Signs and Symptoms of Sleep Apnea

Sleep Apnea

Signs and Symptoms of Sleep Apnea

Sleep apnea is a serious condition linked to snoring. It is important to know the signs and symptoms.

Snoring is seen by most as benign; it can be disruptive and a bit embarrassing, but is nothing to worry about in terms of your health.

Yes, normal snoring doesn’t really pose a direct health risk to you. However, if left unchecked, snoring can lead to sleep apnea – a serious condition that needs addressing.

Obstructive sleep apnea (OSA) is a condition where your breathing repeatedly stops whilst you sleep.

This creates a cycle where breathing stops and you briefly wake up to clear the blockage – a process which can repeat itself hundreds of times throughout the night.

This puts strain on various systems in your body and heightens the risk of many maladies.

It is therefore important to understand what the key signs and symptoms of sleep apnea are. Here, we explore them:

Loud snoring

Loud snoring is one of the biggest signs of sleep apnea.

It is important to note however, that loud snoring is not diagnostic for sleep apnea. Loud snoring does not mean that you definitely have the condition.

95% of people with obstructive sleep apnea (OSA) snore, but not all snorers have OSA [1].

 

What is the difference between snoring and sleep apnea?

Read

 

Louder snoring suggests that there is more excess soft tissue which is flapping and making excessive noise. This makes the airway more prone to complete blockage – an apnea event.

As well as just the volume of the snores, another crucial sign of OSA is if you have been observed gasping or choking in your sleep. This is the moment where you briefly wake – an emergency process by the brain to kick start breathing again.

Importantly, not every apnea episode will end with a gasp or choke. It can often be silent.

Side note: can SnoreLab detect sleep apnea?

We often get asked if SnoreLab can use recorded snoring to find sleep apnea. It is important to note that SnoreLab is not an automatic sleep apnea detector.

Sleep apnea does often have some very distinctive sounds. Whilst SnoreLab could detect this typical sound profile, apnea events are not actually defined by sound.

An apnea is a period during sleep where breathing stops and is therefore identified by measuring both breathing effort and airflow (or lack thereof). A drop in blood oxygen saturation also helps to confirm. Measuring this requires specialist equipment beyond the reach of a consumer app.

In SnoreLab, you can search your session for risky sounds using Full Night Recording mode to ensure that every sound and event is captured.

Some users have used this feature to discover sounds in their recordings that suggested apnea events. They have then found them useful in subsequent medical consultations. For many people, SnoreLab has helped flag sleep apnea they weren’t aware that they had.

Excessive sleepiness

Sleep apnea sufferers often struggle to stay awake during the day.

People with sleep apnea experience repeated micro-arousals. These are periods where you wake up briefly. The cumulative effect of these awakenings means greatly disrupted sleep and excessive tiredness as a result.

This tiredness manifests with sufferers feeling completely unrested upon waking up. They also struggle to stay awake during the day and can easily fall asleep in a variety of situations where they wouldn’t normally.

A popular screening test for sleep apnea, the Epworth Sleepiness Scale (ESS) looks at your level of tiredness. It asks questions about how likely you are to fall asleep in certain day-to-day scenarios, with answers from “never” to “very likely”.

The ESS tries to differentiate normal sleepiness from the excessive sleepiness seen in sleep apnea. We might all get a little sleepy during the day, but excessive sleepiness is where you are barely able to stay awake in a variety of day-to-day situations – not just a warm, dimly lit room with a belly full of lunch!

The science bit – why does sleep apnea make you sleepy?

The tiredness experienced with sleep apnea is simply a result of impaired sleep quantity and quality. Repeated awakenings disrupt both the amount of sleep you get and your pattern of sleep or “sleep architecture”.

Healthy, restorative sleep requires a good spread of the various stages of sleep. Going to sleep is not a simple on/off switch – there are lots of different parts, each with different functions and benefits.

There is some evidence to suggest that people with sleep apnea spend less time in the deeper stages of sleep [2], stages which are useful for physical repair, memory formation and general re-energising.

Difficulty concentrating

A common symptom of poor sleep, those with OSA often have impaired concentration and cognition.

Some sources liken the effects of moderate sleep deprivation to those of mild alcohol intoxication! This can negatively affect your daily functioning and be more serious too.

People with sleep apnea are twelve times more likely to be involved in road traffic accidents. Some countries now make it mandatory to inform the driver registration authorities if you are diagnosed with sleep apnea [3].

Sleep apnea can also affect academic performance. One study assessed the likelihood of medical students to fail their exams based on whether or not they snored. Non-snorers had a failure rate of 13%, whereas 42% of the frequent snorers failed their exams [4].

Headaches and a sore throat in the morning

Sleep apnea sufferers frequently wake up with physical symptoms like a sore throat and a headache.

An apnea episode is usually resolved by a sharp intake of air through the mouth. Repeating this action throughout the night can dry out the throat and cause pain in the morning.

Though the mechanisms aren’t fully understood, it is speculated that the frequent fluctuations in blood pressure seen with apnea episodes can bring on headaches. Typically, these are short-lived headaches felt on both sides of the head and unlike other forms of headache, aren’t accompanied by an aversion to light and sound [5].

Conclusion

Many cases of sleep apnea are undiagnosed. These people feel unrested, have difficulty concentrating and experience physical symptoms too – but they don’t attribute this to their snoring.

Sleep apnea happens when you are in your least receptive state. So despite waking up frequently and gasping for air throughout the night, you’re unlikely to remember it, let alone identify it as a cause for concern.

Therefore, understanding the signs of sleep apnea is important.

Loud snoring, sleepiness, poor concentration, and headaches and sore throat are the most common signs. This is not an exhaustive list – there are other signs that you may not link with sleep apnea.

If you are unsure about sleep apnea, remember to read our other resources on sleep apnea screening and diagnosis, as well as the underappreciated signs of sleep apnea.

Underappreciated Signs of Sleep Apnea

Sleep Apnea

Underappreciated Signs of Sleep Apnea

Obstructive sleep apnea is often undiagnosed, so spotting the signs – including the unusual ones – is important.

Obstructive sleep apnea (OSA) is a condition where your breathing periodically stops whilst you sleep.

Loud snoring and excessive sleepiness are key indicators of OSA. There is also a typical personal profile for sleep apnea sufferers: namely being male, overweight and older.

Unfortunately, it’s not always that straightforward.

Here, we highlight some of the lesser-known symptoms which could be signs of sleep apnea …

Frequently waking to urinate

Waking up to urinate twice or more per night could be a sign of sleep apnea.

Medical professionals are increasingly using how often you wake to urinate as an unofficial screening test for sleep apnea. The exact mechanisms of the link are unknown, though there are three proposed reasons.

Firstly, it is thought that the frequent exertions and efforts during an apnea episode increase abdominal pressure, in turn, putting pressure on the bladder [1].

Second, the arousals experienced with sleep apnea can make you more aware of a perfectly normal need to urinate. Most people can sleep for many hours without needing to urinate as sleep does a good job of suppressing the mental urge. Only when we wake do we acknowledge this need.

Lastly, whilst the connection is not fully studied, a hormone released by heart during apnea episodes also influences the kidneys, increasing the need to urinate.

The science bit – what is this hormone?

Atrial natriuretic peptide (ANP) is a hormone released in the right atrium (one of the four chambers of the heart) in response to increased blood pressure, low-oxygen events and constriction of blood vessels in the heart – all seen during an apnea episode. It acts to dilate these blood vessels to take pressure off of the heart and other organs. ANP acts systemically, meaning it gets into the bloodstream where it can reach other areas of the body and make changes. ANP therefore also helps to reduce blood pressure by increasing urine output via a number of actions in the kidneys [2].

Mood changes

A lack of good quality sleep can affect your mood in the short term and long term.

Depression, anxiety, short temper, irritability – these are symptoms of sleep deprivation, one of the most damaging aspects of sleep apnea. This mental decline can be both an immediate and long-lasting complication.

Sleep apnea is known to increase the likelihood of many physical conditions (diabetes, stroke, heart failure etc.) but there is also evidence to show that sleep apnea also poses an increased risk of depression, bipolar affective disorder and other mood disorders.

A recent cohort study in Taiwan followed 32,000 people with and without sleep apnea. 1.13% of the non-sleep apnea group were diagnosed with a mood disorder compared to more than double (2.84%) in the sleep apnea group [3].

Dry mouth

Frequently waking with a dry mouth is a potential indicator of sleep apnea.

Another unofficial screening question in medical consultations on sleep apnea, patients are often asked if they wake up with a dry mouth.

