Signs You Might Have Sleep Apnea
While sleep apnea symptoms vary between the three main types, the most common signs of Obstructive Sleep Apnea (OSA), Central Sleep Apnea (CSA), and Complex or Mixed Sleep Apnea are easy to recognize. Most people know that having breathing problems during sleep is the first sign of potential apneas, but there are other things to consider as well, especially when you may not be waking completely during events. Taking a look at some of the most common symptoms reported by patients, doctors, and sleep apnea researchers, we have organized a short list of signs and recommendations to help raise awareness about the most important step in the treatment process: the first step. We also provide links to further resources and some tips on when and how to get tested. So if you, your child, or your partner is showing any of the following signs of apnea events or consequences, keep in mind that it is always better to get tested and know for sure, whatever the results.
Obstructive Sleep Apnea Symptoms
The most common sleep apnea signs and symptoms are those that characterize Obstructive Sleep Apnea. This condition is defined by obstruction of the upper airway during sleep. The blockages caused by OSA events are often physically jarring, and can result in rather traumatic choking and/or gasping for breath during the night. This also disrupts the sleep cycle and lowers the level of oxygen in the blood. Since OSA accounts for over 80 percent of sleep apnea diagnoses, most symptom lists for sleep apnea will emphasize the OSA events themselves. For example, WebMD lists “Gasping,” “Snoring,” and “Sleepiness” as the top three warning signs of sleep apnea, a list that clearly characterizes the most prevalent cases of OSA syndrome. And almost every published reference on sleep apnea symptoms or risk factors includes these three factors at the top of the list.
While snoring is not often associated with Central Sleep Apnea, it is extremely common among Obstructive and Complex or Mixed Apnea Syndromes. Along with weight gain and obesity, snoring is the sleep apnea symptom most recognized by the general public, often depicted in sleep apnea images and descriptions in popular culture. But snoring does not always become a sleep apnea problem. In fact, according to the Vancouver Sleep and Breathing Center, an estimated 30 percent of people over 30 snore, and 40 percent over 40 snore. Out of that group, about 28 percent develop sleep apnea. What you want to look for then, as a more accurate sign of the disorder, is heavy or loud snoring, especially when forcing air through the windpipe. This form of heavy snoring is very common warning sign, and should never be ignored.
Daytime Sleepiness and Fatigue
Excessive daytime sleepiness, also called hypersomnia, is one of the first signs of sleep apnea, as the disorder will disrupt the sleep cycle whether or not it causes an awakening as a result. So in many cases the sufferer of the disorder is not aware of the cause of his/her fatigue. This can be extremely frustrating, and only worsens with the addition of other related comorbidities. Daytime sleepiness is also closely related to insomnia and other sleep disorders that can develop alongside a sleep apnea syndrome. If you are having difficulties staying awake, especially at dangerous time such as driving or operating machinery, getting tested should be an absolute priority.
Headaches are a common complaint among those with sleep apnea, and can be difficult to treat, especially with so many other possible causes or contributing factors. Everyday stress, work, life problems, insufficient sleep, not getting exercise or proper diets; all of this can either create or worsen migraines and headaches. But if headaches are occurring with regularity, and are accompanied by feelings of fatigue and other symptoms of sleep apnea, this is a sign of high risk factors for the disorder.
Effects on libido, like a lot of sleep apnea symptoms, often develop later as a consequence of sleep disruption and lowered blood-oxygen levels. As with headaches and other symptoms that affect your quality of life, you will want to narrow down the possible causes as soon as possible. If a decreased libido is part of a larger picture of general lack of energy, there is a high possibility for a sleep disorder issue.
Insomnia or Other Sleep Problems
Insomnia comes in many forms, and in relation to sleep apnea, often includes periodic or intermittent waking, problems with sleep onset, or unrefreshing sleep experiences. Unrefreshing sleep experiences are also common with other sleep disorders, and can be a sign of underlying conditions causing the disorders as well. Since insomnia is a sleep disorder in its own right, it should be assessed whether or not you think it is related to sleep apnea. Either way, you will want to address the problem before it escalates, and if any other health conditions are the cause, a clinical diagnosis will allow you to receive the proper treatment.
