Sleep Apnea – Do You Stop Breathing While Sleeping?

Before looking more closely at what sleep apnea is, here are a few key questions to ask yourself:

  • Have you or your partner noticed that you sometimes stop breathing while sleeping?
  • Do you sometimes wake up in the night feeling breathless, perhaps choking or gasping for air?
  • Are you a loud snorer, sometimes with long pauses between snores?
  • Do you feel sleepy during the day, even if you slept a lot?
  • Do you have insomnia, and maybe also feel sleepy during the day?

If you answered yes to any of these questions, there’s a possibility – though by no means certain – that you might have a sleep disorder called sleep apnea.

People with sleep apnea struggle for air and stop breathing while sleeping. The interruptions occur several times per hour (over 30 in severe cases) and can last for many seconds, even minutes, at a time.

Sleep apnea can have serious consequences for your health if left untreated. So if you do answer yes to any of the questions above, it’s important to speak to your doctor about it.

Unlike some sleep disorders, which can be dealt with by self-help and good sleep habits alone, sleep apnea requires professional help.

And in this article you’ll find an overview of the two main types of sleep apnea, looking at the symptoms, risk factors, diagnosis and treatment options. I’ll also point out some of the main similarities and differences between the two types.

The 2 main types of sleep apnea

There are two main types of sleep apnea. Both are categorized as sleep-related breathing disorders in the latest version of the International Classification of Sleep Disorders (3rd edition).

Obstructive sleep apnea (OSA)

Obstructive sleep apnea is the most common type, and is associated with a blockage of the person’s airways.

It’s traditionally estimated to affect 3-7% of people worldwide, though a recent study suggests that 10-17% of the US population could be afflicted, though many would be unaware of it. There are also distinct adult and child forms of OSA.

Central sleep apnea (CSA)

Central sleep apnea is less common, and is linked with a lack of physical effort from the body’s respiratory system. This then results in a reduction or stoppage of air flow.

The exact prevalence is unknown as it’s suspected that many people remain undiagnosed. The number who have it also differs according to the sub-type, as well as the particular group of people. For example, a higher percentage of elderly people would have it than younger people.

There are in fact eight sub-types of CSA that vary based on age of onset, cause and other features. Furthermore, some people may have a mix of the two main types of sleep apnea.

Symptoms of sleep apnea

There are a few symptoms which are associated with both forms of apnea. Not all sufferers will experience all of these symptoms though.

  • Loud snoring.
  • The person repeatedly stops breathing while sleeping due to obstructed airways and/or central respiratory weakness. This is sometimes seen by another person.
  • Sudden awakening, possibly with breathlessness.
  • Sufferers may report excessive sleepiness during waking hours because the interruptions make it harder to achieve deep sleep.
  • Insomnia might also be a result, either alone or as well as daytime sleepiness.
  • Difficulty with attention during the day.
  • Irritability.

There are also symptoms linked with just one type of apnea:

  • While anyone can snore, people with OSA often do so more frequently and loudly. It also tends to be more abrupt or startling, especially when returning to sleep from a breathing interruption. They may also wake up holding their breath, gasping or choking.
  • CSA is identifiable by reduced chest/abdominal movements when breathing. This symptom is very subtle in most cases though, making it difficult to detect by sight or experience alone.

Possible obstructive sleep apnea risk factors

Ideally, you can try to avoid developing OSA by maintaining good overall health, especially if any of the suggested risk factors below apply to you:

  • Obesity: extreme overweightness that’s defined by a body-mass index (BMI) at least 20% higher than recommended.
  • Large tonsils.
  • Having a large neck even when maintaining a healthy weight.
  • Males face a greater risk.
  • People with Down syndrome are at higher risk.
  • Being older than 40.
  • A family history of sleep apnea.
  • Recessed (tucked-in) chin, often visible as an overbite.
  • Children with neuromuscular diseases, cerebral palsy, gastroesophageal reflux or sickle cell disease.
  • Exposure to tobacco smoke.

