Sleep Apnea

	Topic Overview
	Health Tools
	Cause
	Symptoms
	What Happens
	What Increases Your Risk
	When To Call a Doctor
	Exams and Tests
	Treatment Overview
	Prevention
	Home Treatment
	Medications
	Surgery
	Other Treatment
	Other Places To Get Help
	Related Information
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What is sleep apnea?

Sleep apnea means that you often stop breathing for 10 seconds or longer during sleep. The problem can be mild to severe, based on the number of times each hour that you stop breathing or how often your lungs don't get enough air. This may happen from 5 to 50 times an hour.

This topic focuses on obstructive sleep apnea, which is the most common type.

A less common type of apnea, called central sleep apnea, can occur in people who have had a stroke, have heart failure, or have a brain tumor or infection. Even though this topic isn't about central sleep apnea, some of the treatments discussed here may also help treat it. Talk with your doctor to find out more about central sleep apnea.

What causes obstructive sleep apnea?

Blocked or narrowed airways in your nose, mouth, or throat can cause sleep apnea. Your airway can become blocked when your throat muscles and tongue relax during sleep.

Sleep apnea can also occur if you have large tonsils or adenoids or a large uvula. During the day, when you are awake and standing up, these may not cause problems. But when you lie down at night, they can press down on your airway, narrowing it and causing sleep apnea. Sleep apnea can also occur if you have a problem with your jawbone.

In children, the main cause of sleep apnea is large tonsils or adenoids.

Sleep apnea is more likely to occur if you are overweight, use certain medicines or alcohol before bed, or sleep on your back.

See pictures of normal and blocked airways during sleep.

What are the symptoms?

The main symptoms of sleep apnea that you may notice are:

• Being so sleepy during the day that you fall asleep while working or driving.
• Feeling tired in the morning.
• Waking up with a headache.

Your bed partner may notice that while you sleep:

• You stop breathing.
• You often snore loudly.
• You gasp or choke.
• You toss and turn.

Children who have sleep apnea:

• Nearly always snore.
• May have a hard time breathing during sleep.
• May be restless during sleep and wake up often.

But children may not seem very sleepy during the day (a key symptom in adults). The only symptom of sleep apnea in some children may be that they do not grow as quickly as most children their age.

Should you worry about sleep apnea?

If you have sleep apnea, you may not be sleeping as well as you could. And you may be more likely to end up with serious problems such as:

• High blood pressure.
• High blood pressure in your lungs.
• An abnormal heart rhythm, heart failure, coronary artery disease (CAD), or stroke.
• Depression.

How is sleep apnea diagnosed?

Your doctor will probably examine you and ask about your past health. He or she may also ask you or your sleeping partner about your snoring and sleep behavior and how tired you feel during the day.

Your doctor may suggest a sleep study. A sleep study usually takes place at a sleep center, where you will spend the night. Sleep studies find out how often you stop breathing or have too little air flowing into your lungs during sleep. They also find out how much oxygen you have in your blood during sleep. You may have blood tests and X-rays.

How is it treated?

You may be able to treat mild sleep apnea by making changes in how you live and the way you sleep. For example:

• Lose weight if you are overweight.
• Sleep on your side and not your back.
• Avoid alcohol and medicines such as sedatives before bed.

If you have moderate to severe sleep apnea, you may be able to use a machine that helps you breathe while you sleep. This treatment is called continuous positive airway pressure, or CPAP (say “SEE-pap”). Sometimes medicine that helps you stay awake during the day may be used along with CPAP. If CPAP doesn't work, or if your tonsils, adenoids, uvula, or other tissues are blocking your airway, your doctor may suggest surgery to open your airway.

Frequently asked questions

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	Should I have a sleep study to diagnose obstructive sleep apnea?
	Should I have surgery to treat obstructive sleep apnea?

A blockage or narrowing of the airways in your nose, mouth, or throat generally causes obstructive sleep apnea (OSA). This usually occurs when the throat muscles and tongue relax during sleep and partially or completely block the airway. When you stop breathing or have reduced flow of air into your lungs during sleep, the amount of oxygen in your blood decreases briefly.

Obstructive sleep apnea can also occur if you have bone deformities or enlarged tissues in your nose, mouth, or throat. For example, you may have enlarged tonsils. During the day when you are awake and standing up, this may not cause problems. But when you lie down at night, the tonsils can press down on your airway, narrowing it and causing sleep apnea.