In a recent study, 668 patients referred to a sleep clinic and suspected of having sleep apnea were asked how often they experienced waking with a dry mouth. Those with confirmed sleep apnea were twice as likely to have a dry mouth “almost always” compared to those without sleep apnea [4].

“The prevalence of dry mouth upon awakening was twofold higher in patients with OSA (31.4%) than in primary snorers (16.4%, P < 0.001), and increased linearly from 22.4%, to 34.5%, and 40.7% in mild, moderate, and severe OSA respectively (P < 0.001).”

A plausible explanation for this is that sleep apnea sufferers open their mouth more frequently during the apnea episodes, where the characteristic sharp intake of air necessitates a big gulp through the mouth.

This correlation could also be the reverse, whereby people are experiencing sleep apnea because they are already habitual mouth-breathers.

Low sex drive

Obstructive sleep apnea can negatively impact upon the sex lives of both men and women.

Many studies have linked sleep deprivation from OSA with decreased sexual desire in both sexes [5]. Scientists suggest that the effects of sleep disruption on the hormone testosterone is partly to blame [6].

Testosterone – a steroid sex hormone – naturally increases with sleep. The lack of quality sleep seen in OSA reduces testosterone production. Hence, libido in both men and women, and sexual performance in men is negatively affected [7].

A study in 2009 found that 70% of men referred for sleep apnea treatment also had treatment for erectile dysfunction [8].

Acid reflux

There is a significant relationship between acid reflux and sleep apnea [9].

Acid reflux (sometimes referred to as gastro-esophageal reflux disease or GERD for short) is a condition where the acidic contents of the stomach cause irritation when they move back up into the esophagus.

There are competing theories as to whether acid reflux is a result of sleep apnea or vice versa. Nonetheless, it is estimated that more than half (58-62%) of patients with sleep apnea also experience acid reflux disorder, though this is thought to be at least somewhat attributable to obesity.

The exact mechanics of this link are uncertain, but there is some evidence to suggest that the pressure changes in the chest during apnea episodes can produce reflux symptoms.

Despite this uncertainty, treating sleep apnea has positive knock on effects for reflux. The reverse has also been demonstrated whereby drugs for acid reflux reduce apnea episodes [10].

Conclusion

The classic signs of sleep apnea are loud snoring, sleepiness, headaches and sore throat. There are many more symptoms and complications, some minor, and some that are problematic conditions in their own right.

Sleep apnea often goes undiagnosed. A lack of understanding and social stigma surrounding snoring are big reasons for this. It is important to be able to spot the lesser-known signs to help you make sense of your symptoms and seek the most appropriate course of treatment.

Remember to keep track of factors in the SnoreLab app, mark your Rest Rating and make notes on any symptoms you experience so you can build up a good picture of your snoring and sleep health.

Snoring and Sleep Apnea in Children

Science, Sleep Apnea

Snoring and Sleep Apnea in Children

Just like adults, almost all children will snore occasionally.

The mechanics of snoring are no different in children. Inhaled air becomes partially obstructed which causes excess soft tissue in the upper airway to flap and make noise.

But how do you know if your child’s snores are normal or not?

Normal snoring vs. sleep apnea

We all snore occasionally, particularly if we are unwell. But 10% of children will snore on most nights. This is not normal and could be a sign of something more serious [1].

1-3% of children even experience obstructive sleep apnea (or OSA for short) [2]. This is where airway blockage leads to breathing pauses – a condition that has health implications beyond sleep.

Side note: what is the difference between snoring and sleep apnea?

Normal snoring (a.k.a. “habitual” snoring or “primary” snoring) does not involve breathing stoppage. This is usually benign. When a child has sleep apnea, their breathing stops for at least 10 seconds, generally followed by a big gasp or choke. Those with OSA often snore loudly, but importantly, not all loud snorers have sleep apnea.

Obstructive sleep apnea is problematic in children

Children need lots of healthy sleep for good physical, mental and emotional development. OSA disrupts sleep, therefore sleep deprivation is the biggest concern for children with sleep disordered breathing.

Studies have also linked the sleep fragmentation experienced with sleep apnea to ADHD [3]. Even without an ADHD diagnosis, sleep deprivation can affect children’s behaviour, focus and overall development.

What causes snoring in children?

The various reasons for snoring are the same in children as for adults. Sleeping position, being overweight and allergies can all be implicated in your child’s snoring.

To understand why your child snores, try to explore their triggers:

  • Are they sleeping on their back?
  • Could dust allergies be triggering their snoring? Are there a lot of soft toys in their room that could be collecting dust?
  • Does their snoring happen seasonally? If so, could they be suffering from hay fever? Understand the other signs of this seasonal pollen allergy.
  • Is your child’s face shape responsible? A pronounced overbite (retrognathia) reduces space behind the tongue and is a common anatomical cause of snoring.
  • Is your child overweight?
  • Are they ill? If so, their snoring should be short-lived.

Unlike in adults, the tonsils and adenoids are frequently cited as causes of snoring and sleep apnea. This is because the adenoids are regions of soft tissue that (usually) disappear after puberty. Further, tonsils reach their peak mass between 5-7 years – well before a child’s airway has reached its peak size. These are therefore key obstruction triggers in childhood snoring and sleep apnea.

When is a child’s snoring problematic? The signs to look out for

There are some key signs that can suggest that your child’s snoring is a cause for concern.

5 sleeping flags are:

  1. They snore more than 4 nights per week
  2. They snore frequently throughout the night
  3. The snoring is noisy
  4. You can hear pauses in the child’s breathing
  5. They often sleep with an open mouth.

It can be hard for you to identify these sleeping flags in your child; beyond a certain age, parents don’t usually share a room with their child.

Therefore, it is important to also keep watch for these 5 flags whilst your child is awake:

  1. They have trouble waking up
  2. They are unusually irritable
  3. There are behavioural issues and problems at school
  4. You are told that they fall asleep at school
  5. They report having headaches or a sore throat.

If they are ticking many of these boxes, it is a good idea to seek advice and further investigation from a specialist.

Before a medical consultation, it is recommended that you start a sleep journal. This can help a specialist glean some insight into your child’s snoring. Focus on the 10 sleeping and waking flags above.

The logistics of listening to your child’s entire night of sleep are difficult if they are at the age where you aren’t sharing a room. This is where SnoreLab can be helpful.

Side note: is SnoreLab suitable for children; will my child’s privacy be protected?

Your child’s privacy is not at risk when using SnoreLab. We do not collect audio recordings and therefore cannot share or listen to any audio picked up by the app. We do collect some anonymised, non-audio data on the session – this cannot identify you personally and is nothing more than some numbers on a screen.

Further investigation – do children have sleep studies?

Yes, children have sleep studies too. A sleep study is a way of looking at how your child’s body behaves when they are asleep. This is the reliable way to understand their sleep disordered breathing.

The process is almost identical to adult sleep studies.

On the day of the sleep study, parents are encouraged to help make the process as normal as possible. This means sticking to normal routines, both before and after arriving at the hospital. If an afternoon nap is part of your child’s routine, then don’t deny them it.

To help make the hospital feel as comfortable and homely as possible, bring things from home that help your child to relax and sleep – whether it’s a toy, a blanket, a book or a film to watch before bed.

Your child will be “wired up” before the study starts. This involves attaching an array of monitors which can take up to an hour to set up. The key ones are:

  • Elastic chest bands. These sense the child’s breathing efforts.
  • Pulse/blood oxygen saturation monitor finger/toe clamp
  • Nasal cannula to assess airflow and look for breathing disruptions
  • Electrodes to monitor heart, brain and eye activity are less common in paediatric sleep studies but are still sometimes used.

Importantly, none of these attachments are painful and they should be attached in such a way to avoid any discomfort. Your child should have no problem sleeping with them on.

The technicians attaching these monitors are well-trained in dealing with children and allaying any fears and anxieties they may have. You as a parent can also play your part here too.

Paediatric sleep studies almost always have two beds set up – one for the child and one for the parent. Your presence should help your child relax and get the sleep needed to make the necessary measurements. People say that typically the child sleeps better than the parent!

Similar to adult studies, the session finishes around 6am. Results are analysed by specialists and will be communicated to you at a later date.

What can be done to treat children’s snoring and sleep apnea?

As with anyone’s snoring, what is the “best treatment” depends on the cause. Almost all snoring remedies apart from mouthpieces – if well matched to the cause – are suitable for children.

Surgery is recommended more for children than it is for adults. This is because children’s snoring is more likely to have a clear physical obstruction that can be corrected with surgery – namely by removing the adenoids and tonsils. Indeed, these procedures are performed more than a quarter of a million times per year in the USA alone [4]. It is generally very safe with only minor risks associated.