Decreased Memory or Difficulty Concentrating
Recently linked to sleep apnea in a number of studies, problems with memory retention and focus are indicators of disruptive sleep patterns. But the good news is that treatment for sleep apnea is highly effective using Continuous Positive Airway Pressure (CPAP), and with a proper diagnosis, all symptoms can be addressed rather quickly. Since apnea-related memory and concentration problems are directly associated to fragmentary sleep cycles, the benefits of PAP therapy tend to include boosts in mental acuity, even in some cases for patients who reported no such difficulties prior to treatment.
Weight gain, like other physical signs of sleep apnea, is not so much a symptom as a cause. The increased weight can cause the airway to collapse during sleep, resulting in apnea events. This is by far the most common manifestation of sleep apnea syndromes, with rates as high as 25 percent for adults between the ages of 30 and 70. As a result, some are calling the rise in sleep apnea an epidemic, and public awareness campaigns have been developed to help simultaneously with sleep apnea and obesity, especially among the younger populations who are able to change their habits before the symptoms begin to show.
High Blood Pressure
High blood pressure and hypertension have long been associated with sleep apnea, and can both be a cause and a symptom of the disorder. In most cases, however, the blood pressure issue is exasperated by the apnea events and desaturation of blood oxygen during the night, when the functional aspects of sleep are severely disrupted, with a number of consequences to the overall health of the patient. While high blood pressure on its own is not a primary indicator of sleep apnea, it should, like other physical features of the sleep apnea patient profile, be considered in association with other factors that suggest a possible apnea problem.
The Sleep Apnea Profile as a Screening Tool
In observing the most common symptoms for sleep apnea syndrome, a pattern emerges that characterizes the typical apnea patient as one of obese or near-obese weight for his/her size, a high Body Mass Index as a result, a wide neck circumference, and possible comorbidities such as high blood pressure, heart or cardiovascular problems, and diabetes or pre-diabetes. This profile is usually associated with higher age groups (middle-aged and above), but as we have pointed out, younger cases are becoming much more prevalent. Other indicators may be less obvious, for example, heredity, lifestyle choices, and stress levels can all have an effect on sleep and sleep apnea.
High Body Mass Index (BMI)
According to the National Institutes of Health and the National Heart, Lung, and Blood Institute, a Body Mass Index (BMI) over 25, or over 30 for an individual who is clinically obese, is a clear warning sign of a sleep apnea problem. A Body Mass Index is a measured proportion of height to weight, and is a high predictor of sleep apnea.
The National Heart, Lung, and Blood Institute provides both a BMI calculator and a BMI table to help people calculate their Body Mass Index to see if it poses a risk. You can also get in touch with the NHLBI to request a free assessment about your symptoms.
High Neck Circumferences (NC) of 17 inches or greater for an adult male, and 16 inches or greater for an adult woman, have been positively correlated with sleep apnea syndrome development, as the additional weight can push on the airway during sleep.
For children, having a larger neck size is also a risk factor, and additional tools such as the Neck Circumference Percentile measurement and the Neck Circumference-Height Ratio have been developed to help assess the risk factors of young adults and children. In general, these types of indicators are mostly used as pre-screening tools to help determine when to triage children and young adults for further evaluation by a clinician.
This feature can be the temporary result of a condition such as seasonal allergies, or a permanent result of a physical development such as a uniquely shaped nose or throat, large tonsils, or a physical irregularity. Sometimes referred to as Small Airway Disease, a small airway can also cause breathing problems in general, during both waking and sleeping, but can be treated using drugs and devices that specifically target the airway.
As mentioned previously, all types of sleep apnea can occur at any age. While risks for the disorder do increase as one gets older, younger diagnoses are becoming more common. For OSA in particular, there are sometimes physical reasons why the risk may increase with age. Tissues tend to build up in the neck, tongue, and airway when one ages, and this contributes to the obstructive sleep apnea syndrome. Also, age-related developments in how the brain controls breathing during sleep have been linked to increasing rates of Central Sleep Apnea syndromes, which are caused by brain signal dysfunctions rather than blockages.
Heredity is a risk factor for sleep apnea, but current knowledge is limited as to the extent of its influence. Studies in twins have shown that sleep apnea can be inherited. Some of the Genes related to sleep apnea are associated with the structural development of the face and skull and with how the brain controls sleep and breathing during sleep. Some genes are also associated with obesity and inflammation.
The inheritance pattern of obstructive sleep apnea is unclear. According to the Genetics Home Reference online, the risk of developing this condition is about 50 percent greater for first-degree relatives (i.e. children of parents with sleep apnea) as compared to the general public.
