Hereditary Sleep Apnea: Nature vs. Nurture

Ever wondered if sleep apnea is hereditary or not? Well, you’re not alone! This is a query that has lingered in the minds of many who have experienced this sleep disorder, which seems to leave its marks across generations. In this blog, we trace the pathway of developing sleep apnea from its origins in our genetic code to the practical steps you can take for relief!

But first… let’s discuss the science behind sleep apnea!

What Is Sleep Apnea?

Sleep apnea, also written as sleep apnoea sometimes, is a disorder that causes pauses in breathing when you’re asleep. These pauses can be short, lasting for a few seconds, or long, lasting for even minutes, and can happen multiple times while you’re sleeping!

There are two main ways in which these pauses happen, which is why there are two kinds of sleep apnea:

Obstructive Sleep Apnea (OSA): OSA is the most common form of sleep apnea, occurring when the muscles at the back of your throat relax more than they should. When this happens, your airways become either fully or partially blocked, so you stop taking full breaths. After a few seconds or minutes, your body notices this and nudges you to resume normal breathing so you either find yourself choking or gasping for breath in the middle of the night.

Central Sleep Apnea (CSA): Your brain has got everything to do with CSA. This kind of sleep apnea happens when your brain gets a little clumsy and forgets to send the right signals to the muscles that are responsible for controlling your breathing. This is a rare disorder though, mostly affecting people with medical conditions like heart failure, stroke, or brainstem injury.

Mixed Sleep Apnea: It’s all in the name… this is when you have both OSA and CSA. This is also very rare.

Now you may be wondering how it is that some people have sleep apnea and others don’t. In the next section, we look at several circumstances that put you at a greater risk of developing this sleep disorder.

Risk Factors For Sleep Apnea

Here’s a detailed breakdown of the risk factors that contribute to the development and worsening of sleep apnea, especially OSA:

Family History

There’s evidence to suggest that genetics play a role in OSA susceptibility. People with family members who have OSA are at higher risk of developing the condition themselves.

Ethnicity

Certain ethnic groups, like African Americans, Hispanics, and Pacific Islanders, have been found to have a higher prevalence of OSA compared to other populations.

Obesity

Obesity is one of the most significant risk factors for OSA. Excess body fat, especially around the neck and throat area, can obstruct the airway during sleep, leading to breathing difficulties.

Anatomical Factors

Certain anatomical characteristics can predispose you to OSA. These include a narrow airway, enlarged tonsils or adenoids, a large tongue, or a recessed jaw.

Age

OSA becomes more prevalent with age, particularly in adults over 40. Muscle tone naturally decreases as people age, which can lead to airway collapse during sleep.

Gender

Men are more likely to develop OSA compared to premenopausal women. But, the risk for women increases after menopause, suggesting a hormonal influence on sleep apnea risk.

Smoking

Smoking can increase the risk of OSA due to its detrimental effects on respiratory function and inflammation in the upper airway. Smoking can also worsen existing sleep apnea symptoms

Alcohol and Sedative Use

Alcohol and sedatives can relax the muscles in the throat, leading to increased airway collapse during sleep. Consumption of these substances close to bedtime can worsen OSA symptoms.

Nasal Congestion

Chronic nasal congestion or obstruction, whether due to allergies, sinusitis, or anatomical abnormalities, can contribute to breathing difficulties during sleep, increasing the risk of OSA.

Medical Conditions

Certain medical conditions are associated with a higher risk of OSA. These include hypertension, diabetes, congestive heart failure, and metabolic syndrome. OSA can also worsen the symptoms and outcomes of these conditions.

Neuromuscular Disorders

Conditions that affect muscle control and coordination, like muscular dystrophy or amyotrophic lateral sclerosis (ALS), increase the risk of OSA due to weakened muscles in the upper airway.

Hormonal Factors

Hormonal changes, like those occurring during pregnancy or with hormonal disorders like polycystic ovary syndrome (PCOS), can influence OSA risk, potentially due to changes in airway anatomy or muscle tone.

While these risk factors can increase your likelihood of developing sleep apnea, not every single person with any of these risk factors will necessarily have the condition. Also, addressing certain risk factors like obesity and smoking, can help reduce your chances of having the disorder.

Next, let’s discuss more about the reasons behind the heredity of sleep apnea.

The Science Behind Why Sleep Apnea Is Hereditary

Numerous epidemiological studies have demonstrated an increased risk of sleep apnea among people with a family history of sleep apnea. These studies have provided strong evidence supporting the role of genetic factors in the development of sleep apnea. Here’s an overview of the scientific understanding of sleep apnea and genetics:

Anatomy and Genetics

Certain anatomical features, like a narrow throat or enlarged tonsils, predispose people to sleep apnea. These features have a genetic basis, meaning that they are passed down from parents to children. Variations in genes that control the development and structure of the upper airway also increase susceptibility to these anatomical factors.

