Obstructive sleep apnea (OSA)

Someone who actually sleeps enough but is nonetheless very sleepy and feels exhausted during the day may suffer from obstructive sleep apnea (OSA). Many people with sleep apnea snore and have their breathing interrupted while sleeping – usually without noticing it. The effects can significantly impact their everyday life.

At a glance

  • Many people with sleep apnea snore and have their breathing interrupted during the night – usually without noticing it.
  • Snoring alone is harmless: only when breathing is interrupted does it become sleep apnea.
  • Over the long term, sleep apnea increases the risk of other illnesses and can severely impact the quality of life.
  • Sleep apnea occurs when the muscles in the upper airways relax.
  • Estimates suggest that around 3 percent of women and 5 percent of men have obstructive, i.e. narrowing or closing, sleep apnea.

Note: The information in this article cannot and should not replace a medical consultation and must not be used for self-diagnosis or treatment.

Sleep apnea: man lying in bed wearing a respiratory mask. He appears to be asleep.

What is sleep apnea?

Many people with obstructive sleep apnea (OSA) actually sleep enough, but still feel tired and sleepy during the daytime. This is because sufferers find it difficult to breathe while sleeping and have their breathing interrupted – usually without noticing it. Over the long term, sleep apnea increases the risk of other illnesses. It can also very directly and severely impact one's quality of life.

What are the symptoms of sleep apnea?

Indications of sleep apnea include frequent urination, waking suddenly, severe fatigue throughout the day, night sweats, difficulties concentrating, headaches in the morning, a dry mouth when waking and impotence.

People with obstructive sleep apnea usually snore very loudly. While they sleep their breathing is usually shallow (hypopnea) and they have breathing interruptions (apneas) that last over 10 seconds. Snoring is harmless in itself. But if the breathing is also interrupted, it is a case of sleep apnea.

Older woman supporting her head on her arm which is resting on a table. She appears to be asleep.

Symptoms that may indicate sleep apnea:

  • severe fatigue throughout the day
  • difficulties concentrating
  • night sweats and frequent urination
  • sudden awakenings, sometimes with a racing heart and breathlessness
  • a dry mouth when waking
  • morning headaches
  • impotence

What are the causes of sleep apnea?

Sleep apnea occurs when the muscles in the upper airways relax. This narrows the airways in the throat area, or even blocks them. Loud snoring noises then occur when breathing in and out.

If breathing is disturbed by sleep apnea, the body does not get enough oxygen. The blood pressure and pulse also fall. The breathing center in the brain is alerted by this and it triggers a waking stimulus: sufferers then briefly wake up, usually without noticing it. This brief waking up is also known as an “arousal”. It interrupts the sleeping rhythm, the heart beats faster, the blood pressure rises. Someone who repeatedly wakes up briefly due to sleep apnea may no longer get back into their restful deep sleep, and will then feel tired and groggy during the day.

Obesity and certain issues in the area of the mouth and throat may play a part in sleep apnea. For example, sufferers have enlarged tonsils, a small lower jaw, a small soft palate, or unusual tongue positioning.

In some cases nasal breathing is also disrupted. Sleeping on one's back can favor snoring and breathing disorders. However it is rarely the only cause.

Excessive alcohol consumption, and sleeping pills and tranquilizers, can also help make the breathing muscles relax and exacerbate sleep apnea. The probability of developing obstructive sleep apnea rises constantly after the age of 45.

What is obstructive sleep apnea?

The video below explains more about the symptoms, risk factors and treatment options for obstructive sleep apnea.

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How common is sleep apnea?

Estimates suggest that around 3 percent of women and 5 percent of men have obstructive sleep apnea.

The estimated prevalence of obstructive sleep apnea in men is 5% and 3% in women.

How does sleep apnea develop?

Someone with bad sleep apnea always feels groggy and tired. Sleep fails to bring much rest, and the person's mood suffers. Because people with sleep apnea often feel less well in general, they might also tend to develop depression.

Sufferers also often have high blood pressure or other cardiovascular conditions. So there is an increase in the risk of a stroke, a heart attack, or cardiac arrhythmia.

Interrupted breathing while sleeping does not always result in symptoms or health risks. If they are only brief and do not occur often, they do not cause daytime tiredness. They are then no reason to worry. But if these breathing disruptions and complaints persist it may be useful to consult a doctor.

How is sleep apnea diagnosed?

If doctors suspect obstructive sleep apnea, they first ask about symptoms and habits. This is then followed by a physical examination. The patient may be given a wearable device with which their sleep can be studied. It will record, for example, the breathing, the heart rate, oxygen saturation in the blood, snoring, and the body position. If the analysis highlights anomalies, additional testing in a sleep laboratory may be useful.

The patient then spends one or more nights in a sleep lab. Their sleep is monitored with other recording devices and a video camera.

How is sleep apnea treated?

Obese people can help their sleep apnea by losing weight. Many different treatments are also available: for example devices that help breathing, positional aids, devices such as lower jaw splints, and surgery. It has been scientifically proven that some of these treatments can help.

Medication currently has no role to play in treating sleep apnea. The effectiveness of the drugs available has not been proven.

The most effective treatment for severe sleep apnea is so-called CPAP therapy. CPAP stands for “continuous positive airway pressure”. This treatment involves pumping ambient air at slightly high pressure into the airways during the night. Patients wear a breathing mask attached to a breathing device. The slightly higher pressure keeps the upper airways open. CPAP therapy prevents all or almost all interruptions to breathing. So symptoms such as daytime tiredness can be significantly helped.

The CPAP therapy that is best at alleviating the symptoms needs some getting used to: not everyone wants to put up with wearing a breathing mask every night.

More information about sleep apnea and how it can be treated can be found at gesundheitsinformation.de.

What is everyday life like with obstructive sleep apnea?

Obstructive sleep apnea can heavily affect a person's quality of life. Sufferers sleep badly, are often very tired during the day, and feel knocked out. Some people with sleep apnea unintentionally fall into so-called microsleeps. Sleep apnea can also result in concentration and memory disorders.

Sleep apnea can affect relationships: the loud snoring also disrupts the partner's sleep. The partner is then also irritable and tired during the day. Interruptions to breathing can also be worrying.

A training course can help come to terms with the CPAP therapy and getting used to the therapy. It might also help to share experiences with other sufferers in a self-help group. There are now self-help groups for people with sleep apnea in many cities in Germany. It is particularly important to have a little patience and to get support for problems. If a person affected succeeds in making breathing therapy part of their everyday routine, it can very much improve their quality of life.

The gesundheitsinformation.de website can help you find self-help groups and advisory services.

In cooperation with the Institute for Quality and Efficiency in Health Care (Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen) (IQWiG).

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