Understanding the Causes and Symptoms of Obstructive Sleep Apnea

• Your sleep is repeatedly disrupted — Even if you don’t fully wake up, these breathing interruptions prevent you from reaching deep, restorative sleep, leaving you tired and unfocused the next day.

• OSA is the predominant form of sleep apnea — OSA accounts for up to 80% of all cases of sleep apnea syndrome.³ Another type of sleep apnea is central sleep apnea (CSA), which occurs when your brain fails to send proper breathing signals. Some people have mixed sleep apnea, a combination of both conditions.⁴

• OSA is more common than you think — Studies estimate that between 9% and 38% of adults have obstructive sleep apnea, yet up to 85% of cases remain undiagnosed.⁵

• It affects more than just your sleep — Untreated OSA increases your risk of serious health problems, including high blood pressure, heart disease, diabetes and cognitive decline.⁶

• Loud, persistent snoring — One of the most common and noticeable symptoms, this is often accompanied by pauses in breathing.

• Gasping or choking sounds during sleep — These occur when your airway temporarily closes, causing oxygen levels to drop. Your brain then triggers a sudden gasp or choking reflex to reopen the airway.

• Frequent awakenings — Sleep apnea repeatedly forces your brain to briefly wake up throughout the night to restore breathing. You may not recall these awakenings, but they prevent you from reaching deep, restorative sleep.

• Morning headaches and dry mouth — Oxygen fluctuations and mouth breathing contribute to frequent morning headaches, sore throat or dry mouth upon waking.

• Daytime fatigue and difficulty concentrating — Because OSA disrupts normal sleep cycles, you may experience chronic fatigue, irritability and difficulty focusing during the day. Many people with undiagnosed OSA report falling asleep during routine activities, such as watching TV or even driving.

• Mood changes and poor emotional regulation — Chronic sleep deprivation due to OSA affects brain chemistry, leading to increased stress, anxiety and irritability. Some people even experience symptoms of depression.

• Age and sex — OSA occurs at any age, but the risk increases with age as fatty tissue builds up in the neck and tongue, which narrows the airway. Men are more likely to develop sleep apnea at a younger age than women, though the risk for women rises after menopause.

• Excess tissue in the throat — If you have enlarged tonsils, a thick neck or excess fat deposits around your airway, these physically block airflow, making it harder to breathe during sleep.

• Weak or overly relaxed throat muscles — As you sleep, the muscles in your throat naturally relax, but in some cases, they collapse too much and obstruct the airway. This risk increases with age and is worsened by alcohol consumption, sedatives and certain medications that further relax airway muscles.

• Structural airway abnormalities — If you have a deviated septum, a small jaw, an enlarged tongue or a naturally narrow airway, your breathing will be partially restricted, making OSA more likely. Even if you’re at a healthy weight, these anatomical factors lead to airway blockages during sleep.

• Lifestyle influences — Habits like smoking, excessive alcohol consumption and a sedentary lifestyle increase inflammation, fluid retention and poor muscle tone, all of which contribute to worsening airway obstruction. Poor cardiovascular health also increases your susceptibility to OSA and its long-term consequences.

• Heart and kidney disease — These conditions cause fluid retention in the neck, which obstruct the airway during sleep. Managing cardiovascular and kidney health helps reduce apnea severity.

• Hormonal disorders and metabolic conditions — Hormone levels influence the size and shape of the airway. People with polycystic ovary syndrome (PCOS), hypothyroidism or high levels of insulin or growth hormone are at a greater risk for developing OSA due to changes in airway structure and muscle tone.

• Family history and genetics — OSA often runs in families. Your genes help determine the size and shape of your skull, face and airway, influencing your risk. If you have relatives with sleep apnea, you are more likely to develop the condition.

• Vitamin D influences deep sleep and sleep paralysis — Your ability to enter and maintain deep sleep relies on a neurotransmitter called acetylcholine, which helps regulate REM sleep and sleep paralysis. Because vitamin D plays a vital role in acetylcholine production,¹³ a deficiency can disrupt your sleep cycle and contribute to disordered breathing during sleep.

• The brainstem is covered in vitamin D receptors — The brainstem also regulates sleep patterns and muscle paralysis during REM sleep, which prevents movement while dreaming. Research has shown that the brainstem is rich in vitamin D receptors, suggesting that having optimal vitamin D levels is necessary for normal sleep function.

• Low vitamin D levels are linked to sleep apnea and poor sleep quality — Gominak’s research on sleep disorders found that many patients with poor sleep and chronic fatigue had undiagnosed vitamin D deficiencies. When vitamin D levels were optimized through supplementation, their sleep quality and sleep apnea severity improved.

