Breathe easy: Sleep apnea is dangerous but treatments are available

A condition that causes sufferers to stop breathing for up to two minutes, this disorder can be mitigated by making lifestyle changes before turning to technology or surgery

Of the several types of sleep disorders, sleep apnea is one of the most common, along with insomnia. Known as a “sleep-awake” disorder, sleep apnea can cause sufferers to stop breathing for between 10 seconds and two minutes mid-nod. In severe cases, according to the Cleveland Clinic, someone with this condition could wake up 240 times during an eight-hour sleep cycle.

Is sleep apnea dangerous?

“While breathing repeatedly stops and starts during sleep, sleep apnea is a relatively common disorder,” says Dr Arvind Gaddameedi, specialist endocrinologist at Aster Clinic in Dubai. “These pauses, often lasting 10 seconds or more, can reduce oxygen levels in the blood and disrupt sleep quality.”

The most frequent form of the disorder is obstructive sleep apnea, which occurs when the throat muscles relax and temporarily block the airway. There is also the less common central sleep apnea, in which the brain doesn’t send proper signals to the muscles that control breathing.

Dr Gaddameedi adds: “Sleep apnea is indeed dangerous in that it can lead to a range of health problems. Over time, it puts strain on the cardiovascular system, raising the risk of high blood pressure, heart disease, stroke and even heart failure. Additionally, it causes daytime fatigue, which can lead to accidents and affect mental health.”

Signs and symptoms

Because sleep apnea affects not only the type and quality of sleep, but also physical and mental health when the sufferer is awake, there are a range of conscious and unconscious symptoms to look out for.

“When it comes to sleep-centred symptoms, snoring, waking up multiple times with a choking sensation, heart burn, night sweats and restlessness are the most common,” says Dr Rashmi Fernandez, specialist otolaryngologist at Rak Hospital, Ras Al Khaimah.

In children, symptoms may present as snoring, teeth grinding, bed wetting, drooling, choking, sweating at night, laboured breathing, learning and behavioural issues at school, and daytime sleepiness.

Missing out on quality sleep can have damaging effects, both mentally and physically, during daylight hours. “Chronic lack of quality sleep, such as that caused by sleep apnea, can lead to heightened emotional reactivity and reduced ability to manage stress,” says Devika Mankani, psychologist at The Hundred Wellness Centre Dubai.

“Individuals may experience mood disturbances, such as increased irritability, anxiety and depressive symptoms. Over time, sleep deprivation also affects cognitive functions including attention, memory and decision-making. These psychological effects often create a feedback loop, where the stress from poor sleep quality exacerbates mental health challenges, further impacting sleep,” explains Mankani.

Cause and effect

The sleep disorder comes about from a range of causes, including physiological functions and lifestyle choices. “Several factors increase the risk of sleep apnea, including being overweight, having a thick neck circumference, a family history of the condition, nasal congestion, and lifestyle factors, such as smoking and alcohol use,” says Dr Ahmed Alkasmi, specialist pulmonologist at Aster Hospital, Sharjah.

Dr Waseem Dar, specialist neurologist at RAK Hospital, says: “Being overweight or obese is a major risk factor for obstructive sleep apnea. Obese individuals are four times at the greater risk of obstructive sleep apnea than those in a normal weight range. A 10 per cent weight gain is associated with a 30 per cent increase in risk of sleep apnea.

“Obesity predisposes to sleep apnea through the narrowing effects of upper airway fat on the pharyngeal lumen. It also reduces chest wall compliance and decreases lung volumes resulting in loss of traction on upper airway structures.” For women, the condition may also be tied to weight gain due to polycystic ovary syndrome.

“Excess body weight, especially around the neck, is a major risk factor because it can narrow the airway,” says Dr Gaddameedi. A small airway aside, other anatomical factors such as large tonsils or a recessed jaw can also contribute. Other reasons include old age, diabetes and asthma.

Dr Fernandez adds: “In general, men are two to three times more likely as premenopausal women to have obstructive sleep apnea. However, the risk of obstructive sleep apnea increases in women after menopause.”

Medical and tech interventions

“Several effective treatments exist for sleep apnea, often based on severity,” says Dr Gaddameedi. “Continuous positive airway pressure is a commonly prescribed device that uses gentle air pressure to keep the airway open during sleep. There are also oral appliances, which are custom-fitted devices that shift the jaw or tongue slightly forward to keep the airway open.”

Surgical intervention is also a choice, says Dr Alkasmi, and these procedures remove tissue or reposition the jaw to improve airflow or implant devices to support the airway.

New technologies have also emerged to complement or start to replace the bulky and often noisy continuous positive airway pressure machine. In October, a sleep apnea tracker was added to the Apple Watch to help identify moderate to severe cases of the disorder. “The watch uses the accelerometer to monitor small movements at the wrist that are associated with interruptions in normal respiratory patterns, measured by a new metric called Breathing Disturbances,” said the company. “Users can view their nightly Breathing Disturbances in the Health app on the iPhone and iPad, where they are classified as elevated or not elevated, and can be viewed over a one-month, six-month or one-year period.”

Sleep Revolution, a $15 million project funded by the EU, uses AI to assess sleep apnea and tailor treatments for individuals. Patients are given smart wearables with data tracked via an app, allowing for longer term, at-home, multi-night diagnosis unavailable in hospitals and sleep clinics. The results of the four-year trial will be out in 2025.

Moving diagnosis from hospital to home opens up the possibility of doing multi-night diagnosis, which is too expensive for most to do in a clinical setting. This makes it possible to detect sleep quality and changes in severity different nights and observe people's more natural sleep.

Lifestyle changes and sleeping positions

Before considering surgery or even gadgets, though, experts recommend putting some lifestyle hacks into action. Primary among these is to lose weight: “Dropping even a small amount can reduce pressure on the airway and lessen symptoms,” says Dr Gaddameedi.

Also high on the list of most effective actions are quitting smoking and cutting back on alcohol, particularly before bedtime. “Habits such as regulating sleep schedule, treating existing nasal allergies, minimising the use of opioid medications and sedatives, and increasing physical activity can also help,” says Dr Dar.

Sleep positioning is another useful hack. For those with mild sleep apnea, the condition could worsen if you lay on your back. Sleeping on your side using a specialised pillow for support can prevent the tongue and soft tissue from collapsing into the airway.

Adding in a holistic approach can also benefit. “Alongside medical treatments for sleep apnea, practices such as mindfulness meditation, cognitive behavioural therapy for insomnia (CBT-I), and relaxation techniques such as progressive muscle relaxation can be beneficial,” says Mankani. “These methods help reduce anxiety around sleep and promote relaxation.”