breathing effort. Alleviating factors are the efficient management of sleep apnea symptoms through lifestyle changes and the use of CPAP therapy.

A study by Arnardottir, Erna Sif, et al. (2013), titled “Nocturnal Sweating—A Common Symptom of Obstructive Sleep Apnoea: The Icelandic Sleep Apnoea Cohort,” aimed to assess the prevalence and characteristics of frequent nocturnal sweating in patients with Obstructive Sleep Apnea (OSA) compared to the general population, and to evaluate the impact of positive airway pressure (PAP) treatment. Nocturnal sweating, which is unsettling for patients and their bed partners, was a key focus.

The study was conducted as a case-control and longitudinal cohort study at Landspitali—The National University Hospital, Iceland. It involved 822 untreated OSA patients from the Icelandic Sleep Apnea Cohort, with 700 of these patients also assessed after two years. A control group consisted of 703 randomly selected individuals from the general population.

Patients with OSA received PAP therapy, and the main outcome measured was the frequency of nocturnal sweating, reported on a scale from “never” to “every night.” Full PAP treatment was defined as usage for at least 4 hours per day on at least 5 days per week.

Results showed that frequent nocturnal sweating (occurring 3 or more times per week) was reported by 30.6% of male and 33.3% of female OSA patients, compared to only 9.3% of men and 12.4% of women in the general population, a statistically significant difference (p<0.001). After adjusting for demographic factors, this difference remained significant. Nocturnal sweating was more common among younger patients, those with cardiovascular disease, hypertension, sleepiness, and insomnia symptoms. Importantly, the prevalence of frequent nocturnal sweating in OSA patients decreased significantly with full PAP treatment, from 33.2% to 11.5% (p<0.003).

The study concluded that untreated OSA patients are three times more likely to experience frequent nocturnal sweating than the general population, and that successful PAP therapy lessens this symptom to levels similar to those in the general population. Clinicians are advised to consider the possibility of OSA in patients who report frequent nocturnal sweating.

What Are the Symptoms of Sleep Apnea in Children?

The most commonly observed symptoms of sleep apnea in children are snoring, restless sleep, and daytime behavioral issues. Pediatric sleep apnea affects 1-5% of children and requires prompt treatment to prevent developmental problems. “Obstructive sleep apnea affects 3 to 6 percent of children and is associated with repetitive narrowing of the airways, which is the breathing tube from the mouth and the nose down to the lungs,” explains Yale Medicine’s Dr. Craig A. Canapari, director of the Pediatric Sleep Medicine Program. The most common symptoms of sleep apnea in children are given below as explained by Dr. Craig A. Canapari in the “Factsheets: Pediatric Obstructive Sleep Apnea”:

• Loud snoring: Loud snoring is the noisy, disruptive sound produced by the vibration of soft tissues in the throat during sleep. Persistent, loud snoring occurs in children with sleep apnea. Habitual snoring is the primary symptom of OSA, impacting up to 27% of children, with a median prevalence of around 10–12%, elaborated by Gozal, David (2008) in the study “Obstructive Sleep Apnea in Children: Implications for the Developing Central Nervous System.”

• Mouth breathing: Mouth breathing refers to the habit of inhaling and exhaling through the mouth instead of the nose. This behavior results in dry mouth, dental issues, and disrupted sleep, as it interferes with the body’s natural breathing mechanisms. Breathing through the mouth instead of the nose affects children with sleep apnea. Mouth breathing is a prevalent harmful oral habit in children and a sign of sleep-disordered breathing (SDB). Its prevalence varies from 11 to 56%, as explored by Lin, Lizhuo, et al. (2022) in the research review, “The Impact of Mouth Breathing on Dentofacial Development: A Concise Review.”

• Bedwetting: Bedwetting is the involuntary release of urine during sleep, predominantly in children, but it also affects adults. This condition, known as nocturnal enuresis, ensues from delayed bladder development, deep sleep patterns, or stress. Nighttime urination occurs in 33% of children with sleep apnea, compared to 15% of children without the disorder, spotlighted by Ikpeze, Tochukwu’s study “Sleep Apnea’s Nighttime Urination & Sleep Apnea.”