Such surgical interventions are usually very successful. Some research indicates that children’s stunted mental capabilities, often attributed to the sleep disturbance that accompanies sleep apnea, reverses completely 3 to 10 months after surgical removal of the adenoids [5].

Surgery is not always an option. If a child is diagnosed with OSA which cannot be managed with surgery or other measures, CPAP can also be used. Whilst CPAP can be quite a drastic change for a child to get used to, if presented and handled well by both the medical professionals and the parents, it can be extremely effective [6].

Further, it is speculated that another potential measure is doing nothing! Children develop and grow quickly so certain conditions can resolve themselves. Recent studies have shown that the non-intervention commonly referred to in the medical world as “watchful waiting” saw almost half of sleep apnea cases reversed within 7 months [7].

Conclusion

Snoring has similar causes in both adults and children and can therefore be managed in the same ways.

Occasional snoring is normal and harmless for children. However, extra attention should be paid if your child snores 4 nights or more per week, and snores frequently through the night [1].

Assess your child’s snoring with the following process:

  1. Is it caused by allergies? Does your child have any symptoms such as a runny nose; are there soft toys potentially trapping dust in their room?
  2. What position do they sleep in? See if side-sleeping reduces their snoring. You can also try elevating their head.
  3. Check if they are showing any of the 5 daytime signs of problematic snoring.
  4. If possible, make a sleep journal. Note how often they are snoring and its frequency per night. SnoreLab can help with some objective nighttime measurements.
  5. If these flags raise concerns, seek medical advice.

Discovering Sleep Apnea with SnoreLab – Anna’s Story

Sleep Apnea, User Stories

Discovering Sleep Apnea – Anna’s Story

We like to hear from our users to find out how they use the app and what they have done to combat their snoring. With these user stories, we hope you can pick up some great tips and gain some motivation to address your snoring too.

This story comes from Anna who sent us an email about her experience.

As someone who had never heard of obstructive sleep apnea, Anna used her SnoreLab recordings and the information on our website to investigate her sleep health in more detail. She has since seen remarkable changes after receiving a sleep apnea diagnosis and the necessary treatment …

Dear SnoreLab,

I simply wanted to write to express my heartfelt thanks to you for the app you have developed, as well as the array of sleep information and resources that you provide on your website.

For more years than I can remember, I have woken every morning feeling beyond exhausted and unable to function, made worse by frequent headaches and nausea that plagued my mornings if I had consumed alcohol the night before.

I thought I had grown intolerant to alcohol, I have also had uncontrollable high blood pressure for many years, which I had thought was causing my frequent waking up at night with night sweats and heart palpitations.

I just couldn’t understand how people around me had so much energy, and kept pushing myself to do more than my energy reserves could cope with, but the situation was getting steadily worse and I was convinced there was something badly wrong with my health that I couldn’t figure out.

At age 36 – I felt like I was 86.

I have always snored, quite loudly, but in recent months my husband kept waking me because my snoring had grown so much louder and, as he put it, sounded extremely painful and distressing – as though I couldn’t quite breathe.

Alongside this, I started getting persistent sinus pain and bleeding, and my night-time waking frequency was increasing dramatically.

After some research, I found SnoreLab and thought it would be useful to be able to track my snoring, and also what remedies might help to reduce it – and improve the quality of sleep we both got.

My first few nights were a shock, both in terms of hearing the sheer volume of my Epic snoring, as well as the duration of my snoring – often at its loudest and most painful sounding just before I woke up in the night. I sounded like I was being strangled! I would listen to short sections, and then couldn’t listen to any more of the recording – both shocked and slightly disturbed by the sounds I made in my sleep!

I tried some remedies to begin with – throat sprays, incline pillows, etc. – but they only led to marginal improvements. I continued reading more and more of the resources on SnoreLab and came across an article about sleep apnea, a condition I was unfamiliar with.

I started listening back to my recordings in detail, rather than just the snippets I had listened to previously, and I started hearing long pauses in my breathing, gasping, and long episodes where it sounded like I was struggling to get a breath into my lungs.

Unsure, I spoke to a private sleep disorder consultant who listened to my recordings and who asked more about my background. He was certain I was a very likely to be suffering from sleep apnea and suggested a 2-day home sleep study, which I agreed to. Within a week I had my diagnosis of moderate sleep apnoea, and within 2 weeks I had my CPAP machine.

My life, as a result of this treatment, has been transformed! 

I wake every single morning with so much more energy than I have previously had in my living memory. I have clarity, my headaches are gone, my racing heart rate and night time awakenings have gone, I can do normal things without feeling like I’m running a marathon, my resting heart rate and blood pressure are coming down from dangerous levels, I’m losing weight more easily…..the list is endless.

Frankly, I didn’t know how abnormal my “normal” had been, until I started this treatment and realised what normal SHOULD feel like.

All of this started with SnoreLab, and it has given me my life back. That’s why I wanted to write to say thank you – if it hadn’t been for SnoreLab, I would still have been in depressed, exhausted ignorance of how different life could be.

So, thank you. Thank you, thank you, thank you.

Many people with obstructive sleep apnea remain undiagnosed. People can often have headaches, feel excessively tired and have difficulty staying focussed, but they often don’t make the link with snoring. Sleep apnea is simply a condition that many people haven’t heard of.

Anna was able to identify some tell-tale signs of sleep apnea on SnoreLab and pushed for a sleep study which has given her a reliable diagnosis. You can read about what a sleep study entails here.

She has since made massive strides to improve not only her sleep health, but her risk of many associated conditions.

You can read more about what sleep apnea is and investigating sleep apnea with SnoreLab’s insights.

All of our user stories are genuine accounts from SnoreLab users. If you’d care to share your experience about using SnoreLab, we’d love to hear from you. Please contact us on support@snorelab.com or get in touch via Facebook or Twitter.

In the interest of privacy for our users, names and pictures may be changed. We use the wording quoted to us by our users but may make small stylistic changes.

Is It Snoring Or Sleep Apnea?

Sleep Apnea, Science

Is It Snoring Or Sleep Apnea?

Snoring and obstructive sleep apnea are strongly linked – so how can you tell the difference?

It is normal to have a high Snore Score or be told you snore and then worry if it might be something more serious.

Some important things to consider are:

 

Normal snorers don’t stop breathing

Not everyone who snores has sleep apnea – nearly everyone who has sleep apnea snores

If untreated, snoring can become sleep apnea

What is the difference between normal snoring and sleep apnea?

95% of people with obstructive sleep apnea (OSA) snore, but not all snorers have OSA [1]. Both snoring and OSA are the results of improper airflow through your upper respiratory tract. So what is the difference?

Normal snorers, better known as “primary snorers”, don’t stop breathing. Around 30% of the world snores (40% of men and 20% of women).

Conversely, people with OSA experience apneas – this is where breathing stops for 10 seconds or more. This puts strain on various systems in the body and can increase the risk of a number of disorders including stroke, diabetes, cancers and heart conditions.

Obstructive sleep apnea affects around 1-2% of the population, though it is thought that many more people are undiagnosed.

The factors that put you at risk of OSA also make snoring more likely, so how can you spot OSA over primary snoring?

What are the signs of OSA?

There are a number of symptoms which suggest you may be suffering from OSA:

  • Excessive sleepiness in the daytime

Side Note: What constitutes excessive?

We often get asked if SnoreLab can use recorded snoring to find sleep apnea. It is important to note that SnoreLab is not an automatic sleep apnea detector.

We might all get a little sleepy during the day, but excessive sleepiness is where you are barely able to stay awake in a variety of day-to-day situations – not just a warm, dimly lit room with a belly full of lunch!

  • Persistent headaches in the morning
  • Sore throat upon waking up
  • Mood swings and difficulty concentrating

Whilst you may also experience these symptoms occasionally as a primary snorer or even a non-snorer, a persistent combination of all or most of them should be seen as a red flag.

Another crucial sign of OSA is if you have been observed gasping or choking in your sleep. For people who sleep alone, this can be very hard to recognise. This is where SnoreLab can help. So …

Can SnoreLab tell me if I have OSA?

This is a question we get asked a lot. However, it’s important to note that SnoreLab is not an automatic sleep apnea detector.

It is true that sleep apnea often has some very distinctive sounds – normal breathing followed by at least 10 seconds of silence and then a gasp or choke.

Whilst SnoreLab could detect this typical sound profile, sleep apnea is defined by apneic events and such events are not actually defined by sound.

An apnea is a period during sleep where breathing stops for at least 10 seconds.

