Table of Contents

I. Sleep Apnea Symptoms

II. Health Complications of Sleep Apnea

i. High Blood Pressure

ii. Heart Disease

iii. Stroke

iv. Diabetes

v. Erectile Dysfunction

III. Conclusion

Sleep is vital to our overall well-being and is linked to our physical and mental health. However, for the estimated 39 million Americans living with sleep apnea, sleep disruptions can lead to a variety of distressing symptoms and potential health complications. [1]

In this article, we'll examine sleep apnea symptoms and discuss the serious risks associated with this condition if it remains untreated.

Sleep Apnea Symptoms

Awareness of the symptoms is crucial in seeking the necessary help and treatment when it comes to sleep apnea. The signs can vary depending on the severity of the condition, and they might not always be immediately apparent to the person experiencing them. Sometimes, it may be a partner who notices the symptoms first, while in other instances, changes in sleep patterns or daytime functioning can be telling indicators. [2]

• Loud snoring: One of the hallmark symptoms of sleep apnea is loud snoring. This occurs when air struggles to pass through narrowed airways, leading to vibrations in the soft tissues at the back of the throat. Not everyone who snores has sleep apnea, but if snoring occurs for 15% or more of total sleep time, further evaluation is recommended.

• Choking or gasping during sleep: Individuals with sleep apnea may experience episodes of gasping or choking during sleep, which can disrupt breathing patterns. These incidents may go unnoticed by the affected person but can be alarming for their partner. Seeking a sleep study is advised if these symptoms are observed.

• Excessive daytime sleepiness: Distinguishing between fatigue and daytime sleepiness is essential when diagnosing sleep apnea symptoms. Daytime sleepiness is a common indicator of sleep apnea and can manifest as drowsiness during passive activities such as reading or attending meetings. Even though daytime sleepiness can lead to fatigue, fatigue itself isn’t associated with sleep apnea. 

• Restless sleep: Roughly one-third of individuals with sleep apnea struggle to maintain uninterrupted sleep, often waking multiple times throughout the night. This symptom, more prevalent in women, might not be consciously remembered but can significantly impact overall sleep quality.

• Cognitive changes: Sleep apnea can affect cognitive functions, leading to mood swings, irritability, difficulty concentrating, and memory issues. These changes can impact daily life and relationships, emphasizing the importance of timely diagnosis and treatment.

• Morning headaches: Sleep apnea leads to morning headaches in 30% of people with OSA. The drop in oxygen levels and increased carbon dioxide due to airway obstruction can trigger these morning headaches, typically felt on both sides of the head. These headaches typically last for a few hours after waking up.

• Frequent urination through the night: Sleep apnea-induced disruptions in sleep can result in frequent awakenings and subsequent trips to the bathroom during the night. The pressure on the bladder from strained breathing efforts against an obstructed airway can also contribute to this symptom. [2]

Health Complications of Sleep Apnea

Sleep apnea can cause many health issues if left untreated. That’s why it’s crucial to see your doctor if you think you might have sleep apnea. Some of the common health complications of sleep apnea are high blood pressure, heart disease, stroke, and diabetes.

High Blood Pressure

Of the different types of sleep apnea, only obstructive sleep apnea (OSA) is linked to high blood pressure. Of the people diagnosed with OSA, it’s estimated that around half also have high blood pressure. [3]

• Over-activation of the sympathetic nervous system: This is your body's built-in stress response system. Each time your airway collapses and you stop breathing at night, it activates this fight-or-flight response. Your heart rate spikes, and your blood vessels constrict, leading to surges in your blood pressure.

• Release of sympathetic nervous system hormones: The frequent drops in oxygen levels from breathing disruptions caused by OSA lead to the release of catecholamines, which are stress hormones that raise blood pressure. High levels of these hormones circulating in the blood can cause hypertension.

• Nondipping blood pressure at night: In healthy sleep, your blood pressure drops 10% to 20%. In severe sleep apnea, it may dip less than 10%. This loss of nighttime blood pressure regulation puts extra strain on your heart and blood vessels. [3]

Heart Disease

Sleep apnea and heart health are closely linked, with untreated sleep apnea significantly raising your risk of developing heart problems. It's estimated that people with sleep apnea are two to four times more likely to have abnormal heart rhythms compared to those without this condition. Sleep apnea also increases your risk of heart failure by 140% and coronary heart disease by 30%. [4]

The pauses in breathing that occur with sleep apnea can take a major toll on your cardiovascular system in several ways:

• Activation of the sympathetic nervous system: When you stop breathing during sleep, your blood oxygen levels drop. Your body detects this oxygen deprivation and activates your sympathetic nervous system, responsible for your fight or flight response. Your sympathetic nervous system constricts your blood vessels and increases your heart rate and blood pressure. The repetitive fluctuations in blood pressure throughout the night may lead to high or worsening blood pressure. 

