Haims: Sleep apnea is not just snoring
When most people think about sleep apnea, I’d assume they think of snoring. Snoring is just one type of sleep apnea that most often can be remedied. However, there is another type of sleep apnea that has the potential to be quite concerning — it’s called central sleep apnea.
Snoring is a type of apnea called obstructive sleep apnea. This apnea is the most common type and causes breathing to repeatedly stop and start during sleep. This most often occurs due to a narrowing or blockage in the muscles of the throat. When this occurs, blood levels drop, triggering our brain to wake us up so that we reopen the airway.
Although some of the comorbidities that result from obstructive sleep apnea are not life-threatening, there can be occasions that may be life-threatening. Milder symptoms include daytime sleepiness, irritability, headaches (especially in the morning), depression, high blood pressure, and the onset of diabetes. Conversely, there are instances when obstructive sleep apnea complications can develop and become life-threatening.
When untreated, obstructive sleep apnea can lead to cardiovascular problems like atrial fibrillation and stroke. Further, because obstructive sleep apnea causes intermittent hypoxia, people often develop insulin resistance, higher blood sugar levels, and thus may potentially develop type 2 diabetes.
Lifestyle changes can significantly relieve symptoms of mild sleep apnea. Obesity has been significantly associated with the occurrence of obstructive sleep apnea. According to an article published in the National Library of Medicine, the prevalence of obstructive sleep apnea for people who are considered obese may be 25% to 45%. Alcohol may also make symptoms worse as alcohol relaxes the muscles in the throat, which can narrow the windpipe.

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Sleeping positions have also been shown to affect obstructive sleep apnea. Two of the better suggested sleep positions are on your stomach or side as these positions help keep the airway open and prevent soft tissues in the throat from collapsing. Sleeping on your back is not suggested as the likelihood of the tongue and soft tissue in the throat may block your airway.
In addition to lifestyle modification, there are medical devices that are commonly used to treat obstructive sleep apnea. The most commonly used devices are called positive airway pressure devices. There are three main types of PAPs: continuous positive airway pressure (CPAP), bilevel positive airway pressure (BiPAP), and auto-adjusting positive airway pressure (APAP). A pulmonologist, neurologist or otolaryngologist are most often the medical provider that will determine which device is appropriate for your specific needs.
When PAP devices and lifestyle are ineffective, a medical provider may suggest alternatives such as an oral appliance that is worn in your mouth while sleeping to either reposition the jaw forward and/or adjust the tongue to keep the airway open. In some cases, it may be necessary to address anatomical issues that contribute to obstructive sleep apnea with a surgical procedure.
Another type of sleep apnea is called central sleep apnea. Although any apnea may be a reason for health concerns, central sleep apnea can present itself with more serious sleep disorders as the brain temporarily fails to send signals to the muscles that control breathing, leading to pauses in breathing during sleep. At altitude, central sleep apnea can complicate any apnea as reduced oxygen can potentially lead to more frequent and severe health concerns affecting the heart, i.e. increased risk of irregular heart rhythms, heart failure, and even stroke.
Research indicates that at elevations over about 8,000 feet, “The sleep quality of high-altitude populations is generally affected by the low-pressure, low-oxygen environment, which is primarily characterized by increased awakenings and light sleep, decreased rapid eye movement sleep and deep sleep, fragmented sleep, and more central apnea or hypoventilation events during sleep.”
Regardless of age or athleticism level, sleeping at altitude has proven to have physiological effects. For people who have been diagnosed with COPD, COVID-19, emphysema, or other respiratory concerns, the benefits of using supplemental oxygen while sleeping should be a question addressed with your medical provider.
It is important to note that anyone who experiences any type of sleep apnea at, or near sea level, will most likely notice a change of quality sleep at higher altitudes. The simple explanation for this is that while the percentage of oxygen in the air (about 21%) remains constant between sea level and altitude, air pressure at altitude is lower and thus our body gets less oxygen with each breath.
For both year-round residents and people visiting at altitude, there are preventive measures that may assist with disturbances experienced from altitude-related sleep quality:
- Stay hydrated — dehydration can worsen altitude-related symptoms due to increased levels of respiration and water loss through exhalation.
- Avoid alcohol: alcohol is a diuretic; thus it increases urine production and therefore exacerbates dehydration.
- Slowly ascend — this allows the body to adjust to reduced oxygen levels.
Anybody that has issues with apnea, or sleep in general, will likely experience a change in sleep quality at altitude. Additionally, for people visiting or residing at very high altitudes (greater than 11,000 feet) there will likely be a greater risk of experiencing sleep disturbances. Talk to your medical provider about using supplemental oxygen if you experience significant sleep disturbances or difficulty breathing at altitude.
Universally, medical providers agree that oxygen deprivation always results in reduced sleep quality.
Judson Haims is the owner of Visiting Angels Home Care in Eagle County. He is an advocate for our elderly and is available to answer questions. Connect with him at jhaims@visitingangels.com.
