What is Sleep Apnea Doing to Your Sleep?

Written by Anne Winslow with contributions from Kevin Morton, Spring 2010

What It Is | How To Know If You Have It | Treatment | Video | Your Thoughts

In 2001 my father fell asleep at the wheel on two separate occasions. Both times his life was saved by alert passengers who recognized the danger of the situation and immediately woke him from his microsleep.

This experience was a wake-up call for my father, an extremely loud and chronic snorer. He checked into a sleep clinic shortly afterwards and his sleep was monitored throughout the night. His diagnosis: severe obstructive sleep apnea. Upon hearing this, my entire family had to ask, "What is sleep apnea?"

Dr. Dement

Dr. D's Sleep Book Says...

Sleep apnea is an unrecognized killer, but it is hiding in plain sight. Every night more than 50 million Americans stop breathing. In a stunning evolutionary failure, nature endowed us with throats that tend to collapse during sleep and block air flow but did not endow our sleeping brains with the ability to start breathing without waking up.

Obstructive sleep apnea (OSA) is a condition that affects one's ability to breathe while asleep and is, as more and more people are discovering daily, alarmingly common. While statistics are hard to put an exact finger on, varying considerably based on the criteria used, peer-reviewed studies have found sleep-disordered breathing that meets the criterion for sleep apnea syndrome to be present in 24% of adult men and 9% of adult women (Young et al. 1993).

Picture of normal breathing vs. breathing with obstructive sleep apnea During sleep, an obstructive sleep apnea victim's airway closes, causing him or her to stop breathing until he or she awakens for a second or two to take a breath.

These numbers are simply breathtaking (pun possibly intented here ;). But in all seriousness, think about this. Sleep apnea affects quite a large amount of the population, and, as you will see, is not to be taken lightly in terms of what it can do to you. And yet many people still don't know what sleep apnea is. Taking the time to read this page will put you in a great position to help someone in the future (and quite literally save or extend their life). As the statistics indicate, you are likely to know quite a few people who develop obstructive sleep apnea.

The word "apnea" simply means the absence of breathing. To have sleep apnea thus means to stop breathing during sleep.

Well, that doesn't sound good. At all.

Share your thoughts on sleep apnea with us!

The official definition of a sleep apnea episode that is accepted by sleep specialists is a cessation of airflow at the nose and mouth lasting more than ten seconds despite efforts to breathe (Dement 335). The episodes are often terminated by an abrupt awakening, short enough not to be remembered by the sleeper, but present enough to really compromise the quality of his or her sleep. In severe cases, the sleeper can wake up hundreds of times in a single night.

Differentiating Apneas

There are actually 3 different kinds of sleep apneas, the obstructive variety being by far the most common.

The other two are central sleep apnea (where there is an absence of even the effort to breathe) and mixed sleep apnea (a combination of obstructive and central).

Diagnosed by a polysomnographic sleep test that includes the monitoring of airflow, sleep apnea is ranked in terms of its severity based on the number of sleep apnea episodes experienced per hour. Though the number of episodes varies night to night, the minimum number to receive a diagnosis of obstructive sleep apnea is 5 episodes per hour. This means that a person with even the mildest form of obstructive sleep apnea is waking every 12 minutes throughout the night!

These constant, brief interruptions of sleep are rarely recalled by their victims. Their body wakes up for a split second in order to take a breath and restore oxygen, then falls right back to sleep with no time for the brain to remember the awakening. The result is an individual waking up thinking they obtained good, continuous sleep when in reality they woke up dozens, if not hundreds of times.

Despite eluding memory, these episodes have incredibly detrimental consequences. As you can imagine, not breathing for long enough while asleep has the potential to bring down an individual's blood oxygen levels. Consistently struggling to breathe like this for long enough can cause a number of complications, including high blood pressure, diabetes, acid reflux, cardiac arrhythmias, stroke, and heart failure (Caples et. al.).

The constant interruption of sleep also makes it difficult for the victim to obtain sleep that is restful and rejuvenating. Obstructive sleep apnea patients often accumulate large amounts of sleep deprivation because of constantly having to wake up throughout the night to breathe. This makes it difficult to get into REM or deep sleep. The result is the individual feeling persistently tired throughout the day, often apathetic or depressed, despite the fact that they think they should have slept long enough (because they can't remember awakening at all).

But no matter how long you sleep, if you're having to wake up constantly to breathe you are not going to feel well rested once you wake up.

How Do I Know If I Have Sleep Apnea?

Loud snoring is THE cardinal sign that something is wrong. No matter how normalized we are to snoring taking place (in us, in our loved ones, in general), snoring is never a normal thing for the body to do. Snoring is a struggle to breathe, and as you can imagine struggling to breathe each and every night puts a large strain on one's body.