• Changes in chest pressure: The forced inhalations against a blocked or narrowed airway during obstructive sleep apnea episodes create pressure changes within your chest cavity. Over time, these repetitive pressure changes can damage your heart and lead to abnormal heart rhythms like atrial fibrillation, impaired blood flow to the heart, and even heart failure.

• Oxidative stress: The frequent drops in oxygen levels during sleep in people with obstructive sleep apnea, followed by abrupt restoration of oxygen when breathing resumes, causes significant stress on the body, known as oxidative stress. This oxidative stress promotes inflammation and other reactions that elevate the risk of heart disease. [4]

Stroke

Having sleep apnea can increase your risk of having a stroke, and having a stroke can increase your risk of developing sleep apnea. It's a two-way relationship that's important to understand. [5]

A stroke occurs when blood flow to part of the brain is disrupted. This can happen when blood vessels in the brain rupture or something blocks blood flow. Studies show that having obstructive sleep apnea increases your risk of an ischemic stroke. While the exact reason for this is still being researched, experts have proposed several explanations: [5]

• Reduced blood flow to the brain: During sleep, the repetitive collapsing of the airway in individuals with OSA creates negative air pressure in the chest, impeding blood flow to the brain. This compromised blood flow can contribute to a stroke.

• Limited oxygen: OSA frequently causes oxygen levels in the blood to drop abnormally low. Over time, repeated low oxygen may induce changes in the brain’s blood vessels.

• Increases other risk factors: OSA is linked to several conditions like heart disease, high blood pressure, diabetes, and irregular heart rhythms that also raise stroke risk. [5]

On the other side of the coin, experiencing a stroke seems to trigger sleep apnea, often within the first day. Breathing problems during sleep may be more severe if the stroke happens while sleeping. Studies estimate obstructive sleep apnea occurs in up to 70% of stroke survivors. [5]

• Central sleep apnea (CSA) after a stroke: CSA, where the brain has trouble signaling the breathing muscles, often occurs after a stroke or from opioid use. Research suggests central sleep apnea is most common within five days of a stroke, and breathing disruptions may decrease over time.

• Cheyne-stokes breathing after a stroke: Cheyne-Stokes respiration, a breathing pattern of alternating faster and slower breathing, affects 20% of stroke patients and is usually detected right after the stroke. While Cheyne-Stokes tends to resolve over time, treatment may still be recommended. [5]

Diabetes

Diabetes and sleep apnea are closely connected medical conditions that often co-occur. Research shows that nearly half of people with type 2 diabetes also suffer from sleep apnea. If you've been diagnosed with one of these chronic illnesses, it's important to be aware of and monitor the other. [6]

• Low oxygen levels: Both diabetes and sleep apnea are influenced by oxygen levels in the body. During an apnea episode, breathing stops briefly, and oxygen levels drop. This oxygen deprivation can cause insulin resistance, resulting in high blood sugar. Insulin is the hormone that helps the body use sugars from food. When cells become resistant to insulin, blood sugar rises unchecked.

• Obesity: Excess weight also contributes to both diabetes and sleep apnea. Fatty tissue in the neck can obstruct the airway, triggering apnea episodes. Additionally, excess fat cells are more insulin-resistant, making weight management key for diabetes care. [6]

Erectile Dysfunction

If you're one of the millions of men suffering from obstructive sleep apnea, you may have noticed another frustrating issue - difficulty getting or maintaining an erection. You're not alone. Research shows that erectile dysfunction affects a staggering 69% of men with sleep apnea. [7]

The connection between sleep apnea and erectile dysfunction isn't fully clear, but experts have some theories as to why they often go together:

• Low testosterone production: Testosterone is crucial for libido and sexual function, and our bodies produce most testosterone while we sleep. When sleep is constantly disrupted by apnea events, testosterone production drops. Without enough testosterone circulating in your system, it's difficult to achieve and sustain an erection.

• Sleep deprivation: Feeling chronically tired from poor sleep diminishes your interest in sex. And even if you're in the mood, exhaustion can make it hard to get an erection.

• Low oxygen levels: Getting adequate oxygen is key for proper erectile function. When you stop breathing repeatedly during sleep, oxygen levels in your blood plummet. Over time, this oxygen deficiency can impair blood flow to the penis, making it difficult to get and maintain an erection. [7]

Conclusion

It is crucial to recognize that sleep apnea is more than just a disruption in sleep patterns. It can have serious implications for our overall health and well-being. The various symptoms and associated health complications, including high blood pressure, heart disease, stroke, erectile dysfunction, and diabetes, highlight the importance of timely diagnosis and effective management.

To learn more about sleep apnea, visit our informative sleep apnea blog.

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