The American Sleep Apnea Association (ASAA) estimates that 22 million Americans have sleep apnea. Of this number, about 80 percent are estimated to have moderate or severe Obstructive Sleep Apnea (OSA) but are currently undiagnosed. Adding to that, roughly half of CPAP wearers stop using their device within one to three weeks of use, and you’re looking at a widespread problem.
Too many Americans mistake their sleep apnea symptoms for snoring or don’t take their symptoms seriously and just endure the poor sleep they are receiving. Why is this a problem? Insufficient sleep isn’t just a matter of feeling tired or groggy once in a while. Not getting enough quality sleep and ignoring the telltale signs of sleep apnea can lead to serious health problems. These conditions may hasten the onset of other illnesses and may even take years off of your life.
Untreated sleep apnea can affect literally almost your entire body, so let’s do a check-up and uncover all the ways that untreated sleep apnea impacts you and what you can do about it.
Sleep Apnea and the Development of Health Problems
To start, let’s recap what exactly sleep apnea is. Obstructive Sleep Apnea (OSA) refers to a condition in which your airway completely or partially closes during sleep, thus depriving you of oxygen. Sleep apnea is most commonly treated with CPAP therapy, which delivers pressurized air to help keep your passageways open.
OSA is one of three types of sleep apnea—the other two being Central Sleep Apnea (CSA) and Complex or Mixed Sleep Apnea, which is often known as CompSA to avoid confusion since it would have the same acronym as Central Sleep Apnea.
Lack of sleep directly affects the brain’s ability to process information and remain attentive. Studies show that being awake for 20 consecutive hours creates the same level of cognitive impairment as having a 0.10 blood alcohol content (BAC)—for reference, you may know that most states’ legal limit is 0.08. Two-hundredths don’t make a difference in a lot of things, but when it comes to your ability to safely drive, it’s literally the difference between life or death. In addition, several other studies also back this up, including one where sleep-deprived participants were asked to drive a car in a simulator, which resulted in aggressive driving and a decreased ability to remain in control.
Is Sleep Apnea Dangerous?
Sleep apnea is about more than just snoring. When you have sleep apnea, your nervous system struggles to wake you when you stop breathing in the night, which can occur sometimes dozens of times per hour. These respiratory events, if left untreated, take a toll on your body, especially your heart and circulatory systems.
Your body—including your heart, nervous system, and hormones—needs to go into overdrive in order to wake you, so you’ll resume breathing to take in oxygen and expel carbon dioxide. All of this activity—hours of crisis mode per night—can raise or destabilize your blood pressure and wear out your system before its time.
One study found that over the course of 18 years, untreated sleep apnea and sleep-disordered breathing increased the risk of death, no matter what the participants’ age, body mass index (BMI), or gender. Deaths associated with untreated sleep apnea were most likely to be from cardiovascular disease. Other causes included stroke, cancer, and suicide.
Using CPAP therapy regularly can dramatically reduce your risk of death from a cardiovascular event or illness. Getting your sleep apnea diagnosed and treated reduces the number of apnea or hypopnea events you experience every hour, and therefore reduces the stress your body goes through in order to keep you breathing. If you have sleep apnea and want to stay healthy, CPAP therapy is not optional—it’s essential.
How Serious Is Sleep Apnea?
Quality of sleep is just as important as quantity. You may plan for eight hours or more of sleep and maybe you even think you’re getting it; but if you have untreated sleep apnea, those hours are constantly interrupted by your body waking you up to breathe. The result: your sleep is divided into tiny bits, each too small to allow you to proceed naturally through all the phases of sleep.
If you can’t proceed uninterrupted through all the stages of rapid eye movement (REM) and non-REM sleep, you miss out on important physiological functions that allow your body to regulate itself, consolidate and organize memory, and repair tissue and bone damage.
Good quality sleep also allows the daytime functions of your body to rest, which is not much different than a computer in sleep mode (no pun intended), clearing the way for certain essential functions to take place unimpeded.
What Happens if Sleep Apnea Is Left Untreated?
If left untreated, sleep apnea can cause some serious health conditions. It’s important to remember here the difference between a risk factor and a symptom. A risk factor refers to a condition you may have that may make you more likely to contract another one whereas a symptom refers to a direct effect a condition has on you. So, in the case of OSA, high blood pressure is a risk factor for OSA whereas nocturnal sleep debt is a symptom.
Some crucial consequences of leaving sleep apnea untreated includes impacts on your heart health as well as your sinuses. Those living with untreated OSA often end up breathing through their mouths due to nasal blockages or other sinus-related issues. This can cause dry mouth, which leads to bad breath, gum disease, and other oral health conditions. When you don’t get enough sleep, your sinuses are directly affected. The body loses much of its natural illness-fighting, anti-inflammatory cells located in the nose.
Can You Die from Untreated Sleep Apnea?
Simply put, yes, you can die from untreated sleep apnea. But in reality, you’re more likely to die from those risk factors than sleep apnea itself. There are notable cases of celebrity deaths who were known to have sleep apnea but whose autopsies determined the cause of death to be a risk factor condition and not sleep apnea itself. Such cases include actor Carrie Fisher and former football player Reggie White.
