What is Sleep Apnea?

Key Takeaways

• Large-scale studies show sleep apnea is linked to both high- and low-frequency hearing loss.

• Oxygen deprivation, reduced blood flow, and years of loud snoring may contribute to hearing damage.

• Treating sleep apnea can improve quality of life and may help protect hearing health.

What is Sleep Apnea?

Sleep apnea is a chronic sleep disorder where breathing repeatedly stops and starts during the night. These interruptions, called apneas, can last from a few seconds to over a minute and may occur dozens of times per hour. The most common form is obstructive sleep apnea (OSA), which happens when the throat muscles relax and block the airway during sleep.

When breathing stops, oxygen levels in the blood drop. The brain responds by briefly waking the person so breathing can resume. These awakenings are often so short that the sleeper does not remember them, but they fragment the night’s rest, leading to poor sleep quality.

Common symptoms include:

• Loud, chronic snoring that often disturbs a bed partner

• Gasping or choking during sleep

• Morning headaches, a dry mouth, or sore throat

• Daytime sleepiness, irritability, or difficulty concentrating

Risk factors for OSA include being over age 40, being overweight, smoking, drinking alcohol before bed, and having a family history of the condition. Sleep apnea can affect anyone, but older adults and people with certain health conditions such as high blood pressure or diabetes are more likely to develop it.

How is Sleep Apnea Linked to Hearing Loss?

Research over the past decade has found that people with sleep apnea have a significantly higher likelihood of hearing loss compared to those without the disorder. In one large-scale study of nearly 14,000 people, led by Dr. Amit Chopra, moderate sleep apnea was associated with a 31 percent increase in high-frequency hearing loss, a 90 percent increase in low-frequency hearing loss, and a 38 percent increase in combined high and low-frequency hearing loss.

Several mechanisms may explain this connection:

1. Reduced blood flow to the inner ear. The cochlea, which converts sound vibrations into nerve signals, depends on a steady supply of oxygen-rich blood to function properly.

2. Oxygen deprivation. Repeated drops in oxygen saturation during sleep can damage delicate hair cells in the ear that cannot regenerate once lost.

3. Noise damage from snoring. Years of exposure to loud snoring may contribute to gradual, noise-induced hearing loss.

These factors do not work in isolation. Many people with sleep apnea also have conditions such as high blood pressure, heart disease, or diabetes, all of which can impair circulation and raise the risk of hearing impairment.

High- vs. Low-Frequency Hearing Loss in Sleep Apnea

Hearing loss is not a single condition, and the type a person experiences can influence daily communication challenges.

• High-frequency hearing loss affects the ability to hear higher-pitched sounds, such as birds chirping, doorbells, or the consonant sounds in speech like “s” and “th.” This type can make conversations, especially in noisy settings, more difficult to follow.

• Low-frequency hearing loss makes it harder to hear lower-pitched sounds, such as deep male voices, thunder, or bass notes in music.

In the Chopra study, 19 percent of participants with moderate sleep apnea had high-frequency hearing loss, 1.5 percent had low-frequency hearing loss, and 8.4 percent had both. This suggests that sleep apnea may affect the entire hearing range, not just one part of it.

Other Ear and Balance Disorders Linked to Sleep Apnea

Hearing loss is not the only auditory concern connected to sleep apnea. Studies have identified possible links to other ear and balance problems, which can further impact daily life and wellbeing.

Tinnitus
Tinnitus is the perception of ringing, buzzing, or humming in the ears without an external source. Poor sleep quality, reduced oxygen, and circulatory changes can aggravate tinnitus symptoms. A 2017 case-control study in Taiwan found a significantly higher risk of tinnitus in people with sleep apnea compared to those without sleep disturbances.

Vertigo
Vertigo, a sensation of spinning or imbalance, may be more common among women with sleep apnea. In some cases, untreated OSA can worsen dizziness by limiting blood flow to areas of the brain that control balance.