• Hyperactivity: Hyperactivity is an excessive level of activity and restlessness, observed as an inability to sit still, focus, or control impulses. ADHD-like symptoms during the day affect 23% of children with sleep apnea due to poor sleep quality. Huang, Yu-Shu, et al. (2007) study, “Attention-deficit/hyperactivity disorder with obstructive sleep apnea: A treatment outcome study,” examines whether treating obstructive sleep apnea (OSA) in children with attention-deficit/hyperactivity disorder (ADHD) yields similar results to using methylphenidate (MPH), a common ADHD medication. 

The study included 66 children diagnosed with ADHD and 20 healthy controls. Polysomnography (PSG) identified mild OSA in the ADHD group. Participants were treated with MPH, adenotonsillectomy (surgery for OSA), or no treatment. 

After six months, both MPH and adenotonsillectomy showed improvements compared to no treatment. Nevertheless, the adenotonsillectomy group experienced greater improvements in sleep, daytime symptoms, and ADHD ratings compared to the MPH group. The adenotonsillectomy group’s ADHD scores were similar to those of normal controls. 

The study concludes that addressing mild OSA in ADHD children through surgery minimizes the need for long-term MPH use and its potential side effects.

What Are the Causes of Sleep Apnea?

The causes of sleep apnea are anatomical factors, neurological issues, and lifestyle factors. The most common causes for sleep apnea are explained below based on Singh, Jaspal’s (2013) American College of Cardiology (2013) article “Basics of Central Sleep Apnea.”

• Obstructive Sleep Apnea (OSA): OSA occurs when throat muscles relax excessively during sleep, blocking airflow. Obstructive sleep apnea results from physical blockage of the airway, while central sleep apnea stems from brain signaling problems. This obstruction leads to pauses in breathing lasting 10 seconds or more. Risk factors are obesity, large neck circumference, and anatomical abnormalities of the upper airway.

• Central Sleep Apnea: CSA is the brain failing to signal the breathing muscles properly, often due to nervous system damage such as from amyotrophic lateral sclerosis (ALS) or spinal cord injuries. This produces periods of no breathing effort. CSA is linked to heart failure, certain medications, and high altitude exposure. It accounts for 5-10% of sleep apnea cases referred to sleep labs on the authority of the American College of Cardiology (2013) in “Basics of Central Sleep Apnea.”

• Mixed/Complex Sleep Apnea: This type combines features of both OSA and CSA. It occurs when OSA treatment unmasks underlying CSA. Complex sleep apnea affects approximately 15% of sleep apnea patients treated with CPAP therapy.

What Are the Risk Factors of Sleep Apnea?

The common risk factors of sleep apnea comprise obesity, age, gender, and family history. The most important risk factors for sleep apnea are elaborated below, predicated on the American College of Cardiology (2013) “Basics of Central Sleep Apnea”:

• Obesity
• Large Neck Circumference
• Enlarged Tonsils or Tongue
• Narrow Upper Jaw or Small Lower Jaw 
• Tongue Scalloping: 
• Family History
• Endocrine Disorders
• Lifestyle Habits
• Wakefulness
• Atrial Fibrillation
• Stroke Survivors
• Spinal Cord Injury

How Is Sleep Apnea Diagnosed?

Diagnosing sleep apnea usually involves a healthcare provider asking about your symptoms and history. This initial inquiry helps identify potential signs of the condition and directs the need for further testing, such as sleep studies, to confirm the diagnosis and assess severity as per Cleveland Clinic’s (2022) article “Overview- What is sleep apnea?”

What Tests are Used to Diagnose Sleep Apnea?

The common tests to diagnose sleep apnea are polysomnography, home sleep apnea testing, and drug-induced sleep endoscopy. These diagnostic tools support clinicians in accurately pinpointing and assessing sleep apnea. The most common tests used to diagnose sleep apnea are given below as noted by the Mayo Clinic (2023) article “Obstructive sleep apnea: Diagnosis”:

• Overnight sleep study (polysomnogram): Polysomnography is the gold standard for diagnosing sleep apnea. According to Chuan-Jen Hung et al. (2022) in the study titled “Comparison of a Home Sleep Test with In-Laboratory Polysomnography in the Diagnosis of Obstructive Sleep Apnea Syndrome,” polysomnography (PSG) has shown high sensitivity and specificity in diagnosing obstructive sleep apnea (OSA). Research indicates that PSG can accurately detect OSA in patients, with sensitivity rates often surpassing 90% when compared to other diagnostic methods, such as home sleep apnea testing (HSAT).

