Sleep Apnea

Obstructive sleep apnea is a serious breathing problem that interrupts your sleep.

Obstructive sleep apnea (also called OSA or obstructive sleep apnea-hypopnea syndrome) means you have short pauses in your breathing when you sleep. These breathing pauses – called apneas or apnea events – last for 10 to 30 seconds, maybe longer. People with obstructive sleep apnea can stop breathing dozens or hundreds of times each night leading to sleep disruption and low levels of oxygen.

How obstructive sleep apnea affects your breathing

Obstructive sleep apnea stops you from breathing normally at night. If you have obstructive sleep apnea, you probably repeat this cycle while you sleep:

First, you may sleep quietly and breathe normally. The air in your airway (breathing tube) flows easily to your lungs.

Then, you begin to snore loudly. This is a sign that your airway is partly blocked. If the blockage worsens this may affect the amount of air that can enter your lungs and your oxygen level can drop. (When doctos see this kind of drop in oxygen level due to a partially blocked airway in a sleep test, they call it a hypopnea.)

Next, your airway closes off completely. No air reaches your lungs. Your brain is telling you to breathe as usual, but you can’t take in a breath because your airway has closed off. This is called apnea. After a pause of 10-30 seconds or more, your brain realizes you haven’t been breathing, so it jolts you awake enough for you to take a breath. You take in a big gasp of air and start breathing again.

This cycle can continue through the night: you breathe quietly; you snore; you have a pause in your breathing; you gasp for breath; and you start breathing again. Most people have dozens or hundreds of sleep apnea events a night. This means dozens or hundreds of interruptions of sleep. You can’t get the restful sleep you need to be healthy.

The combination of both apnea events (pauses in breathing) and hyponea events (partly blocked breathing) is called obstructive sleep apnea-hyponea syndrome (OSAHS).

What can make a person’s airway collapse during sleep?

There are a few reasons why a person’s airway can partly or completely collapse during sleep:

  • your throat muscles are too relaxed to hold your airway open
  • your tongue blocks your airway
  • fatty tissue blocks your airway
  • you have a narrow airway.

Anyone of any age can get obstructive sleep apnea. Your risk is higher if you have a combination of these risk factors:

  • You’re obese (very overweight).
  • You have a large, thick neck (larger than 17 inches for men; larger than 16 inches for women).
  • Your family has a history of obstructive sleep apnea.
  • You’re male.
  • You’re older than 40.
  • You have large tonsils.
  • You have a recessed chin (your chin tucks in).

Children are at higher risk of sleep apnea if they have large adenoids and tonsils. Tonsils and adenoids are tissues in the back of the throat. You can see tonsils by looking into the mouth. You can’t see adenoids – they are higher up in the throat.

The two main symptoms of obstructive sleep apnea are:

  • You’re very sleepy during the day, but you don’t know why.
  • You snore and have pauses in your breathing while sleeping.

Some other signs and symptoms of obstructive sleep apnea:

  • You have high blood pressure
  • You’re irritable.
  • You gasp or choke during sleep.
  • You’re very tired (you have fatigue).
  • You’re depressed.
  • You can’t concentrate.
  • You have morning headaches.
  • You have memory problems/ memory loss.
  • For men: you have impotence (difficulty keeping an erection)

If you think you have these signs and symptoms or if you think you have sleep apnea, see your doctor. Your doctor can learn more about your symptoms and give you a test that helps diagnose sleep apnea.

Many people have sleep apnea without knowing it. Sleep apnea can develop slowly, over time. Many people don’t recognize the signs and symptoms.

Often people go to the doctor because they don’t know why they are so tired, or because their bed partner complains that they snore too much. These are clues that a person might have sleep apnea. Family members or bed partners often pick up on the signs of sleep apnea first. Many people with sleep apnea don’t know they’re snoring and gasping for breath at night.

The main symptom of sleep apnea is “excessive daytime sleepiness” – you are sleepier than expected during the day.  You can share your quiz results with your doctor, who can do further tests to see if you have sleep apnea.

Often, the best treatment for obstructive sleep apnea is continuous positive airway pressure (CPAP.).  It’s the only effective treatment for severe sleep apnea.

If you have mild or moderate sleep apnea, your doctor may recommend one of these alternate treatments instead of CPAP:

  • Making lifestyle changes: losing weight, avoiding alcohol and sedatives
  • Dental appliances
  • Surgery, including tonsillectomy and UPPP

Continuous positive airway pressure (C.P.A.P.)

