How is Sleep Apnea Affecting Your Brain?

by on March 28, 2017 | Posted in Sleep Apnea

Obstructive sleep apnea (OSA) not only has a large effect on the heart but can also alter and cause severe effects to the brain. These changes in brain matter can damage to neurons that can lead to memory loss, Alzheimer’s disease and other complications. In recent studies, it is shown that those with sleep apnea have changes of neurotransmitters in the brain.

People with sleep apnea tend to experience symptoms that include excessive daytime fatigue, shortened attention span, moodiness, shortened response time and reduced short-term recall. These are just a small range of daytime symptoms caused by lack of sleep and waking up multiple times throughout the entire night. Studies have shown that people with sleep apnea have trouble converting short-term memories into long-term ones. This memory-creating process occurs during sleep, and if you don’t sleep it leads to impaired memory formation and forgetfulness.

Sleep apnea may hasten memory and cognitive thinking declines, leading to earlier diagnoses of mild cognitive impairment and Alzheimer’s disease. On an average people with OSA were diagnosed with mild cognitive impairment (MCI) nearly 10 years earlier than those who are healthy according to New York University researchers.

Patients with Alzheimers Disease have a five times higher chance of presenting with OSA than cognitively non-impaired individuals of similar age. In addition, data also suggests that around half of patients with Alzheimers Disease have experienced OSA at some point after their initial diagnosis. The changes in cerebral blood flow and the cellular redox status in OSA patients contribute to cognitive decline and may further aggravate Alzheimer’s progression.

“This study is adding to the emerging story that sleep apnea may be contributing in some way to the acceleration of cognitive decline as you age,” said study coauthor. Dr. Andrew Varga, an instructor in medicine at the New York University Sleep Disorders Center. “And that is potentially another good reason to get evaluated and treated.”

Sleep Apnea can actually change the size of the brain. Duress caused during an apnea ( which starves the brain of oxygen) paired with chronic fatigue, can cause physical, & measurable brain damage. Researchers at UCLA compared the mammillary bodies, structures in the brain that are responsible for memory storage of several adults suffering from sleep apnea with those of healthy people. It was concluded that the mamillary bodies in the people with the sleep disorder were nearly 20% smaller.

Doctor Seung Bong Hong of the Sungkyunkwan University School of Medicine in Seoul to concluded that “Poor sleep quality and progressive brain damage induced by OSA could be responsible for poor memory, emotional problems, decreased cognitive functioning and increased cardiovascular disturbances.” In 2008, a UCLA study found significant damage in the brain’s fiber pathways and structural changes in its white matter. These are areas that regulate mood, memory, and blood pressure.

A February 2016 study published in the Journal of Sleep Research by the UCLA School of Nursing investigated the injury caused to the insular cortex of the brain by sleep apnea. It focused on the levels of two important brain chemicals, called neurotransmitters: glutamate and gamma-aminobutyric acid, known as GABA. “We actually found substantial differences in these two chemicals that influence how the brain is working,” said Paul Macey, the lead researcher on the study and an associate professor at the UCLA School of Nursing. “It is rare to have this size of the difference in biological measures,” Macey said. “We expected an increase in the glutamate because it is a chemical that causes damage in high doses and we have already seen brain damage from sleep apnea. What we were surprised to see was the drop in GABA. That made us realize that there must be a reorganization of how the brain is working.” Macey results were encouraging. “In contrast with damage, if something is working differently, we can potentially fix it.” “Stress, concentration, memory loss — these are the things people want fixed.”

There is evidence that treating sleep apnea, (with an Oral Appliance or in this particular study with CPAP therapy) can possibly return a patients’ brain chemicals back to its normal levels. According to the American Academy of Sleep Medicine, studies evaluated the effects of therapy on several subjects who had significant damage of their brain matter. However, after a year of treatment, the patients’ white matter was almost completely restored, while their gray matter had a faster recovery time of only three months. The results of several studies suggest that the early treatment of OSA, particularly in the early stages of Azlhermiers and dementia, may decelerate dementia progression (Ancoli-Israel et al., 2008; Cooke et al., 2009b; Troussière et al., 2014).

If you have symptoms of Sleep Apnea, talk to your us and find out more about testing for sleep apnea. Raphaelson Dental Sleep Center offers a home sleep study that can help diagnose your symptoms. If you’re ready to schedule a sleep study contact us now.