Apnea is therefore identified by measuring both breathing effort and airflow (or lack thereof). A drop in blood oxygen saturation also helps to confirm this apneic event. Measuring this requires specialist equipment beyond the reach of a consumer app.

In SnoreLab, you can search your session for risky sounds using Full Night Recording mode to ensure that every sound and event is captured.

Some users have used this feature to discover sounds in their recordings that suggested apneic events. They have then found them useful in subsequent medical consultations. For many people, SnoreLab has helped flag sleep apnea they weren’t aware that they had.

This is one example of a sleep apnea event found on SnoreLab …

It is important to note however, this not all apnea events can be easily identified like the above.

Some users diagnosed with sleep apnea do not have very high Snore Scores. One user sent us a screenshot of their session with an apnea event playing with barely any sound detected at all …

How can I find out if I have OSA?

So if SnoreLab can flag sleep apnea but can’t diagnose, you may be wondering how to get a reliable idea of whether or not you have OSA.

There is a three step process to investigate potential OSA …

1. Do some screening tests

If your suspicions and symptoms are pointing to sleep apnea, check your risk by answering some screening questionnaires.

These are surveys that evaluate various symptoms and physical features to give you a risk score.

The Epworth Sleepiness Scale asks questions on your likelihood of falling asleep in certain scenarios like watching television or sitting in a meeting. Your answers can range from “Will never fall asleep” to “Very likely to fall asleep”. A score above 11 indicates excessive sleepiness and a risk of sleep apnea.

 

Epworth Sleepiness Scale questionnaire

Take

 

The StopBANG questionnaire looks beyond sleepiness at your weight, sex, age and snoring. The series of 8 yes/no questions helps to calculate your relative risk of sleep apnea.

 

StopBANG questionnare

Answer

2. Seek medical help

Armed with the symptoms, completed screening tests and some suspicious SnoreLab recordings, it is time to visit your doctor to investigate your potential sleep apnea in more detail.

These pieces of evidence is often enough to convince your doctor that a specialist referral is necessary. Many SnoreLab users have shown their recordings to their doctors …

“Made my doctor finally understand. I finally got the help I needed.”

“This app saved my life! Realized how bad my snoring was, saw a doctor to find out I have sleep apnea.

“MD wrote a prescription for me at a sleep study clinic. Interesting to see bad my snoring really is.”

Here, you could see an ENT (ear, nose and throat) specialist and/or be scheduled onto a sleep study.

3. Undergo a sleep study

A professional sleep study is the only way to get a reliable and quantifiable diagnosis of OSA.

During a sleep study, many measurements are taken to build up a picture of what is happening to your body during sleep. This not only helps to detect potential OSA, but also looks for other sleep disorders.

A sleep study can be performed in a specialist clinic or at home. To find out more about what to expect from home and clinic sleep studies, read SnoreLab’s article What Happens in a Sleep Study or have a look at Susan’s story – a firsthand SnoreLab user account of having a sleep study.

Is primary snoring nothing to worry about?

So if you know that you don’t have OSA and instead simply snore, great. But this is not a reason for complacency. Primary snoring should not be considered normal, harmless or inevitable.

Whilst primary snoring itself may not present a direct, short-term health risk to you, if you share a bed, the disturbance and sleep deprivation for your partner can have health implications for them.

There is also evidence to suggest that primary snoring is a slippery slope towards OSA and other conditions.

Obviously, the factors that put you at risk of sleep apnea (weight, sleeping position, sex, anatomy) also predispose snoring. But now, scientists are now discovering that the very action of snoring itself can increase the risk of developing sleep apnea.

One recent study found that primary snoring is linked to nerve damage in the muscles of the upper airway. This results in swallowing difficulties for snorers and makes obstruction more likely [2].

Conclusion

Primary snoring and obstructive sleep apnea can often get confused and incorrectly used interchangeably. Not all snorers have obstructive sleep apnea, but almost all OSA sufferers snore.

Whilst primary snoring is not directly harmful in the short term, it can be a slippery slope to future OSA.

It is important to understand your sleep apnea risk and to identify the factors that are making you snore.

Obstructive Sleep Apnea Treatment

Sleep Apnea, Solutions

Obstructive Sleep Apnea Treatment

If you’ve been diagnosed with obstructive sleep apnea (OSA) or think you might have the condition, you may have questions about how to treat it.

There are several treatment options; the most effective way to treat your sleep apnea depends on the severity of your condition.

Generally, mild to moderate cases can be effectively managed with the same techniques used to treat primary snoring (i.e. non-apnea). Severe cases where your AHI is over 30 are best managed with CPAP.

In extreme cases where CPAP is not tolerated and there is a clear physical obstruction, surgery can also be an option.

This article explores the various methods that can be used to manage obstructive sleep apnea.

Each category has links to other useful SnoreLab articles on the subject.

Side note: what determines sleep apnea severity?

The severity of sleep apnea is split into mild, moderate and severe. These designations are based on how many times you experience apnea or hypopnea episodes per hour – your AHI score. This is where your breathing completely stops or partially stops for 10 seconds or more.

Make sure to read our article about sleep apnea diagnosis to understand sleep studies, the AHI score and classifying the severity of obstructive sleep apnea.

Making suitable lifestyle changes

If your sleep apnea is at the milder end of the spectrum, you can treat it by making some targeted lifestyle changes.

What is most effective depends greatly on what is responsible for your sleep apnea in the first place. Generally speaking, the following lifestyle changes have the most positive impact:

1. Lose weight

Your weight has a significant influence on your likelihood of developing obstructive sleep apnea. Simply put, the heavier you are, the more likely you are to suffer from OSA.

Side note: the statistics of weight loss and sleep apnea

Some epidemiological studies indicate that 70% of patients experiencing sleep apnea are obese, and 40% of obese people are suffering from sleep apnea [1].

Promisingly, research has demonstrated that losing 10-15% of your body weight can half the severity of your sleep apnea [2], and that losing 60% of body fat can eradicate sleep apnea for around 86% of obese people [3].

There’s no shortage of advice or special diets when it comes to losing weight. It can all be a bit confusing and overwhelming. No single technique works wonders for everyone, and drastic solutions are rarely stuck at for very long.

Instead, be sure to check out SnoreLab’s SMART strategy for effective, sustainable weight loss and also have a read of our full article of the impact of weight on snoring and sleep apnea.

2. Stop smoking and reduce alcohol consumption

Smokers, and even passive smokers are more at risk of snoring and experiencing sleep disordered breathing [4][5].

Some studies have found that smokers are 2.5 times more likely to suffer from obstructive sleep apnea [6].

Quitting smoking has shown to reduce your likelihood of experiencing sleep disordered breathing [7]. This is because smoking contributes to greater inflammation and irritation in the upper airway which predisposes it to vibration and collapse [8].

Further, a nightcap is also not ideal for healthy sleep. Alcohol causes your muscles to relax – even more than they do normally when you fall asleep. It therefore increases the collapsibility of your airway and heightens the risk of experiencing apneas.

SnoreLab users amongst many others have found that reducing their alcohol consumption yields drastic reductions in their snoring and sleep apnea.

3. Alter your sleeping position

More than half of all obstructive sleep apnea cases are referred to as “position-induced” sleep apnea [9], where the severity of the condition is made worse by back-sleeping.

By sleeping on your back, your mouth has a tendency to fall open. This changes the shape of your upper airway and makes obstruction more likely.

Sleep apnea can therefore be massively reduced by switching to side-sleeping. There are many techniques you can use to make this change – be sure to check out our guide to sleeping position and snoring.

Anti-snoring mouthpieces

Whilst not recommended for severe cases of OSA, a mandibular advancement device (MAD) can be a good option for those with mild to moderate OSA, or those who do not tolerate CPAP.

MADs brings your lower jaw (mandible) forward (or advance it) to tighten the tissues in your airway that are prone to slackening and causing obstruction.

There are many different types of MAD available so finding the right one can be a bit confusing. To get the best quality we recommend getting a mouthpiece custom fitted by a dentist, though this can be quite expensive.

You can still find great quality mouthpieces without paying loads for a custom-made one. Have a read of our guide to anti-snoring mouthpieces so you know what to look out for when buying generic devices online.

If your tongue causes obstruction in your airway, a different type of mouthpiece called a “tongue retainer” can also be effective for mild to moderate OSA.

CPAP

CPAP stands for continuous positive airway pressure and is a treatment suitable for moderate to severe sleep apnea sufferers. It is the primary method for managing OSA and has a wealth of evidence to support its efficacy.

In most countries, it is only available with a prescription after confirmed diagnosis of sleep apnea.

A CPAP device uses a mask to force air into your nose and throat to keep your airways open.
CPAP does not give you more oxygen. Instead, it introduces a current of normal air that creates positive pressure; this props open your airway to stop it from collapsing.

