Many conditions that affect your breathing tend to get worse if you smoke. Evidence suggests that sleep apnea is no exception, as smoking causes changes in the airway that can make it harder to breathe at night.

You might have some questions about smoking and your sleep apnea risk. Can past smoking still affect present sleep apnea? Does vaping increase the risk of sleep apnea as much as smoking cigarettes?

We’ll cover these and other questions in this article as we explore the connections between tobacco smoking and sleep apnea severity.

Does Smoking Cause Sleep Apnea?

Research shows that smoking tobacco causes chronic inflammation in the upper airway, which can worsen symptoms of obstructive sleep apnea (OSA).

Smoking also affects sleep quality in general and can alter neuromuscular function (how your nerves and muscles communicate) in your upper airway.

Smoking Cigarettes and Sleep Apnea Risk

The association between smoking and OSA is not currently well established. One study linked a higher number of cigarettes smoked per day with more severe OSA.

People who currently smoke were 1.2 times more likely to have OSA than people who had smoked in the past or who had never smoked before. Those who smoked in the past were about 1.49 times more likely to have OSA than people who had never smoked.

Despite these slightly higher risks, smoking wasn’t as strong a risk factor for OSA as age, body mass index (BMI), and alcohol use.

A similar study determined active cigarette smoking to be an OSA risk factor, whereas former smoking habits didn’t make much of a difference.

Vaping and Sleep Apnea Risk

E-cigarettes or vapes are electronic devices that are an alternative to conventional cigarettes. They may contain nicotine and other chemicals, and they’re often marketed as less harmful than conventional cigarettes.

Interestingly, vaping and e-cigarettes don’t appear to increase the risk of OSA as much as cigarette smoking. A study found that people who used e-cigarettes had about the same risk of developing OSA as people who didn’t use tobacco or nicotine products.

However, the study also found that people who smoke both cigarettes and e-cigarettes have the highest risk of OSA among all smoking groups.

If you smoked both cigarettes and e-cigarettes in the past, your risk for OSA is higher than the average. A study in Tobacco Induced Diseases linked past cigarette and e-cigarette use to a higher risk of OSA, especially in women and people with sedentary lifestyles.

How Smoking Affects Sleep

In general, smoking can affect your sleep and nighttime breathing. Some of its impacts may also worsen OSA or other nighttime conditions, like insomnia and restless leg syndrome.

Here are some of the ways smoking can affect your sleep, which may contribute to sleep apnea.

Reducing Neuromuscular Function in the Airway

Smoking can affect how the nerves and muscles in your upper airway communicate. Nicotine in tobacco can reduce neuromuscular reflexes that support your breathing.

Nicotine tends to loosen upper airway muscles and weaken nerve reactions. When these reflexes are impaired, your upper airway is more likely to collapse, which can pause your breathing in OSA.

Increasing Airway Inflammation

Smoking tobacco products can cause chronic inflammation in your upper airway. This inflammation can narrow your airway even further as the tissues expand, making it more likely to collapse.

Reducing Sleep Quality

Many studies have found links between smoking habits and poor sleep quality. Nicotine is a stimulant, which means it increases energy and alertness.

Although many people reach for a bedtime cigarette, smoking nicotine makes it harder to get a good night’s sleep. You may find it harder to fall asleep or stay asleep.

Smoking can also affect your sleep cycle and prevent normal fluctuations between rapid eye movement (REM) and non-REM sleep.

If you smoke tobacco products, you tend to spend more time in “lighter” and less restful stages of sleep. People who smoke are also more likely to snore, which can be a sign of OSA.

Can Smoking Make Sleep Apnea Worse?

Although smoking may only slightly increase the risk of OSA, evidence shows that smoking can make sleep apnea more severe.

Between the upper airway inflammation, reduced neuromuscular function, and poorer sleep quality, you may find that smoking makes your sleep apnea symptoms worse and affects your quality of life.

Smoking can affect nighttime breathing, but nicotine use may also worsen daytime sleep apnea symptoms. Sleep apnea already prevents restful sleep, and nicotine may worsen the daytime sleepiness, morning headaches, and irritability that commonly occur with sleep apnea.

Research shows that people with OSA who smoke are more likely to experience OSA complications, like hypertension (high blood pressure), cardiovascular disease, and metabolic syndrome.

Smoking and OSA each independently increase your risk of heart disease — when you put them together, your risk increases even further.

Smoking and CPAP

Continuous positive airway pressure (CPAP) is one of the most reliable and widely used sleep apnea treatments. Studies show that smoking can make people less compliant with their CPAP therapy, which ultimately makes CPAP less effective for managing sleep apnea.

Usually, positive airway pressure (PAP) therapies help reduce leptin levels in people with sleep apnea. Leptin is a hormone from fat tissue that regulates your hunger and helps you feel full.

Hyperleptinemia (high leptin levels) is associated with obesity and can make your body less responsive to leptin, causing you to feel hungrier.

CPAP doesn’t appear to reduce leptin levels in people who smoke as much as in those who don’t. In fact, leptin levels increased even more in about 40 percent of people who smoked and tried PAP therapies for sleep apnea.

What Happens When You Stop Smoking

When your sleep suffers due to smoking, the lack of quality sleep can increase tobacco cravings that make it harder to stop smoking. However, stopping smoking may improve your OSA symptoms.

Smoking cessation (quitting smoking) may have a positive impact on your sleep apnea by reducing upper airway inflammation and making CPAP therapy more effective.

Although a history of smoking can still increase the risk of sleep apnea, people who currently smoke are more likely to have OSA than people who have stopped smoking for at least six months.

Also, smoking cessation can reduce your risk of common sleep apnea complications like heart disease, as well as other respiratory conditions like chronic obstructive pulmonary disease (COPD).

Smoking Cessation Resources

Tell your doctor if you’d like to stop smoking. Your healthcare provider can give you tips that help reduce nicotine and tobacco cravings. The longer you avoid smoking and tobacco products, the more health benefits you’ll notice.

Your doctor might suggest nicotine replacement therapy (e.g., nicotine patches or gum). Some research suggests that using nicotine gum instead of smoking before bed may reduce sleep apnea episodes during the night.

You can also find tools and support for smoking cessation from organizations like the American Lung Association and the Centers for Disease Control and Prevention. Ask your healthcare provider about resources and support groups for smoking cessation in your area.

Join the Conversation

On MySleepApneaTeam, people share their experiences with sleep apnea, get advice, and find support from others who understand.

Have you noticed changes in your sleep apnea symptoms related to smoking or quitting smoking? Let others know in the comments below.