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Sleep Apnea and Hypothyroidism

Learn about the connection between sleep apnea and an underactive thyroid.
Sleep Apnea and Hypothyroidism
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English writer Thomas Dekker was so right when he said, “Sleep is the golden chain that ties health and our bodies together.” You know that sleep is essential for your health. But did you know that not getting enough -- or good quality -- sleep increases your risks for:

  • Heart and breathing problems?
  • Metabolism-related disorders such as obesity?
  • Cognitive and memory impairment?
  • Reduced immunity?

While we all have good intentions when it comes to sleep, getting a good night’s rest can be challenging. Sleep can be disrupted due to a poor sleep environment or sleep hygiene, stress, or medical conditions, among other causes. Ahead, a Q&A on sleep apnea –  a health condition that can interfere with your sleep and your thyroid function.

What is sleep apnea?

Sleep apnea is a condition that causes you to stop and restart breathing while sleeping. As a result, you can become deficient in oxygen.

The signs and symptoms of sleep apnea include the following:

  • Dry mouth
  • Daytime sleepiness F
  • Headaches
  • Loud snoring while sleeping
  • Gasping for air or making choking sounds while sleeping
  • Sexual dysfunction
  • Waking up often during the night to use the bathroom

There are two types of sleep apnea:

  • Obstructive sleep apnea (OSA) occurs when your upper airway becomes blocked, reducing or stopping your airflow.
  • Central sleep apnea (CSA) occurs when your brain doesn’t signal your chest muscles that control breathing. Certain medical conditions, such as amyotrophic lateral sclerosis (ALS) or myasthenia gravis (MG), change how your brain controls chest muscles, putting you at risk for CSA.

Risk factors for sleep apnea

While the result of OSA and CSA is the same -- breathing stops and restarts while sleeping --  they have different risk factors.

What is the relationship between sleep apnea and thyroid dysfunction?

An imbalance of hormones can contribute to both types of sleep apnea in different ways. For instance, changes in growth hormone, insulin, and thyroid levels can affect the shape or size of your tongue, face, or airway, increasing your risk for OSA. And, a hormone imbalance may alter how your brain controls your breathing, triggering CSA.

Research shows that hypothyroidism increases an individual’s risk of sleep apnea, and studies have found that 10% to about 25% of people with hypothyroidism have OSA. One study of 100 hypothyroid patients found that 74% of the patients with hypothyroidism had OSA! 

There’s one piece of good news, however: If you have OSA, this does not increase your risk of developing hypothyroidism later in life.

A large 2019 study found those with hypothyroidism were two times more likely to have a sleep apnea diagnosis than those without hypothyroidism. This study also noted that those with subclinical hypothyroidism (a mild form of hypothyroidism) who were not taking thyroid medication were less likely to have OSA than those with overt hypothyroidism.

One sign of hypothyroidism can be the enlargement of the thyroid gland, known as goiter. As your thyroid gets bigger, it reduces air movement through your trachea (windpipe) to your lungs, thus increasing your risk of OSA.  Hypothyroidism is also associated with an enlargement of the tongue, known as macroglossia.

Some of the other ways that hypothyroidism may contribute to an increased risk of sleep apnea include:

  • Obesity-related body changes, such as a narrowing of the upper airway
  • Obstruction caused by deposits of proteins and sugars in the upper airway
  • Altered respiratory muscle function  

In summary, studies support the link between hypothyroidism and OSA. However, the degree of thyroid dysfunction does not predict the severity of OSA.

Will taking thyroid medication improve sleep apnea?

Since hypothyroidism contributes to sleep apnea, you may wonder if taking thyroid medication will resolve your sleep apnea. While some people with hypothyroidism show improvement in their OSA symptoms while taking thyroxine (T4) treatment, others have no improvement. 

A 2016 study reported that thyroid medication could sometimes improve OSA, but rarely will it reverse it completely. Individuals may have other risk factors, such as obesity, contributing to OSA. But for those with CSA, thyroid medication may have a more significant effect on their sleep apnea.

The prevalence of OSA is relatively high in hypothyroidism. Patients with hypothyroidism should be screened for OSA for early diagnosis, especially in individuals with higher BMI. Treatment of hypothyroidism reduces the prevalence of OSA.

How is sleep apnea treated?

If you or someone you know has sleep apnea, you may have heard of a CPAP breathing machine. CPAP stands for continuous positive airway pressure. This machine provides constant air pressure, keeping your airway open while you breathe in. Other breathing machines or oral devices are also available to treat apnea, depending on your specific type of sleep apnea.

There are also lifestyle changes that you can make to help improve sleep apnea. These changes not only help your sleep apnea but can also improve your thyroid health. They include:

A note from Paloma Health

If you’re hypothyroid and diagnosed with OSA,  your sleep apnea may improve on optimal thyroid hormone replacement therapy alone. However, remember that only a subset of hypothyroid patients will have a resolution of the OSA on thyroid hormone replacement treatment alone, and you’re more likely to need CPAP treatment.  As a result, experts recommend that patients with hypothyroidism and OSA not postpone starting CPAP therapy to wait for optimal thyroid levels.  

If you have sleep apnea, be aware that research has shown that as many as 8% of people with moderate or severe obstructive sleep apnea also have undiagnosed subclinical hypothyroidism. If you’ve been diagnosed with OSA, thyroid testing must be part of your initial evaluation process. One way to simplify the process is by periodically measuring your thyroid hormone levels with the convenient Paloma Complete Thyroid Test Kit. This easy-to-use test kit accurately measures your TSH, Free T4, Free T3, and Thyroid Peroxidase Antibodies (TPOAb) from the convenience of home. 

If you have an underactive thyroid, consider working with one of Paloma’s knowledgeable thyroid specialists to help map out a treatment plan and optimize your thyroid function. Schedule an appointment today.

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Emilie White, PharmD

Clinical Pharmacist and Medical Blogger

Emilie White, PharmD is a clinical pharmacist with over a decade of providing direct patient care to those hospitalized. She received her Doctor of Pharmacy degree from Massachusetts College of Pharmacy and Health Sciences. After graduation, Emilie completed a postgraduate pharmacy residency at Bon Secours Memorial Regional Medical Center in Virginia. Her background includes caring for critical care, internal medicine, and surgical patients.

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