Many people are fearful of CPAP. Users can also struggle with their devices, experiencing discomfort, claustrophobia and air leakage.

Despite its scary reputation, it’s important to know that CPAP can be a life-saving tool. There are measures you can take to get the most out of it and cope with any difficulties you may have.

 

SnoreLab’s guide to dealing with CPAP issues

Check out

Performing mouth exercises

Research has shown that exercising the muscles in your airway can have a positive impact on mild to moderate sleep apnea.

These techniques are adapted from speech and language therapy and consist of repeated movements in the tongue, cheeks, jaw and soft palate in order to increase muscular tone.

Several studies demonstrate that patients with sleep apnea can reduce their AHI scores and sleepiness by performing these exercises regularly [10] [11] [12] [13].

You can read about all of the evidence and also learn the 5 exercises we recommend.

Surgery

Surgery is usually a last resort only when other techniques to manage your sleep apnea have failed.

Whilst there is some research to show that surgery can produce positive outcomes for OSA, there isn’t enough evidence for surgery to be routinely recommended ahead of alternatives like CPAP.

Usually, to be considered for surgery, there are several requirements that will be assessed by an ENT (ear, nose and throat) specialist first:

  • A diagnosis of severe obstructive sleep apnea, confirmed by a sleep study
  • A clear physical obstruction that can be rectified by surgery
  • Failed treatment with alternative methods such as CPAP and mouthpieces
  • Evidence that the condition is severely affecting your quality of life

There are many types of surgery for snoring and not all are recommended for OSA sufferers.

To get an overview of the surgical interventions available and the important considerations when exploring surgical options, be sure to read our article on surgery for snoring and sleep apnea.

Conclusion

Obstructive sleep apnea can be managed via a number of different means. What is most effective depends on the causes of your condition and its severity.

Regardless of which treatment route you take, many countries have support groups for people with OSA.

These organisations aim to educate and provide support with all facets of OSA.

They give helpful information on living with the condition, provide practical support with CPAP and other treatments, fund and publish the latest research into sleep apnea as well as organising support meetings in person.

Surgery for Snoring and Sleep Apnea

Science, Sleep Apnea, Solutions

Surgery for Snoring and Sleep Apnea

Surgery is perhaps the most drastic snoring remedy available and has the potential to be very effective for some people. There are a number of surgical interventions to reduce snoring and sleep apnea.

In this article, we summarise the different types of surgery for snoring and sleep apnea, as well as exploring some of the important considerations to be made before opting for surgery.

Some important considerations

Surgery should be a last resort

Surgical intervention should only be considered if other methods you have tried have failed.

Surgery is invasive and sometimes irreversible, so careful consideration should be given as to whether alternatives have been pursued to their full capacity.

Though it will usually be discussed in any consultation prior to surgery, some of the most effective methods of treating snoring are non-surgical and always worth mentioning. These include:

Surgery types vary and what is most suitable depends on YOU

There are several different types of surgery that can reduce snoring. Like non-surgical snoring remedies, there is no one solution that will work for everybody.

The most effective type of surgery depends on your snoring and what is causing it in the first place.

Your suitability will need to be assessed with a physical examination

For surgery to be effective to treat snoring, there must be a clear physical cause of snoring. This means you’ll need to undergo a thorough examination by an ENT (ear, nose and throat) specialist to identify the source of the snoring.

Initial examinations will include basic observations of your nose, tongue and throat. The procedure is also likely to involve flexible endoscopy.

Here, a flexible tube with a fibre optic camera is inserted into the nose and down the back of the throat to look for structural abnormalities.

Whilst this tube is in place, the examiner may ask you to recreate a snoring sound to help identify the tissue that is producing the noise.

You may have to undergo a sleep study first

It is important to distinguish between primary snoring and obstructive sleep apnea. This is because certain types of surgery are not recommended for obstructive sleep apnea (OSA) sufferers.

For that reason, if OSA cannot be ruled out after a physical examination, you may have to undergo a sleep study. This can be done either in a specialist sleep clinic or at home.

 

SnoreLab’s article on what to expect from a sleep study

Read

The benefits may not be permanent

The body has a remarkable way of adapting to change, and unfortunately this isn’t always a good thing.

Snoring surgery that addresses soft tissue works by causing intentional scarring to certain parts of the airway to stiffen them. Your body will automatically work to heal these scars, therefore whilst the snoring is reduced in the short term, you may find that it returns in the long term.

You could experience side effects

Whilst the side effect profile depends on the type of surgery you have, surgery will always involve breaking tissue which carries risks.

It is common for patients to experience some mild pain after surgical interventions.

Availability varies depending on where you live

Every country’s health system is different, and for that reason what is recommended, available and suitable in one location may not be so in another.

For example, pillar implants are considered suitable to treat mild-moderate obstructive sleep apnea in the USA but not in the UK [1].

The healthcare system in your location may also affect whether or not you are eligible for snoring surgery. Because snoring is usually considered a trivial condition (though those that live with it would argue otherwise), state funded medical systems are reluctant to fund snoring surgery. Further, snoring surgeries may not be covered by certain insurance policies.

The different types of surgery

There are three main categories of surgery that can help to directly reduce snoring:

  1. Soft Tissue surgery.
  2. Maxillofacial surgery.
  3. Neural stimulation.

1. Soft tissue surgery

The least invasive option, this involves making changes to the soft noisemakers themselves.

Soft tissue surgery aims to remove or stiffen the flappy parts of the airway which vibrate and cause the snoring noise.

Other soft tissue procedures involve making changes to structures in the nose that can cause “downstream” snoring via nasal blockage.

Most types of soft tissue surgery are not recommended for OSA sufferers, though this does vary.

Usually, these procedures can be performed in an outpatient clinic under local anaesthetic (i.e. you are awake but cannot feel pain in that region).

Uvulopalatopharyngoplasty

Also known as UPPP or UP3, this surgery aims to open the upper airway by removing tissue from the uvula, soft palate and pharynx. If they are still present, it can also involve removal of the tonsils and adenoids (the latter usually disappearing in adolescence).

It is the most invasive form of soft palate surgery and must therefore be performed under general anaesthetic (i.e. you are unconscious).

Whilst UPPP is one of the few soft tissue procedures recommended for OSA, it is performed less often than it used to be. This is because less invasive techniques with lower side effect profiles have emerged. It has also fallen out of favour because UPPP can reduce the effectiveness of CPAP.

Laser-assisted uvulopalatoplasty

Using a similar principle to UPPP, as the name suggests, laser-assisted uvulopalatoplasty (LAUP) uses carbon dioxide lasers to stiffen and remove tissue from the soft palate and uvula to widen the airway [2].

Because of the enhanced precision of lasers, it is considered a safer alternative to UPPP.

This procedure is usually done under local anaesthetic in a clinic and is done over three to four separate sessions.

Despite it being said that LAUP is suitable to treat mild to moderate OSA, studies have not demonstrated consistent improvements for these patients [3].

Radio frequency ablation

Also known as “somnoplasty”, this type of snoring surgery uses radiofrequency energy to generate heat for creating controlled lesions in soft tissue. The basis here is that the lesions become scarred and retract, reducing the amount of flappy tissue and stiffening what remains.

This can be performed on different parts of the airway depending on where the blockage is, including the turbinates of the nose (folds of tissue in the nasal cavities), the soft palate and the base of the tongue.

A minimally invasive technique, it is performed under local anaesthetic in an outpatient setting [2].

Injection snoreplasty

In this snoring surgery, no tissue is removed. Instead, sodium tetradecyl sulphate, a chemical used to treat varicose veins, is injected into the soft palate in order to scar it.

Whilst there are advantages here in that it is minimally invasive and doesn’t involve the removal of tissue, this is a fringe therapy and won’t be recommended by many clinicians. This is because the evidence to support its effectiveness is somewhat lacking, with only a few studies with small sample sizes.

Pillar procedure

This popular outpatient procedure performed under local anaesthetic involves inserting three or four small polyester implants into the soft palate to increase its stiffness and reduce vibration.

The pillar procedure has shown to reduce snoring for many patients. However, studies indicate that their effectiveness starts to decline after they have been in place for more than one year [4].

Septoplasty

A slightly different procedure, this surgery involves straightening the nasal septum – the cartilage which separates the two nasal cavities.

A deviated septum is where this cartilage is bent. It is therefore more difficult to breathe through your nose. This causes you to make a switch to mouth breathing which is known to increase the risk of snoring.

A septoplasty is usually performed in an outpatient setting and has very few/rare complications and side effects.

