Do I have sleep apnea?

What happens during an apnea

When you fall asleep, the muscles in your throat relax. In people with obstructive sleep apnea (OSA), the soft tissue at the back of the throat collapses enough to partly or completely block airflow. Oxygen drops, the brain senses the problem and briefly rouses you to reopen the airway, and the cycle repeats, sometimes dozens of times an hour.

You usually do not remember these awakenings. What you notice is the aftermath: unrefreshing sleep, a heavy head in the morning and a fog that coffee does not lift. A less common form, central sleep apnea, happens when the brain does not send the signal to breathe, and it is often linked to heart or neurological conditions.

Signs at night

Many of the night-time signs are noticed by a bed partner rather than by you. The National Heart, Lung, and Blood Institute (NHLBI) lists:

• Loud, frequent snoring, often with silent pauses followed by a snort or gasp
• Breathing that stops and restarts
• Waking up choking or gasping for air
• Getting up often to urinate
• Restless, broken sleep

Signs during the day

Daytime clues are just as important, and they are often the only clues for people who sleep alone.

• Sleepiness during quiet activities, such as reading, watching TV or sitting in traffic
• Morning headaches or a dry mouth on waking
• Trouble concentrating, irritability or low mood
• Reduced interest in sex or erectile problems
• High blood pressure that is hard to control

Sleep apnea can look different in women

Women are less likely to report classic snoring and more likely to describe insomnia, fatigue, morning headaches, anxiety, depression and frequent waking. NHLBI notes that these overlap with menopause symptoms, which can make sleep apnea harder to recognize.

Before menopause, women generally have a lower risk than men. During and after menopause, that risk rises, partly because of hormone changes and weight gain around the neck. If you are in midlife and your sleep has fallen apart, it is worth asking whether apnea could be part of the story rather than assuming it is all hormones.

Who is at higher risk

The U.S. Preventive Services Task Force estimates that among adults aged 30 to 70, about 13% of men and 6% of women have moderate to severe OSA. Risk factors include:

• Older age and male sex
• Excess weight, especially a larger neck
• Large tonsils, tongue or a smaller lower jaw
• Family history of sleep apnea
• Alcohol, which relaxes throat muscles, and smoking, which inflames the airway
• Low thyroid hormone, polycystic ovary syndrome, and heart or kidney failure
• Opioids and other medicines that suppress breathing

Can a questionnaire tell me?

Screening tools such as STOP-Bang ask about snoring, tiredness, observed pauses, blood pressure, BMI, age, neck size and sex. They are good at catching people who might have apnea, but they flag many people who turn out not to have it. The USPSTF found too little evidence to recommend routine screening of adults without symptoms.

In other words, a questionnaire can tell you it is worth looking further, but it cannot diagnose or rule out sleep apnea. If you have symptoms, the right next step is a conversation with a clinician.

A simple, useful step you can take tonight is to ask a bed partner to notice whether your snoring stops and restarts, or to record a few minutes of audio on your phone. That observation, plus an honest account of how sleepy you feel during the day, gives a clinician a lot to work with.

How it is diagnosed

Diagnosis requires a sleep study. For many adults with suspected OSA, that can be a home sleep apnea test worn for one or two nights. People with significant heart or lung disease, or a possible other sleep disorder, may need an overnight study in a sleep lab.

The key result is the apnea-hypopnea index (AHI), the number of breathing pauses and shallow-breathing episodes per hour. In adults, an AHI under 5 is considered normal; 5 to 14 is mild, 15 to 29 moderate and 30 or more severe, according to MedlinePlus.

Why it is worth finding out

Untreated sleep apnea is linked to high blood pressure, heart rhythm problems, heart failure, stroke and drowsy-driving accidents. Treatment options include CPAP and other airway pressure devices, custom oral appliances, weight loss, positional strategies, nerve stimulation implants and surgery. For adults with obesity and moderate to severe OSA, the FDA has also approved tirzepatide (Zepbound) as a treatment.

Get checked promptly if you have fallen asleep while driving, a partner sees long pauses in your breathing, or you wake gasping. Call 911 for chest pain, fainting or severe shortness of breath.