JUST BREATHE: What happens if I don’t treat my sleep apnea?

This is a common question asked by patients in the sleep lab who learn they have been diagnosed with obstructive sleep apnea (OSA).

They discover that they must commit to lifestyle changes and therapies in order to overcome their disorder. This is not easy news to take in a world where we expect to fix everything with a pill or a shot.

It may seem that wearing a therapeutic PAP mask or oral device to bed at night, or opting for an invasive surgical procedure, or embarking upon a major weight loss kick or a challenging new exercise regimen are extreme solutions for a problem they don’t think of as dangerous. These patients may even equate sleep apnea with snoring. 

Snoring is annoying, sure, embarrassing, but could it really be that bad? 

Snoring, itself, may or may not be all that bad. But obstructive sleep apnea, which may also (and usually does) include snoring, is not merely a bad case of snoring. It is a dangerous condition that, left untreated, will lead to a lifetime of health woes and a shorter life span.

When you lie down to sleep, your upper airway requires enough space for your body to inhale and exhale air. This air, introduced as oxygen (O2) molecules into the lungs through the tiny air sacs called the alveoli, brings much needed oxygenation to your red blood cells. These little rafts whisk oxygen molecules away to every nook and cranny in the body in order to help maintain important chemical balances, heal wounds, nourish tissues and cleanse your body at the cellular level. You need every last one of those O2 molecules for the body to work in tip-top shape. 

If you go without adequate oxygen during the day, you simply take a breath and balance is restored. However, at night, while sleeping, your body is essentially working in autopilot. If your upper airway collapses while you sleep, it blocks that important inhalation (or exhalation) of air, and your blood cells cannot do their job. You really can’t expect to stay healthy if, night after night, you are not getting adequate oxygen to your bloodstream. Eventually, the body will begin to break down, fail to heal, and fall into disease or dysfunction.

When you have sleep apnea, systemic inflammatory responses take place throughout the body (pain, swelling) and several body systems suffer the impact of the loss in blood oxygenation caused by this simple mechanical failure of the upper airway to allow air into the lungs while you sleep. 

This is what COULD happen if you don’t treat your sleep apnea. 


The cardiovascular system: When your blood loses oxygen repeatedly over the course of the night, this creates oxidative stress on the heart and leads to sustained elevations in blood pressure (hypertension). Heart attacks, atrial fibrillation, other heart arrhythmias, congestive heart failure, atherosclerosis (“hardening of the arteries”) and chronic vascular disease are all potential hazards of leaving OSA untreated. Stroke is also one of the greatest potential risks that a person with sleep apnea faces if they ignore this condition.

The endocrine system: When it comes to metabolism, obstructive sleep apnea can lead to many different problems. Obesity is perhaps the most notable health condition linked to OSA, but many don’t realize that Type 2 diabetes mellitus has a confirmed relationship to untreated sleep apnea. When the blood’s oxygen levels dip dangerously below normal, this creates a sympathetic response in the body that leads to the maintenance of higher-than-usual levels of adrenaline in the blood over several hours every night. This shift in blood chemistry leads to problems with insulin sensitivity and/or resistance and with glucose tolerance. Polycystic ovary disease is related to the higher insulin resistance that occurs in women who have untreated OSA. Middle-aged adults with this sleep breathing disorder also risk developing acromegaly, a condition in which too many growth hormones are released into the bloodstream, leading to excessive growth in the soft tissues in the upper airway. Chronic edema (swelling) can also occur as a result of chemical imbalances in the body, which then can serve to further perpetuate the mechanical disruptions caused by sleep apnea, as the body’s fluids are redistributed across the body while supine, leading to additional swelling in the soft tissues of the upper airway which cause its mechanical collapse. Finally, hypothyroidism has also been linked to obstructive sleep apnea.

The brain: The repeated drops in blood oxygen saturation overnight have been shown to cause damage to the mammillary bodies in the brain, which leads to the same short-term memory loss and daytime confusion that plagues chronic alcoholics and those suffering from Alzheimers. It can also lead to significant reduction to both the brain’s white and gray matter, resulting in measurable impairments in cognition, mood and alertness. Emotional imbalances are also a side effect of obstructive sleep apnea: irritability, secondary depression and the worsening of preexisting mood disorders can result.

The respiratory system: Smokers, you are probably not breathing well even while you sleep if you have apnea; chronic obstructive pulmonary disease (COPD) is positively linked to untreated OSA. So is pulmonary hypertension. OSA has also been shown to be an independent risk factor for worsening preexisting asthma.