Muscle Tone Regulation

Sleep apnea is also influenced by genetic factors related to the regulation of muscle tone during sleep. During sleep, the muscles of the upper airway normally relax to allow for normal breathing. However, in people with sleep apnea, this relaxation becomes excessive, leading to airway obstruction. Genes involved in the regulation of muscle tone may play a role in determining a person’s susceptibility to this excessive relaxation.

Metabolic Factors

There is growing evidence suggesting a link between sleep apnea and metabolic disorders like obesity and type 2 diabetes. Both sleep apnea and these metabolic disorders have been shown to have a hereditary component. Genes involved in metabolism, appetite regulation, and energy balance may contribute to the development of both conditions, thereby increasing the likelihood of sleep apnea.

Central Sleep Apnea

While obstructive sleep apnea (OSA) is more commonly associated with anatomical and physiological factors, central sleep apnea (CSA) also has a hereditary component. Like briefly mentioned above, CSA occurs when the brain fails to send the appropriate signals to the muscles responsible for breathing during sleep. Genetic variations affecting the central nervous system’s control of breathing also increase the risk of CSA.

In summary, while the precise genetic mechanisms underlying sleep apnea are still under investigation, it is clear that genetic factors play a significant role in determining your susceptibility to the disorder. Understanding these genetic factors may ultimately lead to more effective approaches for diagnosing, treating, and preventing sleep apnea.

Since certain hereditary medical conditions increase the risk for sleep apnea, in the next section, we look at several of these diseases.

Medical Conditions Associated with Sleep Apnea

Obstructive Sleep Apnea (OSA), in particular, is associated with many medical conditions, either as a contributing factor or as a consequence of the sleep disorder itself. These include:

Hypertension (High Blood Pressure)

OSA has been strongly linked to hypertension. The repeated episodes of breathing pauses and oxygen desaturation during sleep lead to increased sympathetic activity, causing blood pressure to rise. Treating sleep apnea often leads to better blood pressure control.

Cardiovascular Diseases

OSA is associated with an increased risk of various cardiovascular conditions, including coronary artery disease, stroke, atrial fibrillation, and heart failure. The intermittent hypoxia and disrupted sleep patterns associated with sleep apnea contribute to the development and progression of these conditions.

Type 2 Diabetes

There is a bidirectional relationship between OSA and type 2 diabetes. People with OSA have a higher risk of developing insulin resistance and impaired glucose tolerance, which can then lead to diabetes. Conversely, diabetes is also a risk factor for the development of OSA.

Obesity

Obesity and OSA often coexist, and there is a strong association between the two conditions. Excess body fat, especially around the neck and throat area, contributes to airway obstruction during sleep, leading to OSA. Weight loss significantly improves the severity of OSA in people living with obesity.

Neurocognitive Disorders

OSA has effects on cognitive function and is associated with an increased risk of neurocognitive disorders like cognitive impairment and dementia. The intermittent hypoxia and sleep fragmentation associated with OSA leads to neuronal damage and cognitive decline over time.

Depression and Anxiety Disorders

There is a bidirectional relationship between OSA and mental health disorders like depression and anxiety. OSA contributes to mood disturbances due to sleep disruption and oxygen desaturation, while people with depression or anxiety may be at higher risk of developing OSA due to altered sleep patterns and increased sympathetic activity.

Gastroesophageal Reflux Disease (GERD)

OSA and GERD often coexist, and there is evidence to suggest a bidirectional relationship between the two conditions. The increased negative intrathoracic pressure during apneic events promotes acid reflux, aggravating GERD symptoms. Conversely, GERD-related symptoms like nighttime heartburn exacerbate OSA by increasing arousal frequency during sleep.

Chronic Respiratory Conditions

Chronic respiratory conditions like chronic obstructive pulmonary disease (COPD), asthma, and bronchiectasis increase the risk of OSA. Airway obstruction and inflammation associated with these conditions predisposes people to sleep-disordered breathing.

Polycystic Ovary Syndrome (PCOS)

PCOS is a hormonal disorder commonly associated with OSA, especially in women with obesity. Hormonal imbalances associated with PCOS, like elevated testosterone levels, contribute to the development of OSA by promoting weight gain and altering upper airway anatomy.

These medical conditions often coexist with OSA such that you may experience worsening symptoms if either condition is left untreated. Proper diagnosis and management of sleep apnea are essential for mitigating the associated health risks and improving overall health outcomes. 

Now, you may be asking yourself, “What can I do at home to lessen the symptoms of sleep apnea?” Let’s talk about this next.

What Can I Do At Home For Sleep Apnea Relief?

While professional medical treatment is often necessary for effective management of sleep apnea, there are several lifestyle changes and home remedies that may help alleviate symptoms and improve sleep quality. Here are some strategies you should try at home for sleep apnea relief:

1. Maintain a Healthy Weight: Losing excess weight, if applicable, can significantly reduce the severity of sleep apnea symptoms. Even a modest weight loss can lead to improvements in breathing during sleep.

