What Factors and Risks Make Obstructive Sleep Apnea Worse?

Sleep Position, Alcohol, and Aging Are Among the Factors that Worsen Apnea

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Sleep apnea may be worsened by certain factors and risks, including aging, alcohol, and sleep position. Getty Images

Though your anatomy may predispose you to having obstructive sleep apnea, there are other factors and risks that might actually make the condition worse. Some of these potential contributors are within your control and others are not. What makes sleep apnea worse and what can you do about it? Discover the roles of anatomy, sleep position, sleep stages like REM, alcohol, menopause in women, prescription medications and muscle relaxations, aging, and weight gain.

Sleep Apnea Starts with Your Anatomy

The most important cause of sleep apnea is the structure of your airway’s anatomy. There are a number of components that have a role: nose, tonsils, palate, tongue, and jaw. These structures develop based on your genetics. Just like we share a familial resemblance with our parents and siblings, so too the internal structures are similarly arranged. Being overweight or obese may worsen your risk of sleep apnea as well. Unfortunately, this foundation is largely out of your control, but there are other factors that might make sleep apnea worse. Some of these additional considerations include: 

Sleep Position

Some people’s sleep apnea is significantly worsened by sleep position. A sleep study might show that sleeping on your back, in the supine position, leads to increased breathing disruption. This occurs because the soft tissues of the airway, including the soft palate and tongue, can fall backwards and block the passage of air.

Gravity contributes and lying on your back will make this occurrence more likely. In some individuals, the use of positional therapy to stay sleeping on your sides can be very helpful.

REM Sleep

It is natural to transition through various sleep stages throughout the night. The majority of sleep consists of non-REM sleep.

However, about every 90 minutes REM sleep occurs. Rapid eye movements occur along with paralysis of muscles. This state is characterized by intense, vivid dreaming, much like watching a movie. In order to prevent the acting out of these dreams, the body is actively paralyzed. The muscles of the airway are also paralyzed. This tube becomes floppy and collapsible. As a result, sleep apnea often worsens during REM sleep. This may cause an increased number of events or more severe drops in oxygen levels as measured by oximetry. As REM sleep is an integral part of quality sleep, this particular risk factor cannot be avoided.

Alcohol

Counter to the tradition of having a nightcap, it is clear that alcohol negatively affects sleep. Although it may make you feel sleepy, as it wears off it leads to sleep fragmentation and insomnia. In addition, as a muscle relaxant, it can make the upper airway more collapsible. This risk factor is within your control. It is best to avoid alcohol before bedtime. As a rule of thumb, allow one hour to elapse for each alcoholic beverage you consume before going to bed.

This will help to minimize the effects of alcohol on your chance of experiencing sleep apnea.

Menopause in Women

Okay, so this one obviously only applies to women. However, it is a significant risk factor to consider. Younger women are protected by the hormones progesterone and estrogen which maintain the patency of the airway. The incidence of sleep apnea among women before the onset of menopause is thus lower. When these hormones are lost, the incidence increases among women to equal that of men. Surgical menopause, a phrase used to describe the state after which hysterectomy and removal of the ovaries has occurred, conveys a similar risk of sleep apnea. Women who take hormone replacement therapy are found to have an intermediate (but lower) risk of sleep apnea.

Prescription Medications and Muscle Relaxants

How might medications affect sleep apnea? In general, there are three classes of medications that are potentially problematic: benzodiazepines, opiates, and barbiturates. Benzodiazepines are often prescribed for anxiety, seizures, and were previously often used for insomnia. They also act as muscle relaxants and this can affect the airway and lead to sleep apnea. Opiates are narcotic medications that are used to control pain. They can contribute to central sleep apnea, characterized by shallow or irregular breathing. In addition, barbiturates are used for sedation and seizure control and these can likewise affect breathing. If you are concerned that your medications may be increasing your risk of sleep apnea, you should speak with your prescribing doctor.

Aging

Finally, aging itself may make your sleep apnea. Just as you lose muscle tone in your arms and legs, you similarly may lose muscle tone within your airway. This may compromise its ability to stay open. There isn’t much to be done about this particular risk factor. The good news is that the incidence of sleep apnea appears to level off at the age of 60. If you are going to develop sleep apnea, it seems, you will develop it by then.

Weight Gain

Gaining weight, especially when becoming overweight or obese, may have a significant impact on sleep apnea. If the airway is narrowed to begin with, the deposition of fat at the base of the tongue and along the airway may make things worse. Weight loss, often at least a 10% decrease in weight, can help to reduce both snoring and sleep apnea.

What Can Be Done to Reduce the Risks of Sleep Apnea?

Start by eliminating any of the above avoidable or reversible risks that you can identify. Regardless of the issue that might be making your sleep apnea worse, there are still effective treatment options available including the use of an oral appliance or continuous positive airway pressure (CPAP).

Discuss the risks you face with your sleep specialist and find the right solution for you.

Sources

Kryger, MH et al. "Principles and Practice of Sleep Medicine." Elsevier. 5th edition. 2011.

The International Classification of Sleep Disorders. American Academy of Sleep Medicine. 2nd edition. 2005.

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