More Than Snoring: 6 Things Everyone Should Know About Obstructive Sleep Apnea

December 19, 2024

A photo of a woman asleep on the couch.

If you’re constantly tired and your snoring is so loud that no one wants to share a room with you, you may have obstructive sleep apnea (OSA) — the most common sleep-related breathing disorder. But those aren’t the only symptoms or risk factors of OSA, and anyone at any age can develop it.

Gracia Nabhane, MD
Gracia Nabhane, MD

“Around 1 billion people worldwide are estimated to have obstructive sleep apnea (OSA), but it often goes undiagnosed or untreated,” says MU Health Care sleep specialist Gracia Nabhane, MD. “There are many reasons someone can feel tired, overworked, stressed out, etc. And until someone complains about your snoring or points out the amount of caffeine you’re consuming, or you go over the rumble strip while driving, or something drastic happens, you tend to ignore it.”

Dr. Nabhane also explains that not everyone realizes what OSA is or how it can affect your body — and the person sleeping next to you. She teamed up with David Chang, MD, an MU Health Care otolaryngologist (ear, nose and throat specialist), to share what everyone should know about OSA:

1. Obstructive Sleep Apnea Is About More Than Just Snoring

OSA is when your upper airway repetitively collapses as you sleep, either partially blocking your airway or cutting off the flow of air altogether. A complete cutoff of airflow is called apnea, while a reduction of airflow that drops your oxygen level by 3-4% is called hypopnea.

Anyone can have disrupted breathing when their muscles relax while sleeping. For adults, if it’s happening five or more times an hour, it’s considered sleep apnea. Having between 15 and 30 apneas signifies moderate OSA. More than 30 events per hour is severe.

The truth is that snoring is only one symptom, and a large percentage of snorers don’t have OSA, says Dr. Nabhane. If you have sleep apnea, other telltale signs you may notice include:

“The problem is that OSA leads to frequent sleep disruptions, which can be taxing," Dr. Nabhane explains. "Even if you live alone or don't snore, it’s important to be aware of these other symptoms."

2. There Are Many Risk Factors for Sleep Apnea

Experts use the STOP-BANG Questionnaire to evaluate your risk for OSA and determine whether you are a candidate for a diagnostic sleep test. It assesses eight common risk factors, including:

  • Snoring, which may be loud and frequent
  • Tiredness even after you get a full night’s sleep
  • Observed apneas, which may sound like gasping, choking or a temporary breathing lapse
  • Pressure, meaning high or uncontrolled blood pressure
  • Body mass index (BMI) or over 35
  • Age of 50 or older
  • Neck circumference of 16 inches or more
  • Gender (sex) with males at higher risk than females

To calculate your risk, give yourself one point for every risk factor that applies to you. A score of two and under is mild risk, while five or more is considered to be very high risk.

“We typically take a closer look at people with scores of three or higher,” Dr. Nabhane says. “But not everyone fits the STOP-BANG mold. Occasionally a young person with a healthy BMI and active lifestyle who doesn’t drink alcohol or smoke can still have severe sleep apnea.”

3. You Can Do a Sleep Apnea Test at Home

If you are at high risk for OSA or have symptoms, you don’t need to spend the night in a sleep lab to test for sleep apnea. Your primary care provider (PCP) can prescribe a home sleep study. You’ll need to watch a quick video, pick up the necessary equipment and then either mail it back or drop it off. Your doctor will call you with the results.

While at-home sleep studies may not be as detailed as in-lab studies, they can effectively diagnose and monitor most patients. They also increase accessibility for homebound individuals and those with limited mobility.

"At-home tests provide valuable insights," Dr. Nabhane explains. "For example, we can see that you experience 16 apneas per hour on your back, but only eight on your side. While eight is still abnormal, we can potentially improve your condition through positional changes, weight loss and increased exercise.

4. Mild Sleep Apnea Doesn’t Always Require Clinical Treatment

If your sleep apnea is mild and isn’t interfering with your daily activity, you may be able to manage it with some behavioral modifications, such as:

  • Avoiding alcohol (or having it early in the evening): It disrupts sleep and further relaxes the muscles that hold your airway open.
  • Increasing exercise: Walking more each day can make a difference.
  • Losing weight: Modest weight loss of 5 to 10 pounds can significantly reduce OSA.
  • Stopping smoking: Smoking can cause inflammation and swelling in the upper airway, which worsens sleep apnea.
  • Changing sleep positions: Sleeping in an upright position or side position may reduce the potential for your tongue falling backwards and blocking the airway.
David Chang, MD
David Chang, MD

“I compare mild sleep apnea to going 56 miles per hour (mph) in a 55-mph speed zone,” Dr. Chang says. “It’s speeding but not as dangerous as going 100 mph. If you barely have sleep apnea and don’t have bothersome symptoms (except for a frustrated sleep partner), behavioral modifications may be enough to get it under control.”

5. Untreated Moderate or Severe OSA May Lead to Other Health Issues

Some chronic health issues are closely related to OSA. In fact, Dr. Nabhane says that many OSA patients are initially referred to a sleep specialist because of other health issues. Having untreated OSA increases your risk for:

“When you sleep, your heart rate and blood pressure typically decrease. Essentially, your body rests by lowering these vital signs while you sleep” Dr. Nabhane says. “OSA puts your body under significant stress at night. Imagine someone repeatedly smothering you while you sleep. This can cause anxiety, increase the heart rate and elevate blood pressure.”

6. There Are Many OSA Treatment Options Available

OSA treatment aims to help you breathe continuously throughout the night. Experts can achieve that goal in several ways, depending on your condition’s severity, including:

  • CPAP (continuous positive airway pressure): This machine uses air pressure to keep your airway open and is the gold standard for treating OSA. That’s because if patients can tolerate it well, it has a near 100% success rate in treating sleep apnea. Newer machines are lightweight, smaller and quieter than ever.
  • Oral appliances: Often fitted by dentists, a nighttime mouthpiece can reposition your jaw and tongue in a more forward position, preventing blockage of your airway.
  • Positional therapy: This behavioral treatment option uses a simple belt, a tennis ball or more sophisticated devices and sensors to discourage you from sleeping on your back. It can be effective for people who only have obstructive sleep apnea when sleeping on their back.
  • Surgery to open your airway: Surgeons can help keep your airway open at night by altering your anatomy, including removing enlarged tonsils, nasal polyps and excess tissue. They can also reduce or reposition your tongue.
  • Surgery to implant a hypoglossal nerve stimulator: A small stimulator (like a pacemaker) is inserted into your upper chest. A breathing sensor monitors your breathing as you sleep and stimulates the tongue muscle to gently move it out of the airway.

“Nonsurgical approaches are always the first choice to manage sleep apnea, with CPAP being the most effective treatment option available,” Dr. Chang says. “But for people who have moderate to severe OSA and cannot tolerate CPAP, we do offer these other options. The most important thing is finding a provider who can educate you on your options, coach you through the initial phases of using a CPAP machine to ensure you are using it effectively, and provide alternatives if CPAP is not possible.”

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