San Francisco and Marin CA
Breathing is supposed to continue automatically while you sleep. But for people with sleep-disordered breathing—particularly obstructive sleep apnea (OSA)—the airway repeatedly narrows or closes during the night.
When that happens, two important things can occur: sleep is repeatedly interrupted, and blood oxygen levels may drop. Your body then has to respond again and again to restore normal breathing.
Over time, untreated obstructive sleep apnea is associated with much more than feeling tired. Research links OSA with high blood pressure, cardiovascular disease, stroke, atrial fibrillation, type 2 diabetes, cognitive difficulties, mood problems, and increased risk of accidents caused by daytime sleepiness.
That does not mean everyone who snores has sleep apnea or will develop these conditions. It does mean persistent signs of abnormal breathing during sleep deserve attention.
What Happens When Breathing Is Interrupted During Sleep?
Obstructive sleep apnea occurs when the upper airway repeatedly becomes partially or completely blocked even though the body is still trying to breathe.
The interruption may last only seconds before the brain reacts and briefly arouses the person enough to reopen the airway. Often, the person does not fully wake up or remember these episodes in the morning.
But repeated episodes can produce two important stresses on the body:
Sleep Fragmentation
Healthy sleep moves through several stages throughout the night. Repeated breathing disturbances can interrupt those cycles and prevent sleep from being as restorative as it should be.
This helps explain why someone with sleep apnea may spend seven or eight hours in bed yet wake feeling exhausted.
Intermittent Low Oxygen
Airway obstruction can also lower the amount of oxygen in the blood.
NHLBI notes that sleep apnea can cause low oxygen levels during sleep while forcing the body to repeatedly work harder to restart breathing. These repeated stresses may affect blood vessels and organs over time.
The combination of disrupted sleep, intermittent oxygen changes, and activation of the body’s stress response helps explain why OSA can affect systems far beyond the airway.
Sleep Apnea and High Blood Pressure
One of the best-established health connections involves blood pressure.
When breathing stops or becomes restricted, oxygen can fall and the nervous system reacts as though the body is under stress. Heart rate and blood-vessel activity can change as breathing resumes.
Repeated night after night, that stress is associated with hypertension, including blood pressure that may be difficult to control. The American Dental Association describes a strong association between obstructive sleep apnea and systemic hypertension.
NHLBI likewise lists difficult-to-control high blood pressure among the cardiovascular conditions associated with untreated sleep apnea.
For someone who has both unexplained sleep symptoms and high blood pressure, the possibility of sleep apnea may be worth discussing with a healthcare professional.
How Sleep Apnea Can Affect Heart and Blood-Vessel Health
The cardiovascular system normally gets an opportunity to recover during healthy sleep.
With untreated OSA, repeated drops in oxygen and repeated arousals can place additional demands on that system.
Obstructive sleep apnea has been associated with increased rates of:
- Coronary artery disease
- Heart attack
- Heart failure
- Atrial fibrillation
- Pulmonary hypertension
- Stroke
The American Heart Association recognizes sleep apnea as an important cardiovascular risk factor and reports associations with high blood pressure, stroke, coronary artery disease, and heart failure.
This does not mean sleep apnea is the sole cause of heart disease. Many of these conditions share risk factors—including age, obesity, metabolic disease, and lifestyle factors.
But untreated OSA can add another source of physiological stress that deserves attention.
Sleep Apnea and Blood Sugar
Sleep-disordered breathing also appears to interact with the body’s metabolic system.
Research has found a significant relationship between OSA and insulin resistance and type 2 diabetes. Repeated intermittent hypoxia, fragmented sleep, inflammation, and nervous-system activation are among the proposed mechanisms linking the two conditions.
NHLBI includes type 2 diabetes and metabolic syndrome among health conditions associated with untreated sleep apnea.
The relationship is complex and appears to work in both directions: people with type 2 diabetes have a higher prevalence of OSA, while OSA is associated with impaired glucose regulation. A recent meta-analysis similarly found a bidirectional association between obstructive sleep apnea and diabetes.
Having diabetes does not mean you have sleep apnea, and having sleep apnea does not guarantee that you will develop diabetes. But the overlap is significant enough that symptoms should not be ignored.
Your Brain Feels the Effects Too
Sleep is essential for attention, memory, decision-making, and emotional regulation.
NHLBI notes that untreated sleep apnea can make it more difficult to concentrate, remember information, make decisions, and control behavior.
Patients may describe:
- Brain fog
- Trouble concentrating at work
- Forgetfulness
- Difficulty staying focused
- Irritability
- Mood changes
- Feeling mentally slower than usual
Depression, anxiety, and cognitive impairment are also associated with OSA.
Those symptoms are not specific to sleep apnea. They can occur with numerous medical, psychological, and lifestyle conditions. But when cognitive or mood changes accompany loud snoring, gasping, breathing pauses, or persistent daytime sleepiness, sleep quality deserves a closer look.
