fbpx
👋 Important News! CoughPro has moved to a subscription model. Learn more here

Sleep Apnea: Causes, Symptoms, and Treatments

Marion Sereti

|

April 27, 2023
CoughPro is not a medical product. It is a wellness app intended only for users to obtain a better understanding of their cough. It is not intended to diagnose, monitor, or treat any illness.

We at Hyfe, Inc., are a company devoted to working on tools to better understand the importance of cough. It is Hyfe’s intention in the future to seek regulatory approval for medical products that analyze cough in order that they may be used to diagnose, monitor, and facilitate better treatment of respiratory illnesses.

A man with sleep apnea sleeping and doing the test for sleep apnea

Sleep apnea is a serious condition that significantly impacts a person's health and well-being. It is important to recognize the symptoms and seek treatment to manage and improve the quality of life.

What Is Sleep Apnea?

Source: Mayo Clinic

Sleep apnea is a sleep disorder identified by breathing pauses or shallow breathing while asleep. These events may last several seconds and frequently happen, sometimes multiple times an hour. A person is said to have obstructive sleep apnea (OSA) if they briefly stop breathing while asleep at least five times an hour.

A similar condition is hypopnea, which is where breathing does not cease but becomes abnormally shallow((Gould, G. A., Whyte, K. F., Rhind, G. B., Airlie, M. A. A., Catterall, J. R., Shapiro, C. M., & Douglas, N. J. (1988). The Sleep Hypopnea Syndrome. American Review of Respiratory Disease, 137(4), 895–898. American Thoracic Society. https://doi.org/10.1164/ajrccm/137.4.895)). The effects of hypopnea can be very similar, if not indistinguishable, from sleep apnea.

Types of Sleep Apnea

Sleep apnea can be classified into three distinct types:

  • Obstructive sleep apnea (OSA)
  • Central sleep apnea (CSA)
  • Complex sleep apnea syndrome (CSAS)/ Treatment-emergent central sleep apnea (TECSA)

Each form of sleep apnea involves disturbed breathing during sleep, but some key distinctions affect their diagnosis, symptoms, and course of treatment. Let us find out below the differences in obstructive vs. central sleep apnea vs. complex sleep apnea.

Obstructive Sleep Apnea (OSA)

Obstructive sleep apnea (OSA) is the most common form of sleep apnea. It happens when the throat muscles relax and then block the airway. Gasping, snorting, or choking sounds may happen from the effort to breathe against the blockage, often waking the person up. The cycle of attempting to breathe, falling back into sleep, and restarting the cycle can continue several times throughout the night, ranging from a few occurrences to as many as a hundred, depending on the apnea severity((Tietjens, J. R., Claman, D., Kezirian, E. J., De Marco, T., Mirzayan, A., Sadroonri, B., Goldberg, A. N., Long, C., Gerstenfeld, E. P., & Yeghiazarians, Y. (2019). Obstructive Sleep Apnea in Cardiovascular Disease: A Review of the Literature and Proposed Multidisciplinary Clinical Management Strategy. Journal of the American Heart Association, 8(1). e010440. https://doi.org/10.1161/jaha.118.010440)).

OSA severity((Hudgel D. W. (2016). Sleep Apnea Severity Classification - Revisited. Sleep, 39(5), 1165–1166. https://doi.org/10.5665/sleep.5776)) is categorized into three levels based on the apnea-hypopnea index (AHI) – the frequency of breathing apneic events during sleep:

  • Mild – Five to 14 apneic events per hour
  • Moderate – 15 to 30 breathing apneic events in one hour
  • Severe – 30 or more apnea episodes during an hour of sleep

Central Sleep Apnea (CSA)

Central sleep apnea (CSA)((Eckert, D. J., et al. (2007). Central sleep apnea: Pathophysiology and treatment. Chest, 131(2), 595–607. https://doi.org/10.1378/chest.06.2287)) is a less common form of sleep apnea. It happens when the brain cannot signal the muscles to breathe. This means that, during a short span, you don't even try to inhale or exhale, which can result in experiencing shortness of breath upon waking up or difficulty falling/staying asleep. This can result from a myriad of reasons((Randerath, W., Verbraecken, J., Andreas, S., Arzt, M., Bloch, K. E., Brack, T., ... & Levy, P. (2017). Definition, discrimination, diagnosis and treatment of central breathing disturbances during sleep. European respiratory journal, 49(1). https://doi.org/10.1183/13993003.00959-2016))

Complex Sleep Apnea Syndrome (CSAS) or Treatment-Emergent Central Sleep Apnea (TECSA)

