What Causes Sleep Apnea?

This chronic disruption of the normal sleep cycle can leave individuals feeling exhausted and sleepy during the day, and put them at increased risk for health problems associated with lack of sleep and with reduced blood oxygen levels during sleep, such as irritability, problems with memory or concentration, anxiety, and depression — even though the disruptions are typically so short most people don’t even realize they’ve been awoken during the night.

But it tends to be most common in people who are older, heavier, and have large necks. The anatomical changes associated with all of those factors make a person more likely to develop the intermittent airway obstructions (resulting in pauses in breathing) during sleep that characterize obstructive sleep apnea (the most common type of sleep apnea).

Here’s a primer on what’s happening in the throat that causes obstructive sleep apnea, and all of the factors that can put you at a higher risk for developing it.

As the brain registers that you are not getting enough oxygen, it jolts your body awake to breathe. This is when a person who has obstructive sleep apnea starts breathing normally again with a snort, cough, or gasping or choking sound.

It can often occur in people who have conditions such as a brain infection, stroke, or heart failure, or in people who take certain types of medication, such as opioids or benzodiazepines.

Large Adenoids or Tonsils Some people have large tonsils or adenoids, or smaller airways, which can contribute to problems breathing during sleep. Large adenoids and tonsils are the most common cause of obstructive sleep apnea in children, says Ronald Chervin, MD, director of the Sleep Disorders Centers and professor of sleep medicine and of neurology at the University of Michigan in Ann Arbor.

Jaw Misalignment or Size Some conditions or genetic factors can lead to an imbalance in facial structure that can cause the tongue to sit farther back in the mouth and lead to sleep apnea, says Robson Capasso, MD, chief of sleep surgery and associate professor of otolaryngology and head and neck surgery at Stanford University School of Medicine in California.

For instance, a lower jaw that’s shorter than the upper jaw, or a palate (the roof of your mouth) that’s shaped a certain way and collapses more easily during sleep can contribute to obstructive sleep apnea.

A Family History of Sleep Apnea If obstructive sleep apnea runs in your family, you may be at increased risk for having the condition. How your airway is shaped and your cranial facial characteristics can be inherited from your relatives, which can all play a role in whether and why you develop sleep apnea.

“Upwards of three-quarters of people with diabetes have sleep apnea,” says James Rowley, MD, professor of medicine and division chief of pulmonary, critical care, and sleep medicine at Wayne State University School of Medicine in Detroit.

Chronic Nasal Congestion People who have persistent nasal congestion at night (regardless of the cause) are more likely to develop obstructive sleep apnea, probably because of the narrowed airways.

Smoking People who smoke are at a higher risk of developing obstructive sleep apnea. Smoking leads to inflammation in the upper airway, which can affect breathing as well as how well the brain communicates with the muscles that control breathing.

Alcohol Drinking alcohol can increase the relaxation of the muscles and tissue in the mouth and throat, increasing the risk of obstructive sleep apnea.

Brain Infection, Brain Tumor, Stroke, Conditions of the Spine, or Other Problems That May Affect the Brain Stem Conditions that compromise the brain stem, which is the area of the brain that controls breathing, can increase risk for central sleep apnea.

Gender and Age Sleep apnea can occur at any age, but being a male and getting older both put you at increased risk of developing sleep apnea, says Dr. Kaplish. “We don’t really understand why but it may have to do with fat distribution and hormones.” For instance, as we age, fatty tissue may increase in the neck and around the tongue.

• Talk to your doctor about ways you can try to minimize your risk factors or catch apnea early. Does your family have a history of sleep apnea? Do you have a health condition, like diabetes, heart disease, or hypertension that is associated with sleep apnea? Do you need to lose weight? Do you snore loudly at night? Discuss with your doctor things you can do to lower your risk for sleep apnea and to detect it as soon as possible.
• Eat a healthy diet. Choose heart-healthy options, like a wide variety of vegetables and fruits. This can not only reduce your sleep apnea risk, but can help you maintain a healthy weight and improve your overall health.
• Exercise regularly. Staying active could reduce your risk for sleep apnea even if you’re overweight or obese. In a recent Massachusetts General Hospital study published in 2021 in the European Respiratory Journal that tracked 137,917 midlife and older adults for up to 18 years, regular exercise reduced obstructive sleep apnea risk by 10 to 31 percent regardless of participants’ body mass index (BMI, a measure of weight compared with height).

  

   Exercise may help by reducing daytime build-up of fluid in the lower legs, which can move upward in the body at night when people are lying down. It may also reduce apnea risk by reducing insulin resistance.
• Stop smoking. Smoking increases your risk of sleep apnea as well as a host of other health problems and illnesses, including cardiovascular disease and cancer.
• Steer clear of depressants and sleep drugs. Cut down the amount of alcohol you drink and avoid any medication, such as sedatives and opioids, that relaxes your muscles and suppresses your central nervous system signals. Avoid sleep medications for the same reasons, too, notes the American Academy of Family Physicians.

  

• Avoid sleeping on your back. Try sleeping on your side (with special pillows if necessary) so that your tongue and soft palate are less likely to collapse into your airway and block the flow of oxygen.