Sleep Apnea: Symptoms, Diagnosis, and What to Expect from CPAP Therapy

Sleep Apnea: Symptoms, Diagnosis, and CPAP Therapy

Obstructive sleep apnea (OSA) affects an estimated 22 million Americans, yet 80% remain undiagnosed. It is a serious condition linked to hypertension, heart disease, stroke, type 2 diabetes, and motor vehicle accidents.

What Is Sleep Apnea?

Sleep apnea is characterized by repeated episodes of partial or complete upper airway obstruction during sleep, causing breathing to stop for 10 seconds or more. These episodes fragment sleep and cause oxygen desaturation.

Types:

• Obstructive sleep apnea (OSA): Most common; caused by physical airway obstruction
• Central sleep apnea (CSA): Brain fails to send proper signals to breathing muscles
• Complex/mixed sleep apnea: Combination of both

Symptoms

Nighttime symptoms:

• Loud snoring (though not all snorers have OSA)
• Gasping, choking, or snorting during sleep (often reported by partner)
• Witnessed apneas (breathing stops)
• Restless sleep, frequent position changes
• Nocturia (waking to urinate)
• Night sweats

Daytime symptoms:

• Excessive daytime sleepiness (falling asleep during quiet activities)
• Morning headaches
• Dry mouth or sore throat upon waking
• Cognitive difficulties (memory, concentration)
• Irritability and mood changes
• Decreased libido

Risk Factors

• Obesity (BMI > 30) — most significant risk factor
• Male sex (2-3x more common in men; risk equalizes after menopause)
• Age > 40
• Large neck circumference (> 17 inches in men, > 16 inches in women)
• Anatomical factors (large tonsils, small jaw, nasal obstruction)
• Family history
• Alcohol and sedative use (relax throat muscles)

Diagnosis: The Sleep Study

Home sleep apnea test (HSAT):

• Portable device worn at home
• Measures airflow, oxygen saturation, heart rate, breathing effort
• Appropriate for uncomplicated OSA
• Less comprehensive than in-lab study

Polysomnography (PSG — in-lab sleep study):

• Comprehensive overnight monitoring
• Measures brain waves (EEG), eye movements, muscle activity, heart rhythm, oxygen, breathing
• Required for complex cases, suspected central apnea, or when HSAT is inconclusive

Apnea-Hypopnea Index (AHI):

• Mild OSA: 5-14 events/hour
• Moderate OSA: 15-29 events/hour
• Severe OSA: 30+ events/hour

Treatment

CPAP (Continuous Positive Airway Pressure) — Gold Standard:

CPAP delivers a continuous stream of pressurized air through a mask, keeping the airway open during sleep.

What to expect:

• Prescribed pressure is determined by titration study
• Multiple mask types: nasal pillows, nasal mask, full-face mask
• Adjustment period: 1-4 weeks to adapt
• Adherence is critical — use at least 4 hours/night on 70% of nights for insurance coverage
• Benefits: improved sleep quality, reduced daytime sleepiness, lower blood pressure, reduced cardiovascular risk

CPAP alternatives:

• BiPAP: Two pressure levels; for those who struggle to exhale against CPAP pressure
• APAP (auto-adjusting CPAP): Automatically adjusts pressure
• Oral appliance therapy: Mandibular advancement device; effective for mild-moderate OSA
• Surgery: For anatomical causes (tonsillectomy, uvulopalatopharyngoplasty, jaw surgery)
• Weight loss: Can resolve OSA in obese patients; 10% weight loss reduces AHI by 26%

Medical Disclaimer

Sleep apnea diagnosis requires a sleep study ordered by a physician. Do not self-diagnose or self-treat sleep apnea.