This test involves monitoring sleep through a sleep lab, where brain waves, heart rate, breathing patterns, and oxygen levels are recorded. Polysomnography is conducted under the supervision of trained technicians and detects the number and severity of apnea episodes, including those caused by airway obstruction. This comprehensive study provides crucial data for diagnosis and treatment planning.

• Home sleep apnea testing: Home sleep tests offer a convenient alternative for diagnosing sleep apnea. These portable devices, used at home, monitor breathing patterns, heart rate, and oxygen levels during sleep. While less comprehensive than polysomnography, home sleep tests accurately diagnose moderate to severe OSA in 87% of cases under a study by Simmonds, Anita K. (2022) in “How Many More Nights? Diagnosing and Classifying Obstructive Sleep Apnea Using Multinight Home Studies.”

• Drug-induced sleep endoscopy (DISE): DISE involves sedating the patient to simulate sleep and visualize upper airway obstruction. This procedure helps identify specific sites of obstruction in the nose, throat, palate, and tongue, guiding decisions for surgical treatment. DISE bolsters surgical outcomes by 64% compared to standard clinical evaluation alone, as noted by Di Bari, Matteo (2023) in “The Effect of Drug-Induced Sleep Endoscopy on Surgical Outcomes for Obstructive Sleep Apnea: A Systematic Review.” Trans-oral robotic surgery and hypoglossal nerve stimulators are advanced surgical treatments that may be considered based on findings from DISE, often requiring coordination with an anesthesiologist.

How Is Sleep Apnea Treated?

The treatment of sleep apnea includes lifestyle changes, positive airway pressure therapy, oral appliances, and surgery. The most common ways sleep apnea is treated are explained below, as revealed by the Cleveland Clinic (2022) in the article “Overview- What is sleep apnea?” Effective treatment improves sleep quality, reduces daytime symptoms, and lowers the risk of associated health complications.

Non-Surgical and Non-Invasive Approaches

Non-surgical approaches are treatment methods that do not involve surgical procedures. These strategies focus on lifestyle changes, behavioral therapies, and medical devices to manage conditions like sleep apnea without the need for invasive surgery. These methods aim to refine overall health and well-being by addressing the root causes of the disorder through non-invasive means. 

Non-invasive approaches refer to treatments that do not require entering the body or breaking the skin. These approaches include using external devices, medications, or techniques that treat a condition without physical intervention. They are preferred due to lower risks, quicker recovery times, and minimal discomfort compared to invasive procedures.

Non-surgical and non-invasive approaches form the first line of treatment for sleep apnea. These methods focus on lifestyle modifications and non-invasive therapies to improve breathing during sleep. The following are the most effective non-surgical approaches for sleep apnea:

• Losing Weight Through Diet and Exercise: Losing weight through diet and exercise involves reducing body weight by adopting healthier eating habits and engaging in regular physical activity. Weight loss cuts excess soft tissue in the throat, which improves airway patency and reduces the severity of sleep apnea. According to the Wisconsin Sleep Cohort Study (1993), a 10% decrease in body weight leads to a 26% reduction in the severity of sleep apnea.
• Position Therapy and Sleep Aids: Position therapy and sleep aids refer to techniques and devices designed to promote sleep in a specific position, usually on the side, to reduce sleep apnea episodes. Sleeping on the side lessens apnea episodes by 30-50% compared to back sleeping. The efficacy of this approach was highlighted in a study by Srithijesh, P. R. et al. (2019) published in the Cochrane Library. Support pillows and positioning devices assist in maintaining an optimal sleep posture, thereby decreasing the frequency of apnea events.
• Nasal Decongestants and Adhesive Nasal Strips: Nasal decongestants and adhesive nasal strips are products used to enhance nasal airflow by reducing congestion and physically opening the nasal passages. These products help diminish snoring and alleviate mild sleep apnea symptoms by ensuring a clearer airway during sleep.
• Addressing the Root Cause: Addressing the root cause involves treating the underlying medical conditions that contribute to sleep apnea, such as hypothyroidism or opioid use. Stopping opioid pain medications resolves these contributing factors and sometimes eliminates sleep apnea symptoms altogether.
• Pharmaceutical Treatments: Pharmaceutical treatments for sleep apnea involve using medications to manage symptoms, particularly in patients resistant to continuous positive airway pressure (CPAP) therapy. One such medication is modafinil, which bolsters daytime alertness in sleep apnea patients, helping them stay awake and function better during the day. 

