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?

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.

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References

  1. Hoffstein V, et al. Snoring: is it in the ear of the beholder? Sleep 1994; 17(6): 522-526. https://www.ncbi.nlm.nih.gov/pubmed/7809565
  2. Ng AK and Guan C. Impact of obstructive sleep apnea of sleep-wake ratio. IEEE Engineering in Medicine and Biology Society Annual Conference 2012; 2012: 4660-3.
  3. Wiseman R. Night School: The Life-Changing Science of Sleep. MacMillan London 2014. P144
  4. Ficker JH, et al. Are snoring medical students at risk of failing their exams? Sleep 1999; 22(2): 205-209. https://www.ncbi.nlm.nih.gov/pubmed/10201064
  5. Lovati C. Sleep apnea headache and headaches with sleep apnea: the importance of being secondary. Expert Review of Neurotherapeutics 2013; 13(11): 1135-1137. https://doi.org/10.1586/14737175.2013.853450

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