The reproductive system: Women with untreated sleep apnea have been shown to suffer from impaired ovarian function; men with untreated sleep apnea may suffer from “low T,” or reductions in testosterone, as well as low sperm counts.

The urinary system: For some, the failure to treat OSA may increase the frequency of overnight urination, not necessarily due to overactive bladder but to the stress response that corresponds with the frequent awakenings caused by apneic episodes. Many people who wake up feeling the need to use the bathroom may not actually have full bladders, but their body chemistry has been forced into a wakefulness that signals for the body to void the bladder. Sleep apnea also occurs at a significantly higher rate in people with chronic kidney disease (between 50 to 90 percent). 

If you have been diagnosed with sleep apnea, please take your doctor’s orders seriously and seek out treatment. There are numerous treatments available; if you fail at one, try another. Your body will thank you later, and so will your loved ones, and you will feel better and live longer.

SOURCES

American Academy of Sleep Medicine || Brain damage caused by severe sleep apnea is reversible
Endocrine Society || Endocrine Aspects of Obstructive Sleep Apnea

Health.com || Sleep Apnea May Damage Brain Cells Associated With Memory 
Healthday || Sleep Apnea Linked to Kidney Disease Progression in Diabetics
Huffington Post & The Stanford Center for Sleep Sciences and Medicine || What Untreated Sleep Apnea Means for your Blood Pressure 
Journal of Clinical Sleep Medicine || Obstructive Sleep Apnea and Asthma: What are the links?
Lung || Chronic lung disease in the sleep apnea syndrome
Mayo Clinic || Sleep apnea complications
Renal Support Network || Sleep Apnea and Kidney Disease
SCOPE/Stanford Medicine || Sleep apnea linked with male infertility

SLEEP || Obstructive Sleep Apnea Syndrome is Associated with Overactive Bladder and Urgency Incontinence in Men
Sleep Better, Live Better Blog || How Does Sleep Apnea impact the brain?

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5 Comments on JUST BREATHE: What happens if I don’t treat my sleep apnea?

  1. I thought it was the lack of sleep that directly caused the stress response, poor memory, etc. The article seems to say it's the lack of oxygen at night. But the lack of oxygen causes the nervous system to wake you up to fix the problem – many times an hour! That in turn causes poor sleep, so you become sleep deprived. The sleep deprivation then causes many of the problems.

  2. You have it right. It's a matter of both low oxygen and resulting poor sleep occurring in an ongoing pattern.

    Lack of oxygen due to apneic breathing fragments the sleeping process because it alerts the nervous system into a stress response, which does, indeed, lead to a lack of sleep.

    People with sleep apnea can literally stop breathing every single minute for at least 10 seconds, resulting in an arousal. That's at least 60 arousals an hour (and it can get even worse than that!). Technically, a person who is thought to have severe sleep apnea is waking up at least 30 times an hour, every hour over the course of the night. This all starts because of a lack of O2.

    There is no sleep happening with these people. They just barely fall asleep and then they are choking and waking up again, and this pattern repeats itself over and over again. I've watched it happen many times at the lab. No wonder they are tired. The lack of oxygen is forcing them awake.

    Interestingly, a lot of people who have suffered insomnia for years and have failed medications find out later that they have unidentified obstructive sleep apnea, which explains why they can't sleep at night AND are extremely tired during the day. They *try* to sleep but their breathing patterns never let them get past shallow stage 1 nonREM sleep.

  3. Question : I have this “old man ” problem ..after about 4 hours of sleep , I find myself waking up and can't go back to sleep . With my mask on , it becomes irritating and I take it off . How is that problem taken care of ??? I'd appreciate any information .. Thank you . Doug

  4. That's a common concern, Doug. I would absolutely take this up with the lab and physician who prescribed your PAP therapy.

    If it has been a few years since you were first diagnosed and prescribed PAP therapy, you may need to go in and have a new study. Changes over time can alter the pressure you need. Maybe you gained or lost weight; even aging or other health conditions that develop over time can alter your breathing physiology. It never hurts to get a new study to confirm the effectiveness of your current pressure (if it's been at least a year).

    You may also need to just get a new or different mask. Machine problems might be at the root… There are lots of things you can look into with the help of your physician and lab. Good luck! Keep trying, even 4 hours of sleep with PAP is better than none. I hope you can achieve more soon!

  5. How do you test yourself for sleep apnea? I've never gotten reports of snoring, but I have a very hard time falling asleep. Some of these symptoms seem to apply to me, but I don't think I have a very severe case. I would just like to be able to sleep through the night without waking up and being unable to sleep again. http://www.drcarolinedentist.com

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