The characteristic snoring pattern for OSA is a series of loud snores interrupted by a sudden silence that signals complete obstruction and inability to breathe. During the apnea, the victim's respiratory efforts increase steadily until finally, there is an interruption of sleep and the obstruction is broken, often with a loud choking, gasping, inspiratory snort (Dement). This process is repeated throughout the night, with the effect of severely disturbing the bed-partner as well the victim.

According to a recent study at the Mayo Clinic in Rochester, Minnesota, the bed-partner of a sleep apnea patient has sleep as disturbed, fragmented and inefficient as an insomniac. This is referred to as "spousal arousal syndrome" and it indicates that obstructive sleep apnea is significantly detrimental to the victim as well as their loved-ones. It can be said then that if you have a bed partner and seek treatment as outlined below, you are essentially getting two for the price of one.

The second cardinal sign that a victim is suffering from sleep apnea is excessive daytime sleepiness. If loud snoring is coupled with persistent tiredness or low alertness throughout the day, the symptoms must not be ignored and the individual should contact a sleep physician immediately. If this sounds like you, don't put off seeking treatment.

Does this sound like you? Let us know what you think.

Valuable Resource:

SleepQuest is a quickly growing company offering diagnostic tests you can take from the comfort of your own home. If the above sounds like you, they are definitely worth checking out so you can get treated. Start learning about SleepQuest from our interview with founder and CEO Robert Koenigsberg here.

Treatments For Sleep Apnea

Fortunately, there are viable options for treating obstructive sleep apnea.

Picture of CPAP Machine The CPAP machine creates a positive pressure in the sleeper's airway to help him or her breathe at night. Because it often helps the bed partner sleep more soundly too, you can say a CPAP is essentially a two-for-one deal!

The most effective and popular treatment is the CPAP machine, a nasal mask that provides continuous positive airway pressure (what CPAP stands for) to prevent the airway from collapsing during inspiration so that unobstructed breathing can occur. It's a common misconception that CPAP machines actually pump oxygen into you; instead it's more that they create the right pressure to keep your breathing tube open.

When utilized on a nightly basis, this relatively inexpensive treatment is extremely effective at reversing OSA episodes and the accompanying daytime symptoms.

Other treatments include surgeries, radio frequency reduction of tissue volume and dental appliances (Dement 350). These treatments all seek to increase the size of the airway and ease the effort to inhale air.

Why Sleep Apnea Treatment Is Absolutely Vital

Treating obstructive sleep apnea can restore a victim's quality of life, reduce the risk of motor vehicle accidents, decrease the risk of developing cardiovascular disease, and provide relief for the behavioral and psychological symptoms of OSA. It can prevent countless injuries and deaths, increase productivity in the workplace and the classroom, and can significantly improve a victim's mood and energy level.

An Early Death

I remember Dr. Dement once remarking that he used to make a practice of asking sleep physicians the age of the oldest person they had ever treated for sleep apnea.

They were never very old at all, because people with sleep apnea die before they can reach old age. Heart attacks, blood pressure, traffic accidents, you name it. Such is the nature of a disorder that makes your body battle to breathe each and every night.

How is it possible then that only one out of twenty people with obstructive sleep apnea receive treatment (Streich)? There is an incredible lack of knowledge among the general population about sleep disorders. This is due in large part to a failure of the educational system and medical professionals to address the importance of sleep and sleep disorders.

It is estimated that only about one out of ten people with obstructive sleep apnea are ever diagnosed. The other 90% live their lives in a state of persistent drowsiness and fatigue, placing their lives and health in incredible danger.

My father's near accidents served as an extreme wake-up call for my entire family. By recognizing a problem and asking his doctor "What is sleep apnea?" we learned that his daily fatigue and loud snoring were actually symptoms of a very serious illness that could be effectively and easily treated. Only with increased awareness and sleep education will this chronic illness be diagnosed and treated with regularity, so that victims can once again sleep easy and breathe softly at night.

The Importance Of Seeking Treatment

A student-made outreach project for Stanford Sleep and Dreams, "Fool's Dream" follows Scrooge in his struggle to come to terms with the dangers of having sleep apnea and not getting treated. Watch and see why sleep apnea treatment is so important as Scrooge is shown his past, present, and future by the Ghosts of Sleep Apnea in a story modeled after Dickens' "A Christmas Carol."

Fool's Dream - Based On Dickens' "A Christmas Carol"

Starring Robert Hintz, Santiago Ibarra, Cassie Montoya, Peter Abraham, James Mannion, and Tatum Sohlberg.

