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Sleep apnea is a condition in which breathing stops for 10 seconds or longer during sleep due to narrowing or obstruction of the upper airways. Individuals at higher risk include men over 45, postmenopausal women, obese people, those with short and thick necks, and those who consume alcohol, smoke, or use sedatives or sleep medications. Genetic factors can also contribute to the development of sleep apnea in some cases.
Sleep apnea occurs when the muscles of the throat relax excessively, causing the upper airway to narrow or collapse. When airflow is blocked, oxygen levels in the blood drop, prompting the brain to briefly awaken the person. This cycle repeats throughout the night, preventing restorative sleep and causing daytime fatigue.
Sleep apnea is typically diagnosed through a polysomnography test performed in a sleep laboratory. During this test, the patient’s brain activity, eye movements, heart rate, leg movements, chest and abdominal movements, and airflow through the nose and mouth are monitored. All these data are recorded overnight using electrodes and sensors. Specialists then analyze the recordings to determine the presence and severity of sleep apnea.
Sleep apnea is classified as mild, moderate, or severe:
This classification is important for determining the treatment plan and assessing its impact on quality of life.
The treatment of sleep apnea is planned according to the severity of the condition.
In mild sleep apnea, if the patient has no chronic diseases (such as hypertension, heart failure, diabetes, or stroke),lifestyle changes form the cornerstone of treatment. Patients are advised to lose weight and avoid alcohol, smoking, and sedative medications.
If a patient experiences apnea only while sleeping on their back, certain recommendations are made to prevent supine sleeping. The most common suggestion is to sew a small cloth pouch containing a ping-pong or tennis ball and attach straps to either side so that the patient ties it to their back while sleeping. The ball inside the pouch prevents the patient from lying on their back.
Every patient diagnosed with sleep apnea is referred to an ear, nose, and throat (ENT) specialist. If an obstruction is found in the upper airway—such as a deviated nasal septum, enlarged turbinates, or hypertrophic tonsils—surgical correction by the ENT specialist can help successfully treat sleep apnea.
Dentists can also treat sleep apnea using custom-made oral appliances that advance the lower jaw. These devices are worn in the mouth at night and help keep the airway open. However, if a patient with mild sleep apnea also has a chronic disease, these measures alone may not be sufficient.
In such cases, treatment with a CPAP device, which delivers positive airway pressure, is recommended. The device uses a mask that covers the nose and mouth to keep the airway open during sleep, effectively treating sleep apnea.
For moderate and severe sleep apnea, CPAP therapy is the definitive solution. Lifestyle changes alone are not enough. If there is a pathology obstructing the upper airway, surgery may provide temporary relief, but apnea often returns after a period of time.
Therefore, for patients with moderate or severe sleep apnea, the only effective and long-term solution is using a CPAP device that delivers air pressure through a mask covering the nose and mouth during sleep.
Initially, patients may find it difficult to adapt to the machine. However, as they experience improved sleep quality and wake up feeling well-rested, many describe the feeling as being “reborn.”
Surgical methods for treating sleep apnea are generally applied in moderate to severe cases where other treatment options have proven insufficient. These surgical interventions aim to facilitate breathing by targeting anatomical structures that obstruct the airway.
Procedures may include uvulopalatopharyngoplasty, reshaping of the salivary glands and soft palate, jaw advancement surgeries, and occasionally operations to relieve nasal obstruction. Surgical treatment can reduce the severity of sleep apnea, alleviating snoring and daytime fatigue, but it is not suitable for every patient and requires a thorough evaluation and personalized planning.
If sleep apnea is left untreated, it can lead to serious long-term health problems.
Repeated pauses in breathing during sleep reduce oxygen levels in the blood, adversely affecting the cardiovascular system. Over time, the risk of high blood pressure, heart attack, stroke, and heart failure increases. Additionally, insufficient oxygen to the brain can lead to cognitive impairments such as poor concentration, memory problems, and excessive daytime sleepiness.
Chronic poor sleep quality can also trigger mental health issues like depression and anxiety. Untreated sleep apnea not only shortens life expectancy but also significantly diminishes quality of life.