Meniere’s Disease
This chronic condition, which causes episodes of hearing loss, vertigo, tinnitus, and ear fullness, may also be more common in people with sleep apnea. Treating sleep apnea can be an important step in managing Meniere’s symptoms by reducing the need for medications that might otherwise worsen dizziness.

Diagnosing Sleep Apnea and Hearing Loss

If you suspect sleep apnea, testing is important both for your overall health and your hearing. The most common diagnostic methods are:

• Polysomnography (PSG). This is an overnight sleep study performed in a clinic or hospital, where sensors monitor brain activity, heart rate, breathing patterns, and oxygen levels.

• Home sleep apnea tests. These portable devices measure airflow, breathing effort, and oxygen saturation while you sleep in your own bed.

For hearing, testing usually begins with:

• Audiograms. A full hearing evaluation that measures how well you hear different pitches and volumes.

• Hearing screenings. Quick checks that identify potential problems and determine if further testing is needed.

People diagnosed with sleep apnea should consider regular hearing assessments, since early detection can help limit the impact of hearing changes on communication and quality of life.

Treatment Options for Sleep Apnea

Treating sleep apnea is important for improving sleep quality, reducing health risks, and potentially protecting hearing. Several approaches are available:

CPAP Therapy
Continuous Positive Airway Pressure (CPAP) involves wearing a mask during sleep that delivers a steady stream of air to keep the airway open. CPAP is considered the most effective treatment for moderate to severe OSA, but some users need time to adjust to the equipment.

Oral Appliances
These custom-made devices reposition the jaw or tongue to improve airflow. They are often used for mild to moderate cases or for people who cannot tolerate CPAP.

Lifestyle Changes
Losing weight, quitting smoking, reducing alcohol consumption, and sleeping on your side can all help reduce apnea events. These changes also benefit heart and vascular health, which in turn supports hearing.

Surgical Options
In severe cases where physical obstructions cause OSA, surgery may be performed to remove or reduce tissue in the airway, correct structural problems, or implant nerve-stimulating devices.

Each treatment has strengths and limitations, and a sleep specialist can help determine the most appropriate plan based on the severity of the condition and the individual’s health profile.

Can Treating Sleep Apnea Protect Your Hearing?

There is growing evidence that addressing sleep apnea may help protect hearing health. By improving oxygen levels and circulation, treatment could reduce stress on the inner ear and slow the progression of hearing loss. While treatment may not reverse existing hearing damage, it can improve alertness, concentration, and energy levels, which may make it easier to manage hearing difficulties.

Because the research is still developing, specialists recommend a comprehensive approach that addresses both conditions, ensuring that hearing is monitored alongside sleep apnea management.

When to See a Doctor or Hearing Specialist

You should seek medical evaluation if you notice:

• Persistent loud snoring, especially if it is accompanied by gasping or choking

• Daytime sleepiness, memory problems, or difficulty focusing

• Changes in hearing, ringing in the ears, or frequent dizziness

Seeing both a sleep specialist and an audiologist can help identify and treat these issues early, improving both health and quality of life.

Frequently Asked Questions

Can sleep apnea cause permanent hearing loss?
It is possible. Studies suggest a link between sleep apnea and sensorineural hearing loss, which is usually permanent. While treatment cannot reverse this type of damage, it may prevent further progression.

Can CPAP improve hearing or tinnitus?
Some people report fewer tinnitus symptoms and clearer hearing after consistent CPAP use, likely because oxygen and blood flow improve. More research is needed to confirm these benefits.

Does loud snoring damage your ears?
Yes. Snoring can reach sound levels high enough to damage the delicate structures in the inner ear over time, especially with long-term exposure.

Should I get my hearing checked if I have sleep apnea?
Yes. Regular hearing tests are important for people with sleep apnea, since both conditions can develop gradually and may go unnoticed until they cause significant issues.