See pictures of normal and blocked airways during sleep.

Other factors that may contribute to sleep apnea include:

• Drinking alcohol, which affects the part of the brain that controls breathing. This may relax the breathing muscles and cause a narrowing of the airway and sleep apnea.
• Obesity. Fat in the neck area can press down on the tissues around the airways. This narrows the airways and can cause sleep apnea. About 70% of people who have sleep apnea are obese.¹
• Some medicines that are taken for conditions such as allergies, depression, insomnia, or anxiety. These medicines, especially sedatives, can also relax the muscles and tissues in the throat, causing it to narrow.

In children, the main cause of sleep apnea is large tonsils or adenoids.

The most common symptoms of obstructive sleep apnea (OSA) that you may notice include:

• Excessive daytime sleepiness, which is falling asleep when you normally should not, such as while you are eating, talking, or driving.
• Waking with an unrefreshed feeling after sleep, having problems with memory and concentration, feeling tired, and experiencing personality changes.
• Morning or night headaches. About half of all people with sleep apnea report headaches.²
• Heartburn or a sour taste in the mouth at night.
• Swelling of the legs if you are obese.
• Getting up during the night to urinate (nocturia).
• Sweating and chest pain while you are sleeping.

Symptoms of sleep apnea that others may notice include:

• Episodes of not breathing (apnea), which may occur as few as 5 times an hour (mild apnea) to more than 50 times an hour (severe apnea). How many episodes you have determines how severe your sleep apnea is.
• Loud snoring. Almost all people who have sleep apnea snore, but not all people who snore have sleep apnea.
• Restless tossing and turning during sleep.
• Nighttime choking or gasping spells.

Older adults may normally have periods when they stop breathing during sleep, making it hard to know whether they have sleep apnea. Short lapses in breathing during sleep usually do not cause a large drop in the blood oxygen level.

Symptoms in children

In children, symptoms of sleep apnea depend on how old the child is:

• In children younger than 5, symptoms include snoring, mouth breathing, sweating, restlessness, and waking up a lot.
• In children 5 years and older, symptoms include snoring, bed wetting, doing poorly in school, and not growing as quickly as they should for their age. These children may also have behavior problems and a short attention span.

Children who have sleep apnea nearly always snore. But they may not appear to be excessively sleepy during the day (a key symptom in adults). The only symptom of sleep apnea in some children may be that they do not grow as quickly as they should for their age.

Although rare, in children sleep apnea can cause developmental delays and can cause the right side of the heart to get bigger (cor pulmonale).

Other conditions with symptoms similar to sleep apnea include an underactive thyroid (hypothyroidism) and other sleep disorders, such as suddenly falling asleep (narcolepsy) or an intense urge to move the legs (restless legs syndrome).

Obstructive sleep apnea (OSA) causes you to stop breathing (apnea) for 10 seconds or longer during sleep. When your breathing stops, you may make grunting, gasping, or snorting sounds and restless body movements. As breathing resumes, loud snoring starts. This may happen many times during a night.

How many times you stop breathing while you sleep determines the severity of sleep apnea.

When you stop breathing, the oxygen levels in your blood go down and carbon dioxide levels go up. This makes your heart and blood vessels work harder and can affect your heart rate and nervous system. This in turn may lead to other problems including high blood pressure (hypertension) and coronary artery disease (CAD). Sleep apnea can also make these diseases worse and more difficult to treat. Sleep apnea also raises your risk of having a stroke.³

Because sleep apnea disturbs your sleep, it can make you very tired during the day. If you have sleep apnea, you may:

• Be more likely to have a car accident.
• Perform poorly at school or work and have difficulty concentrating. You also may have memory problems.
• Have personality changes, anxiety, and depression.
• Lose the desire for sex.

Certain factors make it more or less likely that you will have obstructive sleep apnea (OSA). Some of these you cannot change, while others you can.

