Breathe Easy: A Closer Look at Sleep Apnea

by Maria Paula Guzman, MD

Fall 2024

How often do you wake up feeling groggy or tired, even after a full night’s sleep? The answer may lie in an unsuspected place — undiagnosed sleep apnea. While many aim to get the recommended seven hours of sleep each night, few pay attention to the quality of their sleep. Sleep apnea is a common cause of sleep disruption that can negatively impact quality of life and overall health. Unfortunately, because the symptoms occur during sleep, many people are unaware they have it.

What is Sleep Apnea?

Snoring and sleep apnea are often confused, but they are not the same. Snoring occurs when the throat narrows during sleep, which causes vibrations that produce a harsh sound. This can be normal in some cases. However, sleep apnea occurs when throat muscles relax excessively, leading to a temporary blockage of the airway as the person breathes. This causes breathing to stop and oxygen levels to drop. The brain quickly recognizes the lack of oxygen and forces the person to take a deep breath, restoring normal oxygen levels.

Although a person may not be fully aware of these episodes — after all, they are asleep — this abnormal breathing pattern causes the brain to wake up repeatedly throughout the night. As a result, someone with sleep apnea can sleep a full night but still wake up feeling extremely tired due to the poor quality of their sleep, similar to getting only a few hours of sleep each night.

Obesity and Sleep Apnea

The relationship between obesity and sleep apnea is bidirectional: excess body weight increases the risk of developing sleep apnea, and sleep apnea can contribute to weight gain by disrupting hunger-regulating hormones.

Obesity is a leading risk factor for obstructive sleep apnea. Excess weight, especially around the neck and upper body, can narrow the airway when lying down, making it more difficult to breathe and increasing the risk of airway closure during sleep.

Sleep deprivation caused by sleep apnea can alter hormones that regulate hunger, such as increasing levels of ghrelin and cortisol. Higher levels of these hormones can lead to increased hunger and cravings for high-calorie, high-fat and high-sugar foods, which can result in overeating and potential weight gain.

How is Sleep Apnea Diagnosed?

A sleep study is recommended when someone has symptoms such as loud snoring, pauses in breathing, choking or gasping during sleep, dry mouth, morning headaches, frequent nighttime awakenings and excessive daytime sleepiness. If you or a loved one have these symptoms, it’s important to speak with a healthcare provider about testing.

For individuals with milder symptoms, the STOP-BANG questionnaire is a commonly used screening tool to assess the risk of sleep apnea. This questionnaire evaluates factors associated with sleep apnea, such as snoring, tiredness, observed pauses in breathing, high blood pressure, a body mass index (BMI) of 35 or higher, age 50 or older, a neck circumference greater than 16 inches and being male. If several of these factors are present, a sleep study is often recommended for a definitive diagnosis.

Sleep studies can be done at home or in a specialized sleep center. These studies monitor breathing patterns, oxygen levels, heart rate and brain activity to determine the presence of sleep apnea based on the number of breathing pauses per hour. For those with a high suspicion of sleep apnea, a home sleep study is usually recommended first.

Health Consequences of Sleep Apnea

Untreated sleep apnea can lead to numerous health issues. While daytime sleepiness and fatigue are common symptoms, the risks extend far beyond feeling tired, including:

1. Heart Disease and High Blood Pressure: Repeated oxygen deprivation during sleep stresses the cardiovascular system, which can raise blood pressure and increase the risk of heart attack, stroke, abnormal heart rhythms and heart failure.
2. Type 2 Diabetes: People with untreated sleep apnea are at higher risk of insulin resistance, which can progress to prediabetes and type 2 diabetes.
3. Mental Health Issues: Sleep apnea is linked to mood disorders like depression and anxiety. Poor sleep quality can leave individuals feeling fatigued, irritable, unfocused and depressed.
4. Sexual Dysfunction/Decreased Libido: Erectile dysfunction (ED) is more common in men with sleep apnea, and sexual dysfunction also occurs more frequently in women with the condition.
5. Frequent Nighttime Urination (Nocturia): Nocturia is common in patients with sleep apnea, particularly women. Treatment can reduce nighttime urination episodes.
6. Increased Risk of Accidents: Excessive daytime sleepiness from sleep apnea can impair concentration and slow reflexes, which increases the risk of accidents, especially when driving or operating heavy machinery.

Why is it Important to Treat Sleep Apnea?

Treating sleep apnea is crucial for immediate well-being and long-term health. Treatment can improve mood, energy levels and concentration during the day, enhancing quality of life and reducing the risk of severe health complications, including heart disease, diabetes and stroke.

How is Sleep Apnea Treated?

Several treatment options can effectively manage sleep apnea, depending on its severity and type:

1. Weight Reduction: Losing weight can significantly impact sleep apnea symptoms and reduce the frequency of breathing pauses. Even a 5% reduction in body weight can lessen the severity of sleep apnea.
2. Continuous Positive Airway Pressure (CPAP): A CPAP machine delivers airflow through a mask to keep the airway open during sleep. This is the most effective treatment for moderate to severe obstructive sleep apnea.
3. Oral Appliances: Custom-fitted devices made by a dentist can reposition the jaw and tongue to help keep the airway open, offering an alternative for mild to moderate cases or those who struggle with CPAP.
4. Positional Therapy: Some individuals experience sleep apnea episodes primarily when sleeping on their back. Special pillows can encourage side sleeping and reduce episodes.
5. Inspire Device: This surgically implanted device stimulates airway muscles and the tongue to keep the airway open. It is an option for patients who have difficulty using a CPAP and is usually performed by an ENT specialist.
6. Surgery: In severe cases, surgery may be necessary to remove excess tissue from the airway or correct structural problems contributing to sleep apnea.

While sleep apnea is a serious condition with far-reaching health effects, especially for those struggling with obesity, there is hope! With proper diagnosis and treatment, sleep apnea can be managed effectively, allowing individuals to lead healthier, more energized lives. If you or someone you know is experiencing symptoms of sleep apnea, speak with a healthcare provider to explore treatment options. Taking action now can improve your quality of life, prevent serious health issues and might even help with weight loss!

About the Author:

Maria Paula Guzman, MD, is a board-certified internal medicine physician specializing in sleep and obesity medicine. She is certified by the American Board of Internal Medicine and the American Board of Obesity Medicine. In 2022, she completed a sleep medicine fellowship at Emory University, where she achieved the highest score nationally on the Sleep Medicine In-Training Exam from the American Academy of Sleep Medicine (AASM). Dr. Guzman is a member of the Obesity Medicine Association (OMA) and recently founded Sleep & Obesity MD, a Florida-based telemedicine practice providing evidence-based treatment for sleep and obesity conditions.

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