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Sleep apnea is a common yet potentially serious sleep disorder that affects how a person breathes during sleep. Characterized by repeated interruptions in effective breathing that alarms the brain and abruptly lowers blood oxygen levels , the condition can significantly reduce sleep quality and overall health. Left untreated, sleep apnea has been linked to an increased risk of death, heart failure, high blood pressure, stroke, type 2 diabetes, atrial fibrillation, and other chronic health issues. Recognizing the signs early and seeking timely medical attention can lead to improved health outcomes and better quality of life. Below, we explore some of the most frequently asked questions surrounding sleep apnea to help you gain a deeper understanding of the condition, its causes, and treatment options.
Sleep apnea is a common sleep disorder that is most commonly discovered, evaluated and initially managed by a primary care provider, who serves as the central point of contact for your overall health care. These providers assess your symptoms, such as snoring, fatigue, or observed pauses in breathing, and may perform a physical exam and order screening evaluations. In many cases, they coordinate an overnight sleep study, either in-lab or at home, to confirm the diagnosis. If your case is complex and fails to respond to usual therapy options, they may refer you to a sleep medicine specialist for more advanced diagnostic tests such as MSLT (daytime sleep test) or PAP titration studies, and for less commonly needed invasive treatment options such as ASV or Inspire surgery.
At Treasure Valley Family Medicine in Meridian, Idaho, sleep apnea is one of the many common conditions evaluated and frequently managed as part of their comprehensive primary care services. The team helps identify contributing factors such as obesity, nasal obstruction, or other chronic conditions, and can manage treatments like oral appliances and CPAP therapy. Their integrative approach emphasizes patient education, coordination of care, and ongoing support to ensure each individual receives consistent and effective treatment across all phases of diagnosis and management.
Diagnosing sleep apnea typically involves a sleep study, which captures abnormal sleep breathing causing low blood oxygen. The apnea-hypopnea index (AHI) and respiratory distress index (RDI) are used to formally diagnose and classify sleep apnea. They are calculated by averaging the number of oxygen dropping events per hour. Current guidelines and most commercial insurances recommend using the RDI (3% abrupt drop in oxygen), while Medicare requires use of the AHI (4% abrupt drop in oxygen). Mild sleep apnea is defined as an AHI score 5-14, moderate is 15-29, and severe apnea is 30 or more. Significantly, even “mild” apnea (AHI 12) can mean your brain is alerted out of deep sleep every 5 minutes all night long, impacting sleep quality and overall health. Of note, snoring is only a loose correlate of apnea; severe airway obstruction can cause zero air movement and complete absence of sound.
Treatment options for sleep apnea range from lifestyle changes to surgical interventions. Lifestyle changes, such as weight loss and exercise, can help to reduce the severity of sleep apnea by reducing fat in the neck contributing to airway narrowing. Medical therapy includes FDA approved tirzepatide (ZEPBOUND®) which helps with weight loss. Continuous positive airway pressure (CPAP) therapy is a common treatment for sleep apnea. CPAP involves delivering pressure assistance during inhalation to pop open the airway, like blowing up the neck of a balloon. Oral appliances are a common first-line option due to their portability and convenience. They do typically cost more than CPAP and work by keeping the jaw in the awake position so it does not relax backwards in sleep and close off the airway. Surgery options include tonsillectomy (typically in children), nasal surgery to relieve obstructions (often septoplasty or SMRT), and implantation of nerve stimulators such as Inspire™. Nerve stimulators receive lots of advertising but not all patients are eligible; they also cost tens of thousands of dollars. Nerve stimulators send electrical signals to maintain muscle tone in the throat while sleeping to prevent relaxation and closure.
The choice of treatment depends on the severity of the sleep apnea, patient preference, insurance coverage, and the individual’s overall health. It is important to note that some individuals receiving CPAP will have a high percentage of apnea with a central (brain) cause, resulting in the body failing to receive a signal to even attempt to breathe. When central apnea is prominent, then CPAP or a more advanced version called BiPAP or ASV may be needed, along with in-lab titration to determine the most effective machine settings.
Sleep specialists are doctors who focus their practice on treating sleep disorders only, primarily sleep apnea. They often start as pulmonary medicine, internal medicine, or family medicine trained and then convert to a sleep medicine only focus. Sleep specialists may work in hospitals, clinics, or private practices, and often co-manage with a team of physician assistants and nurse practitioners who also treat only on sleep medicine patients. They may also work with other healthcare professionals, such as ear, nose, and throat (ENT) specialists, to provide comprehensive care for patients with sleep apnea; for example, both sleep medicine and ENT surgeons are required to evaluate and surgically implant nerve stimulators.
If you are experiencing symptoms of sleep apnea, such as excessive daytime sleepiness, unrefreshing sleep, loud snoring/gasping/choking, morning headaches, or fatigue, you should see a doctor. Sleep apnea can lead to serious health problems, including high blood pressure, depression and anxiety, low sex drive, heart disease, stroke and early death if left untreated. Early detection and treatment of sleep apnea can improve sleep quality and overall health. If you have a family history of sleep apnea or are at risk for developing the disorder, you should discuss your increased risk with a healthcare professional.
Sleep apnea is a complex disorder influenced by a combination of genetic and lifestyle factors. Research indicates that genetic factors can significantly contribute to the development of sleep apnea, especially in individuals with a family history of the condition. Traits such as a narrow airway, recessed jaw (retrognathia), nasal obstruction, enlarged tonsils, or a predisposition to obesity can be inherited, increasing the likelihood of developing sleep apnea.
Lifestyle factors also play a crucial role. Obesity is one of the most significant risk factors for sleep apnea, as excess weight can lead to fat deposits around the upper airway, obstructing normal breathing. Smoking, another major risk factor, can cause inflammation and fluid retention in the upper airway, further exacerbating breathing difficulties during sleep.
