Sleep Apnea Explained: Causes, Symptoms & Treatments

Sleep apnea is a common but serious sleep disorder in which breathing repeatedly stops and starts during sleep. These interruptions fragment rest and reduce blood oxygen levels, producing daytime sleepiness and raising the risk of cardiovascular and metabolic problems. Understanding the warning signs, diagnostic process, and the range of therapies — from CPAP to newer implanted stimulators — helps people and clinicians choose the best approach for each individual.

Health impacts and long-term risks

When left untreated, sleep apnea can have wide-ranging effects. Many people notice persistent daytime fatigue, morning headaches, and trouble concentrating. Over months and years, untreated sleep apnea is linked to elevated blood pressure, increased risk of heart disease and stroke, and a higher likelihood of developing type 2 diabetes. Chronic sleep loss also contributes to mood disturbances like irritability or depression and can reduce overall quality of life and work performance.

Common symptoms to watch for

Recognizing symptoms early increases the chance of timely diagnosis and treatment. Typical signs include:

1. Loud, chronic snoring
2. Episodes of gasping, choking, or paused breathing during sleep (often noticed by a bed partner)
3. Excessive daytime sleepiness or falling asleep during routine activities
4. Frequent morning headaches
5. Difficulty concentrating, memory lapses, or slowed thinking
6. Noticeable mood changes, such as irritability or low mood
7. Waking with a dry mouth or sore throat
8. Tossing, turning, or overall unrefreshing sleep

If you or someone close to you experiences several of these symptoms, a medical evaluation is advisable. Early assessment can prevent complications and improve daytime functioning.

How sleep apnea is evaluated

Diagnosis typically combines a clinical evaluation with objective sleep testing. The usual steps are:

1. Medical and sleep history: Your clinician will review sleep behavior, daytime symptoms, risk factors (like obesity and neck size), and family history of sleep disorders.
2. Physical exam: A provider may inspect the airway, nasal passages, throat, and jaw alignment to identify potential anatomical contributors to airway collapse.
3. In-lab polysomnography: Considered the gold standard, a sleep lab study measures brain activity, eye movements, heart rate, breathing, airflow, and blood oxygen while you sleep overnight under observation.
4. Home sleep apnea testing (HSAT): For many patients, a simplified portable monitor used at home can assess breathing patterns and oxygen levels and may be suitable for diagnosing obstructive sleep apnea.

The choice between in-lab testing and a home study depends on symptoms, medical complexity, and whether other sleep disorders are suspected.

Role of CPAP in treatment

Continuous Positive Airway Pressure (CPAP) remains the frontline therapy for moderate to severe obstructive sleep apnea. A CPAP device supplies a steady stream of pressurized air through a mask worn over the nose or mouth to keep the upper airway open during sleep. Benefits of consistent CPAP use include better sleep quality, reduced daytime sleepiness, and lower cardiovascular risk.

Adherence matters: the most effective device is the one you use nightly. Some people find masks or the constant airflow uncomfortable and struggle with compliance. In those cases, mask fitting, humidification, pressure adjustments, or alternative therapies can improve tolerance.

Alternative devices and options

For patients who cannot tolerate CPAP or whose condition is not well managed with a single device, several alternatives exist:

• BiPAP (bi-level positive airway pressure): Delivers two pressure settings (higher on inhalation, lower on exhalation), which can be easier to breathe against for some users.
• Oral appliances: Dental devices custom-made by a dentist push the lower jaw or tongue forward to maintain airway patency and are convenient for milder cases or for those who reject CPAP.
• Adaptive servo-ventilation (ASV): A more sophisticated ventilator that adapts breath-by-breath and is useful in certain central or complex sleep apnea patterns.
• Tongue-retaining devices: Non-custom mouthpieces that hold the tongue forward to prevent collapse of the airway.
• Nasal dilators/valves: Small devices placed in the nostrils to reduce nasal resistance and improve airflow.

Prices, rates, or cost estimates mentioned in this article are based on the latest available information but may change over time. Independent research is advised before making financial decisions.

Hypoglossal nerve stimulation (implantable therapy)

For selected patients who do not tolerate CPAP or do not get adequate benefit from conventional therapies, hypoglossal nerve stimulation offers an implantable option. A small pulse generator is placed under the skin in the chest and connected by a lead to the hypoglossal nerve, which controls tongue movement. When activated during sleep, the device stimulates the nerve to move the tongue forward, preventing it from collapsing back into the airway.

Clinical trials have demonstrated meaningful reductions in apnea events and improvements in sleepiness and quality of life for appropriately screened patients. The procedure is typically done on an outpatient basis, and most people go home the same day. Not everyone is a candidate — careful evaluation, including sleep testing and anatomic assessment, is needed to determine suitability.

Choosing the right approach

Selecting the optimal therapy depends on the type and severity of sleep apnea, anatomical factors, patient preferences, and tolerance for devices. Collaboration between a sleep specialist, primary care clinician, and, when relevant, dental or surgical teams, helps tailor treatment. Behavioral changes such as weight loss, avoiding alcohol before bed, positional therapy, and treating nasal congestion can also support medical or device-based treatment.

Sleep apnea is treatable, and many people experience substantial improvement when they receive the correct diagnosis and follow an individualized treatment plan. If you suspect you have sleep apnea, schedule a discussion with a healthcare professional to begin evaluation and explore the options that best fit your needs.

This article is for informational purposes only and should not be considered medical advice. Please consult a qualified healthcare professional for personalized guidance and treatment.