2. Maxillofacial surgery

Maxillofacial surgery makes structural changes to the bones of the face, jaws and neck. This aims to increase the space in the upper airway.

They are quite serious procedures which need to be done under general anaesthetic and will involve a hospital stay.

hese procedures are further reaching that soft tissue surgery. As a result, maxillofacial surgery can have life-changing benefits for patients with severe obstructive sleep apnea.

Maxilla/Mandible Advancement

This simply refers to repositioning the bones of the jaw. It usually involves moving the lower jaw (mandible) forward. This is done by cutting the bone and holding it in a more advanced position with metal plates and screws.

A receded lower jaw reduces the airway space behind your tongue; moving it forward widens this space and makes obstruction less likely.

This surgery can be likened to a permanent version of what an anti-snoring mouthpiece is designed to do.

If necessary, surgery can also be performed to move both the upper (maxilla) and lower (mandible) jaws forward.

Whilst this surgical option is quite drastic and will involve a period of recovery, it is the only procedure that is considered curative for severe obstructive sleep apnea. In multiple published trials over the years, patients consistently show a decreased AHI and reduced sleepiness.

Because of the changes to the bones of the face, this surgery will often cause irreversible changes to your appearance (often, patients report, for the better).

Hyoid suspension

The hyoid bone rests in the upper part of your neck. It is the only bone in the body that doesn’t connect to any other bone (and is therefore referred to as a “floating bone”).

Anti-snoring surgery can be performed on the ligaments that hold the hyoid bone in place. This helps to move the base of the tongue forward to create more space in the airway.

3. Neural stimulation

This is an exciting, new type of surgery which involves electrical stimulation of the tongue muscles to keep the airway open. It is only ever performed on patients with obstructive sleep apnea.

The system usually consists of three small parts:

  • An electrode wrapped around one of the key nerves that stimulates the tongue to move forward.
  • A generator which creates the electrical impulse. This is implanted in the chest and can be switched off in the morning wirelessly via a remote.
  • A sensor which helps to synchronise the neural stimulation with inward breaths. This is implanted in muscles of the ribs but isn’t always included.

To be considered for neural stimulation surgery, you’ll need a diagnosis of obstructive sleep apnea with an AHI of 20-50 (i.e. moderate to severe) [5].

It is usually recommended only if CPAP has failed. As this is an emerging therapy with restricted approval and a limited number of surgeons trained to perform it, it is not an option available everywhere.

Conclusion

Surgery can be a very effective solution for some snorers and sleep apnea sufferers. However, like all snoring remedies, it isn’t suitable for everybody.

For surgery to work, there needs to be a clear physical abnormality that can be corrected.

Surgery should be a last resort only when other techniques to manage your snoring or sleep apnea have failed.

This article aims to give you insight into all of the different types of surgery available: the established techniques, the emerging procedures and those falling out of favour. It is important to note that what may be offered for you will depend on your symptoms, snoring causes, anatomy and the medical facilities where you live.

What is Sleep Apnea?

Science, Sleep Apnea

What is Sleep Apnea?

It is normal for a snorer to wonder what sleep apnea is and if they are at risk.

Apnea simply means “no breathing”. Sleep apnea is a serious condition where your airway repeatedly closes during sleep, depriving you of oxygen until you gasp awake.

It is a common misconception that all loud snorers have sleep apnea, but if you think you do, ask yourself or your partner if you have any of the following:

  • Loud snoring with periodic silence and choking/gasping
  • Sore throat or headaches in the morning
  • Excessive sleepiness in the daytime
  • Lack of concentration
  • Behavioural changes and mood swings

Snoring, especially loud snoring, puts you at risk of developing sleep apnea later on – as good a reason as any to address your snoring now.

Side note: obstructive vs. central sleep apnea

Sleep apnea comes in two forms; the obstructive condition is linked to snoring as there is an airway blockage. The other type, central sleep apnea, is due to a fault in the brain’s regulation of breathing – this type is not linked to snoring. All subsequent references to sleep apnea refer to the obstructive form.

How does sleep apnea differ from normal snoring?

The key difference between snoring and sleep apnea is whether or not you are breathing.

When you produce a snoring sound, you are breathing; air must be travelling through your airways and into your lungs, albeit a bit bumpily. Noise from snoring is bothersome but the more worrying event is when the sound suddenly stops – now you aren’t breathing.

Here, snoring has made the serious transition to obstructive sleep apnea.

 

“Is it snoring or sleep apnea?”

Read the full article

Thankfully your body has a mechanism to kick-start breathing again. When it stops for too long, the amount of oxygen in the blood drops and carbon dioxide rises; your brain recognizes this dangerous situation. A fizz of brain activity briefly wakes your body up, often with a gasp or snort. Muscles in your neck open the airways so air can get back into the lungs.

Sadly, when you go back to sleep, this process of obstruction, low oxygen and awakening repeats itself again and again.

Why is sleep apnea dangerous?

Sleep apnea is harmful because repeated oxygen debt and fitful sleep every night takes its toll on your body [1]. During the low oxygen events, your heart is having to work harder. This increases blood pressure which damages your arteries, thickening their walls and increasing the likelihood of:

  • Heart problems including angina, heart failure and heart attacks
  • Stroke
  • Diabetes
  • Impotence

These physical problems are only made worse by disturbed sleep. A lack of sleep also has detrimental effects on your day-to-day mental functioning. Many people experience:

  • Low energy
  • Daytime sleepiness
  • Worsened reaction times
  • Poor memory

Beyond the sufferer, sleep apnea impacts upon society too. At work, persistent tiredness shrinks productivity and means more days taken off sick [2].

On the road, studies have found that people with sleep apnea are twelve times more likely to be involved in road traffic accidents. Some countries now make it mandatory to inform the driver registration authorities if you are diagnosed with sleep apnea [3].

What can put you at risk of sleep apnea?

Snorers are not necessarily suffering from sleep apnea, but the risks associated with each are closely aligned. The things that make you more likely to develop sleep apnea mirror the risk factors for snoring:

Identifying potential sleep apnea

There are some important things to watch out for if you suspect you have sleep apnea:

  • Very loud snoring, with periodic silence and gasping
  • Headaches or a sore throat in the morning
  • Being excessively sleepy in the day
  • Lack of concentration
  • Mood swings and behavioral changes

Despite continuously waking during the night, sufferers don’t usually realize it themselves. Many people assume that the fatigue they are experiencing is a symptom of age so fail to seek help. Instead, partners of those with the condition are more likely to spot their sleep apnea.

How does sleep apnea severity vary?

The severity of your condition can be assessed by counting how many times you experience low-oxygen events. This helps to generate an AHI score, the apnea-hypopnea index. This measures the apnea or hypopnea episodes per hour of sleep:

  • Apnea episode – complete airflow blockage for at least ten seconds
  • Hypopnea episode – at least 50% reduction in airflow for at least ten seconds

Your AHI score relates to the severity of sleep apnea:

  • 0-5 events per hour – normal
  • 5-15 events per hour – mild sleep apnea
  • 15-30 events per hour – moderate sleep apnea
  • 30+ events per hour – severe sleep apnea

Your score is very important when deciding on the best way to treat your sleep apnea. Mild to moderate cases can be addressed with normal snoring reduction techniques and consumer remedies. If you have a severe case, continuous positive airway pressure devices (CPAP) are the most effective form of treatment.

Conclusion

It is important to know that relatively benign snoring can make a dangerous transition to obstructive sleep apnea. This is a serious condition where your airway repeatedly closes during sleep, briefly depriving you of oxygen until you gasp awake.

Low oxygen events and continuous poor sleep can have serious repercussions on both your physical and mental wellbeing.

The same things that cause snoring put you at risk of sleep apnea. Some people even consider loud snoring to be the first stage of “sub-clinical” sleep apnea. Importantly, up to 95% of people with sleep apnea snore [4], but not everyone who snores has the condition. Understand your risk and know how to spot the signs so you don’t make the switch.

What Happens in a Sleep Study?

Science, Sleep, Sleep Apnea, Solutions

What Happens in a Sleep Study?

If you snore and are worried about sleep apnea, to get a diagnosis you’ll need to undergo polysomnography in a sleep study.

At SnoreLab, we often get asked “Can the app detect sleep apnea?” Some users have found tell-tale signs of sleep apnea in their SnoreLab recordings, but importantly, these don’t reliably tell you that you have sleep apnea. The only way to robustly diagnose sleep apnea is with a sleep study.

Some estimates put the rate of sleep apnea amongst people aged 30-60 at 16.5%, but the vast majority of these people are undiagnosed [1]. This is because there is a lot of anxiety, unawareness and misinformation surrounding sleep studies.