Lastly, complex sleep apnea syndrome (CSAS)((Zhang, J., et al. (2020). Treatment-emergent central sleep apnea: a unique sleep-disordered breathing. Chinese medical journal, 133(22), 2721–2730. https://doi.org/10.1097/CM9.0000000000001125)), which doctors also call treatment-emergent central sleep apnea (TECSA), refers to the development or occurrence of central sleep apnea and/or hypopnea while a person is already being treated for obstructive sleep apnea. The underlying mechanisms of CSAS/TECSA are not fully understood, but it appears to be distinct from primary CSA. Sometimes, CSA is revealed after treating OSA((Orr, J. E., Malhotra, A., & Sands, S. A. (2016). Pathogenesis of central and complex sleep apnoea. Respirology, 22(1), 43–52. https://doi.org/10.1111/resp.12927)) and sometimes the treatment for OSA seems to cause CSAS((Wang, Y., Penzel, T., Salanitro, M., & Arens, P. (2022). Persistent Treatment-Emergent Central Sleep Apnea (TECSA) Following Hypoglossal Nerve Stimulation. Nature and Science of Sleep, 14, 2227-2236. https://www.tandfonline.com/doi/full/10.2147/NSS.S382710)).

Symptoms of Sleep Apnea

You may observe the following symptoms if you have a form of sleep apnea((Cruz, I. A. C., et al. (2011). Obstructive sleep apnea symptoms beyond sleepiness and snoring: effects of nasal APAP therapy. Sleep and Breathing, 16(2), 361–366. https://doi.org/10.1007/s11325-011-0502-4))12345:

  • Hypersomnia/Excessive daytime sleepiness – Because OSA can interrupt your sleep and prevent you from getting enough rest, you may feel excessively tired during the day
  • Morning headaches – OSA can cause headaches in the morning due to decreased oxygen levels at night
  • Dry mouth or sore throat – Breathing through your mouth while sleeping can lead to a dry mouth or sore throat
  • Irritability, mood changes, or depression – Poor sleep quality can lead to irritability or mood changes and an increased chance of depression
  • Difficulty concentrating – OSA can cause cognitive impairment, such as difficulty concentrating or memory loss
  • Waking up to urinate – Sleeping less deeply means your brain will remain aware of the stimulus, like a mild need to urinate, that it would normally ignore
  • Nocturnal sweating – This may be due to impaired glucose processing
  • Heartburn – This is likely due to an increased prevalence of stomach acid reflux and GERD with sleep apnea
  • Erectile dysfunction – There is an association between sleep apnea and erectile dysfunction, although the relationship is unclear

While sleeping, someone else may observe sleep apnea symptoms that a person with the condition may be unaware of. They include:

  • Pauses in breathing during sleep – These can cause the person to wake up suddenly gasping for air, choking, or coughing((Birring, S. S., et al.(2007). Obstructive sleep apnoea: a cause of chronic cough. Cough (London, England), 3, 7. https://doi.org/10.1186/1745-9974-3-7)) 
  • Loud snoring – It's the most prominent symptom of OSA, and it may be so loud that it disrupts your partner's sleep

The symptoms of OSA and CSA overlap a lot. You must consult a healthcare professional to go about determining if your diagnosis is OSA or CSA. However, CSA sufferers tend to have, in addition to the above((Eckert, D. J., et al. (2007). Central Sleep Apnea. Chest, 131(2), 595–607. https://doi.org/10.1378/chest.06.2287)):

  • Elevated blood levels of CO2
  • Anatomically narrower upper airway dilator muscles

The symptoms of CSAS/TESCA are also very similar, although it develops through the treatment of OSA/CSA and therefore you will likely be under observation by medical professionals already who can put you on the path to diagnosis and treatment.

Risk Factors for Sleep Apnea

Regardless of gender, ethnicity, or age, anyone can develop sleep apnea. However, it is more common in certain groups of people and circumstances.

Risk Factors for Obstructive Sleep Apnea

Risk factors for obstructive sleep apnea include((Motamedi, K. K., McClary, A. C., & Amedee, R. G. (2009). Obstructive sleep apnea: a growing problem. The Ochsner journal, 9(3), 149–153. https://www.ochsnerjournal.org/content/9/3/149.abstract))67

  • Obesity 
  • Large neck size
  • Family history of sleep apnea
  • Older age
  • Sinusitis
  • Allergies
  • Pregnancy
  • Nasal congestion
  • Thyroid and hormonal problems
  • Diabetes
  • Menopause
  • Large tonsils or adenoids
  • Down’s syndrome
  • Recessed chin or a large overbite
  • Smoking and alcohol consumption 
  • Sedentary lifestyle
  • Being male