In the study “Modafinil Improves Daytime Sleepiness in Patients with Mild to Moderate Obstructive Sleep Apnoea Not Using Standard Treatments: A Randomised Placebo-Controlled Crossover Trial,” Chapman, Julia L., et al. (2014) found that in patients with untreated mild to moderate OSA, modafinil significantly improved Epworth Sleepiness Scale (ESS) scores by 3.6 points compared to placebo (95% CI 1.3 to 5.8, p=0.003) over two weeks.

In this trial, patients who took modafinil had an average improvement in their ESS scores by 3.6 points compared to those who took a placebo. The improvement was statistically significant, meaning the difference was unlikely to be due to chance.

The 95% confidence interval (CI) of 1.3 to 5.8 indicates that the true average improvement in ESS scores is likely between 1.3 and 5.8 points, with 95% certainty. The p-value of 0.003 shows that the likelihood of this result happening by random chance is only 0.3%, which confirms that modafinil had a real effect in reducing daytime sleepiness in these patients.

Pressurized Airflow and Adaptive Ventilation Systems

Positive airway pressure is a method that uses a specialized device to increase the air pressure inside your airway while you inhale. Continuous Positive Airway Pressure (CPAP) machines deliver pressurized air through a mask, keeping the airway open during sleep. CPAP therapy eliminates apnea episodes and helps maintain clear airways throughout the night. Additionally, servo-ventilation devices may be used in some cases to assist with breathing by adjusting pressure based on real-time needs, particularly if standard CPAP is insufficient.

CPAP therapy eliminates apnea episodes as measured using the Epworth Sleepiness Scale, where patients report feeling less sleepy by an average of about 2.7 points, as noted by the “Obstructive Sleep Apnea Syndrome,” a Report of a Joint Nordic Project (2007). This improvement reflects better sleep quality and reduced daytime sleepiness, benefiting the function of lungs and airway health.

Mandibular Advancement Splints (MAS)

Mandibular advancement splints are oral appliances used to reposition the lower jaw forward during sleep. This adjustment prevents soft tissue in the head and neck, especially around the mouth and jaw, from collapsing and pressing downward on the windpipe. When these tissues press downward on the windpipe, they can obstruct the airway, leading to obstructive sleep apnea. By keeping the airway open, MAS devices help alleviate this obstruction.

Mandibular Advancement Splints (MAS) are effective in treating mild to moderate obstructive sleep apnea (OSA). They reduce apnea episodes by 50% in 65% of patients, lowering their Apnea-Hypopnea Index (AHI) to fewer than 5 events per hour. This information is supported by the research of Sutherland K. & Cistulli P. (2011) in “Mandibular Advancement Splints for the Treatment of Sleep Apnoea Syndrome.” Collaboration between dentists and sleep medicine specialists is crucial in prescribing and fitting MAS for optimal results.

Neurostimulation Devices 

Neurostimulation devices are advanced medical tools that electrically stimulate specific nerves to enhance bodily functions. In sleep apnea, hypoglossal nerve stimulation devices activate the nerve controlling tongue movements. 

This stimulation prevents the tongue from blocking the airway during sleep, thereby reducing sleep apnea severity by 68% and improving the quality of life for patients who struggle with CPAP therapy, as highlighted by the Cleveland Clinic Sleep Disorders Center’s Kaur, Sunjeet (2023) in the article “Upper Airway Neurostimulation Device for the Treatment of Obstructive Sleep Apnea.”

