Obesity is a common cause of sleep apnea in adults. People with this condition have increased fat deposits in their necks that can block the upper airway.
Large tonsils may contribute to sleep apnea, because they narrow the upper airway.
The endocrine system produces hormones that can affect sleep-related breathing. The following are examples of endocrine disorders associated with sleep apnea:
Sleep apnea is commonly found in people who have advanced heart or kidney failure. These patients may have fluid build-up in their neck, which can obstruct the upper airway and cause sleep apnea.
Genetic syndromes that affect the structure of the face or skull, particularly syndromes that cause smaller facial bones or cause the tongue to sit farther back in the mouth, may cause sleep apnea. These genetic syndromes include cleft lip and cleft palate, Down syndrome and congenital central hypoventilation syndrome.
Babies born before 37 weeks of pregnancy have a higher risk for breathing problems during sleep. In most cases, the risk decreases as the brain matures.
There are many risk factors for sleep apnea. Some risk factors, such as unhealthy lifestyle habits and environments, can be changed. Other risk factors, such as age, family history and genetics, race and ethnicity, and sex, cannot be changed. Heathy lifestyle changes can decrease your risk for developing sleep apnea.
Sleep apnea can occur at any age. The risk for sleep apnea increases as you get older. In younger adults, sleep apnea is more common in men than in women, but the difference decreases later in life. Normal age-related changes in how the brain controls breathing during sleep partially explain the increased risk as you get older. Another possible reason is that as we age, more fatty tissue builds up in the neck and the tongue.
Drinking alcohol, smoking, and overweight or obesity can increase your risk for sleep apnea.
Researchers have identified family history as a risk factor for sleep apnea, but maintaining a healthy lifestyle can decrease this risk. Studies in twins have shown that sleep apnea can be inherited. Some of the genes related to sleep apnea are associated with the structural development of the face and skull and with how the brain controls sleep and breathing during sleep. Some genes are also associated with obesity and inflammation.
In the United States, sleep apnea is more common among blacks, Hispanics, and Native Americans than among whites.
To screen for sleep apnea or other sleep disorders, your doctor may ask you about common signs and symptoms of this condition, such as how sleepy you feel during the day or when driving, and whether you or your partner has noticed that you snore, stop breathing, or gasp during your sleep. Your doctor may ask questions to assess your risk for developing this condition and take your physical measurements. Your doctor will also want to see whether you have any complications of undiagnosed sleep apnea, such as high blood pressure that is difficult to control. If the screening suggests a sleep breathing disorder, you may get a referral to a sleep specialist to help confirm a diagnosis.
If you are concerned about having risk factors for developing sleep apnea, ask your doctor to recommend healthy lifestyle changes, including eating a heart-healthy diet, aiming for a healthy weight, quitting smoking, and limiting alcohol intake. Your doctor may recommend that you sleep on your side and adopt healthy sleep habits such as getting the recommended amount of sleep.
Common sleep apnea signs and symptoms are snoring or gasping during sleep; reduced or absent breathing, called apnea events; and sleepiness. Undiagnosed or untreated sleep apnea prevents restful sleep and can cause complications that may affect many parts of your body.
Common signs of sleep apnea:
Common symptoms of sleep apnea:
Did you know that sleep apnea symptoms may be different for women and children compared with men?
Sleep apnea may increase your risk of the following disorders:
Did you know that sleep apnea can cause inflammation and lead to complications?
When blood oxygen levels drop due to obstructive sleep apnea, your body and brain trigger the “fight or flight” response. This increases your blood pressure and heart rate and wakes you from sleep so that your upper airway can open. These cycles of decreased and increased blood oxygen levels can cause inflammation that may contribute to atherosclerosis, the buildup of plaque in blood vessels, which can increase the risk of heart attack or stroke. Chronic inflammation can also damage the pancreas and lead to type 2 diabetes.
Your doctor may diagnose sleep apnea based on your medical history, a physical exam, and results from a sleep study. Before diagnosing you with sleep apnea, your doctor will rule out other medical reasons or conditions that may be causing your signs and symptoms.
To help diagnose sleep apnea, your doctor may consider the following:
During the physical exam, your doctor will look for signs of other conditions that can increase your risk for sleep apnea, such as obesity, large tonsils, narrowing of the upper airway, or a large neck circumference. A neck circumference greater than 17 inches for men or 16 inches for women is considered large. Your doctor may also look at your jaw size and structure, the size of your tongue, and your tongue’s position in your mouth. Your doctor will check your lungs, heart, and neurological systems to see whether you have any common complications of sleep apnea.
To diagnose sleep apnea or another sleep disorder, your doctor may refer you to a sleep specialist or a center for a sleep study. Sleep studies can be done in a special center or at home. Studies at a sleep center can:
Your doctor may be able to diagnose mild, moderate, or severe sleep apnea based on the number of sleep apnea events you have in an hour during the sleep study.
Visit Sleep Studies for more information.
Did you know that sleep studies can help determine which type of sleep apnea you have?