Poor Sleep Can Become a Safety Issue
One of the most immediate consequences of untreated sleep apnea is excessive daytime sleepiness.
A person may struggle to stay awake while watching television, working at a desk, sitting in a meeting—or driving.
The ADA reports that people with OSA have an increased risk of motor-vehicle accidents, while NHLBI specifically warns that untreated sleep apnea can impair attention and decision-making while driving.
If you are having difficulty staying awake behind the wheel, do not drive until the problem has been appropriately addressed.
Does Snoring Mean Your Health Is at Risk?
Not necessarily.
Snoring occurs when tissues vibrate as air moves through a narrowed airway. Many people snore without having obstructive sleep apnea.
The signs become more concerning when snoring occurs alongside symptoms such as:
- Witnessed pauses in breathing
- Gasping or choking during sleep
- Frequent awakenings
- Waking with a dry mouth
- Morning headaches
- Persistent daytime fatigue
- Excessive daytime sleepiness
- Difficulty concentrating
Glen Park Dental has an existing guide to common sleep apnea symptoms for patients who want to learn more about the warning signs.
If a sleep partner reports that you stop breathing and then suddenly gasp or snort, that is particularly important information to share with a healthcare professional.
How Do You Know If You Actually Have Sleep Apnea?
Symptoms alone cannot confirm the diagnosis.
The American Dental Association states that obstructive sleep apnea is diagnosed by a physician or trained sleep specialist following a medical assessment and appropriate diagnostic testing. The reference standard is an overnight sleep study, although home sleep testing may be appropriate for certain patients.
Dentists can still play an important role.
During a dental examination, a dentist may screen for symptoms and risk factors such as loud snoring, reported breathing pauses, choking or gasping during sleep, excessive daytime sleepiness, and certain oral or craniofacial findings.
Patients who appear to be at increased risk can then be referred for medical sleep evaluation.
Where Does Dental Sleep Medicine Fit In?
Once obstructive sleep apnea has been appropriately diagnosed by a sleep specialist, treatment depends on the patient and the severity of the condition.
Positive airway pressure therapy, including CPAP, is an important treatment option.
For certain adults, a physician may also recommend oral appliance therapy. A custom mandibular advancement device fits inside the mouth during sleep and holds the lower jaw in a forward position to help maintain airway space.
Current guidance recommends a custom, adjustable appliance provided and monitored by a qualified dentist when oral appliance therapy is prescribed for OSA. Long-term dental follow-up is important because appliances can cause changes in the bite or temporary jaw symptoms in some patients.
Glen Park Dental works with local sleep physicians in caring for patients with sleep apnea and snoring and provides dental sleep-apnea care in San Francisco.
Frequently Asked Questions About Sleep Breathing and Overall Health
- Can sleep apnea affect your heart?
- Yes. OSA is associated with high blood pressure, coronary artery disease, atrial fibrillation, stroke, and heart failure. That does not mean every patient with OSA will develop cardiovascular disease.
- Can poor breathing during sleep affect blood sugar?
- Obstructive sleep apnea is associated with insulin resistance and type 2 diabetes. Research suggests that sleep fragmentation and intermittent low oxygen may contribute to metabolic stress.
- Why am I tired if I sleep eight hours?
- If sleep is repeatedly interrupted by breathing disturbances, eight hours in bed may not equal eight hours of restorative sleep. Persistent exhaustion can have many causes, however, so unexplained fatigue deserves broader evaluation.
- Does everyone who snores have sleep apnea?
- No. Snoring is common and does not automatically mean OSA is present. Snoring accompanied by breathing pauses, gasping, choking, daytime sleepiness, or other symptoms is more concerning.
- Can a dentist tell if I have sleep apnea?
- A dentist can screen for risk and symptoms, but medical diagnosis should come from a physician or qualified sleep specialist using appropriate testing. Dentists can then participate in oral-appliance treatment when it is medically appropriate.
Breathing Well at Night Is About More Than Getting Enough Hours of Sleep
Sleep is supposed to give the brain, heart, blood vessels, and rest of the body an opportunity to recover.
When breathing repeatedly becomes obstructed, the combination of fragmented sleep, intermittent oxygen changes, and repeated physiological stress can have consequences far beyond snoring.
If you regularly snore, wake exhausted, experience morning headaches, gasp during sleep, or have been told that your breathing stops at night, it is worth finding out whether a sleep-related breathing disorder may be present.
Glen Park Dental provides sleep-apnea screening and dental sleep care in San Francisco at 4 Joost Ave in the Glen Park neighborhood, near the Glen Park BART station. The practice works with sleep physicians when medical evaluation or diagnosis is needed.
If poor sleep and nighttime breathing symptoms are beginning to affect how you feel during the day, call (415) 799-3900 to discuss a sleep-apnea screening and whether further sleep evaluation may be appropriate.