Blood Pressure And Sleep Apnea

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Sleep medicine is one of the fastest-growing specialties in medicine for a very good reason: more and more people have sleeping problems. Based on current data, more than 50 million Americans already suffer from 80+ types of sleep disorders. An additional 20 to 30 million Americans suffer from intermittent sleep problems each and every year. Some of these sleep disorders like sleep apnea can even affect blood pressure.

About 25 million Americans, in other words, one in five adults suffer from sleep apnea. Many cases are not diagnosed and go undetected. Sleep apnea is associated with high blood pressure, heart diseases, strokes, and cognitive dysfunction. 

About Sleep Apnea

Sleep apnea is defined as a sleep disorder that causes episodes of abnormal breathing during sleep. There are three major types of sleep apnea: obstructive sleep apnea (OSA), central sleep apnea (CSA), and complex sleep apnea syndrome (both OSA and CSA).

Obstructive sleep apnea is more common. It is also the type of sleep apnea associated with high blood pressure and more serious complications. While CSA is not known to be associated with high blood pressure, it has been linked with heart failure. 

During sleep, a person with obstructive sleep apnea will experience episodes of airway collapse that block the normal airflow in the lungs, leading to snoring and gasping during sleep. The underlying mechanism for central sleep apnea is different. Those breathing lapses are due to impaired communication between the brain and the muscles involved in breathing. 

Sleep Apnea Symptoms 

Before having a sleep study to diagnose obstructive sleep apnea, a doctor may suspect sleep apnea based on a few key symptoms: snoring, choking, gasping at night, and episodes when the breathing stops. Restless legs would be another clue, as it is often associated with sleep apnea.

Since these symptoms occur during sleep, the person with OSA will not be aware. It is usually his/her partner who notices these symptoms. Other symptoms of obstructive sleep apnea are experienced during the day, and therefore noted by the person who suffers from this condition: waking up with a dry mouth, headaches in the morning, sleepiness during the day, irritability, and problems with focus and concentration. 

Obstructive sleep apnea risk factors include: 

  • Excess weight – This significantly increases the risk of sleep apnea. Next, is the neck circumference because those with thicker necks seem to have narrower airways. 
  • Age – is another factor, as the risk of developing sleep apnea increases with age.
  • Gender – Men are 2-3 times more likely to be diagnosed with sleep apnea. For women, the risk increases after menopause and if they are overweight.  
  • Smoking, drinking alcohol, and taking certain medications (i.e. sedatives, tranquilizers) – All of these are associated with sleep apnea.
  • Medical conditions such as high blood pressure, asthma, diabetes, Parkinson’s disease, hormonal imbalances, history of stroke

How High Blood Pressure And Sleep Apnea Are Connected 

In healthy people, the levels of blood pressure decrease at night between 10-20%. This is a normal, physiological process called “blood pressure dipping.” However, in cases of severe obstructive sleep apnea, this blood pressure dip is less than 10%. This is an abnormal pattern that increases the risk of heart diseases. Also, OSA is linked with higher than normal blood pressure rises in the morning. This problem adds to the risk of cardiovascular problems. 

Poor sleep strains the heart, and obstructive sleep apnea activates the sympathetic nervous system, or the “fight or flight response,” which causes an increase in blood pressure and heart rate.

When a person has obstructive sleep apnea and has a brief episode when stops breathing, it stimulates the sympathetic nervous system, triggering a spike in blood pressure when breathing resumes.

How To Avoid High Blood Pressure And Sleep Apnea

While there are risk factors you can’t change (like your age), there are factors that you can control and some that you can influence.

  • Avoid bad habits such as smoking and excessive drinking.
  • Lose excess weight slowly so you can maintain it long-term. Aim to lose one pound a week, which means you need to burn off about 500 calories a day more than you eat. Use a combo of diet and exercise.
  • Monitor your blood pressure. Know the numbers. If it is okay but isn’t great, watch it. Normal blood pressure is less than 120/80 mmHg. If you have somewhat high blood pressure, stage 1 and stage 2, visit your doctor. Seek medical treatment right away if your blood pressure is higher than 180 mmHg SBP or higher than 120 mmHg DBP. 
  • If you have diabetes, Parkinson’s disease, hormonal disorders, or asthma, make sure they are well controlled. 
  • If you have some of the risk factors above, ask your doctor for a sleep test. This is the best way to know if you have sleep apnea.