Ancoli-Israel S., Coy T. (1994). Are breathing disturbances in elderly equivalent to sleep apnea syndrome? Sleep 17, 77–83. [PubMed]

Ancoli-Israel S., Klauber M. R., Butters N., Parker L., Kripke D. F. (1991). Dementia in institutionalized elderly: relation to sleep apnea. J. Am. Geriatr. Soc. 39, 258–263. 10.1111/j.1532-5415.1991.tb01647.x [PubMed] [Cross Ref]

Ancoli-Israel S., Palmer B. W., Cooke J. R., Corey-Bloom J., Fiorentino L., Natarajan L., et al. . (2008). Cognitive effects of treating obstructive sleep apnea in Alzheimer’s disease: a randomized controlled study. J. Am. Geriatr. Soc. 56, 2076–2081. 10.1111/j.1532-5415.2008.01934.x [PMC free article] [PubMed] [Cross Ref]

Cooke J. R., Ancoli-Israel S., Liu L., Loredo J. S., Natarajan L., Palmer B. S., et al. . (2009a). Continuous positive airway pressure deepens sleep in patients with Alzheimer’s disease and obstructive sleep apnea. Sleep Med. 10, 1101–1106. 10.1016/j.sleep.2008.12.016

Troussière A. C., Charley C. M., Salleron J., Richard F., Delbeuck X., Derambure P., et al. . (2014). Treatment of sleep apnoea syndrome decreases cognitive decline in patients with Alzheimer’s disease. J. Neurol. Neurosurg. Psychiatr. 85, 1405–1408. 10.1136/jnnp-2013-307544 [PubMed] [Cross Ref]

American Academy of Sleep Medicine
Macey, P. M., Sarma, M. K., Nagarajan, R., Aysola, R., Siegel, J. M., Harper, R. M. and Thomas, M. A. (2016),

Obstructive sleep apnea is associated with low GABA and high glutamate in the insular cortex.
Journal of
Sleep Research. doi: 10.1111/jsr.12392

>Science Daily

University of California – Los Angeles. “Memory Loss Linked To Common Sleep Disorder.” ScienceDaily. ScienceDaily, 13 June 2008.

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Currently, seventy million Americans have sleep disorders and sleep apnea affects at least 12 million to 18 million of them.  Sleep apnea is a disorder that causes uncontrollable pauses in breathing, or shallow breaths during sleep. Snoring is a common symptom, although you may have sleep apnea even if you do not snore. Untreated, sleep apnea can be potentially life-threatening, can lead to serious medical consequences and a decreased quality of life. Pauses in your breathing cause less oxygen to make its way to the brain, overworks the cardiovascular system and other organs in your body. People with sleep apnea are triggered to wake up suddenly out of sleep and gasp for air in a Flight or Fight response. These sleep apnea episodes will wake you up from a deep sleep into light sleep stage, never allowing you to get the restful sleep you need. The multiple episodes of low blood oxygen (hypoxia or hypoxemia) can lead to sudden death from an irregular heartbeat. Sleep apnea can cause symptoms, including loud snoring, choking noises, poor sleep, and feelings of fatigue during the day. Long-term complications of sleep apnea can include an increased risk of heart disease, stroke, diabetes, obesity, depression, memory problems, viruses and sexual dysfunction. Sleep Apnea can cause accidents, learning or memory problems and a poor performance in school or at work.

Fortunately, sleep apnea can be treated with a custom oral appliance, which supports the jaw in a forward position to help maintain an open upper airway. Lifestyle changes which include losing weight, reducing inflammation, improving your diet and starting a regular exercise routine will also help prevent Sleep Apnea.

1. Oral Appliance Therapy

Sleep Appliances are worn much like an orthodontic appliance or sports mouth protector. Worn during sleep to prevent the collapse of the tongue and soft tissues in the back of the throat, oral appliances promote adequate air intake and help to provide normal sleep in people who snore and have Sleep Apnea. Oral appliances are considered first-line therapy for patients who have been diagnosed Obstructive Sleep Apnea according to the American Academy of Sleep Medicine. They are also a great alternative for patients that cannot tolerate their prescribed CPAP. The oral appliance holds the lower jaw forward keeping the airway open. It prevents the tongue and muscles in the upper airway from collapsing and obstructing the airway.

Our oral appliances at Raphaelson Dental Sleep Center are very sleek in design- consisting of smooth, durable and comfortable material. It is also one of the strongest appliances currently available, making it an ideal treatment option for all patients, especially those who clench or grind their teeth at night.

2. Maintain a Healthy Weight

When you are overweight the fat deposits around your upper airway can obstruct normal breathing. If you’re a man with a neck circumference over 17 inches (43 centimeters) or women over 15 inches (38 centimeters, you have a significantly higher risk for sleep apnea.

Obesity increases a person’s risk for Sleep Apnea and poor sleep causes obesity affecting a person’s Leptin and Ghrelin (it is a vicious cycle). Sleep Apnea is most common among adults over 45 who are overweight, especially men, but can also affect women, people of normal weight and even children.

If you’re overweight or obese start with a goal of losing ten percent of your body fat. Here are some tips that can help you:

Eat a high fiber diet:  This means adding more fresh vegetables, fruit, nuts, seeds, sprouted beans or legumes, and ancient whole grains to your diet. Try to add at least 25–30 grams daily.

Eat foods that have healthy fats and high protein: Try cooking with coconut oil. It has natural fat-burning characteristics, and it benefits your gut too. Others healthy foods to add: olive oil, avocado, animal fats from lean meat, nuts and seeds. High protein foods are satisfying for hunger and help will help you build lean muscle too. Start off your morning with cage-free eggs, add some chicken to your lunch and maybe a fish to your dinner.