Factors you cannot change

Factors that you cannot change and that may make it more likely you will have sleep apnea include:

• Aging. Sleep apnea is most common in people age 30 and older.
• Male gender. Sleep apnea is more common in men. Some studies have indicated that about 2 to 3 times more men than women have sleep apnea, and sleep laboratories report that 5 or 6 times more men than women have the disease.¹
• Family history. If other members of your family have sleep apnea, you are more likely to get the disease than someone who does not have a family history of the disease.
• Ethnicity. Blacks, Hispanics, and Pacific Islanders have a greater risk of sleep apnea than white people. Blacks get sleep apnea at a younger age than whites.¹
• Deformities of the spine. Deformities of the spine, such as scoliosis, may interfere with breathing and contribute to sleep apnea.
• Conditions that may cause head and face (craniofacial) abnormalities. Conditions such as Marfan's syndrome and Down syndrome may result in craniofacial abnormalities and increase the risk for sleep apnea.
• Menopause. Recent studies indicate that sleep apnea occurs more often in women who have been through menopause than in women who have not.¹ After menopause, women get sleep apnea at a rate similar to men.² Experts do not know why or how menopause increases the risk of sleep apnea.

Factors you may be able to change

Factors that you may be able to change that will reduce your chances of having sleep apnea include:

• Obesity. About 70% of people who have sleep apnea are obese.¹ Obesity is the factor most likely to lead to sleep apnea.
• Neck circumference. People who are overweight may have extra tissue around their neck, adding to their risk for sleep apnea. The risk increases for a man whose neck measures more than 17 inches around and for a woman whose neck measures more than 16 inches around.
• Enlarged tissues of the nose, mouth, or throat.Enlarged tissues in the nose, mouth, or throat can cause narrowing or blockage of the airway while you sleep, making sleep apnea more likely. Surgery can sometimes correct the blockage and improve sleep apnea.
• Bone deformities. Bone deformities of the nose, mouth, or throat can interfere with breathing, causing sleep apnea. Some people who have sleep apnea have a small, receding jaw. Surgery can sometimes correct these deformities and improve sleep apnea.
• Use of alcohol or medicine. Drinking alcohol or taking certain medicines before going to sleep can increase the risk for sleep apnea. These include sleeping pills and sedatives. Using Viagra (sildenafil) just before sleep also can make sleep apnea worse.⁴
• Sleeping on your back and using pillows. Sleeping on your back and using one or more pillows may make sleep apnea symptoms worse.
• Smoking. Smoking can increase your risk for sleep apnea because the nicotine that is in tobacco relaxes the muscles that keep the airways open.
• Poor sleep habits. Going to bed at different times or in different places may increase your risk for sleep apnea.
• Disorders of the hormone (endocrine) system. Disorders of the endocrine system (such as hypothyroidism and acromegaly) may increase your risk for sleep apnea.

Call your doctor if:

• You or your bed partner snores loudly and heavily and feels sleepy during the day.
• You notice that your bed partner stops breathing, gasps, or chokes during sleep.
• You sometimes fall asleep at inappropriate times, such as while you are talking or eating.
• Your child snores, has difficulty breathing while sleeping, sleeps restlessly, wakes up often, and is very sleepy during the day.

Watchful Waiting

Watchful waiting is a wait-and-see approach. If you get better on your own, you will not need treatment. If you get worse, you and your doctor will decide what to do next. Watchful waiting may be right for you if you snore but are not excessively sleepy during the day.

Watchful waiting may not be right if you notice that your sleeping partner snores loudly and heavily, is restless during sleep, and is sleepy during the day. If you think your sleeping partner may have periods when breathing stops, suggest that he or she talk with a doctor.

Who To See

Health professionals who can check people who have symptoms of obstructive sleep apnea (OSA) include:

• Family medicine physicians.
• Internists.
• Pediatricians.
• Nurse practitioners.
• Physician assistants.

If your doctor thinks that you may have sleep apnea, he or she may have you see a specialist who treats sleep disorders (often a neurologist or pulmonologist). The specialist can help arrange and interpret a sleep study and prescribe treatment for the disease, such as continuous positive airway pressure (CPAP).

Other health professionals may be able to help you if you have other problems that are caused by sleep apnea. If you:

• Have heart problems, you may see a cardiologist.
• Need surgery to remove excess tissue or to correct a defect or injury, you may see an ear, nose, and throat doctor (otolaryngologist).
• Need oral breathing devices, you may see a dentist.

To prepare for your appointment, see the topic Making the Most of Your Appointment

Your doctor will examine you and ask you and possibly your sleeping partner questions about your lifestyle, snoring, sleep behavior, and how tired you feel during the day (this is called a medical history). Your doctor may ask you to complete a questionnaire, such as the Epworth Sleepiness Scale. The answers to questions in this questionnaire can help the doctor find out if you have sleep apnea. If your doctor thinks that you may have obstructive sleep apnea (OSA), he or she may suggest sleep studies or other tests.