• Vitamin D influences all sleep disorders — While sleep apnea is one of the most recognized sleep-related conditions, Gominak’s research found that vitamin D deficiency is linked to insomnia, chronic fatigue, daily headaches, epilepsy and overall poor sleep efficiency. This suggests that correcting vitamin D levels is a key factor in restoring healthy sleep patterns.

• Cardiovascular disease — Every time your airway becomes blocked, oxygen levels drop, forcing your heart to work harder. This strains your cardiovascular system, increasing your risk of high blood pressure, heart attacks, strokes and irregular heart rhythms (arrhythmias).¹⁴

• Type 2 diabetes and metabolic issues — OSA disrupts your body’s ability to regulate blood sugar levels. Frequent oxygen drops and sleep fragmentation contribute to insulin resistance, weight gain and a higher risk of developing Type 2 diabetes.^15,16

• Cognitive decline and memory problems — When your brain is repeatedly deprived of oxygen, cognitive function declines over time. You may struggle with memory, focus and problem-solving, and studies have linked untreated OSA to an increased risk of dementia and Alzheimer’s disease.^17,18

• Weakened immune system — Sleep is when your body repairs and regenerates, but if your sleep is constantly disrupted by OSA, your immune function suffers. This makes you more vulnerable to infections, slows recovery from illnesses and increases inflammation throughout the body.^19,20

• Increased risk of accidents — Excessive daytime drowsiness affects your ability to stay alert and react quickly, putting you at a higher risk of car crashes, workplace accidents and performance errors. Many people with untreated OSA unknowingly fall asleep during routine tasks, further increasing their risk of harm.^21,22,23

• CPAP therapy is the primary conventional treatment — Continuous positive airway pressure (CPAP) therapy uses a machine that delivers a steady stream of air through a mask to keep the airway open.²⁴ While many users report significant symptom improvements, CPAP was never designed as a permanent solution.

According to its inventor, Dr. Colin Sullivan, CPAP was always intended as a temporary measure while addressing underlying causes, such as obesity, anatomical obstructions or airway development issues.²⁵ While effective, CPAP therapy is not well-tolerated by everyone. Common complaints include claustrophobia, nasal congestion, dry mouth or pressure sores from the mask.²⁶

• Oral appliances as an alternative to CPAP — Mandibular advancement devices (MADs) are custom-fitted mouthpieces designed to move the lower jaw forward, preventing the tongue and soft tissues from collapsing into the airway. Specialty-trained dentists collaborate with sleep specialists to ensure optimal airway positioning without causing jaw discomfort.²⁷

• Orofacial myofunctional therapy (OMT) for airway strengthening — OMT focuses on neuromuscular re-education of oral and facial muscles through targeted exercises and behavior modification techniques.

This therapy corrects tongue placement, improves breathing mechanics, enhances chewing and swallowing functions, and promotes proper head and neck posture. OMT is particularly effective for mild to moderate sleep apnea, offering a noninvasive approach with lasting benefits.²⁸

• Emerging therapies — Several alternative therapies target airway muscle tone and breathing mechanics. Neuromuscular electrical stimulation (NMES) devices help tone the tongue and airway muscles when worn for 20 minutes daily, strengthening them to prevent collapse during sleep.²⁹

In more severe cases, surgical intervention may be necessary to enlarge the upper airway by moving the upper and lower jaw forward. Additionally, training yourself to breathe through your nose instead of your mouth normalizes breathing volume, improving oxygenation of tissues and brain function.

1. Optimize your breathing habits — Dysfunctional breathing habits sabotage your health and worsen conditions like sleep apnea. I recommend consulting with a breathing behavior analyst to help you become conscious of your breathing habits, what’s triggering them and how to resolve them.

2. Maintain a healthy weight — Excess weight, particularly around the neck and upper airway, contributes to airway obstruction. If you are overweight or obese, losing even 10% of your body weight leads to noticeable improvements in sleep apnea symptoms.

3. Adjust your sleep position — Sleeping on your back worsens sleep apnea by allowing your tongue and soft palate to fall backward and block your airway. Instead, try sleeping on your side or stomach, or elevating your upper body with a wedge pillow. To prevent rolling onto your back during the night, attach a tennis ball to the back of your pajamas or use strategically placed pillows.

4. Avoid alcohol and smoking — Alcohol relaxes throat muscles, increasing the likelihood of airway collapse, while smoking causes inflammation and fluid retention in the airway, making breathing more difficult. Avoiding alcohol consumption and quitting smoking significantly reduce apnea severity.

5. Steer clear of benzodiazepines — These medications further relax the throat muscles, increasing the risk of airway obstruction. If you take sedatives or benzodiazepines, consider talking to your doctor about safer alternatives for sleep support.