Get regular exercise: Exercise is not only essential to losing weight and live a healthy lifestyle but is also promotes a good sleep. It helps regulate hormones, burns calories and can break up nasal congestion. Go for a thirty-minute walk a couple of days a week. Park your car a little further from your destination. Take group classes at your local gym.

Natural oils:  Grapefruit, cinnamon, and ginger oil can help control your appetite, hormones and digestive symptoms.

4. Avoid Excessive Alcohol and Smoking

Alcohol relaxes the throat muscles, including the uvula and palate, which are important for controlling breathing. Smoking and alcohol can cause inflammation and fluid retention in the airway. And just in case you needed another reason to quit, people who smoke are three times more likely to have obstructive sleep apnea. So try to stop smoking and skip your night cap. If you plan drink do it at least three hours before going to bed.

Over the counter sleep aids, sedatives, and some prescriptions can have the same effects. Keep in mind, you are still waking up at night with these over the counter and prescription sleep aids although you may not be conscious of it. They only way to get a better sleep is to treat the root problem. Also, a lot of these medications can cause you to be more groggy during the day.

5. Treat Acid Reflux, Congestion and Coughs

Acid reflux/heartburn, congestion, and chronic coughs can interfere with normal breathing. Nasal congestion leads to difficulty breathing through the nose and can worsen symptoms of obstructive sleep apnea. Acid reflux causes irritation and swelling around certain throat muscles. Coughs might also irritate your upper airways and increase snoring. Reducing exposure to allergies and raising your head while sleeping can help reduce reflux and congestion. A humidifier will help drain your sinuses and more air to move through your airways. You can also rub essential oils such as eucalyptus oil which is also found in Vicks Vaporub on your chest before sleeping to help naturally open your airways and soothe a stuffy nose or a sore throat.

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Sudden cardiac arrest kills more than 300,000 Americans each year and often strikes without warning. Recent evidence suggests that there is a link between sudden cardiac arrest and sleep apnea, a common sleep disorder that causes a person’s breathing to pause or become shallow. This sleep disorder increases a person’s chances of developing heart disease and places them at a higher risk for sudden cardiac arrest.

Researchers found people with sleep apnea were 2.6 times more likely to have sudden cardiac arrest while sleeping during the hours of 10pm and 6am “The prevalence of obstructive sleep apnea in Western populations is high, (over 18 million) and will likely only continue to grow given the obesity epidemic and direct relationship between obesity and sleep apnea,” said lead author Dr. Apoor Gami, M.D., MSc, FACC, a cardiologist at Midwest Heart Specialists – Advocate Medical Group in Elmhurst, Ill.   In his study that sought out 10,000 Minnesota residents with suspected sleep disorders, it was determined that 78 percent of them had moderate sleep apnea. These patients were tracked and observed for up to 15 years, with an average follow-up every five years. During this time, it was reported that 142 of these patients had a fatal SCA or required resuscitation via CPR or automated external defibrillator (AED). Which concludes that the overall risk of this study was 0.27 percent. However, given that one in five adults suffer from even mild sleep apnea, this could add hundreds of thousands of people to that risk.

So why is sleep apnea so dangerous to the heart? It all has to do with your low blood oxygen levels. The body’s organs respond to the oxygen interruptions by demanding more blood.  This overworks the cardiovascular system and other major organs, which are supposed to be at rest. These sleep apnea episodes will wake you up from a deep sleep into light sleep stage, as your body reacts with a Flight or Fight response. The low oxygen levels during sleep can make you feel very tired in the morning and will contribute to more restless sleep. The multiple episodes of low blood oxygen (hypoxia or hypoxemia) can lead to sudden death from an irregular heartbeat. Individuals with severe sleep apnea, have an 80 percent risk for SCA due to their blood oxygen levels dropping below 78 percent.

Research shows that oral appliance therapy is a very effective treatment option for Obstructive Sleep Apnea. The oral appliance supports the jaw in a forward position to help maintain an open upper airway. It is considered the first line of treatment for OSA by the American Academy of Sleep Medicine. Oral appliance therapy is a benefit provided by many medical insurance plans and our sleep coordinators will be happy to assist you with any questions.

Raphaelson Dental Sleep Center is very proud to be one of the few dental practices on Long Island to help the medical community treat Sleep Apnea. “We are excited to screen our patients for Sleep Apnea, knowing that we are improving their health and potentially saving their lives”. We believe it is our moral responsibility to the health of our patients to screen them for Sleep Apnea. Our sleep specialists are here to help, Transform Your Sleep, Redefine Your Health”.

Symptoms of sleep apnea can include: snoring, silent pauses in breathing, choking or gasping sounds, daytime sleepiness or fatigue, insomnia, morning headaches, feeling irritable, depressed, or experiencing mood swings, and waking up frequently to urinate. Talk to us about your symptoms, we are here to help! Call us for a Free Airway Evaluation today.

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