Possible central sleep apnea risk factors

  • People who wake frequently in the night, either because they are susceptible to waking up easily, or because they have sleep maintenance insomnia.
  • People whose breathing is affected more than usually by Carbon Dioxide.
  • Opioid use.
  • The presence of medical conditions like heart disorders, brain tumor or stroke.
  • Some OSA treatments, like the use of a forced-air device, can increase the risk of CSA.
  • Males are at a higher risk.
  • People over 65 are at higher risk of developing other CSA risk factors.
  • Traveling to a higher altitude than accustomed may disrupt breathing because of decreased oxygen availability.

If you meet the criteria for one or more of the risk factors for either type of apnea, it’s a good idea to watch for symptoms so that they can be addressed while the problem is relatively new.

Apneas aren’t deadly on their own, but they are associated with an increased risk of life-threatening conditions that will be discussed below. Accordingly, symptoms of sleep apnea must be taken seriously and a medical professional should be consulted as soon as possible if they appear.

What causes sleep apnea?

Each type of sleep apnea can be caused by a wide range of issues. The following examples are by no means exhaustive.

Causes of obstructive sleep apnea (OSA)

  1. Deviated septum (displaced nasal tissue) blocking the airway.
  2. Overly relaxed throat muscles block the airway.
  3. Airway blocked by tongue.
  4. Airway blocked by fatty tissue.
  5. Naturally narrow airways.

Causes of central sleep apnea (CSA)

  1. Disruption of the brain area related to breathing by stroke, tumor or other health issue.
  2. Severe obesity can depress the respiratory system.
  3. Use of narcotics depresses the respiratory system.
  4. One of many medical conditions.
  5. Unaccustomed high altitude exposure disrupts breathing due to lower oxygen levels.

How is sleep apnea diagnosed?

The presence of sleep apnea in any form is best confirmed by a test conducted in a sleep lab. A patient would spend one or more nights sleeping at the lab while their breathing and other body activities are monitored.

To diagnose sleep apnea, at least one of the symptoms listed above needs to be found. Additionally, a Polysomnography sleep test needs to show specific results regarding the actually breathing abnormalities.

A polysomnography test measures a large number of things, such as:

  • Electrical brain activity.
  • Sleep stage progression.
  • Eye movements.
  • Heart beats.
  • Body movements.
  • Blood oxygen levels.
  • Breathing patterns.

As you can imagine, there are several instruments that must be worn during sleep in order for these measurements to be taken including, but not restricted to:

  1. Wires attached to the body with pads to measure electrical activity.
  2. A variety of stretchable bands secured around the chest and abdominal areas to record breathing movements.
  3. Finger clips to monitor blood flow properties (heart rate, oxygen saturation, pressure).

Several other tests may also be needed if central sleep apnea is suspected. Magnetic resonance imaging (MRI) could be used to look for physical obstructions in the neck and/or chest area. Additional lung and heart tests may also be required.

While sleep lab visits are the preferable setting for diagnosis, there are also portable kits that can be taken home by patients with suspected OSA if necessary.

Portable devices measure breathing through short tubes that are placed in the nose and mouth. They may also have the necessary belts and clips for testing chest/abdominal mechanics and blood flow.

Results are recorded within the machine so that they can later be retrieved by a doctor for assessment.

CSA diagnosis always requires in-person monitoring by professionals, so tests must be completed in a lab if the central type of apnea is suspected.

And before coming to a diagnosis, a doctor would also need to rule out other possible explanations, such as another sleep or medical disorder, medication or substance use.

Treatments for OSA

image of a man using a cpap machine for apneaThe most common treatment for OSA is the use of a CPAP machine. CPAP stands for “continuous positive airway pressure”.

These devices include a main base, an attached hose and a face mask that secures to your head with straps.

When used during sleep, the CPAP will force a mild but steady stream of air into the nasal passages to help keep the airways from collapsing.

A prescription is needed to obtain a CPAP machine and it has to be calibrated for each individual’s needs, so a couple of visits to a medical facility may be necessary.

There are also a number of lifestyle changes that are recommended for people with mild to moderate cases of OSA:

  1. Weight loss.
  2. Avoiding alcohol and other sedatives that may relax muscles.
  3. Sleeping on your side.
  4. Quitting smoking.
  5. Regular exercise.

Dental appliances can be used in less severe cases to move the tongue or other tissues out of the way and/or to align the jaw for better air passage. These devices require fitting by an experienced dentist and come in a wide variety of models, though they may cause jaw pain or chewing problems.