Enjoy this page? Please help us pay it forward to others who would find it valuable by Liking, Sharing, Tweeting, Stumbling, and/or Voting below.

What Does Sleep Apnea Mean To You?

Are you affected by sleep apnea in some way in your life? Do you or a loved one suffer from it? Do you have questions about why it happens or how to treat it?

Share your thoughts, questions, or stories with us below--your insight could aid others who can relate to what you have experienced or can find answers in your questions.

Read Other Stories About Sleep Apnea

Click on the links below to read the stories and questions of others about obstructive sleep apnea. They were all written by other visitors to this page, just like you.

Thats Me Alright! Sleep Apnea and Restless Legs 
Did a sleep study a few years ago but they said I didn't sleep enough hours to definitely be sleep apnea but definitely restless legs could be diagnosed! …

You Do NOT Have To Snore Or Be Overweight To Have Sleep Apnea! 
I cannot begin to tell you how upset it makes me that every single article I read on sleep apnea always put all the emphasis on snoring with sleep apnea. …

Fatigue and a Feeling of Constant Dread With My Sleep Apnea 
I was diagnosed about 8 years ago with OSA - having about 20-25 episodes every hour (Apnea/Hypopnea Index) where I would stop breathing. I would wake …

Is Sleep Apnea A Normal Life Cycle? 
Dr.Joel Wallach DVM ND was asked about sleep apnea on a Creflo Dollar Health Conference he was invited to attend as the main speaker. He said, "sleep …

Had A Bad Time Before Diagnosis & CPAP 
For years I snored, had nightmares, woke with a headache, and was exhausted by the day's end. This ended back in the 1980s after I saw a TV feature with …

Not all people with sleep apnea snore! 
I was recently diagnosed with Complex (Mixed) Sleep Apnea at the age of 55. I have both obstructive and central sleep apnea, but mostly central. I snore …

Worried About My Husband's Loud Snoring/Stops Breathing!! 
I am so worried about my husband!! I have told him several times about his sometimes VERY LOUD SNORING, and also about how he suddenly just STOPS BREATHING!!! …

Nightmares From Suffocating, Cannot Breathe When My Chin Is Down 
When I am awake and put my chin down, I cannot breathe. If I sleep with too many pillows, my chin is down. I take medicine that sedates me and i have trouble …

Had All The Classic Symptoms Of OSA And Didn't Know What Was Wrong 
For years I had experienced daytime sleepiness, fatigue by the afternoon, awakening with headaches, snoring, nightmares and other classic symptoms of …

Severe OSA - Used Mouth Device Stopped Snoring-Absolutely NO Impact On My Apnea 
I am a 58-year-old NOT overweight female who was diagnosed a year ago with Severe OSA. The diagnosis explained my chronic fatigue, palpitations and various …

13-Year-Old Teenager With Sleep Apnea? 
I'm 13 and I am not overweight. Im pretty physically active. So my concerns started when I had a friend over. She disturbly woken me up which I was not …

Curious what other options besides surgery for sleep apnea if CPAP is not option due to co-morbid claustrophobia 
Curious what other options exist, besides surgery, if CPAP is not option for treating sleep apnea in the case of a person who's claustrophobic and refuses …

Not Buying My Sleep Apnea Diagnosis 
Can one have an apnea diagnosis that is a false positive? Male, 50-some, 20 min's cardio per day >5 days a week, play hockey on weekends, 6'4", 212lbs, …

My Son Works Harder At Night Than During The Day...Trying To Breathe 
I spent a week with my 45 year old son in Alaska on a fishing trip a few months ago. I was shocked to discover that as hard as he worked with all the …

Feel Like My Life Is Crumbling Down & Desperately Wanting Change 
I'm just turned 35 and have had high blood pressure now for going on 5 years, high is usually in around 180/120 give or take a few numbers & heart rate …

I'm A Teenager Who Doesn't Snore: Could I Have Sleep Apena? 
I'm 13 and I have trouble falling asleep, however no matter how much sleep I do get at night I'm always tired during the day. A lot of times I'll have …

No Energy When Awakening, But Light Occasional Snoring 
The article says the cardinal sign of OSA is loud snoring. This is not necessarily true. I was diagnosed last year with mild to moderate OSA, but …

Trouble Breathing Before I Go To Bed? 
Im 16 and have always had a difficult time falling asleep. Over the last month every few days I start falling asleep but then wake up because I feel like …

Loud Snoring, Deviated Nasal Septum, High Blood Pressure, and Now an Irregular Heartbeat 
I was diagnosed with a deviated nasal septum when I was 17. Lots of issues with it then which resolved, so surgery was cancelled. Now at the age of 52, …

