Insights Into Sleep Apnea That May Surprise You

Most people have heard of obstructive sleep apnea, but that may not mean that they fully understand it. There are a lot of misconceptions about the condition, and these can prevent people from getting the proper diagnosis and treatment. Without treatment, sleep apnea may lead to important consequences. Learn about 5 unexpected insights relating to sleep apnea that might leave you saying “Duh!”

Illustration of a man's lungs as he sleeps
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1. Sleep Apnea May Have Unexpected Symptoms

Any observer can easily spot someone with severe sleep apnea: loud snoring is interrupted by relative periods of quiet, as the upper airway collapses, which is ultimately punctuated by gasping or choking and sleep fragmentation. This can lead to daytime sleepiness. Surprisingly, it might also lead to complaints of light sleep and awakenings characteristic of insomnia. Sleep apnea may be associated with frequently getting up to pee at night (nocturia) as well as teeth grinding (bruxism). There may be symptoms at night such as heart palpitations, heartburn, sweating, and restless sleep. It may lead to headaches that are present upon awakening. It can contribute to compromised short-term memory, attention, concentration, and mood. It may exacerbate chronic pain conditions like fibromyalgia.

2. Not Everyone With Sleep Apnea Fits the Stereotype.

If you picture a middle-aged obese man when you think of sleep apnea, you are on the right track, but you’re missing many others who also have the condition. People of normal weight with allergies may have sleep apnea. Women starting at the time of menopause are at 10 times the prior risk of having sleep apnea and quickly catch up to the incidence in men. Anatomy, including the structure of the nasal passage, upper airway, and the position of the jaws may play a role. Children, especially those with enlarged tonsils, are at risk as well. A wide net must be cast to capture these varying presentations.

3. Sleep Apnea Impacts Your Health

As discussed above, there are many symptoms associated with sleep apnea. The scary thing is that untreated sleep apnea also has broad implications for overall health. Research strongly supports its role in exacerbating numerous conditions, including:

  • Hypertension
  • High cholesterol (hyperlipidemia)
  • Cardiac disease
  • Diabetes
  • Congestive heart failure
  • Atrial fibrillation
  • Heart attack
  • Stroke
  • Dementia

The good news is that effective treatment of sleep apnea reduces the risk of these other health consequences.

4. CPAP Isn't for Everyone

No one should claim that continuous positive airway pressure (CPAP) is the only appropriate treatment option for everyone who suffers from sleep apnea. Each case is different. You should discuss what options are best for you in your specific situation with your board-certified sleep physician. The machines and masks have greatly improved in the past few years. Despite this, not everyone tolerates CPAP therapy; despite a user’s best efforts, sometimes it just doesn’t work out. Oral appliances made by a dentist may be appropriate for mild to moderate obstructive sleep apnea. Surgery can be helpful in select cases. Positional therapy, in which a device is used to keep you off your back, may be helpful. Weight loss in those who are overweight or obese often helps. Adjunctive treatment of allergies may be necessary. Children may benefit from orthodontic treatment. Don’t close the door to treating your sleep apnea just because you have struggled to use CPAP.

5. You Want to Choose a Treatment That Works​

No matter what treatment you select, it should be one that works. This is a surprisingly common issue. Don’t settle for a therapy that leaves you with residual sleep apnea. An optimal treatment should reduce your apnea-hypopnea index (AHI) below 5, which is the normal range. Ideally, optimal CPAP therapy should get this number down to 1 or 2 events per hour. For children, the goal is below 1. In order to assess the effectiveness of treatments beyond CPAP, you will likely need to have a repeat sleep study. If surgery occurs, it should be several months after recovery. If an oral appliance or positional therapy is provided, you should have the test while using the device to ensure it works. If it doesn’t, you shouldn’t hesitate to seek a better alternative.

If you are concerned that you may have symptoms of sleep apnea or have an interest in discussing optimal treatments, speak with a sleep specialist and explore ways to improve both your sleep and health.

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  • Kryger, M.H. et al. “Principles and Practice of Sleep Medicine.” ExpertConsult, 5th edition, 2011.

By Brandon Peters, MD
Brandon Peters, MD, is a board-certified neurologist and sleep medicine specialist.