Surgery could be necessary to treat some forms of OSA. For example, if tonsils are blocking the airway then a tonsillectomy could be employed to remove them. Surgery is usually avoided if possible though, due to the risk of infection and serious respiratory complications.

Treatments for CSA

Individual cases of CSA must be carefully diagnosed and targeted for treatment of the underlying cause. A CPAP or similar (but stronger) device may be used to assist in the meantime.

Oxygen therapy is necessary in more severe cases. If medication is found to be the cause, then it will need to be changed or have its dosage reduced.

Living with sleep apnea

The most important points in managing sleep apnea are sticking to your treatment plan and making the appropriate lifestyle changes. If sleep apnea isn’t addressed properly, it can lead to many serious conditions, such as:

  • High blood pressure.
  • Increased risk of heart disease, heart attack or stroke.
  • Type 2 diabetes.
  • Irregular heart beat.
  • Worsening memory and concentration.
  • Car accidents.

Obtaining a proper diagnosis and adhering to the recommended treatment is important, and may help reduce the likelihood of these potentially fatal developments.

References

  1. Qaseem, A., Dallas, P., Owens, D. K., Starkey, M., Holty, J. E. C., & Shekelle, P. (2014). Diagnosis of obstructive sleep apnea in adults: a clinical practice guideline from the American College of Physicians. Annals of Internal Medicine, 161(3), 210-220.
  1. Llanos, O., Ayoub, K., Ayub, S., Colaco, C., Khasawneh, K., & Prince, A. (2016). Variation in sleep apnea severity according to hypopnea definition. In A80-A. Are HSTS Obsolete? Novel Diagnostics in SDB (pp. A2518-A2518). American Thoracic Society.
  1. American Academy of Sleep Medicine. International classification of sleep disorders, 3rd ed. Darien, IL: American Academy of Sleep Medicine, 2014.
  1. LaGrotte, C., Fernandez-Mendoza, J., Calhoun, S. L., Liao, D., Bixler, E. O., & Vgontzas, A. N. (2016). The relative association of obstructive sleep apnea, obesity and excessive daytime sleepiness with incident depression: A longitudinal, population-based study. International Journal of Obesity.
  1. Eckert, D. J., Jordan, A. S., Merchia, P., & Malhotra, A. (2007). Central sleep apnea: Pathophysiology and treatment. Chest Journal, 131(2), 595-607.
  1. Kimoff, R. J. (2015). When to suspect sleep apnea and what to do about it. Canadian Journal of Cardiology, 31(7), 945-948.
  1. Batool‐Anwar, S., Goodwin, J. L., Kushida, C. A., Walsh, J. A., Simon, R. D., Nichols, D. A., & Quan, S. F. (2016). Impact of continuous positive airway pressure (CPAP) on quality of life in patients with obstructive sleep apnea (OSA). Journal of Sleep Research.
  1. Mutter, T. C., Chateau, D., Moffatt, M., Ramsey, C., Roos, L. L., & Kryger, M. (2015). A matched cohort study of postoperative outcomes in obstructive sleep apnea: Could preoperative diagnosis and treatment prevent complications? Survey of Anesthesiology, 59(2), 94-95.
  1. Kendzerska, T., Mollayeva, T., Gershon, A. S., Leung, R. S., Hawker, G., & Tomlinson, G. (2014). Untreated obstructive sleep apnea and the risk for serious long-term adverse outcomes: a systematic review. Sleep medicine reviews, 18(1), 49-59.
  1. Punjabi, N. M. (2008). The epidemiology of adult obstructive sleep apnea. Proceedings of the American Thoracic Society, 5(2), 136-143.
  1. Javaheri, S., Germany, R., & Greer, J. J. (2016). Novel therapies for the treatment of central sleep apnea. Sleep Medicine Clinics, 11(2), 227-239.
  1. Mayo Clinic Staff (2016, June 28). Central sleep apnea. Retrieved August 19, 2016.
  1. Latshang, T. D., Bloch, K. E., Lynm, C., & Livingston, E. H. (2012). Traveling to high altitude when you have sleep apnea. JAMA, 308(22), 2418-2418.

