Always tired? You may have sleep apnea
FDA photo montage.
U.S. Food and Drug Administration (FDA)
Getting treatment for obstructive sleep apnea or OSA can save your life and help you feel better every day.
Do you feel tired or have a headache when you wake up in the morning? Something might be going wrong while you sleep that you don’t know about: obstructive sleep apnea (pronounced app-nee-uh).
What is Obstructive Sleep Apnea?
The Greek word “apnea” means “without breath.” An apnea is defined as a pause in breathing for at least 10 seconds. Obstructive sleep apnea, also called OSA, causes you to stop breathing in your sleep for several seconds, up to many times an hour.
People diagnosed with OSA have at least five breathing pauses an hour and can have many more. During these breathing pauses, your brain, heart, kidneys, and other essential organs do not get enough oxygen, and carbon dioxide can build up in your body. When your brain notices there is not enough oxygen and too much carbon dioxide in your body, it sends out a signal to take a breath. You wake up enough to take a few breaths, but not enough to remember it the next morning. This cycle repeats itself many times each night, making you feel tired or exhausted in the morning.
When you have OSA, the apnea is caused by an obstruction or blockage. Usually the blockage is tongue muscles, soft palate or parts of your throat that relax too much during sleep and block your airway. A less common form of sleep apnea, called central sleep apnea, happens if the area of your brain that controls breathing does not send the correct signals to the muscles that help you breathe.
If you have OSA, a person sleeping near you may notice that you snore loudly, and occasionally pause breathing and make a snort or choking sound when you start breathing again. 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.
• Waking up often during the night to urinate.
• 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 pause breathing each hour during sleep.
Getting Treatment
There are treatments for OSA that work well. Eric Mann, M.D., Ph.D. at the FDA’s Center for Devices and Radiological Health says, “Many FDA-approved and FDA-cleared devices can help people with OSA wake up in the mornings feeling rested and refreshed, improving their overall health.”
Getting treatment for OSA is key because OSA not only affects your sleep but also increases your risk of serious health problems and even death. Chronic (ongoing), untreated 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. 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 treatment (CPAP machine). Depending on your health status and the type of OSA you may have, your doctor may prescribe one of these OSA treatments.
OSA Treatment Options
• CPAP Machine
The most common OSA treatment is for you to use a continuous positive airway pressure machine, commonly known as a CPAP machine, every night during sleep. CPAPs use 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 CPAP settings and that are both comfortable and effective for you.
• BiPAP Machine
Some people may not be able to use a CPAP machine due to the amount of continuous pressure. As a result, your doctor may prescribe a bilevel positive airway pressure, or BiPAP, machine. A BiPAP machine delivers different air pressure levels for inhaling and exhaling. CPAPs deliver the same amount of air pressure whether you are inhaling or exhaling.
• 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 in your airway to keep it 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 that lead (under the skin of the neck) to the nerves that control your tongue and nearby muscles. The implant sends mild electrical impulses through the wires to nerves that control 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 turn 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 device called a position accelerometer. When you are lying on your back, or face-up, during sleep, the device vibrates with 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.