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What is Sleep Apnea?

Updated: Oct 1

Sleep apnea may be a word heard in daily conversations with family, friends, coworkers, or with healthcare providers, but what is it really? 


This blog post breaks down sleep apnea, highlighting the systemic changes that occur during apneic events and how these alterations in systemic functions lower quality of life and overall systemic health. 


So, let’s get nerdy and learn together! 



Sleep apnea, defined: 

Sleep apnea is a condition in which breathing stops during sleep for more than 10 seconds straight due to a partial or complete collapse of the upper airway, or because the brain doesn’t properly control breathing patterns, or both.


The severity of a sleep apnea diagnosis is dependent on the number of apneic events per hour of sleep, which is identified as the apnea/hypopnea index (AHI) score given from data obtained during a sleep test (i.e., polysomnogram). 


Apnea = breathing stops for at least 10 seconds [8] Hypopnea = airflow decreases at least 30% below normal levels [8]

Diagnosis Criteria [11]

  • None or minimal: Less than 5 events per hour

  • Mild: Between 5 and 14 events per hour

  • Moderate: Between 15 and 29 events per hour

  • Severe: More than 30 events per hour


Another key element of sleep apnea is a cycle of oxygen desaturation and reoxygenation that is seen with interrupted breathing patterns during apneic events. It's this pattern of repeated blood oxygen dips and recoveries that causes widespread systemic effects, not just the desaturations themselves.


Oxygen desaturation = a single dip in blood oxygen levels Intermittent hypoxia (IH) = repeated cycles of dips and recoveries of blood oxygen levels


Types of sleep apnea [9, 11]

  • Obstructive sleep apnea (OSA)

    • Muscles and soft tissues of the upper airway relax during sleep, physically restricting and blocking the space in which inhaled & exhaled air travels behind the tongue and nose (i.e., the nasopharynx and oropharynx)


[12]

nasopharynx

  • Central sleep apnea (CSA)

    • Different from OSA, CSA is a condition where the brain doesn’t send appropriate signals to breathing-related muscles to work properly during sleep 

    • No subconscious effort is made to breathe for a short period of time

  • Complex sleep apnea 

    • A combination of both OSA and CSA

      • Often discovered during treatment of OSA and thus also known as “treatment-emergent central sleep apnea” 


Treatment-emergent central sleep apnea develops in 5-15% of people who are given positive airway pressure (PAP) therapy for OSA. [10]


Now that we know what sleep apnea is, let’s discuss common symptoms of this condition. 


Symptoms [1, 11]

  • Headaches, especially after waking

  • Night sweats

  • Mood alterations

    • Irritability 

    • Anxiety

    • Depression

  • Sexual dysfunction

  • Frequent nighttime waking (micro-arousals)

  • Breathing pauses while asleep 

  • Unusual breathing patterns 

    • Faster, deeper, and/or shallower 

  • Snoring

  • Gasping, choking, or snorting during sleep

  • Daytime fatigue

  • Excessive sleepiness

  • Poor memory

  • Dry mouth (i.e., xerostomia), especially after waking

    • Increase in cavities

    • Periodontal disease

    • Halitosis

    • Fungal overgrowth (i.e., oral thrush) 

  • Teeth clenching and grinding

    • Cracked teeth

    • TMJ pain


Patients with OSA are 3x more likely to suffer from depression. [1]

Snoring

One of the first signs of upper airway resistance syndrome (UARS)—the first stage of airway dysfunction that ultimately ends with sleep apnea—is snoring. 

[4]

sleep disordered breathing

While it may seem harmless— and maybe even cute in children —snoring is an outward symptom of partial obstruction of the upper airway and needs to be treated as the serious warning sign it truly is. 


[1]

snoring

ADHD-Type Behavior

Interestingly, symptoms of sleep apnea often mimic symptoms of ADHD, especially in children. To help address the root cause of ADHD, it’s essential for all individuals to be screened for airway dysfunction before beginning medications. [5]

  • Sadly, it is common for a misdiagnosis of ADHD if an airway evaluation isn’t included in assessment protocols (or if screening protocols are done by providers without adequate training), so please find reliable sources and ask questions! 



Contributing Factors [1, 9, 11]

  • Genetics

  • Epigenetics

  • Male gender

  • Petite body frame

  • Obesity

  • Large neck circumference

  • Alcohol or sedative use

  • Smoking

    • Increased inflammation and fluid retention

  • Nasal congestion

    • Enlarged tonsils and adenoids

      • Mouth breathing

      • Allergies

      • Sickness

  • Nasal obstruction

    • Deviated septum

    • Undersized maxilla (i.e., upper jaw)

    • Undersized and/or retruded mandible (i.e., lower jaw)

  • Elongated soft palate

  • Enlarged tongue (macroglossia)

  • Tongue-tie

    • Low resting tongue posture

    • Mouth breathing

    • Narrow, insufficient facial growth 


People who smoke are 3x more likely to experience OSA than those who don’t smoke. [1]


Systemic Impacts [3, 11]

  [2]

metabolic disorder

As oxygen levels in the blood drop during apneic events, a survival reflex is initiated, and the body enters fight-or-flight mode with the intent to wake an individual up just enough to resume breathing.

  • These episodes of intermittent hypoxia increase sympathetic activity (i.e., they activate the sympathetic nervous system or fight-or-flight mode), which increases the production of reactive oxygen species (ROS) and levels of the stress hormone cortisol.


More specifically, repeated events of Respiratory Effort-Related Arousals (RERAs) are micro-arousals that occur during sleep and result in interrupted sleep cycles, restless sleep behavior, and ultimately impact systemic functions, especially cardiovascular health. 