23 CommentsLeave a comment

  • Right now I’m only a teenager but I’ve been having on and off of what I believe is sleep apnea for almost two years. It started at the age of thirteen and it would happen every night two to four times each night. What would happen is I would sit right up gasping for air and it wouldn’t even take a minute to remember how to breathe and go back to sleep. Now I didn’t say I would wake up because I’m always aware of what is happening. I’m always barely falling asleep or maybe even just barely awake and I can feel myself not breathe and it’s like my soul is yelling at me to breathe but I just can’t. The first month it started I told my father and he didn’t take me to the doctor but instead suggested I get an extra pillow and kind of keep my head elevated. This worked and the “sleep apnea” stopped for almost the rest of the year. It didn’t even return while my head wasn’t elevated. It returned towards the end of the year but only for a week. Now this past summer it returned but there was more. I would shake in my sleep and get up gasping for air. Then it stopped in July. Now, it has returned and it started this week on Monday. And it’s just gotten out of hand. I elevate my head and it still doesn’t work. I end up gasping for air two to four times a night. And usually it takes me less than a minute to recover from it and I go back to sleep. Now that can’t take more than yen minutes to recover from all the times it happens. So I get plenty of sleep but since it’s come back, I’ve found it hard to wake up in the morning to go to school and towards the middle of the day I can barely keep my eyes open. I don’t know for sure what is going on. I’m not overweight. I don’t snore. It just feels like I’ve drowned and I’m dead until someone does CPR and I’m spitting out water and gasping for air. It’s frightening and I don’t know what to do.

    • Hi Gregoria
      Thanks for your comment. I think you really need to speak to your personal physician or doctor about this. I’m sure your father did what he felt was best at the time in suggesting the pillow, but it sounds to me like you need a professional medical assessment. If you can’t go on your own to your doctor, ask your father again and tell him that you’ve been reading about sleep apnea and want to speak to a doctor about it. If he’s not able to take you for whatever reason, then I would mention it to any medical figure you have in your school and ask them for their support in speaking to a doctor.
      I don’t want to cause you any problems with your father of course, but I think with potentially serious health problems – which breathing difficulty in your sleep can be – needs to be looked at.
      Regards
      Ethan

  • Got very bad sleep apnea, its affecting my life very badly so depressed the lack of sleep is killing me I feel so exhausted everyday

  • With this information above I think I’m having Central sleep apnea. I far as I rember I had it few time during my teens. Im 24 now and it’s becoming worse. I have to wake up totally and not to fall back to sleep because if I go back to sleep I cant breath. It’s so tiring. It’s not happening every sleep but like 1 to 3 times a week and sometimes not on a week.

  • Hi Dr I have central sleep apnea with oxygen attached. Hears my problems I am definitely more confused and more forgetful however I would love to wear this machine but the seal leeks and I end up waking up more than I sleep. Can I try using the oxygen machine with the small canulla ?

    • Hi Carol
      Thanks for your comment. The best thing is to speak to your doctor and/or the person who helped you set up the cpap machine the first place. They can help you adjust it so it works properly.
      Regards
      Ethan

  • I’ve read somewhere else that a study concluded people with un-diagnosed sleep apnea died at triple the rate of those without sleep apnea. If that is true, I wouldn’t hesitate to have a consultation if I or a loved one exhibited symptoms of sleep apnea. Due to the potential danger it presents, it would make it that much more important to seek appropriate treatment if you are diagnosed with it.

    • Hi John
      Thanks for your comment. Can you remember any details about that study other than that rather worrying statistic? I do agree though that it’s important to get yourself checked out if you suspect you might have sleep apnea.
      Regards
      Ethan

  • I have snored very loud all my life. For me, I have a very large neck and a somewhat receding lower jaw as you mentioned in your article. In addition, I am slightly overweight because I am a foodie, do not exercise, smoke cigars, enjoy wine and tequilas, and have somewhat of a fear to go to bed physiologically because of not feeling safe and/or lack of breathing from Apnea when I breath. Additionally, I use ambien to get over the fear of sleep and most significantly the uncomfortableness of the CPAP mask. I have about a 20 percent compliance rate with the CPAP without ambien and about an 80 percent compliance rate with the mask. My question is whether it is better to take ambien or not based on the competing health effects of taking the ambien versus the noncompliance rate going substantially up without the ambien? I understand that I need lifestyle changes and honestly I am very unlikely to change some of the issues causing the Apnea, I prefer the quality of life today knowing the it will severely impact the quality of life later. I am assuming my situation is probably the same for hundreds of thousands of people in the US. Wondering if any research has been done on the pros and cons of using ambien with a CPAP machine? If not, I would be curious about your thoughts. Cheers, Mike.