Understanding these genetic and lifestyle factors is essential for identifying individuals at risk and developing targeted treatments. By recognizing the signs early and addressing both genetic predispositions and lifestyle choices, healthcare providers can offer more effective interventions to manage and treat sleep apnea.
Sleep apnea is more than just a common sleep disorder; it has far-reaching implications for overall health. Untreated sleep apnea can lead to a host of serious health problems, including high blood pressure, heart disease, and stroke. The repeated interruptions in breathing can cause significant stress on the cardiovascular system, leading to these severe conditions.
Moreover, sleep apnea can drastically affect daily life. Excessive daytime sleepiness, a hallmark of the disorder, increases the risk of accidents, injuries, and workplace errors. This constant fatigue can impair cognitive function, making it difficult to concentrate and perform daily tasks effectively.
Early detection and treatment of sleep apnea are crucial. By improving sleep quality, treatments like CPAP therapy or oral appliances can mitigate these health risks, enhance overall well-being, and reduce the likelihood of serious complications. Addressing sleep apnea promptly not only improves sleep but also contributes to better long-term health outcomes.
One of the lesser-known but significant effects of sleep apnea is its contribution to body weight gain and difficulty losing weight. This connection is driven by hormonal imbalances, fatigue, and changes in behavior that result from disrupted sleep. When sleep is interrupted, the body’s production of leptin—an appetite-suppressing hormone—decreases, while ghrelin, the hormone that increases hunger, rises. This imbalance leads to increased food cravings, particularly for calorie-dense, sugary, or carbohydrate-heavy foods.
As a result, sleep apnea actually causes weight gain and weight gain worsens apnea – a vicious positive feedback loop. A simple way to think of the situation is that you cannot threaten the brain with suffocation multiple times per hour without inducing stress responses that damage your health.
Moreover, people with untreated sleep apnea often suffer from chronic fatigue, making it more difficult to maintain a consistent exercise routine. Even simple daily activities can feel exhausting, leading to more sedentary behavior. Over time, reduced physical activity paired with increased calorie intake contributes to metabolic dysfunction and continued weight gain. Addressing sleep apnea often has a positive domino effect: once breathing is restored during sleep, many patients experience increased energy levels, more motivation to be active, and greater control over their eating habits—supporting long-term weight management. Addressing lifestyle factors such as diet and exercise can also play a crucial role in managing sleep apnea and its associated weight gain. Conversely, ignoring sleep apnea can sabotage your efforts at weight loss or blood pressure control.
Additionally, body fat distribution plays a crucial role in sleep apnea, with genetic factors influencing how fat is stored in the body. Understanding these patterns is important for assessing health risks associated with obstructive sleep apnea (OSA).
Morning headaches are a common complaint among those with sleep apnea, and they often stem from nighttime oxygen deprivation and abnormal fluctuations in carbon dioxide levels. As the airway becomes obstructed during sleep, oxygen levels drop (hypoxia), while carbon dioxide levels rise (hypercapnia). These changes cause blood vessels in the brain to dilate, which can create pressure and pain similar to a tension headache or migraine.
The impact of poor quality sleep due to sleep apnea also contributes to tension headaches. Constant awakenings can result in muscle tension, especially in the neck and shoulders, which can trigger or exacerbate headaches. For individuals who grind their teeth or clench their jaw in response to poor sleep, temporomandibular joint (TMJ) strain may also be a factor. Additionally, sleep bruxism, which is often linked to obstructive sleep apnea (OSA), can contribute to headaches due to the strain it places on the jaw muscles.
Why does the brain cause grinding, muscle tension, and even leg kicking in sleep? It is trying to force a change so that the airway will open and improve oxygen delivery. If these efforts fail and the brain perceives a life threatening lack of oxygen, it can force a person to wake up suddenly, as if having a panic attack or “bad nightmare” with a racing heartbeat. Fortunately, treatment often leads to a marked reduction in the frequency and severity of headaches and other muscle related abnormal movements by normalizing oxygen levels and improving sleep quality.
A deviated nasal septum occurs when the cartilage dividing the nasal passages is off-center, narrowing airflow through one or both nostrils. This condition can make nasal breathing difficult and may lead to mouth breathing, which is a common contributor to airway collapse during sleep. While a deviated septum is unlikely to be the sole cause of sleep apnea, it can exacerbate existing apnea or reduce the effectiveness of CPAP therapy by restricting airflow. A deviated septum can also affect the function of upper airway muscles, further contributing to breathing difficulties during sleep. Additionally, a deviated septum may contribute to central sleep apnea by disrupting normal breathing patterns and signaling.
Patients who experience chronic nasal congestion, sinus infections, or nighttime breathing difficulties may benefit from an evaluation to determine whether a deviated septum is playing a role. Treatment options can range from nasal sprays and decongestants to surgical correction (septoplasty). Correcting nasal airflow issues may improve sleep quality, enhance oxygen intake, and make sleep apnea treatments more effective. If nasal obstruction is suspected, a primary care provider or ENT specialist can recommend the best course of action.
If you are experiencing symptoms of sleep apnea, such as excessive daytime sleepiness, unrefreshing sleep, loud snoring/gasping/choking, morning headaches, or fatigue, you may be dealing with sleep apnea. A primary care provider can be your first step toward diagnosis and effective treatment. At Treasure Valley Family Medicine in Meridian, Idaho, our team offers personalized sleep apnea evaluations and ongoing support for managing this common condition, as well as the multitude of related complications needing help such as high blood pressure, heart conditions, hormone replacement therapy, and mental health disorders.
