Sleep Apnea: Causes and Risk Factors

The condition can also cause complications including fatigue, high blood pressure, heart problems, and metabolic syndrome, but the causes and risk factors vary. Obstructive sleep apnea (OSA), the most common type of sleep apnea, tends to be most common in people who are heavier, have larger necks, and are older, among other risk factors.

Here’s a primer on what causes the various types of sleep apnea, and all of the factors that can put you at a higher risk for developing the condition.

Different types of sleep apnea have different causes, but there is some overlap.

Obstructive Sleep Apnea

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. However, those with sleep apnea and their partners may not notice this necessarily.

Central Sleep Apnea

It can be caused by conditions such as a brain infection, neck conditions, stroke, or heart failure; by taking certain medications, such as opioids or benzodiazepines; or by being at a high altitude.

Complex Sleep Apnea

Obesity

Obesity is the most common risk factor for obstructive sleep apnea. “Fat deposits in the neck and around the tongue and palate make the airway much tighter and smaller,” says sleep medicine specialist Neeraj Kaplish, MD, medical director of sleep labs and clinics and clinical professor of neurology at the University of Michigan in Ann Arbor. “It becomes much more [closed up] during sleep when you’re lying down.” (It should be noted that thin people can also have obstructive sleep apnea and that not all individuals who are overweight have the condition.)

Large Adenoids or Tonsils

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 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.

Family History of Sleep Apnea

Chronic Nasal Congestion

Smoking

Using Alcohol, Sedatives, or Tranquilizers

Asthma

Having asthma is also a risk factor for obstructive sleep apnea. The relationship between the two conditions works both ways, Chervin explains: “Sleep apnea can make asthma worse and asthma can make sleep apnea worse.”

Medication, Such as Opioid Pain Relievers

The neurological communication that happens between the brain and body to regulate breathing can be numbed by benzodiazepines and opioids, says Dr. Capasso. As a result, these drugs reduce airway muscle activation and can contribute to sleep apnea.

Gender and Age

High Blood Pressure (Hypertension)

Diabetes

History of Stroke

Prior stroke is linked to both obstructive sleep apnea and central sleep apnea, but it’s not clear which is causing which, Dr. Chervin says. “As many as three-quarters of stroke patients have sleep apnea, and sleep apnea also raises the risk for stroke,” says Chervin. Sleep apnea leads to low oxygen levels and high blood pressure, both of which can increase one’s risk of a future stroke.

Heart Failure

Lowering your risk of developing sleep apnea is in large part about minimizing the risk factors that you have control over. Here are some of those steps you can take:

• 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, such as 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.

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• Exercise regularly. Staying active could reduce your risk for sleep apnea even if you’re overweight or obese. In one study that tracked 137,917 midlife and older adults for up to 18 years, higher levels of physical activity and fewer sedentary hours were associated with lower incidence of obstructive sleep apnea.

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   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.

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• Steer clear of central nervous 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.

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• 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.

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If you suspect you might have sleep apnea, ask your doctor about a sleep test, either at home or in a lab, to know for sure. There are several available treatments for sleep apnea, including a CPAP machine, weight loss medication, oral appliances, and surgery.

• Obstructive sleep apnea, the most common type of sleep apnea, tends to be most common in people who are heavier, have larger necks, and are older or male, among other risk factors, such as having certain medical conditions.
• Central sleep apnea, a much less common type of sleep apnea, can be caused by conditions such as a brain infection, neck conditions, stroke, or heart failure; by taking certain medications; or by being at a high altitude.
• Complex sleep apnea, also known as treatment-emergent central sleep apnea, can occur as a result of receiving treatment for obstructive sleep apnea, such as a CPAP machine. The exact causes aren’t totally understood.
• Understanding your risk factors for sleep apnea, such as your family and medical history, may help you take steps to prevent sleep apnea or identify it early before it causes any complications.