    • Hi Mike
      Thanks for your comment. I can understand your dilemna – the combination of insomnia and apnea isn’t much fun. I think your question is ultimately best discussed with your doctor. Sorry to dodge answering it, but it’s a complex one and one which the person who best knows your situation and medical history should address.
      Perhaps you could also try speaking to a professional about your anxiety around the apnea. It could be that addressing that anxiety might help as well, rather than getting past it with a strong sleep aid. As you say, lifestyle changes might not be something you feel like doing, but ultimately it sounds like you’re doing a selection of things which are known to be bad for apnea and sleep generally. Even if you don’t want to totally change those things, even some small changes might help considerably. I understand that life is short and so it’s tempting to want to enjoy it while you can, but at the end of the day, I personally think it’s wise to have a think about how future you will feel!
      Regards
      Ethan

  • I like how you mentioned that loud snoring and sudden awakening can be signs of sleep apnea. My husband has always been a really loud snorer, and he’s recently mentioned waking up suddenly at various points at night. Perhaps it would be a good idea to visit a professional to see if it’s sleep apnea and to get it treated.

  • i have trouble sleeping i dont go to sleep untill 1am because wake up about 4 times then its six am the i get uo i admit my day s alomgt but if i try to go to be d thats when it happends i stop breathing in my slle and then iam gasping for for around 30 second and the thing s slowly get better bout for leasar an hour i am shaking and too scsred to go b

    • Hi Gary
      Thanks for your comment. I had a little trouble understanding your comment, but I gather you stop breathing and wake up gasping for breath. If that’s the case, it’s important that you talk to a doctor about it and get help if you have apnea.
      Regards
      Ethan

  • Hi I have been snoring quite loudly sometimes waking myself up but last night I woke up gasping for air. I was so frightened. Do you think its possible I have sleep apnia?
    I remember as a a child watching my dad sleep and he appeared to stop breathing I was very frightened then too.
    I have a history of insomnia, I smoke about 10 cigarettes a day, do limited exercise. Often feel tiers in the day usually the afternoon. I am not overweight and drink a glass if wine a day??

  • The truth is that the sleep apnea sufferer is totally unaware that they aren’t breathing. However their partner is kept awake by snoring and occasionally has to resort to physical violence because they are so terrified that the sufferer isn’t actually going to restart breathing!

  • I have been diagnosed with obstructive sleep apnea and have a CPAP machine.
    In my initial diagnosis I had an average of 20 events per hour. However this broke down to 59 events when lying on my back and 0.3 events when on my side.
    After consulting with a hypnotherapist I have learnt to sleep on my side and now often record Zero events. I am convinced that the CPAP machine has nothing to do with this and would prefer to use a less obtrusive monitor that just measures whether I am sleeping on my back or my side. Any suggestions?
    I do believe that the CPAP machine often interferes with my sleeping and end up awake for hours so it is self defeating.

    • Hi Stephen
      Thanks for your comment. It was very interesting to hear what you had to say about sleeping on your side making such a big difference. Unfortunately, I don’t know of any monitor that measures whether you sleep on your back or side.
      A couple of things spring to mind though, that might interest you. One is to film yourself sleeping – it might be tedious going through it, but for the occasional night, you could at least double check with complete accuracy what position you sleep in.
      Secondly, I while ago someone wrote to me about their kick-starter campaign for a belt you wear with some balls attached which you can adjust to make it so it forces you to sleep in the only position that is comfortable. I can’t remember what it was called, but if you look around online you might find it, or something similar.
      Regards
      Ethan

  • I can only imagine how awful it must be to live with sleep apnea. I’ve experienced what it’s like to wake up with breathlessness a few times when I had a cold, and it’s awful (and terrifying). If I had to live with that night after night… I just don’t know what I’d do.

    • Hi Ray
      Thanks for your comment. Yes, I agree that sleep Apnea can be a difficult sleep disorder to live with. Fortunately, it can be controlled with medical supervision and the correct treatment, and people do learn to live with it.
      Regards
      Ethan

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