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.

Obstructive sleep apnea (OSA) is the most common type of sleep apnea. There are three other types of sleep apnea: central sleep apnea, mixed or complex sleep apnea and sleep-hypoventilation syndrome.

Central sleep apnea

Central sleep apnea occurs when 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.

Mixed sleep apnea

It is possible to have both obstructive and central sleep apnea, which is called mixed 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). 

Sleep-hypoventilation syndrome

Someone with sleep-hypoventilation syndrome doesn’t breathe enough during the day and night to take in the oxygen they need. 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.

How obstructive sleep apnea affects your breathing

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

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).

Who’s most at risk for obstructive sleep apnea?

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.

Causes of obstructive sleep apnea

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.

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”, meaning that you are sleepier than expected during the day. If you have signs and symptoms of sleep apnea, you should see your doctor for a full exam and diagnosis. Your doctor can give you a test that will show whether you have sleep apnea.

Diagnosing obstructive sleep apnea

Polysomnography

The best way to diagnose sleep apnea and other sleep problems is an overnight test in a sleep laboratory. This test is called polysomnography (PSG).

Polysomnography measures many things, including:

• brain activity
• stages of sleep
• eye movement
• muscle tone
• heart beats
• leg movement
• breathing
• air movement
• movement of your chest
• movement of your abdomen
• oxygen level in your blood

To get a polysomnography test, you go to a special sleep lab. A sleep specialist attaches small wires to your head, face, chest and legs. You will also have stretchy bands placed around your chest and stomach to record your breathing. The sleep specialist or tester may also use a video camera to record your sleeping position. Once you’re hooked up to the monitors, you fall asleep. You sleep the whole night in the lab. When your test is over, a sleep doctor will look at your results, make a diagnosis and suggest a treatment.

Portable home monitoring devices 

The most comprehensive way to test for sleep apnea is polysomnography, a test that takes place overnight in a sleep lab. But there are long wait lists for polysomnography, so your doctor may consider giving you a different test for sleep apnea, using a portable home monitoring device.

Doctors use portable home monitoring devices in cases where they are fairly sure the patient has sleep apnea. Doctors ten not to use offer home monitoring to patients with other serious respiratory or cardiac problems – those patients should take the polysomnography test.

A woman wearing a home monitoring device, which helps diagnose sleep apnea.

By taking a home monitoring test, you can avoid the long wait for polysomnography. This means you can start your treatment sooner.

Portable home monitoring devices measure your oxygen levels, the airflow through your nose and mouth, your breathing patterns and snoring. Your doctor or another health-care provider will show you how to hook up the machine and explain how it works. Then you’ll bring it home, put it on and wear it overnight as you sleep at home, in your own bed. The machine will keep track of your results. Later a doctor will read your results, diagnose your problem and recommend a treatment.

Is it mild, moderate or severe sleep apnea?

A sleep specialist will determine 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

Your healthcare provider will also consider: 

• 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

Treatments for obstructive sleep apnea

If it’s not treated, sleep apnea can lead to daytime sleepiness and reduced cognitive function. People with untreated OSA have an increased risk of motor vehicle crashes, cardiovascular disease, hypertension and early death. Thankfully, there are excellent treatments for 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, which 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.

Avoid alcohol 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. 

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 

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 to hold your tongue and jaw towards the front of your mouth, so your tongue doesn’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 many 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

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. 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 is surgery to remove your tonsils if you have sleep apnea because your tonsils are too big. 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 or “U triple P”) involves the surgeon cuting 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.

Treating severe sleep apnea

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

See our Frequently asked questions about using a CPAP machine page

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.

To get CPAP treatment, you need a prescription from your doctor. Medical suppliers can’t sell you CPAP equipment unless you have a prescription.

CPAP is a treatment, not a cure. While you’re using CPAP, your sleep apnea symptoms stop. Your breathing and your sleep are healthy. If you stop using CPAP, your sleep apnea symptoms will come back. Your breathing and sleep will be interrupted again.

If your doctor says you need to use CPAP, you must use it every time you sleep.

There are many experimental treatments for obstructive sleep apnea; 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. 

• 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.

Tips for living with sleep apnea

You have no control over the shape of your face, or the size of your jaw or airway, but there are things that you can control that might help your sleep apnea.

You can control:

• Your diet and weight
• How much you exercise
• What medications you take
• How you use alcohol and caffeine
• Whether you smoke

Changing your diet and weight to improve sleep apnea symptoms

Many people with sleep apnea are overweight. If you lose weight, your sleep apnea symptoms may improve.

Some people find it easier to lose weight once they get their sleep apnea treated. People who have untreated sleep apnea symptoms don’t get restful sleep, and this can interfere with the signals in their brains. If you don’t get enough sleep, your brain can have trouble deciding if you are hungry or full. Once you start sleeping properly, brain’s hunger signal stops being confused. You know when you’re full, so you know when to stop eating. You’re less likely to overeat. This can help you lose weight.

Ask your doctor to refer you to a dietician to help you lose weight. Or join a proven weight loss support program. Most people need long-term support to keep the weight off.
If you gain or lose more than 30 pounds, your CPAP pressure may need to be changed. If you’ve gained or lost 30 pounds or more, go back to your sleep specialist for another evaluation.

Exercise to improve sleep apnea symptoms

Regular exercise has many benefits for people with sleep apnea, including:

• better endurance
• better muscle tone
• more energy
• less tension, depression and anxiety
• better chance of controlling weight
• lower blood pressure
• better circulation
• lower risk of heart attack or stroke

Always speak to your doctor before starting an exercise program.

