How Sleep Apnea Affects Brain Function, Heart Health, and Much More

The snoring grows louder, like it’s building to some kind of crescendo. But instead, the loud breathing stops. All is quiet. A mo­ment later, there is a sudden gasp for air and the sequence begins again.

While obstructive sleep apnea (OSA) doesn’t always feature loud snoring, it is characterized by pauses in breathing—dozens or even hundreds of times a night depending on the severity of the condition. An estimated 40 million people in the United States have OSA, a sleep disorder in which the upper airway becomes blocked during sleep, causing you to stop and start breathing throughout the night.

But OSA is not simply a sleep problem that leaves you tired the next day. It is a major risk factor for memory and thinking-skills problems, as well as high blood pressure and other cardiovascular and cerebrovascular complications, says John Winkelman, MD, PhD, Chief of the Sleep Disorders Clinical Research Program at Massachusetts General Hospital.

Dr. Winkelman explains that OSA affects your health in three main areas. The first is a decrease in oxygen reaching the brain on a consistent basis. The second is the activation of the sympathetic nervous system, which increases your blood pressure, heart rate, and the production of stress hormones. The third is the disruption of sleep. “All of those things contribute to the brain-related negative consequences of sleep apnea,” Dr. Winkelman says.

OSA and the Brain

Even though you aren’t consciously aware of every pause in breathing (apnea), a part of your brain awakens each time you gasp to restart your (apnea), a part of your brain awakens each time you gasp to restart your breathing. That means you spend more time in the lighter stages of sleep, rather than the deeper, more restorative stages that support optimal brain health.

The ways in which sleep apnea affects thinking skills is an active area of research. OSA may lead to both short-term and long-term impacts on memory and thinking skills, as well as on your mental and emotional health.

A study presented at the American Academy of Neurology’s 2024 annual meeting found that people who experience sleep apnea may be more likely to have memory or thinking problems. The findings were similar

to other research that has found a strong association between sleep apnea and thinking-skills troubles.

As for long-term problems associated with OSA, researchers have also published several studies in recent years suggesting a strong connection between OSA and an increased risk of dementia. One meta­analysis including 11 studies involving more than 1 million adults found that individuals with sleep apnea had increased risks of developing Alzheimer’s disease, Parkinson’s disease, and certain neurocognitive disorders down the road.

One possible explanation for the increased risk of cognitive impairment caused by OSA is that decreased oxygen levels can, over time, damage the brain’s white matter—the network of nerve fibers that allow brain cells to communicate with one another. Without optimal communication, your cognitive function can suffer.

Dr. Winkelman notes that OSA can lead to decreases in daytime alertness, mood, and quality of life.

Reduced daytime alertness means you are less able to pay attention and process new information. As a result, you’ll have a harder time remembering that information. “We talk about a pyramid of cognitive function, and at the top of the pyramid is your ability to maintain alertness,” Dr. Winkelman says. “If  you can’t attend or pay attention, you can’t learn and you can’t remember.”

And just as OSA can affect your ability to focus and stay sharp, it can also negatively affect your mood. Some of these mood-related problems range from occasional feelings of grouchiness and impatience after an especially poor night’s sleep to more serious OSA-associated changes, such as stress, depression, and anxiety.

The combination of cognitive and psychological impacts can, as you might expect, reduce your quality of life and mental well-being.

Treating OSA

Several types of treatments are available for OSA, though the gold standard remains continuous positive airway pressure (CPAP). With CPAP therapy, you wear a mask over your mouth and/or nose, and that mask is attached to a flexible tube that connects to a small bedside machine that blows air into the tube. CPAP helps keep your upper airway open, so there is no breathing pause.

The key for CPAP to be effective is that it must be used properly for at least four hours a night and should be used nightly, not occasionally. Consistent use can be challenging for some people, Dr. Winkelman says. “About a third of people love it right off the bat and a third of people can learn to love it, or at least use it regularly,” he explains. “And a third of people are never going to use it.”

He adds that it can take some time to get used to CPAP, both as the user and that person’s bed partner. But the results can be life-changing. “If people use CPAP, many of the negative health consequences of sleepapnea can be addressed,” Dr. Winkelman says, noting that CPAP users often report improvements in mood, alertness, and quality of life.

There are alternatives to CPAP, including oral appliances that also help keep the airway open. These include mandibular repositioning devices that fit like a mouthpiece over your upper and lower teeth and keep the jaw positioning slightly forward to prevent it from sliding back and blocking your airway. The other oral appliance is a tongue-retaining device that keeps the tongue from sliding back to block your airway.

In some cases, surgery to remove excess tissue in the back of the throatcan reduce airway blockage. Similarly, a tonsillectomy can help some people who have especially large tonsils.

Dr. Winkelman notes that weight loss can sometimes reduce sleep apnea problems, as can changing your sleeping position. OSA is sometimes more problematic when you sleep on your back, so special pillows or home remedies such as sewing a tennis ball into the back of a T-shirt or pajama top can help keep you sleeping on your side.

If you suspect you have OSA or you suspect your bed partner has OSA, talk with your doctor or a sleep specialist. You may be able to learn more about your condition and treatment options with a sleep test in an overnight sleep lab or with a home sleep apnea test in your own bed.

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