• Sleep studies are a series of tests that record what happens to your body during sleep. The most important test for sleep apnea is polysomnography. This test records electrical activity of your brain, eye movement, muscle activity, heart rate, breathing, airflow through your nose and mouth, and blood oxygen levels (saturation). Polysomnography is the only sure way to find out whether you have sleep apnea. For more information, see:

  Should I have a sleep study to diagnose obstructive sleep apnea?

Other tests that you may have include:

• Blood tests to check for hypothyroidism (TSH test) or a high red blood cell count (complete blood count).
• Electrocardiogram (EKG, ECG) to see if sleep apnea has affected your heart.

If your sleep apnea has not improved after initial treatment, and if enlarged tissues in your mouth and throat are causing it, your doctor may do one or more tests before suggesting surgery to remove the excess tissue. These tests may include:

• Fiber-optic pharyngoscopy, to see whether your airway is too narrow or collapses during breathing.
• A CT scan of the head to look for an overly large tongue and excessive soft tissue in the neck, as well as to locate the narrowest part of your airway.
• X-rays. A cephalometric X-ray is a type of head X-ray that allows your doctor to see bone deformities of the skull. This type of X-ray test may not be available in every hospital.

To diagnose sleep apnea in children, doctors follow similar steps. According to the American Academy of Pediatrics:⁵

• During a routine checkup, your doctor will ask you and your child about snoring. If your child snores, be sure to tell your doctor.
• A complete sleep study generally is needed to tell if your child has sleep apnea and is not just snoring.
• Children who have sleep apnea and who also have genetic disorders, lung disease, sickle cell disease, disorders of the head or face, Down syndrome, cerebral palsy, facial disorders, or severe heart or lung problems should see a specialist.

You may need sleep tests after your treatment begins, to see how well it is working.

Treatment for obstructive sleep apnea (OSA) includes lifestyle changes, continuous positive airway pressure (CPAP) (to prevent the airway from closing during sleep), the use of dental devices (oral breathing devices) to help keep your airway open, medicine to help you stay awake during the day, and surgery. The goals of treatment are to relieve symptoms such as snoring and excessive daytime sleepiness and prevent other problems, such as high blood pressure. Your doctor will base your treatment on how severe your sleep apnea is.

Generally, your doctor will have you try lifestyle changes and CPAP first. Surgery might be a first choice only if the sleep apnea is caused by a blockage that is easily fixed.

You may need to be treated for other health problems before you are treated for sleep apnea. For example, people who also have inflammation of the nasal passages (rhinitis) may need to use nose spray to reduce the inflammation. People who have an underactive thyroid gland (hypothyroidism) need to take thyroid medicine.

Children have the same treatment options as adults. But surgery (tonsillectomy and adenoidectomy) generally is the first choice because enlarged tonsils or adenoids cause most cases of sleep apnea in children. Children are treated using CPAP if surgery is not possible or does not work.

Initial treatment

The first treatment for obstructive sleep apnea (OSA) consists of making lifestyle changes. Your sleep apnea may be helped if you:

• Lose weight (if needed). Small studies have shown that losing weight decreases the number of times an hour that you stop breathing (apnea) or that a reduced amount of air enters your lungs (hypopnea).⁶ Experts agree that weight loss should be part of managing sleep apnea.⁶
• Go to bed at the same time every night.
• Sleep on your side. Try this: Sew a pocket in the middle of the back of your pajama top, put a tennis ball into the pocket, and stitch it shut. This will help keep you from sleeping on your back. Sleeping on your side may eliminate mild sleep apnea.⁷
• Avoid the use of alcohol and some medicines, especially sleeping pills and sedatives, before bed. Taking Viagra (sildenafil) shortly before sleeping may make sleep apnea worse.⁴
• Quit smoking. The nicotine in tobacco relaxes the muscles that keep the airways open. If you don't smoke, those muscles are less likely to collapse at night and narrow the airways.
• Raise the head of your bed 4 in. (10 cm) to 6 in. (15 cm) by putting bricks under the legs of the bed. You can also use a special pillow (called a cervical pillow) when you sleep. A cervical pillow can help your head stay in a position that reduces sleep apnea. Using regular pillows to raise your head and upper body will not work.
• Promptly treat breathing problems, such as a stuffy nose caused by a cold or allergies.

