Sleep Apnea Symptoms: Signs You Should Get Checked

Sleep apnea is easy to miss because its most obvious signs happen while you are asleep. Often a bed partner notices first: loud snoring that stops, a silence that goes on too long, then a snort or gasp as breathing restarts. You may only notice that you wake up tired, however long you spend in bed.

This article explains the two main types of sleep apnea, the night and daytime symptoms that suggest it, how it differs from ordinary snoring, and how it is diagnosed and treated. It can help you decide whether to get checked, but it cannot diagnose you. Only a sleep study can confirm sleep apnea.

What is sleep apnea?

Sleep apnea is a common condition in which your breathing stops and restarts many times while you sleep, according to the National Heart, Lung, and Blood Institute (NHLBI). MedlinePlus notes that these pauses can last from seconds to minutes and may happen 30 times or more an hour.

There are two main types:

• Obstructive sleep apnea (OSA) is the most common type. Your upper airway becomes blocked again and again during sleep, for example when the tongue drops back, which reduces or completely stops airflow.
• Central sleep apnea happens when your brain does not send the signals needed to breathe. The problem is in how the brain controls breathing during sleep, not a blocked airway.

The repeated pauses break up your sleep, often without you being aware of it. Sleep apnea is one of several conditions where sleep, heart health, and daily energy overlap, which is why it comes up across our physical health guide.

What are the signs of sleep apnea at night?

The main nighttime signs are loud, frequent snoring, breathing that stops and starts, and gasping or choking for air. NHLBI notes that you may only learn about these signs when someone else points them out, because you are asleep when they happen.

• Loud snoring: frequent loud snoring is a telltale sign of obstructive sleep apnea, and it is more common in men. Not everyone who snores has sleep apnea, though.
• Pauses in breathing: a partner may notice snoring interrupted by a long silence while breathing stops.
• Gasping or choking: the silence often ends with a loud snort, gasp, or choking sound as breathing restarts.
• Waking to urinate: NHLBI lists waking up often during the night to urinate as a symptom.
• Broken sleep: waking often, or trouble falling or staying asleep, can be part of the picture. Insomnia is a more common sleep apnea symptom in women.

Waking suddenly with a gasp can be frightening, and it is not the only reason people jolt awake feeling unsettled. Our guide to waking up shaking walks through other causes, from low blood sugar to anxiety, and how to tell them apart.

What are the daytime symptoms of sleep apnea?

The most common daytime symptom is sleepiness and tiredness, even after what seems like a full night in bed. NHLBI notes that this daytime sleepiness can lead to problems with learning, focusing, and reacting.

• Feeling sleepy or drowsy throughout the day
• Headaches, especially in the morning
• A dry mouth on waking
• Sleep that does not feel refreshing
• Irritability, forgetfulness, or low mood
• Sexual problems or a lower sex drive
• High blood pressure that is hard to control

Tiredness has many causes, and sleep apnea is only one of them. If you feel tired all the time, it is worth looking at the whole picture, including stress, mood, anemia, thyroid problems, and medicines, as well as how you sleep.

Do symptoms look different in women and children?

They can. NHLBI notes that fatigue, headache, and insomnia are more common sleep apnea symptoms in women, while loud snoring is more common in men. If you have ongoing fatigue, headaches, or insomnia, sleep apnea is worth raising with your doctor even if no one has mentioned snoring.

In children, NHLBI says sleep apnea may show up as being overactive, bedwetting, worsening asthma, or trouble paying attention in school. MedlinePlus notes that enlarged tonsils or adenoids are a common risk factor in children. If your child snores and has any of these signs, talk to their pediatrician.

Is it sleep apnea or just snoring?

Snoring is common, and not everyone who snores has sleep apnea. It happens when tissues at the top of your airway vibrate as air moves past them. What points toward sleep apnea is snoring that comes with pauses in breathing, gasping, or daytime sleepiness. The table below compares the two, but only a sleep study can tell them apart for certain.

Sign	Ordinary snoring	Possible sleep apnea
Snoring	Steady, may be loud	Loud and frequent, broken by silent pauses
Breathing during sleep	Continues normally	Stops and restarts, often with a snort, gasp, or choking sound
How you feel in the morning	Usually rested, though heavy snoring can still disturb sleep	Unrefreshed, sometimes with a headache or dry mouth
During the day	Normal alertness	Sleepy or drowsy, with trouble focusing
Waking at night	Not usually	Waking often, including to urinate
Other clues	None	High blood pressure that is hard to control, irritability, low mood
Next step	Simple changes may help, such as limiting alcohol near bedtime and not sleeping on your back	See your doctor about a sleep study

Steps that may reduce snoring, according to MedlinePlus, include losing weight if you are overweight, limiting alcohol and sedatives near bedtime, and not sleeping flat on your back. MedlinePlus advises seeing a provider if you snore and are often tired during the day, feel you do not sleep well, or wake up gasping.

Who is most at risk of sleep apnea?

Excess weight, older age, being male, and a family history are among the main risk factors for obstructive sleep apnea, according to NHLBI. Extra fatty tissue around the neck and tongue can narrow the upper airway during sleep.

• Age: risk rises as fatty tissue builds up in the neck and tongue over time.
• Excess weight: extra fat in the neck may block the upper airway. Keeping a healthy weight can help prevent or treat it.
• Airway anatomy: large tonsils, a large neck, or a large tongue can narrow the airway.
• Sex: it is more common in men, who tend to have more serious cases and are diagnosed younger.
• Family history: genes help shape the skull, face, and airway.
• Hormone conditions: polycystic ovary syndrome (PCOS), low thyroid hormone, and high insulin or growth hormone levels raise the risk.
• Heart or kidney failure: these can cause fluid to build up in the neck.
• Alcohol and smoking: alcohol relaxes the throat muscles, and smoking inflames the upper airway.

