How Sleep Apnea Can Worsen Your Asthma

Sleep apnea, or obstructive sleep apnea syndrome as it's officially called, is a disorder where people repeatedly stop or reduce their breathing while sleeping. The temporary episodes decrease airflow, which can lead to low oxygen levels in the bloodstream and put strain on the heart.

Person wearing sleep apnea equipment
D. Sharon Pruitt Pink Sherbet Photography / Moment / Getty Images

Most people with obstructive sleep apnea snore loudly, stop breathing during sleep, and have gasping, choking, gagging, and coughing episodes that wake them up frequently during the night.

Often, the person isn’t aware that they are waking up dozens of times throughout the night. But these episodes of breathing trouble lead to restless sleep and therefore daytime fatigue, regardless of how many hours the person tries to sleep.

While many people have sleep apnea who aren't asthmatic, studies suggest that people with asthma are at increased risk for sleep apnea. Sleep apnea can also worsen asthma and asthma symptoms in a number of ways.

How Sleep Apnea Affects Asthma Symptoms

One way sleep apnea may influence asthma symptoms is through weakening the airways. Sleep apnea leads to more irritation and contraction of the smooth muscle around the airways in people with asthma, narrowing the airways and worsening asthma symptoms.

Sleep apnea may also cause an increase in the number of inflammatory chemicals within the bloodstream, which could worsen the inflammation in the lungs caused by asthma. These inflammatory chemicals also contribute to weight gain and obesity, which further worsens asthma.

Another way sleep apnea affects asthma symptoms involves acid reflux. Sleep apnea can cause and/or worsen acid reflux by decreasing the ability of the sphincter muscles in the esophagus to keep acid in the stomach. Acid reflux during sleep can then cause or worsen night-time asthma symptoms.

Acid reflux can irritate the nerves in the esophagus and throat, leading to smooth muscle contraction of the airways. It is also possible that refluxed stomach contents get into the lungs, which also irritates the airways. This can lead to wheezing, coughing, and other asthma symptoms.

Sleep apnea, acid reflux, obesity, and asthma interact in complex ways. For example, if you have acid reflux, you may tend to overeat because saliva from chewing food helps to neutralize the acid. That could lead to weight gain, which could worsen asthma, sleep apnea, and the reflux.

Treatment

There are several treatment options for sleep apnea. The most common, and gold-standard, therapy is a continuous positive airway pressure (CPAP) machine. Other treatments include an oral appliance, which involves wearing a device similar to a retainer while you sleep, and surgery.

Continuous Positive Airway Pressure

Continuous positive airway pressure (CPAP) is the preferred therapy for obstructive sleep apnea. CPAP involves wearing a mask while sleeping. The mask provides a continuous stream of pressurized air to keep the airways open.

When used with a doctor's supervision, CPAP seems to reverse many of the harmful effects of sleep apnea. CPAP therapy stabilizes the airway, which means more oxygen to the lungs and decreased contraction of the smooth muscles around the airway.

CPAP therapy also improves acid reflux and lowers inflammatory chemicals in the bloodstream, which may, in turn, reduce inflammation in the body, including the lungs.

Be sure to follow your prescribing physician's instructions closely, as using CPAP incorrectly can actually cause symptoms to worsen.

Oral Appliance

Despite its industrial-sounding name, an oral appliance is much like an orthodontic retainer. An oral appliance either prevents your tongue from blocking your airway or moves the lower jaw forward to keep your airway open while you sleep.

Although CPAP has been shown to be better at reducing interrupted breathing episodes and arousals, an oral appliance is a good option if CPAP therapy isn't working for you.

When getting an oral appliance for sleep apnea, it's best for a dentist to fit you with a custom one.

Surgery

There is a surgical option for the treatment of obstructive sleep apnea, called a uvulopalatopharyngoplasty (UPPP or UP3). This is a procedure used for the treatment of several ailments, but it is the most commonly performed surgery for obstructive sleep apnea.

UPPP involves taking out the tonsils and part of the soft palate and uvula. It's recommended for patients who are not overweight or obese. However, even with the UPPP surgery, many people still need CPAP therapy.

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