Continuous positive airway pressure (CPAP) is the best treatment for obstructive sleep apnea.

With CPAP treatment, you wear a special mask attached to a CPAP machine (also called a flow generator). The CPAP machine blows a steady stream of air through the mask, into your nose and down your throat (airway). The stream of air creates pressure, which holds the tissue in your airway open. This stops your airways from collapsing. Your airway stays open all night, so you can breathe properly all night. To get CPAP treatment, you need a prescription from your doctor.

Other sleep apnea treatments

CPAP is the first and the most effective treatment choice for substantial obstructive sleep apnea. There are other treatments; your doctor may prescribe these if you have mild or moderate sleep apnea.

Lifestyle changes to treat mild obstructive sleep apnea

Some people with mild OSA can improve their symptoms by making some changes. In some people, these changes will be enough to treat their sleep apnea symptoms:

Lose weight. Overweight people can have extra tissue around their necks- this tissue can block their airway. By losing weight, you can shrink the tissue around your airway, and allow more air to pass to your lungs. Studies show that people who lose 10% of their weight can have a 30% decrease in their sleep apnea symptoms.

cohol and sedatives (medicines that make you sleepy). Alcohol and sedatives can make your throat muscles relax too much, allowing your airway to close off. If you avoid alcohol and sedatives, you may be able to keep your airway open. Read more about avoiding alcohol to improve sleep apnea symptoms. 

Sleep on your side, not your back. Some people only get obstructive sleep apnea when they sleep on their backs. Sleeping on your back lets gravity pull on the tissues at the back of your throat and neck. This can make your airway narrow or make it collapse completely. You can train yourself to sleep on you side by:

  • putting pillows against your back to prop yourself on your side.
  • using the “tennis ball trick”: sew a pocket onto the back of your pajama top and put a tennis ball in it. If you start to roll to your back during sleep, the pressure from the ball will make you roll back onto to your side.

Lifestyle changes don’t work for everyone, and may not work forever. As you get older or if you gain weight, these simple solutions may no longer treat your sleep apnea symptoms. Keep track of your sleep apnea symptoms.  If your symptoms come back, see your doctor for another kind of treatment.

Dental appliances for obstructive sleep apnea

If you have mild or moderate sleep apnea, your doctor may suggest you use a dental appliance (also called an oral appliance). The dental appliance fits over your teeth. You wear it at night. It holds your tongue and jaw towards the front of your mouth, so they don’t slip back and block your airway.

There are two types of dental appliance for obstructive sleep apnea:

  • Fixed dental appliances fit over your teeth. They can’t be adjusted.
  • Adjustable dental appliances also fit over your teeth, but they can be adjusted. The dentist can adjust them forward or back, so the appliance has a fit that’s suited to your mouth size and shape. Adjustable dental appliances are better that fixed ones.

To get fitted for a dental appliance, you should see a dentist that has experience in fitting these devices. There are over 80 models of dental appliance on the market. Your dentist should work with your sleep specialist doctor to choose the model that’s right for you.

Some people have jaw pain and temporary chewing problems as they get used to wearing a dental appliance. If your dental appliance isn’t comfortable, talk to your dentist. It’s important that you have an appliance that’s comfortable enough to wear every night.

Once you’ve started using a dental appliance, your doctor may send you for a follow-up sleep study polysomnography or home monitoring. This will show whether the dental appliance gets rid of your obstructive sleep apnea symptoms.

Surgery for obstructive sleep apnea

If you can’t use CPAP therapy, your doctor may suggest surgery to treat your obstructive sleep apnea symptoms. Surgery for sleep apnea is not ‘one size fits all’. For surgery to help, the doctor needs to know exactly what part of your airway is getting blocked. An ear, nose and throat specialist (otolaryngologist) can examine your nose, mouth and throat to pinpoint the problem.

Please keep in mind that surgery can be risky. Most surgery isn’t reversible- once it’s done, it’s done. In some cases, surgery may actually worsen a person’s obstructive sleep apnea symptoms. This is why doctors don’t recommend surgery in most cases.

These are the types of surgery available for some people with obstructive sleep apnea:

Tonsillectomy – surgery to remove your tonsils. If you have sleep apnea because your tonsils are too big, you can have surgery to remove them. Like any kind of surgery, tonsil surgery can lead to complications (problems). Tonsil removal is the most common treatment for obstructive sleep apnea in children.