Recent developments in sleep apnea treatment have brought new hope to patients by offering promising options beyond traditional CPAP machines. These include:
Pharmacologic Treatments: Researchers have shown that Tirzepatide, a drug used for diabetes and obesity, can reduce airway obstruction and effectively decrease sleep apnea, particularly in obese patients (Tirzepatide for the Treatment of Obstructive Sleep Apnea and Obesity. Authors: Atul Malhotra, M.D., Ronald R. Grunstein, M.D., Ph.D., Ingo Fietze, M.D., Terri E. Weaver, Ph.D., Susan Redline, M.D., M.P.H., Ali Azarbarzin, Ph.D., Scott A. Sands, Ph.D., +5, for the SURMOUNT-OSA Investigators. Published June 21, 2024, DOI: 10.1056/NEJMoa2404881).
Another drug, AD109, has shown promising results in clinical trials by targeting upper airway muscle relaxation—a key factor in sleep apnea—reducing apnea events and improving both nighttime and daytime symptoms (American Journal of Respiratory and Critical Care Medicine, Volume 208, Issue 12, Pharmacologic Therapy for Obstructive Sleep Apnea: Are We Seeing Some Light at the End of the Tunnel?).
Oral Devices: The first oral appliance developed for severe sleep apnea, the Complete Airway Repositioning and Expansion (CARE) device, has been approved by the FDA. These devices keep the airway open during sleep by expanding the palate and repositioning the lower jaw, offering a less invasive alternative to CPAP and demonstrating significant improvements in many patients (https://www.sleepfoundation.org/sleep-news/fda-clears-first-oral-appliance-for-severe-sleep-apnea-therapy).
Continuous Negative External Pressure (cNEP): This novel therapy involves a device that applies negative pressure outside the neck to prevent airway collapse. Compared to CPAP, it offers a less invasive option. Early studies suggest it may be a viable alternative for patients who cannot tolerate CPAP (Sleepopolis).
Yes, sleep apnea can be treated, and the approach depends on the severity of the condition. In mild cases, lifestyle changes, weight management, and adjusting sleep positions may be sufficient. For moderate to severe cases, the use of CPAP or bi-level positive airway pressure devices is common, keeping the airway open and preventing apnea episodes. Oral appliances and certain surgical interventions can also address anatomical issues and help control the condition. Treatment should always be planned by a specialist to improve quality of life and reduce long-term health risks.
The goal of sleep apnea treatment is to keep the airways open and ensure adequate oxygen intake during sleep. Treatment methods are generally determined based on the severity of the condition, the patient’s lifestyle, and any additional health concerns. Mild cases may be managed with lifestyle modifications alone, while moderate and severe cases may require medical devices or surgical interventions. Common treatment options include:
CPAP (Continuous Positive Airway Pressure) devices deliver a constant, gentle stream of air to keep the upper airways open during sleep. This prevents apnea and hypopnea episodes.
Lifestyle changes can be effective both on their own in mild cases and as a complement to medical treatments. Key modifications include:
In some patients who do not respond to medical treatments or have anatomical airway obstructions, surgical options may be considered. Procedures may include removing tonsils and adenoids, reshaping the soft palate and uvula, or adjusting the jaw and tongue base. These interventions widen the airway, making it easier to breathe during sleep and reducing the frequency of apnea episodes. Surgical decisions are made by specialists based on the patient’s anatomy and sleep study results.
The duration of sleep apnea treatment depends on the severity of the condition and the chosen method. Lifestyle modifications and sleep position adjustments may show benefits quickly in mild cases, while moderate to severe cases may require ongoing use of medical devices or surgical interventions. CPAP therapy is typically a long-term solution, with effects felt soon after regular use, although achieving full adaptation and lasting improvement may take several weeks. Recovery and effectiveness of surgical interventions vary depending on post-operative care and individual healing.
Untreated sleep apnea can lead to serious health problems. Cardiovascular risks increase, including hypertension, heart failure, arrhythmias, and stroke. Excessive daytime sleepiness and poor attention can result in workplace or traffic accidents. It can also contribute to metabolic disorders, raising the risk of type 2 diabetes and obesity. Additionally, poor quality of deep, restorative sleep significantly reduces daily functioning and energy levels.
In some cases, home-based methods can alleviate symptoms and support treatment. Changing sleep positions, especially sleeping on the side, can reduce apnea episodes. Weight management and regular exercise help minimize airway obstruction, while limiting alcohol and sedative intake improves sleep quality. For mild cases, oral appliances or CPAP devices can be used effectively at home under medical guidance, promoting healthier sleep throughout the night. Home treatments are generally applied alongside medical therapies, and regular follow-up is important.
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Prof. Dr. Elif KüpeliChest Diseases Specialist
Prof. Dr. Elif Küpeli
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