Risk Factors for Central Sleep Apnea

Additional risk factors are associated with central sleep apnea((Walker, J. M., Farney, R. J., Rhondeau, S. M., Boyle, K. M., Valentine, K., Cloward, T. V., & Shilling, K. C. (2007). Chronic Opioid Use is a Risk Factor for the Development of Central Sleep Apnea and Ataxic Breathing. Journal of Clinical Sleep Medicine, 3(5), 455–461). https://doi.org/10.5664/jcsm.26908))87: 

  • Heart problems, such as congestive heart failure or irregular heart rate
  • Stroke
  • Brainstem abnormalities
  • Age above 65
  • Using narcotic pain medicines

Risk Factors Associated with CSAS/TESCA

Finally, risk factors associated with CSAS/TESCA include((Nigam, G., Pathak, C., & Riaz, M. (2016). A systematic review on prevalence and risk factors associated with treatment-emergent central sleep apnea. Annals of Thoracic Medicine, 11(3), 202). https://doi.org/10.4103/1817-1737.185761)):

  • High number of apnea incidents per hour (AHI)
  • High base level of CSA

While obesity is a risk factor for OSA and CSA, one study found it was those with a lower weight who were more likely to develop CSAS/TESCA((Nigam, G., Pathak, C., & Riaz, M. (2016). A systematic review on prevalence and risk factors associated with treatment-emergent central sleep apnea. Annals of Thoracic Medicine, 11(3), 202). https://doi.org/10.4103/1817-1737.185761)).

Complications of Sleep Apnea

There can be serious, even lethal, consequences to untreated sleep apnea. It is estimated that untreated OSA((Kapur, V., Blough, D. K., Sandblom, R. E., Hert, R., de Maine, J. B., Sullivan, S. D., & Psaty, B. M. (1999). The medical cost of undiagnosed sleep apnea. Sleep, 22(6), 749–755. https://doi.org/10.1093/sleep/22.6.749)) adds around $3.4 billion to healthcare costs in the US every year.

OSA is linked with certain medical conditions or anatomical variations in the head or neck that can impede breathing. Often, these conditions coincide with risk factors that elevate the likelihood of developing the condition. Many of these are also true for CSA. The interplay between risk factors for and complications of sleep apnea make untangling the relationships between cause and effect difficult, and often a consequence of sleep apnea can also be a risk factor that makes it more likely you’ll keep having it if untreated.

Here are some of the complications that can happen if you have obstructive or central sleep apnea:

  • High blood pressure
  • Diabetes
  • Hyperthyroidism
  • Stroke
  • Spinal cord injury
  • Depression
  • Cardiovascular issues – These may be worse in CSA due to the complete cessation of breathing, the loss of oxygen which can impair heart health, and can lead to an increased incidence of heart attack, irregular heart rhythms, and congestive heart failure

Overall, CSAS complications are a combination of OSA and CSA complications. 

Sleep apnea has different consequences in children, including hyperactivity, slowed growth, and decreased intelligence.

Diagnosing Sleep Apnea

To diagnose sleep apnea, your healthcare provider will assess your symptoms and medical history. They may refer you to a sleep disorder center where a sleep specialist can further evaluate you. 

The Mayo Clinic suggests that two different procedures are used to identify sleep apnea((Mayo Clinic Staff. (2023). Sleep apnea - Diagnosis and treatment. Mayo Clinic. Retrieved 13th April 2023 from https://www.mayoclinic.org/diseases-conditions/sleep-apnea/diagnosis-treatment/drc-20377636)):

  • Nocturnal polysomnography – This entails having monitoring devices connected to you while you sleep. The devices track a number of bodily processes, including heart rate, breathing patterns, lung and brain activity, limb and leg movements, and blood oxygen levels.
  • At-home sleep test – This examination is more streamlined and gauges vital signs like pulse rate, blood oxygen levels, airflow, and breathing patterns. 

If central sleep apnea specifically is suspected from the at-home test, your healthcare provider may recommend polysomnography in a sleep testing facility. Your doctor might recommend therapy without running another test if the test findings are sufficiently abnormal. Also, even if your initial findings are within the normal range, your doctor may still advise polysomnography because portable monitoring devices occasionally miss sleep apnea.

A man with sleep apnea sleeping and doing the test for sleep apnea with an at home monitoring device

Treatments for Sleep Apnea

Sleep apnea treatment aims to enhance sleep quality and decrease breathing disturbances. Obstructive and central sleep apnea are treated differently due to their differing causes.