Uvulopalatopharyngoplasty (UPPP) to treat obstructive sleep apnea. In this procedure, which doctors call “U triple P”, the surgeon cuts away the uvula and part of the soft tissue at the back of the throat. UPPP may reduce snoring and sleep apnea events (pauses in breathing). Like any kind of surgery, UPPP surgery can lead to complications (problems). Some people who’ve had UPPP surgery have nasal regurgitation (fluids going up your nose when you swallow).

If your sleep apnea is not controlled, you may have trouble using CPAP after this surgery.

Experimental treatments for obstructive sleep apnea

You may hear of new sleep apnea treatments on the web or in newspapers. They may have benefits if you have mild or possibly moderate sleep apnea. For people with severe sleep apnea, CPAP is still the only treatment option. If you are thinking about trying a new treatment for sleep apnea, talk with your sleep specialist. Your sleep specialist can tell you the risks and benefits of any new treatment, and can explain whether it would be helpful in your particular case.

Health risks if you do not treat your sleep apnea

Sleep apnea is not just an annoying habit; it is a serious condition. It could even kill you. If you do nothing about your sleep apnea, you put yourself at higher risk for diseases, accidents, and early death.

Here are some of your risks if you don’t treat your sleep apnea:

  • You can develop high blood pressure.
  • Your risk of heart attack or stroke increases.
  • Your memory and concentration can worsen.
  • You are at much higher risk of causing a car accident (motor vehicle crash).
  • You may develop an irregular heart beat.

What’s the difference between mild, moderate and severe sleep apnea?

Sleep specialists decide if your sleep apnea is mild, moderate, or severe by counting how many times your breathing stops each hour. The times when your breathing stops are called “apneas” or “events”. They can count these events using polysomnography or portable home monitoring.

  • 5 to 15 events per hour : Mild sleep apnea
  • 15 to 30 events per hour : Moderate sleep apnea
  • over 30 events per hour : Severe sleep apnea

There are other things doctors consider when they are deciding how severe your sleep apnea is. Some other considerations are:

  • How sleepy you feel
  • How low your oxygen level dips
  • How long your oxygen level stays below 90%
  • Other medical conditions you may have, such as heart disease

What is central sleep apnea?

In central sleep apnea, your brain forgets to tell your muscles that you need to breathe. Your throat and airway are normal- it’s your brain that has the trouble. Central sleep apnea is not as common as obstructive sleep apnea. Often people with central sleep apnea have another medical condition, such as heart failure. Treating their other medical condition can improve the central sleep apnea. Some newer devices may improve central sleep apnea.

It is possible to have both obstructive and central sleep apnea. This is called mixed sleep apnea.

What is sleep-hypoventilation syndrome?

When a person doesn’t breathe enough during the day and night to take in the oxygen they need, this is called is called Sleep-hypoventilation syndrome. Hypoventiation means to breathe less than is necessary to keep the levels of oxygen and carbon dioxide in the blood normal. Sleep Hypoventilation is linked to obesity.

The first choice of treatment for sleep-hypoventilation syndrome is continuous positive airway pressure (CPAP). If a person’s oxygen and carbon dioxide levels don’t improve with CPAP, the doctor will recommend a more sophisticated machine, like a bilevel positive airway pressure (BiPAP) machine.

What is Mixed or complex sleep apnea?

In Mixed or Complex sleep apnea a person has a blend of both central and obstructive sleep apnea. Each episode usually begins when your brain forgets to tell your muscles that you need to breathe (central sleep apnea). Then your body tries to breathe, but the airway is blocked (obstructive sleep apnea).

How common is sleep apnea?

  • 1 of every 5 adults has at least a mild form of sleep apnea (20%)
  • 1 of every 15 adults has at least moderate sleep apnea (6.6%)
  • 2 to 3% of children are likely to have sleep apnea
  • Over 1 in 4 (26%) Canadian adults have a high risk of having or developing obstructive sleep apnea.

What is Mixed or complex sleep apnea?

In Mixed or complex sleep apnea a person has a blend of both central and obstructive sleep apnea. Each episode usually begins when your brain forgets to tell your muscles that you need to breathe (central sleep apnea). Then your body tries to breathe, but the airway is blocked (obstructive sleep apnea).

I have sleep apnea. Is it safe to travel?

Yes, it’s safe for people with sleep apnea to travel, as long they continue their treatment. Sleep apnea does not take a vacation. You need to take your CPAP with you when you travel.

If you are flying, bring your CPAP machine as carry-on luggage. To make getting through security as smooth as possible, bring a letter from your doctor explaining what your CPAP machine is, and that it’s medically necessary for you to use it.

