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Sleep Apnea: Causes, Symptoms, and Treatments

Marion Sereti


April 27, 2023
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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 shallow1. 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 severity2.

OSA severity3 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)4 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 reasons5

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

Lastly, complex sleep apnea syndrome (CSAS)6, 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 OSA7 and sometimes the treatment for OSA seems to cause CSAS8.

Symptoms of Sleep Apnea

You may observe the following symptoms if you have a form of sleep apnea9 10 11 12 13 14:

  • 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 coughing15 
  • 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 above16:

  • 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 include17 18 19

  • 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 apnea20 21 19: 

  • 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 include22:

  • 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/TESCA22.

Complications of Sleep Apnea

There can be serious, even lethal, consequences to untreated sleep apnea. It is estimated that untreated OSA23 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 apnea24:

  • 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 obese25
    • 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 apnea26. 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)27, 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 therapy28.
  • 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 CSA29:

  • 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 options30 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.


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.

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