Some of the major conditions often linked to sleep apnea in those who have died include:
- Cardiac Conditions. Heart attacks, arrhythmias, atrial fibrillation (a-fib), and myocardial infarctions are all well-known to be linked to the deaths of people who also had sleep apnea.
- Mood Disorders and Mental Health Issues. Depression and anxiety symptoms are prevalent in people with OSA and disturbed sleep, particularly women.
Cardiac Conditions and Sleep Apnea
For individuals with untreated sleep apnea, a cardiac arrhythmia—or irregular heartbeat—may occur. While the exact cause isn’t certain, studies suggest that the change in pressure to the chest cavity may impact the heart.
Another known heart condition that impacts untreated sleep apnea is atrial fibrillation, which is better known as a-fib. The heart has four chambers and a normal electric current pathway. This current keeps the heart beating in a rhythmic fashion. A-fib is another way of saying your heartbeat becomes irregular. With a-fib, instead of the heart passing blood from one chamber to another, blood pools in areas it shouldn’t and causes blood clots. If the clots break down, they can travel through the blood vessels and go places it shouldn’t like the brain, causing a stroke.
Multiple studies have shown a link between sleep apnea and sudden cardiac death. One five-year study found that OSA raised the risk of sudden cardiac death, particularly when oxygen saturation levels fell below 78 percent. Researchers also found that individuals with OSA have more than 2.5 times the risk of experiencing sudden cardiac death between the hours of 12 a.m. and 6 a.m. compared to those without the condition.
Over time, the increased load to the heart from high blood pressure can also increase the risk of having a heart attack. Staying on top of high blood pressure is one way to help prevent major heart issues.
Mental Health and Sleep Apnea
Studies suggest that sleep fragmentation and lack of oxygen may disturb neurochemical functions and impede the frontal lobe of the brain from regulating emotions. However, there is good news: CPAP therapy can greatly improve depression and anxiety symptoms in people with sleep apnea.
In children, sleep apnea is often mistaken for attention deficit and hyperactivity disorder (ADHD). Kids with undiagnosed sleep apnea may act out in school, struggle with focusing and paying attention, and may have difficulty regulating their moods. Whereas adults with sleep apnea may report chronic tiredness and daytime exhaustion, children with sleep apnea may seem to display the opposite behavior: edginess and hyperactivity. Treatment can help to resolve or improve the side effects of untreated sleep apnea,
Sleep apnea is also related to epilepsy and seizures although those links are harder to establish, especially when it comes to Central Sleep Apnea (CSA). This is because with CSA the brain fails to tell the throat muscles to flex, so you can breathe. When someone suffers from seizures, their brain basically fails to send signals to any part of the body to perform a certain action, which makes it hard for researchers to distinguish CSA from seizures.
Untreated Sleep Apnea and Life Expectancy
How is sleep apnea related to life expectancy? The Centers for Disease Control (CDC) estimates the average life expectancy in America to be 78.7 years old. There is no average age of when a person develops sleep apnea, but generally, about 3 percent of men aged 20 to 44 years old have some form of it. In the 45 to 64 age group, that figure rises to 11 percent and lastly, to 18 percent in men aged 61 to 100.
Diagnosing that 61 to 100 age group is a challenge though because elderly people are diagnosed less often with OSA due to the fact that they present atypical symptoms when compared to an average person with sleep apnea. Traditional risk factors such as obesity, BMI, neck circumference, and snoring are less prevalent among the elderly, leading to diagnostic challenges for healthcare professionals.
This is a double-edged sword though because the association between OSA and other medical conditions such as hypertension, heart-related diseases, and strokes makes getting the elderly properly diagnosed with OSA difficult.
How Long Can Someone Live With Untreated Sleep Apnea?
It’s hard to determine how long someone can live with untreated sleep apnea because of two factors:
- Improbability. When passing away because of sleep apnea, the risk factors and symptoms experienced as a result of sleep apnea affect the cause of death.
- Age. The older you get, the higher your odds are of dying from a risk factor.
You can’t really put an exact number on how much less or longer someone with untreated sleep apnea will live compared to the average life expectancy. The best that science has been able to achieve is loosely calculate your odds of developing a side effect or risk condition if you’ve had sleep apnea for a certain amount of time. Those with more severe cases of OSA are three times more likely to have eventual heart failure.
What Are the Dangers of Untreated Sleep Apnea?
Untreated sleep apnea carries with it a slew of consequences and some are more serious than others. There are also several risk factors that if left unchecked, along with your untreated sleep apnea, can have serious consequences, including death. Some of these include:
- Cardiovascular Conditions. Untreated sleep apnea is also linked to virtually all major cardiovascular issues, ranging from high blood pressure to heart problems to stroke risks.
