Snoring can be a daily nuisance, especially if you share a bed with a light sleeper. But snoring can also be a sign of a more serious health problem: sleep apnea. Once a little-known condition, there are now several treatments for sleep apnea, with new ones being developed. But many sufferers still don’t know about their condition and don’t get the treatment they need.
The word “apnea” simply means that breathing stops. This can happen for a variety of reasons, including loud sobs. Sleep apnea is defined as the absence of breathing (for 10 seconds or more) multiple times throughout the night, anywhere from 5 to 100 times per hour. There are two main forms of sleep apnea: central sleep apnea and obstructive sleep apnea (OSA). OSA occurs when the muscles in the airway physically block a person’s breathing, while central sleep apnea occurs when the actual muscles used for breathing fail due to a lack of signals from the brain (a third, combined form, has both types). Of the two, OSA is by far the more common, with around 12% of American adults estimated to have the condition, compared to less than 1% with central sleep apnea.
Although snoring may be the symptom most commonly associated with sleep apnea, snoring does not necessarily mean you have sleep apnea, as approximately 25% to 50% of people snore at least occasionally. Other signs can include trouble sleeping, waking up with a dry mouth, and feeling sleepy during the day. Over time, sleep apnea can negatively impact our health and increase the risk of other diseases, such as heart disease, diabetes, brain damage, and even premature death.
“The harm is twofold. One, when breathing stops, your oxygen levels drop, and low oxygen levels make your heart and brain sick, and repeated reductions in oxygen can cause damage,” Douglas Kirsch, a sleep medicine physician and spokesperson for the American Academy of Sleep Medicine, told Gizmodo in a phone interview. “And when you start breathing again, because we always start breathing again, your blood pressure and heart rate go up. If your blood pressure continues to rise multiple times each night after each attack, this can also cause problems for the heart and brain,” he added.
It was once a mysterious disease
Sleep apnea is common, but we’ve only recently learned about it: the condition was officially named sleep apnea in 1965, but records of it may date back thousands of years. (Before sleep apnea became popular, it was sometimes called “Pickwickian syndrome,” after a character in a Charles Dickens novel.) The Pickwick Papers For the first few decades after sleep apnea was discovered, treatment was anything but gentle: Doctors would typically perform a tracheotomy, or make a hole in the windpipe and insert a permanent tube into the windpipe to allow air to flow through it at night. (This procedure is still sometimes performed, but only in the most severe cases.)
But in the early 1980s, Dr. Elliot Phillipson and Dr. Collin Sullivan, inspired by Dr. Sullivan’s work with dogs with breathing problems, developed the first continuous positive airway pressure (CPAP) machine. To this day, CPAP machines remain the gold standard for treating apnea, but they’re sometimes misunderstood, says Oliver Sampin, a sleep-disorders clinician and researcher at Stanford University.
“There’s a common misconception about CPAP: that it gives you oxygen or that it helps you breathe,” Sampin told Gizmodo over the phone. “There are variations, but a basic CPAP just uses air pressure to open up your airways, similar to how blowing air into a balloon causes the walls of the balloon to separate.”
Although CPAPs are very effective for sleep apnea, they do have limitations. For example, while they have become more comfortable to wear over time, there are still many people who have problems with long-term use or have medical conditions that prevent them from using them. There are now other options, such as upper airway stimulators, which are implanted in the chest and neck and send electricity to the hypoglossal nerve, helping to control tongue movement.
While you sleep, the device senses your breathing and stimulates your tongue to keep it from blocking your airway. The only other device of its kind that has been explicitly approved is the Inspire Implant, which was approved by the Food and Drug Administration in 2014. While these devices aren’t too intrusive for everyday use, Sampin says they aren’t for everyone. There are also dental devices that reposition the jaw and tongue, but these aren’t widely considered effective. And, as we’ve previously covered, while taping your mouth may be TikTok’s latest sleep-health trend, there’s little evidence on its use for sleep apnea.
“CPAP can be tried by almost anyone with sleep apnea. It doesn’t work perfectly for everyone, but it’s widely applicable. With something like hypoglossal nerve stimulation, careful patient selection is more important, and even then, the results are often not as good as with CPAP,” says Sampin. “But for patients who can’t use CPAP for some reason, it can be a reasonable alternative.”
Sleep apnea medication
Approved drugs specifically for treating sleep apnea may be available in the near future. In April, Eli Lilly announced early results from two Phase 3 trials testing tirzepatide, a diabetes and obesity drug, in patients with both obesity and obstructive sleep apnea. As other studies have shown, people who took tirzepatide lost significantly more weight, up to 20% of their baseline body weight, compared with people who took a placebo. But apnea also tended to be significantly reduced, with episode frequency dropping by up to two-thirds, or about 30 episodes per hour. The company has already applied for expanded FDA approval of tirzepatide to include sleep apnea, which could happen as early as later this year.
While this approval is extremely significant, Kirsch points out that tirzepatide and similar drugs are not a panacea for sleep apnea. Obesity is one of the most common risk factors for the disease, but it is not the only one, and it can occur in people who are not obese. The drug’s effect on sleep apnea appears to be mainly due to the weight loss effect, meaning that many patients will have little effect. Clinical trial data also showed that just under half of the patients who took tirzepatide experienced significant enough relief from their sleep apnea that they could be considered cured.
“I think it’s important to recognize that weight management is part of a good treatment approach if it’s an issue for all patients with sleep apnea, but perhaps one of the other types of devices alone can’t provide an alternative for all patients,” Kirsch said.That said, there are other drugs farther down the development pipeline that aim to directly address the mechanisms of apnea, such as a pill to keep the airway open at night.
Unfortunately, regardless of medication or devices, many people experience no improvement in their apnea symptoms due to a persistent lack of awareness of the condition. Studies estimate that up to 80% of sleep apnea cases go undiagnosed, and this disparity may be even more severe for disadvantaged populations (those in low-income areas are less likely to start treatment even if diagnosed).
Sampin is encouraged by the development of wearables, or “nearables,” and other technologies that make it easier to test for sleep apnea. In February, the Samsung Galaxy Watch became the first device in the U.S. to receive FDA clearance to detect sleep apnea by measuring blood oxygen levels. Kirsch also points out that formally diagnosing apnea is becoming easier over time, thanks to easier tests.
“A lot of my patients don’t want to see a sleep specialist because they don’t want to do a sleep study in a lab, but now in some cases you can do it at home. Or they don’t necessarily want to see a sleep specialist because they don’t want to think about using a CPAP machine. I always tell them to figure out how serious the problem is before they think about what kind of treatment to give them, because the seriousness of the problem can change how they think about treatment,” Kirsch says.
While the future of sleep apnea treatment looks bright, perhaps the most important goal is to educate people who have sleep apnea about it in the first place.