The letter from the doctor should say:

  • That your CPAP equipment is required for a medical condition.
  • The model (e.g. ResMed S7 Elite) and the serial number of all your equipment

Check about the type of electrical supply in the country where you are traveling. You may need a converter. You may also want to bring a battery pack.

You should bring your CPAP with you everywhere you sleep. If you go to the hospital, bring your CPAP machine and use it.

Get the flu vaccine and encourage others in your family to get the flu vaccine too. Regardless of what you may have heard, the flu vaccine is generally very safe and greatly reduces your risks. The flu vaccine is recommended for everyone aged 6 months or older unless there is a reason it should not be given.

The flu vaccine is especially recommended for people who are at higher risk and those who have regular contact with people at higher risk. People at higher risk from the flu include:

  • People with health conditions such as lung diseases (e.g., asthma, chronic obstructive pulmonary disease)
  • People 65 years of age and older and children under 60 months of age
  • Pregnant women
  • Indigenous peoples
  • Residents of nursing homes and other chronic care facilities

Getting the flu vaccine also helps reduce the risk that you will spread the flu to others in your family and community who may be at higher risk of serious complications. The more people who get the flu vaccine in your community, the less risk to everyone of getting the flu. This is called “herd immunity” or “community immunity”.

If you are pregnant, getting the flu vaccine can reduce the risk that your baby will get the flu after it is born.

In individuals aged 65 and older, the immune system response to the flu vaccine is not as strong as it is in younger people. Those aged 65 and older may get more benefit from the high-dose flu vaccine, which has four times the usual dose and is now available for free to seniors in Ontario.

Other measures that can help stop the flu from spreading include:

  • Wash your hands regularly. When soap and water are not available, use a hand sanitizer that contains at least 60% alcohol.
  • Keep your hands away from your nose, mouth and eyes when in public
  • Regularly clean common areas of your home (e.g., door handles, light switches, hand rails, taps, remote controls, keyboards)
  • Avoid crowded places and people who have a cold or the flu
  • Sneeze and cough into a tissue then throw it away right after use and wash your hands. If you don’t have a tissue, sneeze and cough into your sleeve.
  • If you are sick with the flu, stay home from work, school and public places
  • Find a flu vaccine clinic in Ontario by visiting www.ontario.ca/flu.

Typical flu symptoms can include:

  • Tiredness
  • Cough
  • Sore throat
  • Muscle aches
  • Chills
  • Runny or congested nose
  • Fever
  • Headache
  • Lack of appetite

If you get the flu, stay home and take these steps:

  • Get bed rest
  • Drink plenty of fluids
  • Manage symptoms (e.g., headache, congestion) with non-prescription medications
  • Reduce contact with others to prevent passing on the infection

If you get the flu and have any health concerns, contact your health-care provider. If you are at a higher risk of complications from the flu, your health-care provider may prescribe an antiviral medication for you to take. Antiviral medications may reduce the severity of the flu and how long it lasts.

Can I get the flu from the flu vaccine?

No, you cannot get the flu from the flu vaccine since the viruses in the vaccines have been altered so that they cannot cause an infection.

Is the flu vaccine safe?

Yes, the flu vaccine is generally very safe. There are so many flu vaccines given every year, yet very few significant side effects. Generally, the health risks from getting the flu are much greater than the health risks from the flu vaccine.

Why do I need a flu vaccine every year?

The flu viruses that spread around the world are different every year. Therefore the flu vaccine contains protection against a new set of viruses every year. Plus the immunity you get from a flu vaccine decreases over time. 

I’ve never had the flu. Why should I get the flu vaccine?

Even if you’ve never been in a serious vehicle collision in the past, do you still put on your seat belt? Most people do since it greatly reduces their risk of injury and death in the unlikely event of a vehicle collision. The fact that you have not been infected with the flu in the past does not mean you won’t be infected in the future. Getting the flu vaccine greatly reduces your risk of the flu.

Getting the flu vaccine also helps protect others who may not be able to fight off the infection as well as you. The more people who get vaccinated in a community, the less chance the infection spreads around.

What is the difference between a cold and the flu?

The common cold is a name given to minor infections in the nose and throat. The flu is a more serious disease caused by viruses that are different from cold viruses. Flu and cold infections are both very contagious.

With the flu, it is common to have a fever, headache, body aches, and weakness. With a cold, these symptoms are much less common.

If you are not sure if you have a cold or the flu, refer to the Public Health Agency of Canada chart, IS IT A COLD OR THE FLU?.