Treatment for Obstructive Sleep Apnea 

  • Lifestyle changes – Sometimes, changing your lifestyle can help with obstructive sleep apnea. For example:
    • Weight loss – Reducing body weight by 10% can substantially enhance sleep apnea for individuals who are overweight or obese((Peppard, P. E. (2000). Longitudinal Study of Moderate Weight Change and Sleep-Disordered Breathing. JAMA, 284(23), 3015. https://doi.org/10.1001/jama.284.23.3015))
    • Regular exercise
    • Quit smoking
    • Reduce alcohol intake
    • Positional changes during sleep and sleep aid tools – Sleeping on one's back increases the chances of sleep apnea((Cartwright, R. D. (1984). Effect of Sleep Position on Sleep Apnea Severity. Sleep, 7(2),. 110–114. https://doi.org/10.1093/sleep/7.2.110)). Special pillows or similar items can change sleeping positions, keeping the body off the back, preventing soft tissue from compressing the windpipe, and obstructing breathing
    • Nasal sprays and adhesive strips – Over-the-counter products can help to breathe by making air travel through the nose easier. These products may be useful in mild sleep apnea and snoring but not moderate or severe sleep apnea.
  • Positive airway pressure (PAP) therapy – This term encompasses various forms of treatment that actively push air into your body to keep your airways open. The most common is a continuous positive airway pressure (CPAP)((Baessler, A., Nadeem, R., Harvey, M., Madbouly, E., Younus, A., Sajid, H., Naseem, J., Asif, A., & Bawaadam, H. (2013). Treatment for sleep apnea by continuous positive airway pressure improves levels of inflammatory markers - a meta-analysis. Journal of Inflammation, 10(1).. https://doi.org/10.1186/1476-9255-10-13)), which has a single level of air pressure, but bilevel positive air pressure (BiPAP) and auto-adjusting positive air pressure machines also exist, which have different air pressure levels for inhale and exhale or depending on your needs.
  • Oral appliances – Some people with obstructive sleep apnea can benefit from wearing a device in their mouth to help keep their airway open. They can be a successful alternative for mild and medium-to-severe OSAS; however, rigorous monitoring is necessary due to individual variations in response to this therapy((Teixeira, A. O. de B., Abi-Ramia, L. B. P., & Almeida, M. A. de O. (2013). Treatment of obstructive sleep apnea with oral appliances. Progress in Orthodontics, 14(1). https://doi.org/10.1186/2196-1042-14-10)).
  • Surgery – Surgery may sometimes be necessary to treat obstructive sleep apnea. This might involve removing the excess tissue from your throat or repositioning your jaw to help keep your airway open. Another surgical procedure entails implanting a device to stimulate a nerve that aids in breathing regulation.

Treatment for Central Sleep Apnea 

Central sleep apnea (CSA) can be a challenging condition to treat, and it often requires the management of any underlying medical conditions contributing to the condition. In addition to the above, the following treatments may be used to help manage CSA((Randerath, W., Verbraecken, J., Andreas, S., Arzt, M., Bloch, K. E., Brack, T., ... & Levy, P. (2017). Definition, discrimination, diagnosis and treatment of central breathing disturbances during sleep. European respiratory journal, 49(1). https://doi.org/10.1183/13993003.00959-2016)):

  • Medications – Certain medications, such as acetazolamide, zolpidem, and triazolam, may help regulate breathing patterns during sleep and improve CSA symptoms
  • Oxygen therapy – Supplemental oxygen delivered via a mask or nasal cannula may help improve breathing and oxygen levels during sleep
  • Positive airway pressure (PAP) therapy – A mask over the nose or nose and mouth delivers a continuous stream of air to help keep the airway open during sleep
  • Adaptive servo-ventilation (ASV) – This therapy uses a machine to monitor breathing patterns and deliver the appropriate amount of pressure to help regulate breathing during sleep
  • Lifestyle changes – Quitting smoking, avoiding alcohol and sedatives, and maintaining a healthy weight may also help improve CSA symptoms

It's important to note that the most effective treatment for CSA will depend on the underlying cause and severity of the condition, and a doctor or sleep specialist should be consulted for proper diagnosis and treatment.

Treatment for Complex Sleep Apnea Syndrome/Treatment-Emergent Central Sleep Apnea

The management of CSAS can be challenging and may require a multidisciplinary approach. Treatment options((Pusalavidyasagar, S. S., Olson, E. J., Gay, P. C., & Morgenthaler, T. I. (2006). Treatment of complex sleep apnea syndrome: a retrospective comparative review. Sleep medicine, 7(6), 474–479. https://doi.org/10.1016/j.sleep.2006.04.005)) may include optimizing positive airway pressure therapy, adjusting medication use, or other interventions based on the underlying cause of CSAS. Patients may sometimes require specialized sleep therapies or devices, such as adaptive servo-ventilation (ASV), to effectively manage CSAS.