All people who have sleep apnea should make these lifestyle changes. They may be all that is needed to relieve mild sleep apnea.

Some people use nasal strips, which widen the nostrils and improve airflow. Although these strips may decrease snoring, they cannot treat sleep apnea.

First medical treatment

Continuous positive airway pressure (CPAP) is nearly always the first medical treatment for sleep apnea.

• With CPAP, you use a breathing device that prevents your airways from closing during sleep.
• CPAP is the preferred treatment for moderate or severe sleep apnea.
• It may take time for you to be at ease when you use CPAP. You may find that you want to take the mask off, or you may find it difficult to sleep while using it. If you can't get used to it, talk to your doctor. You might be able to try another type of mask or make other adjustments.

Other medical treatment includes:

• Devices that are similar to CPAP. These devices automatically adjust air pressure or use different air pressures when you breathe in or out. They are easier and more comfortable for some people to use.
• Oral breathing devices. These devices reposition your tongue and jaw during sleep, which opens up your airways.

Surgery might be the first treatment when a blockage can be fixed easily, such as when you have overly large tonsils.

Ongoing treatment

Ongoing treatment for obstructive sleep apnea (OSA) includes using continuous positive airway pressure (CPAP) or an oral breathing device and making changes in your lifestyle. Lifestyle changes include losing weight (if needed), improving sleep habits (such as going to bed at the same time every night and sleeping on your side), avoiding the use of alcohol and certain medicines (especially sleeping pills and sedatives) before bed, and stopping smoking. Sometimes medicine to help you stay awake during the day is used along CPAP.

If CPAP is not working, you may need another sleep study to find out whether your CPAP machine needs to be adjusted. You may also need to think about surgery. Surgical choices include:

• Uvulopalatopharyngoplasty, which removes excess tissue in the throat to make the airway wider. It is the most common surgery to treat sleep apnea in adults.
• Tonsillectomy and/or adenoidectomy, which removes the tonsils and/or the adenoids. It may be used if you have enlarged tonsils and adenoids that are blocking your airway during sleep. This is often the first treatment option for children because enlarged tonsils and adenoids are usually the cause of their sleep apnea.
• Other surgical procedures, which are used to repair bone and tissue problems in the mouth and throat.

Should I have surgery to treat obstructive sleep apnea?

Treatment if the condition gets worse

If your obstructive sleep apnea (OSA) gets worse, talk to your doctor. You may need another complete sleep study, and you may need to adjust your continuous positive airway pressure (CPAP) machine. You may be able to take medicine to help you stay awake during the day. You may also need treatment for problems that sleep apnea may cause, such as high blood pressure.

In some cases, you may need surgery. Surgical options include:

• Uvulopalatopharyngoplasty, which removes excess tissue in the throat to make the airway wider. It is the most common surgery to treat sleep apnea in adults.
• Tonsillectomy and/or adenoidectomy, which removes the tonsils and/or the adenoids. It may be used if you have enlarged tonsils and adenoids that are blocking your airway during sleep. This is often the first treatment option for children, because enlarged tonsils and adenoids are usually the cause of their sleep apnea.
• Other surgical procedures, which are used to repair bone and tissue problems in the mouth and throat.
• Tracheostomy, which creates a hole in the windpipe (trachea). A tube is then put in the hole to bring air in. Doctors rarely use this surgery because it may cause other health problems. But when other techniques have failed, almost all people who are treated with tracheostomy will be cured of their sleep apnea.
• Bariatric surgery if you are extremely overweight (severely obese) and the excess weight is making your sleep apnea worse. This surgery is done only for people who cannot lose weight with diet and exercise. Bariatric surgery can promote weight loss that improves sleep apnea.⁸

Should I have surgery to treat obstructive sleep apnea?

What To Think About

Research shows that continuous positive airway pressure (CPAP) decreases daytime sleepiness, especially in people who have moderate to severe sleep apnea.^{9, 6} But CPAP may not work as well for people who have mild sleep apnea.⁶

CPAP can lower daytime and nighttime blood pressure.¹⁰

If you use CPAP to treat sleep apnea, you need to use it every night. If you do not use it, your symptoms will return right away.

