Loud snoring and persistent daytime tiredness can be signs of sleep apnoea, particularly if your breathing repeatedly stops and starts while you sleep. Many people with sleep apnoea are unaware that they have the condition. Other possible symptoms include morning headaches, poor concentration and waking during the night gasping or choking.
What is sleep apnoea?
Sleep apnoea is when the breathing stops and starts repeatedly when you are asleep. It can cause you to stop breathing for 20-30 seconds at a time throughout the night. It’s not always easy to tell if you have the condition as you are likely to be unaware that it is happening. Loud snoring, persistent tiredness and morning headaches are all potential indicators and should not be ignored.
What happens during sleep apnoea?
There are different types of sleep apnoea.
Obstructive sleep apnoea is the most common form and occurs when the throat narrows, blocking the flow of air into the lungs. As the throat walls relax, they block the airway which is what creates loud snoring, or a choking or gasping noise. A drop in the oxygen levels in your blood triggers you to wake up briefly to breathe. You may not remember waking, but these constant interruptions to your sleep throughout the night prevent you from dropping into a deep sleep and leave you feeling constantly tired during the day.
Central sleep apnoea is caused by the brain failing to send proper signals to the muscles that control the breathing. This is due to issues with your respiratory control centre, which is linked to your central nervous system. Central sleep apnoea most often affects people with neuromuscular diseases like amyotrophic lateral sclerosis, as well as those with heart failure or other forms of heart, kidney or lung disease, along with people who’ve had a stroke. It can also be linked to hormone levels, ageing or opioid use.
Complex sleep apnoea is a combination of obstructive and central sleep apnoea. It begins as obstructive sleep apnoea but develops into central sleep apnoea during treatment for the former.
What are the symptoms of sleep apnoea?
You may have sleep apnoea if:
- You snore loudly and persistently
- Your partner notices interruptions to your breathing when you are asleep
- You jolt awake gasping or choking
- You wake up with a very dry throat or a headache
- You are constantly tired, maybe even falling asleep during the day
- You have trouble concentrating or experience mood swings or forgetfulness
- You feel anxious or depressed
The more serious your condition, the more often your sleep will be interrupted and, therefore, the most severe your symptoms are likely to be.
What causes sleep apnoea?
Anyone can be affected by sleep apnoea however certain factors increase your risk. These include being overweight or having a large neck circumference that can make your airways narrower. If you have a narrowed airway due to your unique anatomy or because of enlarged tonsils or adenoids you may be prone to sleep apnoea. Men are more likely to have the condition than women and it is more common as you age. Smoking, drinking alcohol and using sedatives or tranquilisers all increase your risk. It is also common if you have nasal congestion or a family history of sleep apnoea. Certain medical conditions are associated with sleep apnoea, including type 2 diabetes, Parkinson’s disease and PCOS.
Can snoring and tiredness mean you have sleep apnoea?
Snoring alone does not necessarily mean that you have sleep apnoea. However, loud persistent snoring combined with excessive daytime tiredness, witnessed pauses in breathing, or waking up gasping or choking can be signs of obstructive sleep apnoea.
Because the interruptions to breathing can repeatedly disturb your sleep without you being aware of them, you may feel tired during the day even if you believe you have slept for a normal number of hours.
If these symptoms occur regularly, particularly if someone has noticed that your breathing stops and starts while you sleep, it is worth seeking medical advice.
How is sleep apnoea diagnosed?
To diagnose sleep apnoea, your doctor or respiratory consultant will ask about your symptoms and health history. They may suggest wearing a breathing monitor while you are asleep which will track your breathing patterns, heart rate and blood oxygen levels. You may then be invited to a sleep clinic which will connect you to sensors that assess brain, heart and lung activity as well as the movements of your arms and legs.
If you have mild sleep apnoea, you typically experience 5-15 episodes of breathing interruption per hour. Moderate sleep apnoea causes 15-30 episodes per hour, while more than 30 episodes is categorised as severe.
Are there treatments for sleep apnoea?
Sleep apnoea cannot be cured however there are treatments available. These will vary depending on what type of sleep apnoea you have and how severe it is. A sleep apnoea mask is worn over your face at night to deliver air directly into your airways. A continuous positive airway pressure (CPAP) machine has a mask that covers your nose and mouth and blows air directly into your airways. A bilevel positive airway pressure (BPAP) machine delivers a greater force as you inhale, which works better for some people.
Some people prefer to use an oral appliance, such as a sleep mouth guard or tongue retaining device. Other devices are designed to encourage you to sleep on your side rather than your back, which can help prevent airway obstruction.
With central sleep apnoea you may need extra oxygen when you sleep, alongside treatment for any underlying conditions.
Dr Shalin Diwanji also offers surgical options for severe cases of sleep apnoea. These include:
- Uvulopalatopharyngoplasty (UPPP) to remove excess tissue from the throat
- Genioglossus advancement to reposition the tongue muscle attachment
- Maxillomandibular advancement to reposition the jaw
Frequently Asked Questions
No. Snoring is common and does not necessarily mean that you have sleep apnoea. However, loud persistent snoring accompanied by pauses in breathing, gasping or choking during sleep and excessive daytime tiredness may indicate obstructive sleep apnoea.
Sleep apnoea repeatedly interrupts normal breathing and sleep during the night. These interruptions can prevent restorative sleep, leaving you feeling tired or sleepy during the day even if you have spent a normal amount of time in bed.
Possible signs include loud snoring, witnessed pauses in breathing during sleep, waking up gasping or choking, morning headaches, excessive daytime tiredness and difficulty concentrating.
Sleep apnoea is investigated by monitoring your breathing and other measurements while you sleep. Depending on your circumstances, this may involve monitoring at home or a more detailed sleep study at a sleep clinic.
Untreated sleep apnoea can affect quality of life and is associated with an increased risk of several health problems. Excessive daytime sleepiness can also increase the risk of accidents, which is one reason persistent symptoms should be assessed.
Seek medical advice if you regularly experience symptoms such as loud snoring combined with excessive daytime tiredness, witnessed pauses in breathing, or waking up gasping or choking. Assessment can help establish whether sleep apnoea or another sleep-related condition is responsible.