At Wit's End - Sleep Apnea Without Snoring 
I appreciate this site. It shows that more people are taking these problems seriously but it hasn't turned out to be as simple as some of these articles …

Ex-Military With Sleep Apnea 
Well to start off I am an ex military personnel. I have gone to 3 separate conflicts, the last one Iraq. While being there the constant alertness of being …

Wake Up Trying To Swallow, Having Dreams That I Can't Breathe 
Sometimes I will be having a dream that I can't breathe and then wake up trying to swallow. I've haven't had it checked out but I bet I have sleep apnoea. …

A Simple And Pleasant Way Of Getting Rid Of Sleep Apnea 
I have had sleep apnoea for quite a number of years. I did not know why I felt so sick on getting up or why sometimes I would wake up with a snort. Finally …

Could My 13 Year Old Son Have Sleep Apnea? 
My 13 year old will go to bed at 10 pm and then in the morning is still very tired, will do his chores but while sitting on a chair can fall asleep. …

Click here to write your own.

Frequent Sleeping 
My uncle goes to sleep sometimes unexpectedly (i.e: Watching a movie, playing the game, after cooking dinner etc.) He generally stops breathing after a …

Headache And Dreams 
My doctor is considering a study for me.....I wake from my sleep with a headache and my blood pressure has increased. When I am awake there is not a blood …

Effectiveness Of Only Maxillary Advancement On OSA 
Why does obstruction in nasal breathing cause OSA? Why doesn't the body succeed then in breathing through the mouth, assuming the tongue isn't in the …

Sleep Aponea - Still Sleepy And Sluggish 
I'm a loud snorer and despite having laser on the palette it has failed. I still continue to feel sleepy and sluggish during the day. I thought it was …

More Apneas With CPAP Than When Sleeping On Side - What Should I Do? 
I'm 36 years-old with a normal BMI that was recently diagnosed with Sleep Apnea after having a Sleep Study done. It seems I may have had this condition …

Click here to write your own.

Sources used for this article:

Young, et al. "The Occurrence of Sleep-Disordered Breathing among Middle-Aged Adults."
Check it out at www.nejm.org/doi/full/10.1056/NEJM199304293281704

Kushida, et al. "Symptom-Based Prevalence of Sleep Disorders in an Adult Primary Care Population" Check it out at http://www.ncbi.nlm.nih.gov/pubmed/11894194

Caples, Sean, Apoor Gami, and Virend Somers. "Obstructive Sleep Apnea." Focus 3 (2005): 557-67. Web.

Dement, William. The Stanford Sleep Book. USA. 2002

Dement, William. "Lecture 17 - OSA I: Breathing is Everything!" Psychiatry 135. Stanford University. Stanford, 10 May 2010

Streich, Elizabeth. "Sleep Apnea Impairs Blood Vessel Function in Obesity".
Check it out at http://insciences.org/article.php?article_id=8757.

More Resources Available

For more information about treating sleep apnea, you can check out Snoring-Solutions-That-Work.com. Regardless of if you have sleep apnea or not, if your snoring disturbs your sleep or that of your bed partner, empower yourself with a number of ways to alleviate it with their Snoring Treatments article.

About This Site

Welcome! This site is continuously being created by students of Dr. William C. Dement's Sleep And Dreams course at Stanford University.

We made this site as a call to action for people all over the world to live healthier, happier, safer, and more productive lives by learning about their own sleep. We have faith that reading the information provided on this site will motivate you to be smart about your sleep deprivation and strategic about your alertness in order to live life to your fullest, most energetic potential.

In fact, we challenge you to do so! What do you say, are you up for the challenge?

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The Stanford Sleep Book

Stanford Sleep Book Picture

Dr. Dement's pioneering textbook has been the core text for Sleep and Dreams since 1980, but it has just recently been made available to the wider public for the first time.

In it you'll find a more detailed account of the most important things you need to know about sleep, alertness, dreams, and sleep disorders. Studies, statistics, plus plenty of Dr. Dement's classic anecdotes painting the history of sleep medicine.

Preface | Intro | Contents | Get A Copy

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A revolution in personal sleep tracking, the Zeo is a wireless headband that transmits your brainwaves in realtime to a dock (pictured here) or your smartphone. The result? You can wake up and see exactly what stages of sleep you were in during the night! Unprecedented personalized sleep knowledge.

Sleep Paralysis: A Dreamer's Guide

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Ever woken up paralyzed? A surprising number of us have, believe it or not. But few know the actual causes of this phenomenon, and fewer still how to exert control over it. Dream researcher and sleep paralysis expert Ryan Hurd shares breakthrough insights into how to do just that.

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