2. Sleep Position: Sleeping on your side helps to prevent the tongue and soft tissues in the throat from collapsing backward and obstructing the airway. This is why side-sleeping is often recommended for people with sleep apnea, so consider using a body pillow to maintain this position. Our Cuddler, for instance, provides ergonomic support, helping to ensure proper spinal alignment during the night.

3. Elevate Your Head: Elevating the head of your bed or using extra pillows to raise your head may help reduce snoring and alleviate mild sleep apnea symptoms by preventing the tongue and soft palate from collapsing backward.

4. Avoid Alcohol and Sedatives: Avoid consuming alcohol or sedatives, especially close to bedtime, to minimize the risk of sleep apnea episodes.

5. Quit Smoking: Quitting smoking can improve respiratory function and overall health, leading to reduced severity of sleep apnea.

6. Practice Good Sleep Hygiene: Establishing a regular sleep schedule, creating a relaxing bedtime routine, and optimizing your sleep environment (e.g., keeping the bedroom dark, quiet, and cool) can promote better sleep quality and reduce the frequency of sleep apnea episodes.

7. Use a Humidifier: Dry air can irritate the throat and nasal passages, exacerbating sleep apnea symptoms. Using a humidifier in your bedroom can help keep the air moist and prevent nasal congestion, making breathing easier during sleep.

8. Try Nasal Decongestants or Nasal Strips: If nasal congestion is contributing to sleep apnea symptoms, over-the-counter nasal decongestants or nasal strips may help improve airflow through the nasal passages, reducing the likelihood of airway obstruction during sleep.

9. Maintain Good Sleep Posture: Proper posture during sleep can help keep the airway open and reduce the risk of breathing difficulties. Avoid sleeping in awkward positions that may constrict the airway, like slouching or tucking your chin into your chest.

10. Practice Relaxation Techniques: Stress and tension can worsen sleep apnea symptoms. Practicing relaxation techniques like deep breathing, meditation, or progressive muscle relaxation before bedtime can help promote relaxation and reduce muscle tension, facilitating better sleep.

These home remedies provide some relief for mild sleep apnea symptoms, but they are not a substitute for professional medical evaluation and treatment. If you suspect that you have sleep apnea or if your symptoms persist despite home remedies, consult with a healthcare professional for proper diagnosis and management.

Next, let’s look at what signs you need to look out for to know that it’s time to see a doctor to check for sleep apnea.

When To See A Doctor

Here are some indicators of when to see a doctor for suspected sleep apnea:

1. Loud and Persistent Snoring: If you or your sleep partner notice loud and chronic snoring, especially if gasping and choking tag along, it could be a sign that sleep apnea has something to do with your experience.

2. Witnessed Breathing Pauses: If someone observes that you stop breathing or experience pauses in breathing during sleep, this is a red flag for sleep apnea.

3. Excessive Daytime Sleepiness: If you generally feel so tired or fatigued during the day, even though you’re sleeping for at least 8 hours every night, your body may be pointing fingers at sleep apnea.

4. Morning Headaches: Waking up with headaches in the morning can be a symptom of sleep apnea, especially if they happen regularly.

5. Frequent Nighttime Urination: Waking up frequently during the night to urinate (nocturia) can be a sign of sleep apnea, as the frequent awakenings interfere with normal sleep patterns.

6. Difficulty Concentrating or Remembering: Problems with concentration, memory, or cognitive function can be caused by disrupted sleep due to sleep apnea.

7. Mood Changes: Irritability, mood swings, depression, or anxiety may be related to poor sleep quality. It is important to see a sleep specialist to check if sleep apnea could be the culprit behind this.

8. High Blood Pressure: If you have hypertension that is difficult to control despite medication, sleep apnea may be a contributing factor.

9. Other Health Conditions: Certain medical conditions, like type 2 diabetes, heart disease, or stroke, have been associated with an increased risk of sleep apnea.

If you experience any of these symptoms or risk factors, schedule an appointment with your primary care physician or a sleep specialist. They can conduct a thorough evaluation, which may include a physical examination, sleep history assessment, and possibly a sleep study (polysomnography) to diagnose or rule out sleep apnea.

Conclusion

While sleep apnea has some genetic roots, it is not entirely up to your DNA whether or not you develop this sleep disorder. Understanding if sleep apnea is hereditary or not simply shows that it is a complex sleep disorder, which is why it needs careful medical attention.

Even if you have a family history of sleep apnea or other risk factors like obesity and cardiovascular diseases, you can still do your best to embrace a holistic lifestyle to reduce your chances of developing sleep apnea. And if you already have sleep apnea, not to worry – there are multiple ways to get proper treatment! Sleep apnea may be part of your sleep experience, but it doesn’t get to define your journey towards restful nights.