However, further research is needed to understand the mechanisms of CSAS better and develop more effective treatment strategies for this condition.

Conclusion

Sleep apnea is a serious condition that can significantly impact a person's health and well-being. As 85% of people suffering from sleep apnea are undiagnosed, it is important to recognize the symptoms and seek treatment to manage and improve your quality of life. Therefore, if you suspect that you or a loved one may have sleep apnea, it is important to speak with a healthcare provider who can evaluate your symptoms and determine the underlying cause.

  1. Russell, M. B., et al. (2014). Headache in sleep apnea syndrome: Epidemiology and pathophysiology. Cephalalgia, 34(10), 752–755. https://doi.org/10.1177/0333102414538551 []
  2. Zhang, C., et al. (2020). The role of dry mouth in screening sleep apnea. Postgraduate Medical Journal, 97(1147), 294–298. https://doi.org/10.1136/postgradmedj-2020-137619 []
  3. Akashiba, T., et al. (2002). Relationship Between Quality of Life and Mood or Depression in Patients With Severe Obstructive Sleep Apnea Syndrome. Chest, 122(3), 861–865. https://doi.org/10.1378/chest.122.3.861 []
  4. Oginska, H., & Pokorski, J. (2006). Fatigue and Mood Correlates of Sleep Length in Three Age‐Social Groups: School Children, Students, and Employees. Chronobiology International, 23(6), 1317–1328. https://doi.org/10.1080/07420520601089349 []
  5. Meijer, Habekothé, & Van Den Wittenboer. (2000). Time in bed, quality of sleep and school functioning of children. Journal of Sleep Research, 9(2), 145–153. https://doi.org/10.1046/j.1365-2869.2000.00198.x []
  6. Ahbab, S., Ataoğlu, H. E., Tuna, M., Karasulu, L., Cetin, F., Temiz, L. U., & Yenigün, M. (2013). Neck circumference, metabolic syndrome, and obstructive sleep apnea syndrome; evaluation of possible linkage. Medical science monitor: International Medical Journal of Experimental and Clinical Research, 19, 111–117. https://doi.org/10.12659/MSM.883776 []
  7. Badr, M. S., & Javaheri, S. (2019). Central Sleep Apnea: a Brief Review. Current Pulmonology Reports, 8(1), 14–21. https://doi.org/10.1007/s13665-019-0221-z [] []
  8. Bradley, T. D., & Floras, J. S. (2003). Sleep Apnea and Heart Failure. Circulation, 107(13), 1822–1826. https://doi.org/10.1161/01.cir.0000061758.05044.64 []

Your Cough Matters

4.9
Based on our results in Google Play & App Store
  • Excellent, insightful
    By dust mite dan - Apr 7, 2023 - App Store
    This app is easy to use, aesthetically pleasing and has provided me with useful information about my cough and disease patterns that have improved my overall health!

    Try CoughPro for Free
  • Great app!
    by Imtfx0019 — Dec 6, 2022 - App Store
    Impressed with how well it detected my coughs, even very slight ones.
    Try CoughPro for Free
  • App is Great!
    by HBert Quach — Jan 22, 2023, - Google Play
    App is great at tracking cough when little ones are sick. I treat it as a early warning indicator before the cold gets back. Customer service is awesome, they actually respond to all my questions.
    Try CoughPro for Free
  • Great Experience
    by Christi Hammock — Mar 7, 2023, - Google Play

    I had an issue logging into the new app but I contacted the support team and they were awesome in helping me figure out the issue. It turned out to be a technical issue which they resolved very quickly and I was kept in the loop on the status from start to finish. This app is really helpful when talking to my doctor too..
    Try CoughPro for Free
  • Impressive app
    By KayakTina - Apr 7, 2023 - App Store
    "The app accurately is recording my coughs with excellent ways to review the results. I can add notes to help me identify patterns or have accurate information for my physicians. I’ve hoped for an app like this for years to help me accurately track the amount of coughing I’m doing"
    Try CoughPro for Free
  • Accurate count of coughs
    by Beardonna — Mar 8, 2023 - App Store

    Just installed the app. Very accurate measuring coughs so far! Cannot wait to see how much coughing I do while sleeping. I'll have a better picture to discuss with my physician at my next visit.

    Try CoughPro for Free

Recent Posts

CoughPro-new-logo
© 2024 All Rights Reserved.
linkedin facebook pinterest youtube rss twitter instagram facebook-blank rss-blank linkedin-blank pinterest youtube twitter instagram