Here are some good ways to make exercise part of your routine:

• Walk every day. Even short walks are helpful.
• Park a distance from the store and walk across the parking lot.
• Use the stairs instead of the elevator
• Join an exercise program
• Go biking with friends
• Do an activity that interests you; swimming at the local pool, dancing, golfing, or another activity. Look at your local recreation guide to find what’s available in your area.

Medications and sleep apnea

Medications such as tranquilizers or muscle relaxants can make sleep apnea worse. Please discuss all your medications with your sleep doctor, including herbal and over-the-counter remedies.

Getting dental and medical care if you have sleep apnea

If you’re getting sedated (anesthesia, “going under”) for a dental procedure, a test or surgery, be sure to tell all the people looking after you that you have sleep apnea. And remember to use your CPAP machine or dental device everywhere you sleep, including times when you may stay overnight at a hospital.

You should also wear a medical alert bracelet that says you have sleep apnea.

Alcohol, caffeine, and sleep apnea

Alcohol and caffeine can cause problems with sleep if you take them within four hours of your bedtime. Avoid alcohol and caffeine before bedtime. Caffeine is found in many items including coffee, tea, soft drinks and chocolate. To avoid caffeine, drink water or decaf versions of coffee, tea, or cola. If you do want to drink something with alcohol or caffeine, drink it earlier in the day, with a meal.

Smoking and sleep apnea

Smokers are at greater risk of developing sleep apnea. Smoking can make your nose stuffy and irritated, which can interfere with your CPAP therapy. Consider the pros and cons of smoking. Once you are ready to quit, get help. Learn more about how to quit smoking and where to get help.

If your partner has sleep apnea

Sleep apnea is a serious condition. Your support will help your partner get the help he or she needs. Once your partner gets proper treatment, you may sleep better too!

Doctors, equipment suppliers and health educators work as a team to help people use their CPAP equipment successfully. You, the partner, play a very important role as well. Here are some ways you can help:

• Learn all you can about sleep apnea. To start, read through the information on this website.
• Learn about your partner’s prescribed treatment for sleep apnea  (for example, CPAP). Help your partner get used to his or her treatment.
• Encourage your partner to continue with the treatment.
• Reassure your partner that using CPAP does not affect how you feel about him or her.
• Support your partner’s efforts to lose weight and exercise regularly and to quit smoking.

Sleep apnea in children

Lack of good quality sleep is just as important in children as in adults and the number of children with sleep disordered breathing is surprisingly high. Depending on the child’s age, the symptoms can vary. It can cause daytime sleepiness like it does in adults, but it can also cause hyperactivity and inattention leading to behavioural problems.

Causes

Children most often experience OSA due to large tonsils and adenoids that block the airway at nighttime when their airway muscles relax. Similar to adults, obesity can be a risk factor that may be related to OSA.

Other factors that may put children at risk for sleep apnea include:

• Uncontrolled asthma or other airway diseases
• Allergic rhinitis or nasal allergies
• Acid reflux or GERD

There are other children with genetic disorders that lead to severe problems in the ability to breathe. These may also cause central sleep apnea.

• Neuromuscular or skeletal disorders
• Retrognathia (small jaw)/Pierre Robin syndrome
• Trisomy 21/Down’s syndrome
• Chiari malformation

Symptoms

At night, parents may notice symptoms such as:

• Snoring
• Pauses in breathing
• Unusual sleep positions (e.g., neck extended with head back or sitting up with mouth open)
• Restless sleep
• Night sweats
• Snorting, coughing or choking
• Mouth breathing
• Bed wetting
• Night terrors

During the day, parents may notice:

• Mouth breathing with trouble breathing through the nose
• Difficulty paying attention in school/learning problems
• Poor performance in school
• Behavioural problems
• Hyperactivity at home or school
• Excessive sleepiness
• Depressed mood
• Morning headaches

If your child is experiencing symptoms of OSA, ask your family doctor or pediatrician for a referral to a pediatric respirologist who specializes in sleep medicine.

Treatment

The most common treatment for OSA in children is the surgical removal of the tonsils and adenoids, which is called an adenotonsillectomy. This is the initial treatment for most children with sleep apnea and is very effective. Nasal steroid sprays may be tried to determine if decreasing the airway swelling will reduce apnea episodes.

Despite these treatments, some children will still need treatment with CPAP therapy, similar to adults. Child-specific masks are available and are similar to adult masks, just smaller. Depending on the illness, other therapies may also be required, and your pediatric respirologist can help you.

Pediatric CPAP grants

For information on the Canadian Lung Association’s grant program to fund pediatric CPAP machines, email info@lung.ca.

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“Sleep apnea (in children) can cause daytime sleepiness, fatigue, poor growth, heart problems, delays in proper brain development, bed wetting and behavior problems both at home and at school.

The best way to treat sleep apnea is with CPAP, which can cost upwards of $3,000. Some of our families are lucky enough to have insurance to help them cover this cost, but many do not. This can be a real hardship for families who are often desperate to help their children to sleep better.

The support of the Canadian Lung Association in helping our families who cannot afford this equipment on their own has been a game changer for us. Without (this funding), many children would simply have to go without this life-changing therapy.”

Angie is a social worker with the Alberta Children’s Hospital Pediatric Sleep Clinic.

“The Canadian Lung Association was a huge help in a situation that I otherwise wouldn’t be able to take care of and I am super grateful.”

Lena’s son received a CPAP machine through a grant from the Canadian Lung Association.