Sleep Apnea and Heart Health After 40
You spend seven or eight hours in bed and still wake up exhausted. Your partner may notice loud snoring, pauses in your breathing, or gasping during the night. These can be signs of obstructive sleep apnea (OSA), a condition that repeatedly interrupts breathing during sleep.
OSA can disrupt your sleep and place stress on your heart and blood vessels. It is linked to high blood pressure, atrial fibrillation, and other cardiovascular conditions.
What Is Obstructive Sleep Apnea?
Obstructive sleep apnea is the most common form of sleep apnea. It occurs when your upper airway repeatedly narrows or closes during sleep. As airflow slows or stops, your blood oxygen may fall, and your brain may briefly rouse you as breathing resumes. These episodes can interrupt restorative sleep even if you never remember waking up.
Why Does Sleep Apnea Become More Common With Age?
The risk of obstructive sleep apnea increases with age. Other factors include excess weight, a larger neck circumference, family history, and the shape of the upper airway. Alcohol, especially close to bedtime, can worsen breathing interruptions.
How Sleep Apnea Can Show Up During Menopause
The risk of sleep apnea increases during and after menopause, partly because of hormonal changes. Women with sleep apnea may notice fatigue, insomnia, frequent awakenings, or morning headaches. These symptoms can overlap with menopause symptoms. If they persist, ask your clinician whether a sleep evaluation makes sense.
How Does Sleep Apnea Affect Your Heart?
Breathing interruptions can activate the body’s stress response and cause temporary changes in heart rate and blood pressure. The effort to breathe against a blocked airway also changes pressure inside the chest, adding strain on the heart.
High Blood Pressure
Repeated spikes in blood pressure during sleep can contribute to hypertension and make existing high blood pressure harder to control. The American Heart Association recommends screening for OSA in people with resistant or poorly controlled high blood pressure.
Atrial Fibrillation
Atrial fibrillation (AFib) is an irregular heart rhythm that starts in the heart’s upper chambers. OSA is common in people with AFib. The American Heart Association recommends screening for OSA when AFib returns after cardioversion or ablation, two procedures used to manage abnormal heart rhythms.
Coronary Artery Disease, Heart Failure, and Stroke
OSA is also associated with coronary artery disease, heart failure, and stroke. If you have a cardiovascular condition and notice signs of sleep apnea, tell your clinician. Your symptoms and medical history can help determine whether you need a sleep study.
What Are the Warning Signs of Sleep Apnea?
During Sleep
- Loud, frequent snoring
- Breathing pauses that someone else notices
- Gasping or choking
- Frequent awakenings
On Waking or During the Day
- Dry mouth or a headache on waking
- Persistent fatigue or excessive daytime sleepiness
- Difficulty concentrating
Ask your primary care clinician about a sleep evaluation if someone notices pauses in your breathing, you regularly wake up gasping, or daytime sleepiness persists despite spending enough time in bed.
How Do Doctors Diagnose Sleep Apnea?
A clinician reviews your symptoms and medical history to decide which type of sleep testing is appropriate.
In-Lab Sleep Study
An overnight study at a sleep center, called polysomnography, measures breathing, oxygen levels, heart rhythm, brain activity, and body movements. An in-lab study is recommended in certain situations, including when a person has significant heart or lung disease, a history of stroke, or severe insomnia.
Home Sleep Apnea Test
A home test may be appropriate for some adults with suspected moderate to severe obstructive sleep apnea. A portable device typically measures airflow, breathing effort, and oxygen levels. If the results are negative or unclear, or the device fails to record enough usable data, the American Academy of Sleep Medicine recommends an in-lab study.
How Is Obstructive Sleep Apnea Treated?
CPAP Therapy
Continuous positive airway pressure (CPAP) uses gentle air pressure delivered through a mask to keep the airway open during sleep. CPAP can reduce breathing interruptions and daytime sleepiness. It may also modestly lower blood pressure. Randomized trials have yet to establish whether CPAP reduces heart attacks or strokes overall.
Oral Appliances
For some people, a custom oral appliance that moves the lower jaw forward can help keep the airway open during sleep. A sleep clinician and a dentist trained in dental sleep medicine can help determine whether this option is appropriate.
Lifestyle Changes
Depending on your situation, your clinician may recommend losing weight if you carry excess weight, exercising regularly, limiting alcohol before bed, or sleeping on your side. These measures can complement prescribed treatment.
Frequently Asked Questions
Can you have sleep apnea without loud snoring?
Yes. Some people with sleep apnea notice fatigue, insomnia, or morning headaches without reporting loud snoring. Breathing pauses or gasping during sleep are also reasons to ask about a sleep evaluation.
Can sleep apnea make high blood pressure harder to control?
Yes. Repeated interruptions in breathing can cause nighttime blood pressure surges. If your blood pressure stays high despite medication, ask your clinician whether screening for obstructive sleep apnea is appropriate.
What if my home sleep apnea test is negative?
Ask your clinician about an in-lab sleep study. The American Academy of Sleep Medicine recommends in-lab testing after a negative home test when evaluating suspected obstructive sleep apnea.
When to Ask About Your Leg Circulation
If you have leg pain when walking, one foot that feels cooler than the other, or a foot wound that heals slowly, ask about a vascular evaluation. These symptoms can occur with peripheral artery disease (PAD). South Florida Vascular Associates, led by Dr. William Julien, evaluates patients for circulation problems and offers minimally invasive treatment when appropriate.
Medical References
National Heart, Lung, and Blood Institute on sleep apnea causes and risk factors
National Heart, Lung, and Blood Institute on sleep apnea in women
National Heart, Lung, and Blood Institute on sleep apnea treatment
American Academy of Sleep Medicine guideline on diagnostic testing for obstructive sleep apnea
American Academy of Sleep Medicine guideline on positive airway pressure therapy
JAMA analysis of CPAP and recurrent cardiovascular events
American Heart Association guide to peripheral artery disease symptoms
Dr. William H. Julien is a double board-certified interventional radiologist and the founder and president of South Florida Vascular Associates. He has more than 30 years of experience and over 40,000 vascular procedures behind him. In 2004, he became the first physician in the U.S. to open an office-based interventional suite. He earned his medical degree at Washington University School of Medicine and completed fellowship training at the Miami Cardiac & Vascular Institute. Dr. Julien co-founded the Outpatient Endovascular & Interventional Society (OEIS) and trains physicians nationally in Prostate Artery Embolization (PAE).