Sleep studies can monitor the movement of your muscles and help determine breathing patterns and whether you have obstructive or central sleep apnea. Sleep studies of patients with obstructive sleep apnea often show an increase in breathing muscle activity when muscles try to open an obstructed upper airway. In contrast, sleep studies of patients with central sleep apnea tend to show decreased activity in chest muscles, which can lead to periods of slowed or no breathing.
Your doctor may order the following tests to help rule out other medical conditions that can cause sleep apnea:
Your doctor will also want to know whether you are using medicines, such as opioids, that could be affecting your sleep or causing breathing symptoms of sleep apnea. Your doctor may want to know whether you have traveled recently to altitudes greater than 6,000 feet, because these low-oxygen environments can cause symptoms of sleep apnea for a few weeks after traveling.
If you are diagnosed with sleep apnea, your doctor may make recommendations to help you maintain an open airway during sleep. These could include healthy lifestyle changes or a breathing device such as a positive airway pressure (PAP) machine, mouthpiece, or implant. Talk to your doctor. Depending on the type and severity of your sleep apnea and your needs and preferences, other treatments may be possible.
To help control or treat your sleep apnea, your doctor may recommend that you adopt lifelong healthy lifestyle changes.
A breathing device, such as a CPAP machine, is the most commonly recommended treatment for patients with sleep apnea. If your doctor prescribes a CPAP or other breathing device, be sure to continue your doctor-recommended healthy lifestyle changes. Read Living With to learn more about properly caring for your breathing device.
Oral devices, also called oral appliances, are custom-fit devices that you typically wear while you sleep. There are two types of oral devices that work differently to open the upper airway while you sleep. Some hybrid devices have features of both types.
A new type of oral device was recently approved by the FDA for use while awake. The device delivers electrical muscle stimulation through a removable mouthpiece that sits around the tongue. You wear the mouthpiece once a day for 20 minutes at a time, for 6 weeks. The device stimulates the tongue muscle while awake to help prevent the tongue from collapsing backward and obstructing the airway during sleep.
If you have sleep apnea, your doctor may prescribe an oral device if you do not want to use CPAP or cannot tolerate CPAP. Your doctor will recommend that you visit a dentist who will custom-make an appliance for you, make sure that it is comfortable, and teach you how to use it to get the best results.
Implants can benefit some people with sleep apnea. Some devices treat both obstructive and central sleep apnea. You must have surgery to place an implant in your body. The Food and Drug Administration has approved one implant as a treatment for sleep apnea. The device senses breathing patterns and delivers mild stimulation to certain muscles that open the airways during sleep. More research is needed to determine how effective the implant is in treating central sleep apnea.
A nerve stimulator can also treat sleep apnea. This treatment also involves surgery. A surgeon will insert a stimulator for the hypoglossal nerve, which controls tongue movement. Increasing stimulation of this nerve helps position the tongue to keep the upper airway open.
Children and adults with sleep apnea may benefit from therapy for mouth and facial muscles, known as orofacial therapy. This therapy helps improve tongue positioning and strengthen muscles that control the lips, tongue, soft palate, lateral pharyngeal wall, and face.
You may need surgery if you have severe obstructive sleep apnea that does not respond to breathing devices such as a CPAP machine, or that is caused by visible obstruction to the upper airway, perhaps due to large tonsils. Possible surgical procedures include:
If surgery is considered as a possible treatment, talk to your doctor about the different types of surgical procedures, the risks and benefits of the procedures, potential discomfort, and the recovery time you will need after surgery.
If you have been diagnosed with sleep apnea, it is important that you adopt and maintain healthy lifestyle habits and use your prescribed treatment. Read more about how to use and care for your breathing device or mouthpiece, how your doctor may monitor whether your treatment is working, and when you may need a repeat sleep study. Learn other tips to keep you safe if you have sleep apnea.
It is important that you properly use and care for your prescribed breathing device or mouthpiece. If your doctor prescribed a breathing device or CPAP machine:
You should visit your doctor to monitor your response to treatment and see whether you have any complications that, if left untreated, can be life-threatening. Your doctor may do any of the following to monitor your condition.
Sometimes, repeat sleep studies are necessary. Your doctor may have you repeat a sleep study to monitor your response to the treatment, especially if your sleep symptoms continue, if you are using a mouthpiece, if your weight changes significantly, or if your employer requires these tests.
Side effects of CPAP treatment may include congestion, runny nose, dry mouth, dry eyes, or nosebleeds. If you experience stomach discomfort or bloating, you should stop using your CPAP machine and contact your doctor.
Sleep apnea can increase your risks of complications if you are having surgery, and it can affect your ability to drive.
Learn about the following ways the NHLBI continues to translate current research into improved health for people with sleep apnea.
Learn about some of our pioneering research contributions that have improved clinical care.
In support of our mission, we are committed to advancing sleep apnea research in part through the following ways:
Learn about exciting research areas that the NHLBI is exploring about sleep apnea.
We lead or sponsor many studies relevant to sleep apnea. See whether you or someone you know is eligible to participate in our clinical trials.
After reading our Sleep Apnea Health Topic, you may be interested in additional information found in the following resources.