This article aims to demystify sleep studies so you know what to expect if you want to make a positive step towards understanding and treating sleep apnea.

What does a sleep study do?

A sleep study does exactly what the name suggests, it studies your sleep. This is done via a process called polysomnography (PSG) which literally translates to “many sleep measurements”.

Sleep apnea cannot be diagnosed with your snoring sounds on their own, therefore other measurements are necessary. As well as capturing your sounds with a microphone, PSG will also measure:

  • Blood oxygen levels – blood oxygen drops during apnea episodes.
  • Brain activity – to detect the microarousals that accompany apnea events and assess sleep stage.
  • Muscle activity
  • Heart rate
  • Breathing rate and effort – to provide evidence of breathing interruptions.
  • Eye movement – helps to determine what stage of sleep you are in.
  • Sleeping position – gives some insight into what triggers sleep apnea.

PSG can also be used to study other conditions such as narcolepsy, restless leg syndrome, periodic limb movement disorder, insomnia, sleepwalking and night terrors.

How do I get a sleep study?

Medical referral

If you think you might have sleep apnea, first assess your risk with some questionnaires. Scoring high on screening questionnaires such as the STOP-Bang questionnaire and the Epworth Sleepiness Scale can be useful in persuading clinicians that a sleep study is necessary.

You can then see your doctor to request further investigation into your sleep breathing problems.

As well as your screening questionnaire results, SnoreLab can often be very helpful in giving your doctor some evidence of your loud snoring or maybe even some apnea episodes.

If seeing a general practitioner for your initial consultation, you may first be referred to a sleep specialist or an ear, nose and throat (ENT) clinician before being offered a sleep study.

Requesting a home study online

In some countries, there are online companies that conduct home sleep studies without you ever having to attend a medical consultation. After filling out an online assessment form and paying a fee, these companies will post your study equipment to you with instructions.

Which type of study is best for me?

If your specialist deems you to be at risk of sleep apnea, you should be offered a sleep study to confirm this suspicion.

There are two types of study, one done at a specialist sleep lab, the other in your home.

Studies done at sleep labs:

  • Give more reliable insight into what is happening to your body during sleep
  • Use more attachments and measurements; can detect a wider variety of conditions
  • Are usually more expensive
  • Often have less availability meaning longer waits

Whereas studies performed at home:

  • Are more comfortable due to the familiar settings, therefore can give better quality sleep
  • Still give reliable results, particularly if your symptoms are quite severe
  • Are usually less expensive
  • Are more convenient
  • Can be prone to error if not fitted correctly

Often, your specialist will recommend the most suitable type of study for you and will make you aware of the relative merits of each.

Sleep lab studies – what to expect

Sleep studies conducted at specialist labs are more comfortable than many people think. The word “lab” conjures images of cold indifference; people in white coats and unfriendly, clinical surroundings. Most bedrooms in specialist sleep clinics are comfortable and sympathetically decorated, with a real bed as opposed to a hospital trolley – some say akin to a three-star hotel.

Before your study

To ensure good sleep and reliable data, there are a few things to do in the lead up to your study:

  • Maintain a normal and healthy sleep routine on the nights leading up to the study.
  • Avoid napping on the day of the study.
  • Limit caffeine consumption and avoid alcohol altogether.
  • You may also need to adjust your medications (ask the referring specialist beforehand).

What to bring

Make sure to bring:

  • Suitable night clothing
  • A change of clothing for the next day
  • Toiletries
  • Something to keep you occupied before going to sleep. There will likely be a period of winding down before the study starts, so a book or puzzle to keep you occupied (without excessive stimulation) is a good idea.
  • Any medication you take routinely, both to maintain that routine and to show to the staff, as this can provide some insight into your sleep symptoms.
  • Any necessary documentation

Getting wired up

Because PSG measures many different things, there are lots of attachments that need to be made. Ultimately, you need to be relaxed enough to sleep properly, so the technician should take time to make sure the attachments are secure yet comfortable. This will take anywhere from thirty minutes to an hour, so you should use this time to ask any questions you have.

Different labs will vary, but typically you will have these various attachments on a number of places on your body:

  • Head – electrodes taped on to measure your brain activity.
  • Side of your eyes – these measure the movement of your eyes to help determine your sleep stage.
  • Chin – electrodes here assess the muscular tension in your jaw.
  • Nose – a nasal cannula rests two small tubes into your nostrils to measure breathing rate.
  • Chest – a strap here monitors your breathing effort. This part may also include a small box where other channels are connected to.
  • Finger – a small clamp usually on your index finger measures blood oxygen levels by shining infra-red light through your finger nail.

Once all of these attachments are in place, your technician may ask you to blink or make some snoring noises to test the connections.

You are likely to then be given some time to wind down before going to sleep.

Depending on the time of your study and the individual practices of different labs, you may be provided with a meal.

Getting to sleep

As more and more pieces of wire are attached to you, you’ll probably feel that it’s less and less likely that you’re going to be able to sleep in this strange environment.

People often start to worry that they won’t sleep or get accurate results. In reality, only a tiny proportion of sleep tests fail due to inadequate sleep data. It may take a little longer to fall asleep, but usually, you’ll get plenty of sleep which will give the clinicians lots of data to work with.

Throughout the night

Typically, you are given six to seven hours to sleep. A technician will monitor you overnight. If you need to urinate in the middle of the night, simply let the technician know and they will come to disconnect the relevant attachments properly.

In the morning

Don’t be surprised if you wake up to a different technician. Sleep studies last about ten hours from initial arrival so it’s likely that the staff will change over.

Once you have been given time to change and freshen up, you might be asked to complete some questionnaires about your sleep and symptoms. Everything is usually done by 7am.

Home studies – what to expect

Typically, you will have your home sleep study about four weeks after your initial referral.

Attaching the equipment

If you have booked your home study through a clinic, you will probably have to attend that clinic on the day of your study. This is your chance to get as much information as you can and ask any questions if you have them. There are two possible set-up methods, you will either:

  1. Collect the equipment and attach the components yourself once at home. Here, you will be given the home study equipment with a set of instructions. These types tend to have fewer pieces and therefore give less detail
  2. Get the main components attached by a technician with just a few connections for you to do once home before you go to sleep. Having a specialist fit the components allows use of more connections giving more measurements.

If you have mobility issues, it may be possible for a sleep technician to deliver and fit the study equipment in your home.

Home sleep studies tend to be less involved than those conducted in specialist labs, so there are likely to be fewer attachments. You will have a minimum of:

  • Nasal cannula – rests two small tubes in your nostrils to assess your airflow.
  • Finger clamp – this is a pulse oximeter: a device that measures the amount of oxygen in your blood.
  • Chest strap – this measures your breathing efforts as well as containing a box where the other wires connect.
  • Heart rate monitor.

This is the minimum. Some home studies, particularly those where a specialist gets you fitted at the clinic beforehand, have more attachments that can also measure brain, eye and muscular activity; much like a lab study.

Getting to sleep

Once wired up, despite being in the comfort of your own bed, you are likely to take a little longer to get to sleep. Most people report that the attachments feel a little strange but not uncomfortable. The set-up should allow you to sleep in whatever position you like.

If you worry that you aren’t sleeping enough, remember that only a tiny handful of sleep studies fail due to inadequate sleep data. Though you may feel you haven’t slept particularly well, chances are, you slept much more than you think you did.

In the morning

Most equipment is quite easy to disconnect. Clinics don’t usually require the parts to be bundled up neatly and often supply a simple plastic bag or box for you to simply stuff the parts into. Usually, the cannula is disposable.

Some units will have a little light that shines either green or red in the morning to indicate whether the test has sufficient data. You’ll be given instructions before as to what to do if the light is red.

You then need to return the study to the clinic for them to generate the results.

To better understand what happens in a home sleep study, read Susan’s story, a SnoreLab user’s first-hand account of getting a sleep apnea diagnosis through a home sleep study.

Understanding your results

Getting your sleep study results back can take days to weeks. If you have had a home study and your results are unclear, your specialist may refer you for a lab study instead.

You will get a document that gives many details about what was recorded during your study. Here is a breakdown of what usually gets measured and what it all means …

Sleep physician/technician’s report

This is a summary of the findings. They will say whether your sleep and the data obtained was adequate as well as an overview of the findings including: sleep position, sleep stages and apnea episodes.

