Chris Iliades, MD is a regular contributor to Bottom Line Health. He was an ear, nose, throat, head, and neck surgeon before becoming a full-time medical writer.
According to the American Heart Association and the American Academy of Neurology, obstructive sleep apnea (OSA) is bad for brain health. Studies show that OSA causes cognitive impairment, which is the loss of your brain’s ability to remember, think, concentrate, learn, and make decisions.
In people with OSA, the oral or nasal airway collapses during sleep and breathing stops for a short period. This is called apnea. Blood oxygen levels decrease and carbon dioxide levels increase. Rising carbon dioxide triggers your brain to wake you up enough to breathe. Almost everyone with OSA snores, usually loudly, so a sleeping partner may hear loud snoring followed by quiet, and then sudden gasping for air. In mild-to-moderate OSA, there may be between five and 30 episodes per hour. In severe OSA, these instances can occur more than 30 times per hour.
A 2021 study reported at the American Academy of Neurology annual meeting showed that people with OSA were 60 percent more likely to score in a lower range on cognitive testing than people without it. The worse the OSA, the worse the cognitive decline. The average age of study participants was about 70.
Further, OSA increases the risk of heart attack, stroke, heart arrhythmia, high blood pressure, and type 2 diabetes.
The American Heart Association estimates that OSA may affect close to 40 percent of U.S. adults and up to 80 percent of people with cardiovascular disease. It is more common in men and in people who are overweight. You could be at higher risk if you have a family history of OSA. Other risk factors include smoking, drinking alcohol, taking sleeping pills, and having any type of narrowing of the nasal or oral airway, like a deviated nasal septum or large tonsils or adenoids.
Lowering risk can be as simple as exercising. An important study presented at the 2021 meeting of the American Heart Association showed that exercise reduces the risk of both OSA and cognitive decline.
In the study, 47 patients with varying degrees of cognitive loss were tested for a cognition score. Half of the patients were given a six-month-long supervised exercise program. After six months, the exercise group had fewer OSA episodes, a 32 percent improvement in their cognitive scores, and better glucose metabolism in the brain.
In addition to exercise, lifestyle changes that reduce the risk or improve symptoms of OSA include not drinking, not smoking, and losing weight. Sleeping on your side and propping up your upper body during sleep may also reduce OSA. In some cases, surgery can be used to correct a deviated septum or remove tonsils and adenoids if they are contributing to OSA.
Mark Twain said, “There ain’t no way to know why a man can’t hear himself snore,” but there is a way to find out if you have sleep apnea. If your sleeping partner describes periods of snoring and apnea, or you wake up groggy with a headache and feel sleepy all day, you should have a sleep study.
During the sleep study, you spend a night in a sleep lab, where specialists called polysomnographers document sleep apnea and grade the severity. Sleep study kits you can use at home are now available, so you may not need to spend the night sleeping in a laboratory.
For mild sleep apnea, lifestyle changes, sleeping position, and sometimes an oral appliance that keeps your tongue from blocking your oral airway may be all you need. For more severe OSA, the treatment of choice is CPAP. During CPAP treatment, you wear a mask while you sleep that provides humidified oxygen through your nose to force open your airway. It is very effective but takes some getting used to, and you may need to experiment with different types of masks, levels of air pressure, and humidification devices to find the most comfortable option.
A new technology called hypoglossal nerve stimulation may eliminate the need for CPAP for some people who can’t tolerate it. With this treatment, a pacemaker implanted in the chest stimulates the hypoglossal nerve to open the back of the throat.
OSA is that it is both common and dangerous. If you have the symptoms, tell your doctor and get OSA under control now. Your brain and your sleeping partner will thank you.