Surgery

The surgery for sleep apnea includes radiofrequency ablation for snoring and sleep apnea, surgical removal of tonsils and adenoids, uvula, palate, and throat surgery for obstructive sleep apnea, maxillomandibular advancement (mma) or orthognathic surgery, septoplasty and turbinectomy. Surgical interventions target anatomical obstructions in the upper airway, aiming to widen the airway and improve airflow during sleep. The most common surgical procedures for sleep apnea: are explained below as discussed by J., Christine H., et al. (2007) in “Surgical Treatment of Obstructive Sleep Apnea: Upper Airway and Maxillomandibular Surgery”:

• Radiofrequency Ablation for Snoring and Sleep Apnea: This minimally invasive procedure uses radiofrequency energy to shrink and stiffen soft palate tissue. According to Abd-Elsayed, Alaa et al.’s study (2020) “The Long-Term Efficacy of Radiofrequency Ablation With and Without Steroid Injection,” patients who underwent RFA experienced an average pain relief improvement of 46-48% lasting 126-138 days.
• Surgical Removal of Tonsils and Adenoids: Known as tonsillectomy and adenoidectomy, these surgeries eliminate airway obstruction in children with sleep apnea. This surgery cures sleep apnea in 80-90% of pediatric cases, as proscribed by the Royal Children’s Hospital Melbourne (2018).
• Uvula, Palate, and Throat Surgery for Obstructive Sleep Apnea: Uvulopalatopharyngoplasty (UPPP) is a procedure that removes excess tissue in the throat to widen the airway. A systematic review by He, Mu, et. al. (2019) titled “Long-term Efficacy of Uvulopalatopharyngoplasty among Adult Patients with Obstructive Sleep Apnea: A Systematic Review and Meta-analysis,” discloses that UPPP alleviates sleep apnea symptoms in 50-60% of patients.
• Maxillomandibular Advancement (MMA) or Orthognathic Surgery: MMA surgery moves the upper and lower jaws forward to enlarge the airway space. The Mayo Clinic’s article “Maxillomandibular Advancement Surgery: A Classic Procedure Refined” notes that 70% of patients feel their facial appearance improves post-surgery, while 20-25% report no significant change. Long-term negative effects are rare, but outcomes are evident within nine to twelve months.
• Septoplasty and Turbinectomy: These surgical procedures clear nasal airflow to flow better. Septoplasty corrects a deviated nasal septum, while turbinectomy reduces or removes parts of the turbinates, which are structures in the nose that can obstruct breathing when enlarged. 

Valero A., et al. (2018) in their “Position paper on nasal obstruction: evaluation and treatment,” noted that the prevalence of nasal obstruction in adults ranges from 15% to 30%, underscoring its widespread footprint.

Is There a Connection Between Sleep Apnea and Insomnia?

Yes, there is a strong connection between sleep apnea and insomnia. Research published in the Journal of Clinical Medicine, specifically “Comorbid Insomnia and Obstructive Sleep Apnea: Challenges for Clinical Practice and Research” by Luyster, Faith S., et al. (2010), shows that 39-58% of sleep apnea patients also experience insomnia symptoms. The two conditions share similar symptoms, including difficulty falling asleep, frequent awakenings, and daytime fatigue.

The co-occurrence of insomnia and obstructive sleep apnea (OSA), two prevalent sleep disorders, was first documented in 1973. This condition, known as comorbid insomnia and sleep apnea (COMISA), is highly prevalent. Research by Sweetman, Alexander, et al. (2021), “Bi-directional relationships between co-morbid insomnia and sleep apnea (COMISA),” showcases that 50-60% of patients diagnosed with OSA also experience chronic insomnia, while 30-40% of those initially diagnosed with insomnia have comorbid OSA. 

Researchers, as printed by Neurology Advisor (2022) in their research “Insomnia and Sleep Apnea Is a Challenging Co-Occurrence: Here’s What We Know, researchers at the Adelaide Institute for Sleep Health,” Flinders University, in Australia, introduced the term COMISA to describe this overlap, as reported in Sleep Medicine Reviews (2016).