Calculated variables

These are your apnea measurements:

  • Total AHI – the average number of times per hour, you experienced an apnea or hypopnea event (total or >50% breathing cessation for 10 seconds or more).
  • NREM AHI – the AHI during the non-REM stage of sleep.
  • REM AHI – the AHI during the REM stage of sleep.
  • Minimum oxygen saturation – the lowest level of oxygen detected in your blood.
  • Longest apnea – the duration in seconds of your longest period of complete breathing cessation.
  • Longest hypopnea – the duration in seconds of your longest period of partial (>50%) breathing restriction.
  • Mean apnea/hypopnea duration – the average time in seconds of each episode.
  • Arousal index – the number of times per hour you aroused from sleep.
  • Apneas experienced in different positions

Conclusion

This identifies if you have sleep apnea and its relative severity:

  • Normal: AHI = 0-5. This will sometimes just be called “primary snoring”.
  • Mild obstructive sleep apnea: AHI = 5-15
  • Moderate obstructive sleep apnea: AHI = 15-30
  • Severe obstructive sleep apnea: AHI = 30+

Sleep statistics

These are the measurements of your sleep, the relative times spent in each sleep stage and how long you took to fall asleep:

  • Time available for sleep – i.e. when the lights were off.
  • Total sleep time
  • Sleep efficiency – this is the percentage of time spent asleep during the time that the lights were off
  • Sleep latency – the time taken to fall asleep
  • REM sleep time
  • NREM sleep time
  • Sleep in supine position – time spent sleeping on your back.

Different sleep stages with SnoreLab’s insights into the Architecture of Sleep.

Learn more.

The next steps

Your results report may also include some recommendations. If your results show little to worry about (i.e. normal primary snoring) you’ll get some general advice that takes into account both the study results and your general health.

If sleep apnea has been detected and you had your study through a referral process, you will then have some follow up appointments to discuss treatment options.

Mild to moderate sleep apnea can often be improved with consumer anti-snoring remedies and positive lifestyle changes. Usually, severe sleep apnea requires treatment with CPAP.

See SnoreLab’s guides to the different types of CPAP mask and how to fix common problems with CPAP.

This article gives an overview of the general processes in most laboratory and home sleep studies. Individual practices may vary.

Study for Sleep Apnea – Susan’s Story

Sleep Apnea, User Stories, Using SnoreLab

Sleep Study Story – Susan


We like to hear from our users to find out how they use the app and what they have done to combat their snoring. With these user stories, we hope you can pick up some great tips and gain some motivation to address your snoring too.

This story comes from Susan who responded to a post about sleep apnea on our Facebook page. After using SnoreLab and identifying some concerning audio on her recordings, Susan requested a sleep study and found out she had very severe obstructive sleep apnea. This story details her route from being blissfully unaware, through investigation, diagnosis and treatment of her sleep apnea …

For a while I suspected that I only snored intermittently throughout the night. My snoring has generally occurred under the usual “snoring circumstances” such as laying on my back, after drinking alcohol and being extremely tired.

My snoring seemed to get worse after coming to an early menopause which also coincided with some weight gain.

I found with my VivoFit band that I was waking frequently, but it didn’t provide comprehensive information so I started looking at other sleep monitoring methods. That’s when I can across the SnoreLab app.

After thinking I was only an occasional snorer, I was shocked to see that I snored consistently all night with a large chunk of it being the “Epic” level.

I’ve had problems breathing through my nose for some time, so saw an ENT specialist thinking this was the likely cause of my snoring. I mentioned my SnoreLab results and that I thought my snoring was a bigger problem than I initially had thought and that I wanted it investigated. He didn’t really ask about sleep apnea or snoring and instead I had nose surgery which wasn’t particularly successful.

Once I had used SnoreLab for a bit, I didn’t really suspect I had sleep apnea, I just thought I was a chronic snorer. It was while researching chronic snoring that I came to think that I might have sleep apnea, or that it was at least worth doing a sleep study.

I analyzed my SnoreLab results and I started to notice some tell-tale signs. I did full night recordings and there were some silent areas in my sessions with some gasping noises. This made me think that sleep apnea was a possibility, but thought that it was probably mild as mostly the results were showing snoring sounds all night long.

More alarm bells started ringing when I realized that I was feeling extremely tired all the time, yawning at my desk after only a few hours at work. Once I had joined the dots – the excessive sleepiness and the snoring – I then seriously considered sleep apnea as a possibility.

I noticed my Snore Score was getting higher so I looked closer at the audio and found more silent areas and gasping.

My doctor was very obliging in referring me to a sleep specialist after I explained my SnoreLab results and my constant tiredness. The sleep specialist was interested in the app, and after some questions I was offered a sleep study straight away without any further investigations.

I had the choice of a home study or one in a sleep clinic. The home study seemed to tick the boxes in terms of cost, so I asked if this was as reliable as one performed in a specialist clinic. He explained that due to the severity of my symptoms, a home study will likely give a reliable diagnosis. If he wasn’t sure from the home study results, he would insist on a clinic study.

Four weeks after my initial consultation I had my home sleep study.

On the day of the study, I went to a late afternoon appointment at the sleep clinic so a technician could help me fit all of the parts. There were many attachments: finger clamp sensors, heart rate monitors, a microphone, various electrodes that attached to my head and chest as well as some other parts to look for leg movement. She attached everything in an orderly fashion and explained it all as she went along.

I then went home (with a jacket on to cover up my attachments so I didn’t attract unwanted attention) and got on with my evening. Despite having these pieces attached to me, I was still able to move around easily and do the things I’d normally do before bed. 

Of all the connections, there were a few that I had to fit myself before going to sleep. The leads from the various attachments were bundled into one plug to be connected at the front of a belt around my middle. Then I had to put in the nasal prongs and a small clamp on my finger which were also connected to the belt. 

When I went to sleep, it was an unusual feeling, but certainly not uncomfortable. I didn’t feel like I slept very well for fear of the leads disconnecting. In a Catch-22 scenario, I then started to worry that because I thought I wasn’t sleeping well the test wouldn’t give an accurate representation of my normal sleep (this later proved to be an unfounded fear, as there was plenty of data when my results came back, and the diagnosis was clear as day).

Before, the technician had explained what needed to be disconnected in the morning. Everything came off very easily like she said it would. By undoing the two connections on the front belt, the entire system slipped off like a cardigan.

She had also explained that there was no need to tidy up the leads or disconnect anything else, I simply had to put everything into a bag and return it to the clinic.

The results were sent away to be analyzed and I got them back in four weeks.

I was very surprised. After thinking that if I did have sleep apnea, it would be very mild or not detected, my results came back as “Very Severe Obstructive Sleep Apnea”. My AHI score was 100! This means that my sleep was disrupted 100 times per hour. Sometimes, oxygen was interrupted completely for 30 seconds at a time.

Following the initial shock, I was then excited to think that there are known treatments for sleep apnea and that I would one day hopefully not feel so tired.

The sleep specialist wrote a script for a CPAP machine and gave me a list of suppliers. Helpfully, the script also had instructions to the supplier as to what settings the machine should have.

Interestingly, the chemist I rented the CPAP machine from had a sleep apnea trained assistant. I discussed the app with her and she was intrigued. She mentioned that a lot of people assume they can rent a CPAP machine without a script (they can’t here in Australia). She then said that SnoreLab would be a great way to give evidence to doctors and convince them that a sleep study is necessary.

I had to use the machine for a month so they could determine its effectiveness and whether the airflow settings were correct. The machine I was given had a feature that meant it could also detect apnea events. After a month of use, my AHI score reduced from 100 to 3!

I’m so glad I did the sleep study and started CPAP treatment, especially since I did some research about the detrimental effects of sleep apnea. Having such a high score meant I was a prime candidate for stroke and many other health problems.

I am still using a CPAP machine, and whilst I’m still a bit tired in the day, I’m optimistic that this will improve. Even though my sleep still isn’t quite where I want it to be, I feel comforted that my breathing obstructions are not so life threatening!

I sing the praises of SnoreLab all over the place and honestly don’t think I would have pushed for a sleep study had I not used the app beforehand.

Many people snore loudly and feel tired throughout the day, but don’t make a link between the two. Susan was able to identify some tell-tale signs of sleep apnea on SnoreLab and pushed for a sleep study which has given her a reliable diagnosis. You can read about what a sleep study entails here.

She has since made massive strides to improve not only her sleep health, but her risk of many associated conditions.

You can read more about what sleep apnea is and investigating sleep apnea with SnoreLab’s insights.

All of our user stories are genuine accounts from SnoreLab users. If you’d care to share your experience about using SnoreLab, we’d love to hear from you. Please contact us on support@snorelab.com or get in touch via Facebook or Twitter.

In the interest of privacy for our users, names and pictures may be changed. We use the wording quoted to us by our users but may make small stylistic changes.

Privacy Preference Center