  • Endothelial dysfunction

  • Cardiac arrhythmia

  • Insulin resistance

  • Diabetes

  • Abnormal liver function

    • Nonalcoholic fatty liver disease

  • High blood pressure

  • Heart damage and failure

  • Myocardial infarction (i.e., heart attack) 

  • Stroke

  • Pulmonary hypertension 

  • Sudden cardiac death

   [6]

sleep apnea


Management & Treatment of Sleep Apnea

Treatment of sleep apnea is a lifelong process. It begins with managing a healthy weight, incorporating exercise into daily routines, and avoiding highly inflammatory foods. 

With proper care and interventions, the severity of OSA may decrease or be eliminated altogether. 


Available Interventions

  • Diet and exercise for weight loss and improved soft tissue & muscle tone

  • Orofacial myofunctional therapy 

  • Oral expansion therapy — for both children and adults

rapid palatal expander

  • Habit correcting appliances

oral habit corrector appliance

  • Oral appliance therapy (OAT) 

    mandibular advancement device


NOTE: There are several forms of OAT and expansion devices available. If interested, please schedule with a specially trained airway dentist to find the appliance that best fits your individual needs. 


Check out my list of local Omaha & Lincoln, Nebraska, providers to find airway support in the area.

  • Positive Airway Pressure devices [10]

    • CPAP - continuous positive airway pressure

      • Provides a constant, steady stream of pressurized air throughout sleep to physically keep airway structures open 

    • BiPAP - Bilevel positive airway pressure

      • Provides two air pressures, one during inhalation & one during exhalation, which can also be auto-adjusting and offer a variable rate of pressure depending on a sleeper’s needs

    [7]

    CPAP, BiPAP

  • APAP - auto-adjusting positive airway pressure 

    • Provides a frequently altered stream of air that auto-adjusts based on what the device determines the sleeper's needs are at any given moment

  • Nasal Surgery

    • Septoplasty to repair a deviated septum

    • Turbinate reduction to improve chronic nasal congestion caused by enlarged turbinates

    • Tonsil & adenoid removal

  • Jaw Surgery - the most complex & multifactorial treatment option available. Seek treatment from a specially trained airway orthodontist for the best outcomes. 



Final Thoughts

Sleep apnea is not just a sleep problem—it’s a systemic health concern that affects cardiovascular, metabolic, neurological, and oral health at any age. Receiving interdisciplinary care from appropriately trained providers is essential for optimal treatment outcomes. 


Have questions? Want to share your personal journey with sleep apnea? 


Comment below to start a discussion!



Check out my other blog posts to learn more about oral-systemic health!

For links and discounts on products mentioned in this post, check out my Resources page.


Talk soon,

Liz Laney, BSDH, RDH

Oral-Systemic RDH & Educator


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Sources

  1. Causes complications of sleep apnea. Fort Worth ENT & Sinus. https://fortworthent.net/ear-nose-throat/snoring-obstructive-sleep-apnea-osa/sleep-medicine-snoring-or-sleep-apnea/causes-complications-of-sleep-apnea/ 

  2. Drager LF, McEvoy RD, Barbe F, Lorenzi-Filho G, Redline S. Sleep apnea and cardiovascular disease: Lessons from recent trials and need for team science. Circulation. 2017;136(19):1840-1850. doi:10.1161/circulationaha.117.029400 

  3. Galan N. Hypopnea: What you need to know. Medical News Today. October 18, 2017. https://www.medicalnewstoday.com/articles/319378#12 

  4. Hasan A, Uzma N, Santhosh Kumar B. Obstructive sleep apnea and the metabolic syndrome: Clinical Profiles and Relationships. Modulation of Sleep by Obesity, Diabetes, Age, and Diet. Published online January 23, 2015:139-153. doi:10.1016/b978-0-12-420168-2.00016-8

  5. Kalaskar R, Bhaje P, Kalaskar A, Faye A. Sleep Difficulties and Symptoms of Attention-deficit Hyperactivity Disorder in Children with Mouth Breathing. Int J Clin Pediatr Dent. 2021;14(5):604-609. doi:10.5005/jp-journals-10005-1987

  6. Lee K. Symptoms that mean you may have sleep apnea and should get screened. EverydayHealth.com. August 29, 2023. https://www.everydayhealth.com/sleep-apnea/symptoms-consider-screening/.  

  7. Rodriguez J. What is a CPAP machine? (Difference between CPAP, APAP, BiPAP and ASV). Advanced Sleep Medicine Services, Inc. https://www.sleepdr.com/the-sleep-blog/what-is-a-cpap-machine-difference-between-cpap-apap-bipap-and-asv/ 

  8. Salamon M. Hypopnea: What you need to know About This Sleep Disorder. WebMD. July 6, 2024. https://www.webmd.com/sleep-disorders/sleep-apnea/sleep-hypopnea-overview.

  9. Sleep apnea. Mayo Clinic. April 6, 2023. https://www.mayoclinic.org/diseases-conditions/sleep-apnea/symptoms-causes/syc-20377631.

  10. Summer JV. APAP vs. CPAP. SleepApnea.org. August 25, 2025. https://www.sleepapnea.org/cpap/apap-vs-cpap

  11. What is Sleep Apnea? Cleveland Clinic. July 15, 2025. https://my.clevelandclinic.org/health/diseases/8718-sleep-apnea.

  12. What is the Nasopharynx? Cleveland Clinic. February 6, 2025. https://my.clevelandclinic.org/health/body/22376-nasopharynx 

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