Symptoms of Sleep Apnea

Sleep apnea is a disorder in which breathing is interrupted during sleep, which prevents the body from getting the oxygen it needs. Without treatment, breathing issues impair sleep quality, diminish day-to-day functioning, and increase the risk of health problems like heart disease, stroke, and high blood pressure.

Many people with sleep apnea don’t realize that their sleep is disrupted and this breathing disorder often goes undiagnosed. Fortunately, recognizing the signs of sleep apnea and getting treatment can alleviate symptoms and reduce the risk of further complications.

Equipping yourself with information about the signs and symptoms of sleep apnea can help you understand this common sleep disorder, learn how it’s diagnosed and treated, and decide when to contact your doctor. 

The primary symptom of sleep apnea is abnormal breathing during sleep. People with sleep apnea may have periods in which their breathing becomes slow, shallow, or pauses. Because many people are unaware of their nighttime breathing issues, symptoms may be first noticed by caregivers, roommates, or bed partners. 

Other symptoms of sleep apnea include:

• Snoring
• Snorting, choking, or gasping during sleeping 
• Abrupt nighttime wakings 
• Waking up at night to urinate
• Restless sleep
• Waking up feeling tired or groggy
• Headaches in the morning
• Feeling sleepy throughout the day 
• Irritability and mood changes
• Slowed thinking, trouble concentrating, or forgetfulness

The symptoms of obstructive sleep apnea (OSA) and central sleep apnea (CSA) overlap and neither condition can be diagnosed based only on a person’s symptoms. Instead, doctors diagnose the type of sleep apnea based on the results of a sleep study.

A sleep study is an overnight test that takes place in a specialized sleep laboratory. During the test, various measurements are recorded that help doctors diagnose and assess sleep problems. Doctors can tell the difference between OSA and CSA using measurements that establish whether a person is trying to inhale during a nighttime breathing disruption.

OSA, the most common type of sleep apnea, is caused by a physical blockage or narrowing of the throat. During nighttime breathing disruptions, a sleep study shows that a person with OSA tries to inhale despite their blocked or narrowed airway.

Central sleep apnea is a less common form of sleep apnea that occurs when the brain briefly stops sending the signals that trigger breathing. This means that, in contrast to OSA, a person with CSA does not try to inhale during a breathing disruption.

Sleep apnea symptoms can differ from person to person. Additionally, both obstructive and central sleep apneas may be asymptomatic, which means that a person may not notice any obvious signs of nighttime breathing issues.

People with both types of sleep apnea may not realize that their breathing is abnormal during sleep until told by a caregiver or bed partner. Symptoms that may be observed by a caregiver or bed partner include:

• Snoring, gasping, or choking 
• Pauses in breathing 
• Shallow or irregular breathing 
• Restless sleep 

In mild cases of OSA, a person may have few daytime symptoms. People with moderate to severe OSA may develop more significant symptoms that interfere with their daily life, including:

• Needing regular naps
• Cutting back on daytime activities due to sleepiness 
• Falling asleep frequently during the daytime 
• Dozing off at inappropriate times 

For people diagnosed with central sleep apnea, symptoms also depend on the type of CSA that was diagnosed. Because CSA is often related to an underlying medical issue, symptoms vary based on the condition causing breathing issues.

To diagnose sleep apnea, doctors consider a person’s symptoms and medical history in addition to the results of a physical exam and a sleep study. Also called polysomnography, a sleep study can diagnose sleep apnea, identify the type of breathing disruptions, and determine the condition’s severity.

The apnea-hypopnea index (AHI) is a calculation based on measurements taken during a sleep study. AHI describes the number of breathing disruptions that a person experiences during each hour of sleep. To diagnose sleep apnea, doctors consider AHI in addition to a person’s symptoms, coexisting health conditions, and breathing patterns seen during the sleep study.

In some cases, doctors may order other tests to detect complications of sleep apnea or rule out other health conditions. For example, if a doctor suspects CSA, additional tests may be used to find the underlying cause of breathing issues.