How people live their lives will always affect their health in the long term, and the effects of certain habits and behaviors can be quicker than people often assume. Excessive use of alcohol, for example, can cause the muscles in the mouth and throat to relax and possibly close up, especially if you are already predisposed to this condition. And it doesn’t just affect obstructive sleep apnea. It can also influence how the brain controls breathing during sleep.
Smoking cigarettes or cannabis can cause inflammation in the upper airway, and congest and irritate the lungs. Over time, emphysema, lung cancer, or other respiratory illnesses can develop.
Diet and exercise are major issues for the health of the human body. Unhealthy eating habits and inactivity can not only lead to obesity, but can contribute to a large number of health problems associated with body mass and insulin resistance, all of which can lead to the development of sleep apnea as a result.
Some Additional Warning Signs for Children
For children, there are a number of additional signs and symptoms that may arise. For example, problems with learning or schoolwork may or may not be related to sleep apnea, but when other symptoms are observed, a sleep apnea diagnosis is more likely. Other things to look for include bed wetting and sweating, restlessness, irritability and crankiness, and most importantly, tonsil- or adenoid-related health problems, which are linked quite often to early-onset apnea syndromes.
These signs are for parents to watch out for, and in the case of children with potential sleep apnea symptoms, a physician’s assessment and recommendation should be sought immediately. Symptoms do not always occur with regularity in the beginning, so the earlier you address the issue, the better.
How to Get Tested
Healthcare providers use overnight sleep studies to provide a clear and accurate diagnosis of sleep apnea. This usually involves a nocturnal polysomnography in addition to other observations made by the physician during the process. During a polysomnography test, the patient is hooked up to equipment that monitors breathing, heart, lung, and brain activity, as well as any movements during the night. Blood oxygen levels are also recorded during any apnea events that occur. An overnight sleep study provides doctors with the most complete and accurate information about a patient’s sleep.
In some cases a home test will be the most convenient option. Home tests are often used when sleep apnea is the primary condition and other sleep disorders can be ruled out. Home tests use small monitor devices to collect data as you sleep. The devices are much less complicated than a polysomnogram, and usually just measure breathing and blood oxygen levels, along with apnea events. Some may measure your heart rate or other information as well.
Sleep apps for phones and other devices often include some of these features, but doctors and sleep specialists recommend using devices specifically approved by physician to test for sleep apnea. Some of the apps currently available can vary in terms of reliability, and there is no guarantee of accuracy when using third-party apps that are not certified for medical use.
Doctors will often send you home with one or more home tests to assess your sleep, but some of these tools are used for preliminary screenings as well. The American Sleep Apnea Association uses a Snore Score to determine whether a case of snoring is related to sleep apnea. The Epworth Sleepiness Scale is used as a self-reporting measure of your sleep quality, and can be very useful in tracking the effectiveness of treatments or lifestyle changes. The Berlin Sleep Questionnaire is similar to the Epworth Scale, which asks a number of questions meant to isolate specific variables for analysis. Normally, these tools are paired with objective data for diagnostic accuracy.
Keep in mind that the causes of sleep apnea syndromes are often complex. This condition results from a combination of genetic, health, and behavioral factors, and each treatment decision should reflect this, focusing on the specific needs of the patient.
Alaska Sleep Clinic – https://www.alaskasleep.com/blog/signs-you-might-have-sleep-apnea
Genetics Home Reference – https://ghr.nlm.nih.gov/condition/obstructive-sleep-apnea#inheritance
Journal of Clinical Sleep Medicine – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4773632/
Journal of Sleep Medicine – https://www.e-jsm.org/journal/view.php?number=195
National Institutes of Health – https://www.nih.gov/news-events/news-releases/nih-study-identifies-ideal-body-mass-index
National Heart, Lung, and Blood Institute – https://www.nhlbi.nih.gov/health-topics/sleep-apnea#
National Institute of Neurological Disorders and Stroke – https://www.ninds.nih.gov/disorders/all-disorders/sleep-apnea-information-page
National Sleep Foundation – https://www.sleepfoundation.org/sleep-apnea
Pediatric Pulmonology – https://www.ncbi.nlm.nih.gov/pubmed/24574055
Sleepeducation.org – http://sleepeducation.org/essentials-in-sleep/sleep-apnea/symptoms-risk-factors
Statistic Brain Research Institute – https://www.statisticbrain.com/snoring-statistics/