- Alzheimer’s Disease. Those with untreated sleep apnea are at a higher risk of developing Alzheimer’s as sleep has been proven to flush out the A-beta deposits that build up. If the A-beta deposits aren’t flushed out due to continual lack of sleep, it may eventually lead to the development of Alzheimer’s.
- Diabetes. The link between OSA and type 2 diabetes is well-known by researchers and physicians. Untreated OSA is often associated with insulin resistance, which is a condition that increases blood sugar. It’s also associated with glucose intolerance, which is a form of hyperglycemia that is a predictor of type 2 diabetes. Untreated sleep apnea may eventually lead to type 2 diabetes. If this form of diabetes is untreated or poorly managed, the risks associated with it include serious health issues like organ damage, cardiovascular disease, nerve damage, vision problems, and even death.
Side Effects of Untreated Sleep Apnea
There are numerous side effects specific to untreated sleep apnea that may be to some nothing more than a nuisance and to others that if left untreated can lead to more serious consequences. Among them are:
- Sleep Issues. Nocturnal sleep debt, daytime sleepiness, and morning headaches are all telltale signs that you may have sleep apnea.
- Glandular Problems. Sleep regulates the production and transportation of various hormones throughout the body and many of which are made in one of these three bodily glands. Under normal conditions, growth hormone levels jump up at night – promoting cellular regeneration, muscular repair, and overall growth.
- Gastrointestinal. Pancreatitis has been linked to sleep apnea as well as the risk of developing type 2 diabetes.
- Skincare. Lack of sleep can also quickly cause the skin to appear older and less radiant.
- Fatigue. Did you know athletes love to nap? That’s because to perform at their best, they need plenty of rest to rebuild muscles, stave off fatigue and inflammation, and keep their brains sharp. In addition to a solid night’s sleep, athletes frequently include naps in their training schedule, especially on game days when they play in the evenings.
Nocturnal Sleep Debt
While it’s obvious that untreated sleep apnea would lead to sleep issues, lack of sleep itself carries some pretty serious concerns that will make you wonder why you’re always feeling sleepy or groggy.
One of those is nocturnal sleep debt. If you don’t sleep enough, you begin owing your body back hours of sleep to make up for it. This is called nocturnal sleep debt, and it’s why if you had a long work week and only slept a few hours a night, you’ll still find yourself waking up on Saturday morning after sleeping 10 hours telling yourself, why am I so tired? I slept 10 hours last night! You’re still tired because you haven’t paid your sleep bill back to your body yet.
Another one is daytime sleepiness, which can cause a lot of other issues, like sleep-related driving accidents. Not only does someone low on sleep risk falling asleep behind the wheel but they may also suffer from delayed reaction times. This is clinically referred to as impairment with executive functions and occurs when you have a hard time concentrating and issues with short-term memory. Remember, when you’re tired and you get behind the wheel, you aren’t putting just yourself at risk, but also those in the car with you and on the road.
Lastly, morning headaches are commonly associated with sleeplessness and therefore, with untreated sleep apnea. Many with untreated sleep apnea are likely to experience headaches when they wake up in the morning. This is due to the lower levels of oxygen you have as a result of untreated sleep apnea. This causes your blood vessels to widen and results in those dull, morning headaches. As you breathe more normally, during your wake state, the headache will likely begin to lift.
Can Untreated Sleep Apnea Cause Weight Gain?
Appetite hormones—ghrelin and leptin—have long been linked in research between sleep deprivation and weight gain. In particular, those living with untreated sleep apnea tend to have higher than average levels of these two hormones.
Untreated sleep apnea will make you hungrier. This will make you more likely to overeat, gain weight, and eventually exacerbate your OSA due to an increase in BMI. However, a consistent CPAP therapy regimen can bring ghrelin and leptin levels closer to normal.
Your endocrine system and bone metabolism also play a role in this connection. Research indicates that disturbed sleep and sleep apnea influence the process of bone remodeling, which can lead to osteoporosis in women. A number of hormones, including melatonin (the hormone that regulates the circadian rhythms) and leptin, are involved with the repair and resorption of the bones. Fragmented sleep from untreated sleep apnea can affect these hormone levels and functions, leading to a decrease in bone density, especially in older adults.
Untreated sleep apnea doesn’t just simply make you feel tired. In fact, it interferes with dozens of your body’s most important functions and can attack your health, wellness, and longevity from your head to your toes. If you suspect you or a loved one is suffering from untreated sleep apnea, speak with your doctor for a diagnosis and treatment plan.
If you have the risk factors for sleep apnea and you have not yet been diagnosed, your doctor would recommend you take a polysomnography (sleep study) to determine whether or not you have sleep apnea and what the severity may be. In some cases, you can even take this test as a home sleep test from the comfort of your own bed. There are pros and cons to both the in-lab and home test, so talk to your doctor about what you’re experiencing, and they can help determine which option would be best for you.
Andre is a newcomer to CPAP therapy. He was diagnosed in 2020 through CPAP.com’s home sleep test. Andre enjoys learning more about living with sleep apnea, advances in CPAP technology and treatment, and sharing his insights with the CPAP.com community.