Central sleep apnea has different risk factors, NHLBI says, including heart failure, stroke, some nerve and muscle conditions, long-term use of opioid pain medicines, and premature birth. It is also more common in men and with age.

How is sleep apnea diagnosed?

Sleep apnea is diagnosed with a sleep study, a painless test that records how you breathe and how your body responds during sleep. Your doctor will usually start by asking about your symptoms, risk factors, and family history, and may refer you to a sleep specialist.

• Sleep history and diary: your provider may ask you to keep a sleep diary tracking how long and how well you sleep and how sleepy you feel during the day. A bed partner's description of your snoring and breathing can help too.
• In-lab sleep study: the most common type, called polysomnography, is done overnight at a sleep center. Sensors on your scalp, face, chest, limbs, and a finger track brain waves, heart rate, breathing, blood oxygen, and movement.
• Home sleep test: your doctor may decide you can be tested at home with a portable device instead.
• Other checks: blood tests for thyroid problems or PCOS, and questions about medicines such as opioids, or recent travel above 6,000 feet, which can cause sleep apnea symptoms for a few weeks.

A sleep study can show which type of sleep apnea you have and how severe it is, and that guides which treatment makes sense.

What are the treatment options for sleep apnea?

A breathing device called a PAP machine is the most common treatment, according to NHLBI, and healthy lifestyle changes can be very effective, often alongside it. The right choice depends on the type and severity of your sleep apnea, so treatment is something to work out with your doctor or a sleep specialist.

Treatment	How it works	Who it may suit
CPAP and other PAP machines	A mask delivers air pressure through your nose or mouth to keep the airway open; some machines adjust the pressure	The most common treatment; works well for most people with OSA when used for all sleep
Lifestyle changes	Regular activity, a healthy weight, limiting alcohol and caffeine, quitting smoking, and sleeping on your side	Everyone with sleep apnea; may be enough on their own in some mild cases
Oral appliances	A custom mouthpiece fitted by a dentist holds the lower jaw or tongue forward	People who do not want to use or cannot tolerate CPAP
Weight-loss medicine	An injected medicine approved by the FDA for moderate to severe OSA in people with obesity	Adults with obesity and moderate to severe OSA; it can have serious side effects
Nerve stimulation implant	A device placed under the skin of the chest stimulates the nerve under the tongue to keep the airway open	An option to discuss with a sleep specialist
Surgery	Removing the tonsils or other tissue, moving the jaw forward, or weight-loss (bariatric) surgery	Often a last resort for severe symptoms when other treatments have not worked

Getting used to CPAP can take time. NHLBI advises being patient, using the machine for all sleep including naps, and contacting your provider if the mask fits poorly or feels claustrophobic, since a different mask or machine may help. Side effects such as congestion, a dry mouth, or nosebleeds are worth raising too.

You will usually need regular checkups to make sure treatment is working, and you may need another sleep study if you gain or lose a lot of weight.

What happens if sleep apnea goes untreated?

Untreated sleep apnea strains your heart and blood vessels and raises the risk of several serious conditions, according to NHLBI. Restarting breathing over and over during sleep takes a lot of effort, and over time this can damage organs and blood vessels.

• High blood pressure that is difficult to control
• Heart attack, heart failure, irregular heart rhythms, and stroke
• Type 2 diabetes and metabolic syndrome
• Kidney disease, reflux, and worse asthma attacks
• Pregnancy complications, and dementia in older adults
• Anxiety, depression, and problems at work or school

Blood pressure is worth keeping an eye on. If your readings have been creeping up, our guide to what your blood pressure numbers mean explains the categories and when to act.

Your heart rhythm matters too. If you often wake with a pounding heart, the article on why your heart races at night covers sleep apnea alongside other possible causes.

Why is drowsy driving a concern?

Daytime sleepiness from untreated sleep apnea makes it harder to pay attention, and MedlinePlus notes that people with sleep apnea have a higher risk of car crashes and workplace accidents. NHLBI's advice is simple: do not drive if you feel tired or sleepy.

Warning signs that you are too drowsy to drive include nodding off, drifting from your lane, reacting more slowly, and forgetting the last few miles you drove. If you notice any of them, the CDC's National Institute for Occupational Safety and Health advises pulling over for a short nap before continuing, while noting that the only real cure for fatigue is sleep.

When should you see a doctor or call 911?

See your doctor if you or your partner notice signs of sleep apnea, especially loud snoring with pauses in breathing or gasping, combined with daytime sleepiness. Sleep apnea is treatable, and a sleep study is the way to find out.

Make an appointment if you have:

• Loud, frequent snoring with pauses in breathing, gasping, or choking that someone has noticed
• Daytime sleepiness or fatigue that does not improve with more time in bed
• Morning headaches, a dry mouth on waking, or unrefreshing sleep
• Frequent waking to urinate at night
• High blood pressure that is hard to control
• A child who snores and is overactive, wetting the bed, or struggling to pay attention
• Diagnosed sleep apnea with symptoms that return, or a CPAP mask you cannot tolerate

Call 911 for chest pain or pressure, sudden weakness or numbness on one side of the body, trouble speaking, severe shortness of breath while awake, or someone who cannot be woken. These can signal a heart attack, stroke, or another emergency, whether or not sleep apnea is involved.

And if you ever find yourself nodding off at the wheel, pull over somewhere safe straight away and get your sleepiness checked before you drive long distances again.