Treatment of obstructive sleep apnea in people with coronary artery disease lowers the risk of some heart problems.¹¹

Laser-assisted uvulopalatoplasty may be used to treat snoring. It is sometimes used to treat mild to moderate sleep apnea, though it does not benefit all people. This surgery is not approved by the American Academy of Sleep Medicine to treat sleep apnea.¹²

You can help prevent obstructive sleep apnea (OSA) and snoring if you:

• Avoid the use of alcohol and medicines, such as sleeping pills and sedatives, before bed. You should also avoid taking Viagra (sildenafil) shortly before sleeping, because it can make sleep apnea worse.⁴ These can relax your throat muscles and slow your breathing.
• Eat sensibly, exercise, and stay at a weight that is as close as possible to a healthy body weight.
• Sleep on your side. Sleeping on your back can increase snoring. Try this: Sew a pocket in the middle of the back of your pajama top, put a tennis ball into the pocket, and stitch it shut. This will help keep you from sleeping on your back. Sleeping on your side may eliminate mild sleep apnea.⁷
• Quit smoking. The nicotine in tobacco relaxes the muscles that keep the airways open. If you don't smoke, those muscles are less likely to collapse at night and narrow the airways.
• Raise the head of your bed 4 in. (10 cm) to 6 in. (15 cm) by putting bricks under the legs of the bed. You can also use a special pillow (called a cervical pillow) when you sleep. A cervical pillow can help your head stay in a position that reduces sleep apnea. Using regular pillows to raise your head and upper body will not work.
• Promptly treat breathing problems, such as a stuffy nose caused by a cold or allergies. Breathing problems can increase the risk of snoring. Avoid taking antihistamines because they can make you drowsy and make apnea episodes worse. Instead, use decongestants, which decrease drainage.

You can treat obstructive sleep apnea (OSA) at home if you have mild sleep apnea (5 or fewer apnea episodes per hour). Home treatment for sleep apnea includes:

• Losing weight. Many people who have sleep apnea are overweight. Small studies have indicated that losing weight reduces the number of times an hour that you stop breathing (apnea) or that the airflow to your lungs is reduced (hypopnea).⁶ Experts agree that weight loss should be part of managing sleep apnea.⁶
• Limiting the use of alcohol and medicine. Drinking excessive amounts of alcohol or taking certain medicines, especially sleeping pills or sedatives, before sleep may make symptoms worse. Also, taking Viagra (sildenafil) shortly before sleeping may make sleep apnea worse.⁴
• Getting plenty of sleep. Apnea episodes may be more frequent when you have not had enough sleep.
• Sleeping on your side. Try this: Sew a pocket in the middle of the back of your pajama top, put a tennis ball into the pocket, and stitch it closed. This will help keep you from sleeping on your back. Sleeping on your side may eliminate mild sleep apnea.⁷ You can try using a special pillow (called a cervical pillow) when you sleep. A cervical pillow can help your head stay in a position that reduces sleep apnea.

If you are using a continuous positive airway pressure (CPAP) machine to help you breathe, use it every night. If you don't use it all night, every night, your symptoms will return right away.

Doctors generally do not suggest medicines for the treatment of obstructive sleep apnea (OSA). But medicine can help reduce daytime sleepiness when continuous positive airway pressure (CPAP) is reducing apneas—the number of times you stop breathing at night—but daytime sleepiness continues.^{13, 14}

Medication Choices

The U.S. Food and Drug Administration (FDA) has approved wakefulness-promoting medicines for people who are using CPAP but still have excessive daytime sleepiness:

• Wakefulness-Promoting Medicines

What To Think About

People with sleep apnea who take wakefulness-promoting medicines should continue using CPAP to treat sleep apnea.

Surgery for obstructive sleep apnea (OSA) is usually not done unless other treatments have failed or you are unable or choose not to use other treatments.