Treatment for sleep apnea is aimed at improving breathing during sleep and bringing the body’s oxygen levels back to normal. By normalizing breathing and oxygen levels, treatments help to alleviate the symptoms of sleep apnea. Treatment may improve breathing, enhance sleep quality, and reduce or eliminate sleep apnea symptoms.

Treatment options depend on an individual’s medical history, the type of sleep apnea diagnosed, its severity, and any underlying medical conditions that may be contributing to breathing difficulties. Doctors also take into account a person’s preferences for certain types of treatment. 

Many treatment options are available for sleep apnea.

• Positive airway pressure therapy: Positive airway pressure (PAP) therapy uses air pressure to keep the airway open during sleep. Common ways of delivering this therapy include continuous positive airway pressure (CPAP) and bilevel positive airway pressure (BiPAP or BPAP).

• Supplemental oxygen: People diagnosed with certain types of CSA may be given supplemental oxygen as they sleep, either alone or in combination with PAP therapy.

• Oral appliances: Oral appliances are an option for some people with OSA and work by shifting the lower jaw or pulling the tongue forward to keep the airway from becoming blocked.

• Surgery: Surgery is typically used as a second-line treatment for sleep apnea when other approaches are unsuccessful. There are a wide variety of surgeries that may be used to treat sleep apnea, which alter tissues to prevent obstructions during sleep or use an implantable medical device to stimulate breathing.

The most important step in getting relief from sleep apnea symptoms is to talk to your doctor. Treatment can help alleviate symptoms, so be sure to contact your doctor if your sleep quality is suffering or if you have daytime symptoms suggestive of sleep apnea.

Your doctor may also suggest tips for reducing sleep apnea symptoms.

• Exercise and watch your weight: If you’re overweight or obese, weight loss and regular exercise can improve your health, reduce obstructive breathing problems, and ease daytime symptoms. Your doctor can discuss dietary changes, safe ways to exercise, and other options like medications and surgery.
• Be cautious about drinking and smoking: Smoking and drinking alcohol can worsen episodes of OSA and exacerbate daytime symptoms, so doctors recommend quitting smoking and restricting alcohol consumption.
• Change your sleeping position: If breathing gets worse when sleeping on your back, changing your sleeping position may reduce the symptoms of sleep apnea. Switching sleeping positions can be challenging, though several devices are available that help people learn to sleep in a new position.
• Review your medications: Both OSA and CSA can be triggered or exacerbated by certain medications such as benzodiazepines and some opiates. If you’re on medication and have sleep apnea symptoms, consider meeting with your doctor to review your medications use. 

Tips for Caregivers

Caregivers can play an important role in helping people notice sleep apnea symptoms, talk to their doctor, and adjust to sleep apnea treatment.

• Record symptoms: Caregivers may be the first to notice sleep apnea symptoms, so it may be helpful to keep a sleep diary that notes the type and frequency of breathing issues, daytime sleepiness, or other related symptoms. 
• Help with driving: Sleep apnea can cause people to fall asleep or feel tired behind the wheel of a car. Caregivers can play an important role in assisting their loved ones with transportation.
• Support treatment: It can take time to adjust to treatments for sleep apnea, so caregivers can help people adhere to the recommended sleep apnea treatments and resolve any challenges that arise.

About The Author

Afy Okoye

Staff Writer, Sleep Health

Afy is a writer and creative strategist in San Francisco with a master’s degree in international health policy from the London School of Economics. She has written for VeryWell Health, BlackDoctor.org, and Paste magazine and edited peer-reviewed journal manuscripts for Elsevier. Afy says her work with The Sleep Doctor is anything but “sleepy.” She enjoys the opportunity to learn new information and share knowledge that gives people the power to make better choices. Afy also likes to read non-fiction, do creative writing, and travel solo.

• Position: Side sleeper
• Temperature: Hot Sleeper
• Chronotype: Bear

Ask The Sleep Doctor

Have questions for The Sleep Doctor? Submit them here! Each week Dr. Breus will pick a few questions to answer in our weekly video series, Wake Up Wednesday. You can also send us an email. Please note, we cannot provide specific medical advice, and always recommend you contact your doctor for any medical matters.