Sleep Apnea: Warning Signs You Shouldn't Ignore

Snoring is often treated as a joke or a nuisance for bed partners. But loud, frequent snoring can be a sign of a serious and common condition: sleep apnea. Many people who have it don't know it, because the symptoms happen while they're asleep.

What is sleep apnea?

Sleep apnea is a disorder in which breathing repeatedly stops and starts during sleep. There are two main types:

• Obstructive sleep apnea (OSA): the most common type. The muscles in the throat relax too much during sleep, causing the airway to narrow or close. Breathing pauses until the brain briefly wakes you up to reopen the airway, often with a gasp or snort.
• Central sleep apnea: less common. The brain doesn't send proper signals to the muscles that control breathing.

These pauses can happen dozens or even hundreds of times a night, often without you remembering them.

Warning signs

At night (often noticed by a partner)

• Loud, frequent snoring
• Pauses in breathing
• Choking, gasping, or snorting sounds
• Restless sleep
• Waking up frequently to urinate

During the day

• Excessive daytime sleepiness, even after a full night in bed
• Morning headaches
• Dry mouth or sore throat on waking
• Trouble concentrating or memory problems
• Irritability or depression
• Falling asleep while watching TV, reading, or driving

Who is at risk?

Anyone can develop sleep apnea, including children. Risk is higher in people who:

• Have excess weight, especially around the neck
• Are male (although risk in women rises after menopause)
• Are older
• Have a family history of sleep apnea
• Have a narrow airway, large tonsils, or a recessed jaw
• Have nasal congestion
• Smoke or drink alcohol, especially before bed
• Have high blood pressure, type 2 diabetes, or heart failure

Why it matters

Untreated sleep apnea does more than make you tired. Repeated drops in oxygen and constant awakenings strain your body. Sleep apnea is linked with:

• High blood pressure that's hard to control
• Heart disease, irregular heart rhythms (such as atrial fibrillation), and heart failure
• Stroke
• Type 2 diabetes
• Depression
• Motor vehicle and workplace accidents due to drowsiness

How sleep apnea is diagnosed

If your doctor suspects sleep apnea, they may order a sleep study:

• In-lab polysomnography: You spend a night at a sleep center while sensors monitor your breathing, oxygen levels, heart rate, brain waves, and movements.
• Home sleep apnea test: For many adults with suspected moderate-to-severe OSA, a simplified test can be done at home with a portable device.

The results show how many times per hour your breathing pauses or becomes shallow (called the apnea-hypopnea index, or AHI).

Treatment options

Sleep apnea is very treatable. Options include:

• CPAP (continuous positive airway pressure): A machine delivers a gentle stream of air through a mask to keep the airway open. It's highly effective when used consistently. Modern masks are much smaller and quieter than older versions.
• Oral appliances: Custom-fitted mouthguards from a dentist reposition the jaw to keep the airway open. These can work well for mild to moderate OSA.
• Weight management: Losing excess weight can reduce or sometimes resolve OSA. Some newer weight-loss medications have also been studied for OSA; ask your doctor whether they're appropriate for you.
• Positional therapy: Some people have apnea mainly when sleeping on their back.
• Lifestyle changes: Avoiding alcohol and sedatives before bed and quitting smoking.
• Surgery or implanted devices: For select patients who can't use CPAP, options include airway surgery or a hypoglossal nerve stimulator.

Tips for getting used to CPAP

• Work with your provider to find a comfortable mask style
• Start by wearing it while relaxing before bed
• Use the humidifier setting if your nose or mouth gets dry
• Clean your equipment regularly
• Give it a few weeks; most people adjust with time

When to see a doctor

Talk with your doctor if you or your partner notice loud snoring, breathing pauses, gasping, or if you feel unusually sleepy during the day. Don't drive if you're drowsy.

The bottom line

Sleep apnea is common, often undiagnosed, and seriously affects health. The good news is that diagnosis is straightforward and treatment can dramatically improve energy, mood, and long-term heart health. If the warning signs sound familiar, don't wait to get checked.