Signs of Sleep Apnea

It may be time to see a sleep specialist — for your health and the sake of anyone sharing your bed.

When you or your bed partner has sleep apnea, a restful night’s sleep can be hard to come by. Treating this common condition not only eases annoyances, but it can prevent a range of serious health issues.

Sleep apnea causes breathing to repeatedly stop and start during the night. You may stop breathing for 20 to 30 seconds or more at a time and your brain wakes you just enough to breathe again. This pattern can happen several times throughout the night, interrupting your sleep cycle and preventing restful sleep.

Yet many people with sleep apnea don’t know they have it.

Many cases do go untreated — simply because not everyone has someone to wake them up and tell them to quit snoring already. So they have no idea they’re living with a medical condition that could easily be treated.

“Many of our patients come in because a bed partner or roommate notices snoring and disrupted sleep,” says Caroline Baran, MD, a sleep and obesity medicine specialist at Geisinger. “However, many patients are referred to us by cardiologists, neurologists and other specialists who recognize some of the effects of sleep apnea like heart disease and stroke. Recognizing symptoms early can help you get treatment before the related health issues go from bad to worse.”

Signs of sleep apnea

Although you may not know you have this condition — since you’re sleeping (or nearly sleeping) when it happens — there are some signs of sleep apnea to watch for:

Sleepiness

Do you wake up feeling tired no matter how much sleep you’ve had? Repeated awakenings can make restorative sleep impossible and leave you feeling tired and irritable throughout the day. Dozing off in a meeting might be funny to your coworkers. But dozing off while driving is dangerous.

While sleep apnea is a common cause of sleepiness, a sleep provider may find other causes of insufficient sleep, like narcolepsy. They can detect this condition with a special sleep study.

Loud snoring

If your very loud snoring has been waking up your bed partner, they’ve probably mentioned it a few (hundred) times. It might be time to talk to a sleep specialist. While not all snorers have sleep apnea, the two often go hand-in-hand.

Irregular breathing, gasping and choking

Feeling short of breath when you wake up or suddenly waking yourself by jerking, gasping for air or choking? The likely cause is sleep apnea. Pauses in breathing during sleep — known as apneas — are a key symptom of obstructive sleep apnea.

They happen when the airway becomes blocked, temporarily stopping airflow. This pattern can repeat multiple times in an hour, all night long, making it hard to get deep, restful sleep. If you or a bed partner notice irregular breathing patterns, seek a sleep evaluation.

Difficulty sleeping

Waking up frequently, tossing and turning, disrupted or fragmented sleep, and insomnia are classic symptoms for many with sleep apnea.

Frequent nighttime urination

Are you waking up in the middle of the night a lot to urinate? Oddly, it can be a sign of obstructive sleep apnea. Disrupted sleep patterns can lead to an increased urgency to use the bathroom.

Cognitive and mood changes

Signs of sleep apnea you might not expect include memory problems, reduced productivity at work, anxiety, depression and loss of interest in sex. Getting a restful night’s sleep can enhance your mental and emotional health.

Feeling bad when you wake up

When your airway is obstructed, oxygen levels drop, carbon dioxide levels rise and blood vessels dilate. This combination can cause morning headaches. And waking up with a dry throat and mouth or a severely sore throat are signs of sleep apnea, too.

Types of sleep apnea

There are 2 major types of sleep apnea: obstructive and central.

The most common of the 2 types, obstructive sleep apnea, is caused by a complete or partial blockage of the airway. It occurs when your throat muscles relax or collapse and block the flow of air into the lungs.

Risk factors include being male, over 40 or overweight, and having a large neck and tonsils. People with gastroesophageal reflux (GERD), a family history of sleep apnea and nasal obstruction are also at risk. Ethnicity can play a role, too.

Central sleep apnea occurs when your brain doesn’t transmit the proper signals to your breathing muscles. Those who are using certain opiate medications or who have had heart failure or a stroke are at risk.

What happens if you have sleep apnea?

Loud snoring and disrupted sleep can leave you tired and irritable the next day, but the effects of depriving the body of oxygen numerous times throughout the night can run much deeper.

“Recognizing the type of sleep apnea and getting the proper treatment is very important,” says Dr. Baran. “Otherwise, it can lead to a range of serious health problems and even traffic accidents. Untreated sleep apnea is also a major cause of hospital readmissions, including for diseases such as COPD.”

Resulting health problems include:

Heart failure
Arrhythmia, such as atrial fibrillation
Heart attack
Stroke
High blood pressure
Type 2 diabetes
Headaches or migraines
Cognitive and memory issues
Mood changes, such as depression or irritability

Sleep apnea treatment options

Your treatment options will vary depending on how severe your symptoms are and the type of sleep apnea you have.

For mild cases (breathing stops up to 15 times per hour), lifestyle changes, such as weight loss, limiting alcohol and quitting smoking, changing sleep positions and practicing good sleep habits may resolve it.

If these methods don’t work or you have a moderate (breathing stops between 15 and 30 times per hour) to severe case (more than 30 times per hour), other interventions may be necessary.

CPAP (continuous positive airway pressure)

A CPAP breathing machine delivers a steady stream of air through a mask worn over the nose or mouth to keep the windpipe open when you sleep. It’s the most effective form of treatment for obstructive sleep apnea.

Alternate treatments, such as dental devices worn during sleep to reposition the tongue and jaw, as well as nasal devices, have shown variable success.

“Some people find a CPAP machine uncomfortable or might still have symptoms,” says Dr. Baran. “There are many reasons for this, including having a more complicated breathing problem than obstructive sleep apnea. That’s why you need to follow up with your sleep physician for regular monitoring if you’re on a CPAP. Advanced technology allows sleep physicians to track your breathing using an internet-based system while you’re using the CPAP at home.”

Luckily, many other treatment options exist for obstructive and central sleep apnea. Tell your sleep provider if you have difficulties with CPAP so they can find a better approach for you.

Surgery

Surgical therapies to treat sleep apnea have traditionally included tonsillectomies and other tissue-removing surgeries that open the nasal or throat passages.

A newer means of treating obstructive sleep apnea is an implantable pacemaker device called hypoglossal nerve stimulation, or the Inspire^® device. It works by delivering mild electrical stimulation to the hypoglossal nerve, which forces the tongue forward to keep it in a position that doesn’t block the airway.

For central sleep apnea, there’s a similar implantable pacemaker-type apparatus called phrenic nerve pacing, or the Remedē^® System. It works by stimulating the phrenic nerve, which causes the diaphragm to contract, mimicking natural breathing and stabilizing gas exchange during sleep.

Weight-loss medication

Weight loss can be an effective treatment for obstructive sleep apnea, particularly for overweight and obese patients, by significantly reducing symptoms and severity. Zepbound^®, a weight-loss drug, has recently been approved by the U.S. Food and Drug Administration to treat moderate to severe obstructive sleep apnea. Compared to other sleep apnea treatments, Zepbound addresses the underlying obesity, a major risk factor for sleep apnea.

A multi-pronged approach

Given the advances in sleep medicine, managing sleep apnea and sleep disorders has become a multidisciplinary process. After your initial visit with a sleep specialist, you may be referred for ENT (ear, nose and throat) surgery, oral maxillofacial surgery or psychological treatment to improve your sleep health — which should lead to better health overall.

“Work with your sleep provider to determine the right therapy for you,” says Dr. Baran. “Effective sleep apnea treatment can help you feel more alert, rested and improve your overall health. Why put up with another night of snoring? Everyone deserves a good night’s sleep.”