Surgery Choices

• Uvulopalatopharyngoplasty removes excess tissue in the throat to make the airway wider. It is the most common surgery to treat sleep apnea in adults.
• Tonsillectomy and/or adenoidectomy removes the tonsils and/or the adenoids. It is an option if you have enlarged tonsils and adenoids that are blocking your airway during sleep. This is often the first treatment option for children because enlarged tonsils and adenoids are usually the cause of their sleep apnea.
• Other surgical procedures are used to repair bone and tissue problems in the mouth and throat.
• Tracheostomy creates a hole in the windpipe (trachea). A tube is then put in the hole to bring air in. Doctors rarely use this surgery because it may cause other health problems. But when other techniques have failed, almost all people who are treated with tracheostomy will be cured of their sleep apnea.
• Bariatric surgery is done for weight loss. If you are extremely overweight (severely obese) and the excess weight is making your sleep apnea worse, you may consider surgery to help you lose weight. Bariatric surgery can promote weight loss that improves sleep apnea.⁸

Should I have surgery to treat obstructive sleep apnea?

Surgery for children

Tonsillectomy and/or adenoidectomy generally is the first choice for children, because enlarged tonsils or adenoids cause most cases of sleep apnea in children. Other types of surgery may be needed to correct birth defects that can cause sleep apnea symptoms.

What To Think About

If you are thinking about having surgery to treat sleep apnea, talk with your doctor about having a sleep study done first. Experts generally suggest trying continuous positive airway pressure (CPAP) before considering surgery. CPAP is a machine that increases air pressure in the throat and prevents tissues in the airway from collapsing when you breathe in.

In adults, uvulopalatopharyngoplasty (UPPP) is the most common surgery used to treat sleep apnea.

• There is no clear research on how well UPPP works for sleep apnea.¹⁵
• UPPP may stop snoring, but apnea episodes may continue.¹
• Limited research indicates that about 40% to 60% of people who have UPPP see an improvement in their symptoms.²
• You may still need other forms of treatment, including continuous positive airway pressure (CPAP), after surgery.
• You will need sleep studies after surgery to make sure periods of apnea do not continue or return.
• UPPP usually is not used to treat sleep apnea in children.

Tracheostomy is used only when all other treatments for severe sleep apnea have failed or when you cannot tolerate other treatments.

A rarely used option is repositioning facial bones (maxillofacial reconstruction) if CPAP or UPPP do not work. This surgery is designed to increase the size of the bones around the tongue and to create pull (traction) on the base of the tongue, which enlarges the airway. You will usually need more than one surgery.

Laser-assisted uvulopalatoplasty uses a laser to perform surgery. It is sometimes used to treat mild to moderate sleep apnea, although not all people benefit. This surgery is not approved by the American Academy of Sleep Medicine to treat sleep apnea.¹²

Other treatment choices for obstructive sleep apnea (OSA) include:

• Continuous positive airway pressure (CPAP). You use a breathing device that prevents your airway from closing during sleep. It is the preferred treatment for moderate or severe sleep apnea.
• Other devices that are similar to CPAP. These devices automatically adjust air pressure or use different air pressures when you breathe in or out. They are easier and more comfortable for some people to use.
• Oral breathing devices. These reposition your tongue and jaw during sleep, which opens up your airways. They may not work as well as CPAP.

What to think about

Research shows that continuous positive airway pressure (CPAP) decreases daytime sleepiness, especially in people who have moderate to severe sleep apnea.^{9, 6} But CPAP may not work as well for people who have mild sleep apnea.⁶

If you use CPAP to treat sleep apnea, you need to use it every night. If you do not use it, your symptoms will return right away.

It may take time for you to be at ease when you use CPAP. You may find that you want to take off the mask, or you may find it difficult to sleep while using it. If you cannot get used to it, talk to your doctor. You might be able to try another type of mask or make other adjustments.

Nasal strips to decrease snoring are available in most pharmacies. Nasal strips widen the nostrils and improve airflow. Although these strips may decrease snoring, they cannot treat sleep apnea.

If you are overweight and have sleep apnea, think about getting nutritional counseling to help you lose weight.

Organizations

• Sleep Problems, Age 12 and Older
• Snoring

Citations

1. Malhotra A, White DP (2002). Obstructive sleep apnea. Lancet, 360(9328): 237–245.

2. Guilleminault C, Abad VC (2004). Obstructive sleep apnea syndromes. Medical Clinics of North America, 88(3): 611–630.

3. Arzt M, et al. (2005). Association of sleep-disordered breathing and the occurrence of stroke. American Journal of Respiratory and Clinical Care Medicine, 172(11): 1447–1451.

4. Roizenblatt S, et al. (2006). A double-blind, placebo-controlled, crossover study of sildenafil in obstructive sleep apnea. Archives of Internal Medicine, 166(16): 1763–1767.

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