Snoring is an annoying habit, especially for people who share a bed with a light sleeper. For others, however, snoring may be a sign of a more serious health problem: shortness of breath. Once the condition is diagnosed, there are several treatments available for sleep apnea and more to follow. But many sufferers are still in the dark about their apnea and don’t get the help they need.
The word “apnea” simply means a pause in breathing, which can be for a number of reasons, including a good cry. Sleep apnea is defined as having multiple and continuous episodes (10 seconds or longer) of not breathing throughout the night—anywhere from 5 to 100 times per hour. It comes mainly in two forms: central and obstructive sleep apnea (OSA). OSA occurs when the muscles of the airway physically block a person’s breathing, while central apnea is when the actual muscles used for breathing stop working, usually due to a lack of a signal from the brain (a third complex form has both types). Of the two, OSA is more common, with approximately 12% of American adults estimated to have the condition compared to less than 1% of adults estimated to have obstructive sleep apnea.
Although snoring may be the symptom most associated with sleep apnea, it does not guarantee that you have it, as approximately 25% to 50% of people snore at least occasionally. Other symptoms include trouble sleeping, waking up with a dry mouth, and feeling sleepy during the day. Over time, apnea can affect our health for the worse, possibly increasing the risk of other conditions such as heart disease, diabetes, brain damage, and even premature death.
“The damage is twofold. First, when you relax your breathing, oxygen levels drop, and low oxygen levels make the heart and brain less excited, and from then on they can’t sustain damage due to repeated reductions in oxygen,” said Douglas Kirsch, a sleep medicine physician. a spokesperson for the American Academy of Sleep Medicine, told Gizmodo by phone. “Also, when we start breathing again, because we always start breathing again, our blood pressure and heart rate increase, and that repeated increase in blood pressure after each episode, day and night, over and over again, can also cause heart and brain problems,” he added.
It used to be a Mysterious Illness
As for how common sleep apnea is, it’s only recently that we’ve started to learn more about it. The condition was only officially named sleep apnea in 1965, although written reports of it may date back thousands of years (before sleep apnea was widely used, the condition was sometimes called “Pickwickian syndrome”—a reference to the Charles Dickens character. The Pickwick Papers who showed many telltale signs). In the first few decades after its discovery, the treatment of sleep apnea was very difficult. Doctors used to perform a tracheostomy, cutting a hole and inserting a permanent tube into the trachea that is kept open at night to allow air to flow (surgery is sometimes still used today, though only in extreme cases).
But in the early 1980s, doctors Eliot Philipson and Colin Sullivan developed the first continuous airway pressure (CPAP) machine, an invention inspired in part by Sullivan’s research on dogs with respiratory problems. To this day, CPAP machines remain the gold standard for apnea treatment, although they are sometimes misunderstood, according to Oliver Sum-Ping, a sleep disorder physician and researcher at Stanford University.
“There are common misconceptions about CPAP, like it gives you oxygen directly, or that it breathes for you,” Sum-Ping told Gizmodo over the phone. “There are variations, but basic CPAP uses air pressure to simply help expand your airway, similar to how blowing air into a balloon helps to spread the walls of the balloon.”
CPAP can be very effective in treating apnea, but it has its limitations. Although they have become more difficult to wear over time, for example, many people still have trouble wearing them for long periods of time or have medical conditions that prevent their use. There are now other options, such as upper respiratory stimulation devices, which are placed in the chest and neck to send electricity to the hypoglossal nerve, which helps control tongue movement.
During sleep, the device senses the person’s breathing and uses stimulation to prevent the tongue from blocking the airways. The only clearly approved device of this type is the Inspire implant, which was approved in 2014 by the Food and Drug Administration. While these devices aren’t too disruptive on a daily basis, they aren’t for everyone according to Sum-Ping. There are also dental appliances that try to reposition the jaw or tongue, although these are not considered to be very effective either. And as we’ve covered before, mouth tapping may be the latest sleep health trend on TikTok, but there’s little evidence of its use with sleep apnea.
“With CPAP, you can try it for almost anyone who has trouble sleeping. That doesn’t mean it will work perfectly for everyone, but it does work broadly. “With something like hypoglossal nerve stimulation, it’s very important to carefully select patients, and even then, the results are often not as good as CPAP would be,” Sum-Ping said. “But for patients who can’t use CPAP for one reason or another, it can be a reasonable alternative.”
Drugs for Sleep Apnea
In the near future, we may see drugs approved specifically for the treatment of apnea. In April, Eli Lilly announced the first results of two Phase III trials testing the diabetes and obesity drug tirzepatide in people with both obesity and obstructive sleep apnea. As some studies have shown, people using tirzepatide lost a lot of weight, up to 20% of their initial weight compared to placebo. But they also tend to experience a significant reduction in apnea, with the frequency of episodes reduced by up to two-thirds, or as few as 30 episodes per hour. The company has already submitted an expanded FDA approval for tirzepatide to treat sleep apnea, which could come later this year.
Although this approval may be important, Kirsch points out that tirzepatide and similar drugs will not be a cure for apnea. Obesity is one of the most common risk factors for this condition, but it is not the only one, and people who are not obese can develop it. Since the drug’s effect on apnea appears to be largely due to the effect of weight loss, that means it won’t do much for most sufferers. Even with clinical trial data, slightly less than half of the patients on tirzepatide had a reduction large enough for their apnea to be considered resolved.
“I think it’s important to note that it’s part of good practice to try to help all of our patients with insomnia with their weight, if that’s a problem. “But it’s probably not going to be a restorative treatment for one of these other types of devices alone for all people,” Kirsch said. That said, there are other drugs further down the pipeline that specifically aim to address the processes that cause apnea, such as pills designed to keep people’s airways open at night.
Unfortunately, regardless of medication or device, many people do not find relief from their apnea, due to a continued lack of awareness. Studies have estimated that up to 80% of sleep apnea cases go undiagnosed, a disparity that may be even worse in the most disadvantaged populations, such as those who are poor (people living in low-income areas also appear to be less likely to begin treatment even once diagnosed).
Sum-Ping is encouraged by the development of technology that can easily diagnose sleep apnea, such as wearables and “wearables.” This past February, the Samsung Galaxy Watch became the first such device in the US to have an FDA-approved sleep detection feature, which measures blood oxygen levels. And Kirsch notes that it has become easier over time to formally diagnose apnea, thanks to simple tests.
“Many people I see did not want to come to the sleep doctor because they did not want to go to a sleep test in the laboratory. But now we can do those at home, in some cases. Or people don’t really want to see a sleep doctor because they don’t want to think about using a CPAP machine. And I always tell them that before we worry about the type of treatment, let’s find out how bad the problem is, because the severity of the problem sometimes changes the way we think about treatment” says Kirsch.
The future of apnea treatment looks bright, but perhaps the most important goal is to make sure people who have it know about it in the first place.
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