Sweetman, Alexander, et al. (2019), in the study “Cognitive and Behavioral Therapy for Insomnia Increases the Use of Continuous Positive Airway Pressure Therapy in Obstructive Sleep Apnea Participants with Co-morbid Insomnia: A Randomized Clinical Trial,” found that the ‘double whammy’ of co-occurring insomnia and obstructive sleep apnea is best managed with targeted non-drug psychological interventions. 

Following simple new guidelines led to substantial advancements in both sleep and overall health for those with these concurrent conditions, with around a 50% drop in global insomnia severity and night-time insomnia after six months.

What Happens If I Have Sleep Apnea and Don’t Treat It?

If you have sleep apnea and don’t treat it, serious health complications arise. Untreated sleep apnea imposes excessive daytime sleepiness, expanded risk of car accidents, high blood pressure, heart disease, stroke, and type 2 diabetes, as analyzed by Cleveland Clinic’s (2022) article“Overview- What is sleep apnea?” The repeated drops in blood oxygen levels during apnea episodes strain the cardiovascular system, doubling the danger of a heart attack and stroke.

Can I have Sleep Apnea even If I don’t Snore?

Yes, you can have sleep apnea even if you don’t snore. Snoring is a standard symptom of OSA, affecting 95% of patients, not everyone with sleep apnea snores loudly, as posited by the National Council on Aging (2024), which reports that approximately 5-10% of sleep apnea patients do not report major snoring.. Central sleep apnea, in particular, does not always incorporate snoring. 

How Common Is Sleep Apnea in Men?

Sleep apnea is more common in men, affecting 24% of males and 9% of females. In the Wisconsin Sleep Cohort Study (1993), sleep-disordered breathing prevalence, characterized as an AHI of 5 or higher, was 9% for women and 24% for men. The higher prevalence in men stems from anatomical differences in the upper airway and the influence of male hormones. Risk factors for sleep apnea in men are obesity, large neck circumference, and age over 40.

How Common Is Sleep Apnea in Women?

Sleep apnea is less common in women, affecting 9% compared to 24% in men, with pervasiveness rising after menopause. Men aged 30 to 49 are four times more likely to have sleep apnea than women. 

Nonetheless, this gap narrows between ages 50 and 70, with men being only twice as likely as women to experience OSA, according to Peppard PE., et al. (2013) in the research “Increased Prevalence of Sleep-Disordered Breathing in Adults” published in the American Journal of Epidemiology. Hormonal changes during menopause inflate the peril of sleep apnea by 3-4 times. Women with sleep apnea present with differing symptoms than men, such as insomnia, depression, and morning headaches. 

How Common Is Sleep Apnea in Young Adults?

Sleep apnea is less common in young adults, held at 16%. Postulated by Zasadzińska-Stempniak, Katarzyna, et al. (2024) in the research review “Prevalence of Obstructive Sleep Apnea in the Young Adult Population: A Systematic Review,” “the prevalence of OSA among young adults was found to be ~16%.” 

Risk factors in this age group are obesity, craniofacial abnormalities, and certain medical conditions writes Douglas Neil J. (2002) in the book, “Clinician’s Guide to Sleep Medicine.” Young adults with sleep apnea experience considerable daytime sleepiness and cognitive impairment, affecting academic and work performance.

How Common Is Sleep Apnea in Kids?

Sleep apnea is less common in children, impacting 1-5%, with a peak prevalence between ages 2 and 8. The most common cause in children is enlarged tonsils and adenoids. Untreated pediatric sleep apnea induces growth problems, behavioral issues, and learning challenges, as discussed by Savini S. et al. (2019) in the research assessment “Assessment of obstructive sleep apnoea (OSA) in children: an update.”

Does CPAP Really Help Sleep Apnea?

Yes, CPAP does help with sleep apnea. Consistent CPAP use rallies sleep quality, cognitive function, and quality of life as concluded by Cleveland Clinic’s (2024) article “Overview- What is a CPAP machine?” CPAP treatment also lowers blood pressure and reduces the risk of cardiovascular complications associated with sleep apnea.