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Smoking and Sleep Apnea: What You Should Know

By Lan Pham, Manjari Bansal
Smoking may make you more susceptible to sleep apnea. Here are four facts about the link between smoking and sleep apnea.

It’s no secret that smoking has a potential negative effect on your health. It could even impact your sleep quality and predispose you to developing sleep apnea. In fact, research has shown a possible connection between smoking and obstructive sleep apnea (OSA), the most common form of the disorder. While additional studies are needed to determine the specific factors linking smoking to sleep apnea, research has provided some important insights. Read on for 4 facts about smoking and sleep apnea. 

There are a number of theories that could explain the link between smoking and OSA. 

A 2014 study published in the journal Chest reports that the following four mechanisms may explain the link between smoking and OSA: 

Changes in Sleep Architecture. Smoking disturbs sleep architecture (i.e., the basic pattern of sleep stages) by causing sleep deprivation and sleep interruptions. The decrease in sleep quality associated with smoking could be an intermediate step toward developing OSA. 

“Smoking interferes with your body’s natural sleep cycle and sleep architecture—circadian rhythm and sleep cycles,” Holly Schiff, PsyD, a licensed clinical psychologist at Jewish Family Services of Greenwich, tells WebMD Connect to Care. “Heavy smokers display the greatest risk for sleep-disordered breathing.”

Inflammation in the Airway Passage. “Smoking acts as an irritant that can provoke swelling in the nose and throat, which reduces the space left for airflow. This makes it harder to breathe as the tissue in your throat becomes more swollen and irritated—this can cause obstructive sleep apnea,” Schiff says.

Arousal Threshold Changes. Researchers hypothesize that cigarette smoking can affect your arousal threshold, or your propensity to awaken from sleep. 

Pediatric studies show that infants exposed to maternal smoking have lower levels of both spontaneous and evoked arousals from sleep. In adults, studies have shown that current smokers demonstrate longer apneic episodes and greater oxygen desaturation levels. These findings suggest that smoking could disrupt the body’s normal triggers that rouse you from sleep because you aren’t breathing. 

Changes in the Neuromuscular Reflexes. Another theory is that the nicotine in cigarettes impairs muscular reflexes in the upper airway, leading to OSA. This theory is supported mainly by studies on animals, and additional human studies are required. 

Smoking may increase the severity of OSA.

A 2019 study published by Advances in Respiratory Medicine found that smoking impacted the severity and daytime symptoms of OSA. In the examined group, smokers were found to have measurably more severe sleep apnea, lower blood oxygen saturation during sleep, and higher daytime sleepiness when compared to non-smokers.

“Smoking cigarettes puts you at a higher risk of developing obstructive sleep apnea and may actually increase its severity,” Schiff says.

Smoking cessation may improve the symptoms of OSA.

The 2014 study published by Chest reports that giving up smoking can be beneficial for OSA patients. 

Nicotine withdrawal may cause symptoms similar to OSA, like sleeplessness and irritability, when smoking cessation first begins. However, data demonstrates that those who give up smoking on a long-term basis enjoy better sleep quality than those who do not. 

Exposure to tobacco smoke can be a risk factor for OSA in children.

A 2020 study published in Pediatrics International evaluated the correlations between exposure to cigarette smoke and the occurrence of sleep-disordered breathing in children. 

160 children between the ages of 6 to 18 years were enrolled in the study. The evaluation went on for almost 4 years, from 2012 to 2016. It found that OSA occurs more often in children who have been exposed to tobacco smoke. These children also exhibited a higher rate of other issues like tiredness, irritability, and concentration problems.

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