Symptoms That Mean You May Have Sleep Apnea and Should Get Screened

Medically Reviewed
mature fatigued man
Feeling tired during the day, morning headaches, and irritability can all be signs of sleep apnea.Stocksy
Sleep apnea is estimated to affect nearly 30 million people in the United States, according to research published in August 2016 in the Journal of Clinical Sleep Medicine.

 But, doctors say the number is likely much higher because the condition is widely thought to be underdiagnosed, notes the National Heart, Lung, and Blood Institute.

This common sleep disorder causes temporary and multiple pauses in breathing during the night, which interrupts the sleep cycle and typically prevents a person from getting a good night’s sleep.

The condition often goes undiagnosed because many of the symptoms that would clue you in that there’s a problem — such as snoring, breathing pauses, and gasping for air — occur during sleep. Those breathing pauses wake you up temporarily, but usually not enough for you to pull yourself out of sleep completely or remember being awake. That means a lot of individuals with sleep apnea, may not have any idea the next day that they experienced breathing difficulties during the night.

“Some estimates say sleep apnea probably affects one-quarter of middle-aged men,” says Ronald Chervin, MD, professor of sleep medicine and neurology and the director of the Sleep Disorders Centers at the University of Michigan in Ann Arbor, citing a report published in 2019 by the Institute for Quality and Efficiency in Health Care.

Here are the symptoms you and your bed partner should be on the lookout for in each other during the night, as well as symptoms people with sleep apnea may experience during the day.

What Types of Sleep Problems Should You Tell Your Doctor About?

Alex Dimitriu, MD, a Menlo Park, California–based psychiatrist and sleep medicine physician, says these are the red flags that could be a sign of a sleep disorder, or problems your doctor can help with.
What Types of Sleep Problems Should You Tell Your Doctor About?

Common Sleep Apnea Symptoms That Happen During Sleep and Warning Signs You May Notice During the Day

If your partner or a family member tells you that you exhibit these symptoms during sleep, you may want to make an appointment with your doctor to be evaluated for sleep apnea. According to the National Institute of Neurological Disorders and Stroke, these symptoms are common in all types of sleep apnea, including the most common type, known as obstructive sleep apnea, and the less common types: central sleep apnea and complex sleep apnea.

  • Habitual snoring that may be loud enough to be heard outside the room soon after you fall asleep (though snoring doesn’t necessarily always mean someone has sleep apnea and not everyone who has sleep apnea snores)
  • Breathing that stops for 10 seconds or more, followed by snorting and gasping for air; in some cases this pattern can repeat 30 times or more in an hour
Per Mayo Clinic, other warning signs of sleep apnea you may see include:

  • Having a dry mouth in the morning when you wake up
  • Morning headache
  • Extreme sleepiness and fatigue during the day
  • Irritability
  • Waking up feeling tired despite sleeping seven or more hours — the minimum number of hours of sleep recommended for adults by the American Academy of Sleep Medicine, published in 2015 in the Journal of Clinical Sleep Medicine

  • Problems with memory, attention, and concentration, per MedlinePlus

  • Decreased libido or sexual dysfunction
  • Depression
  • Hyperactivity (particularly common in children with sleep apnea)
According to MedlinePlus, some symptoms that are more typical of central sleep apnea (which you may experience in addition to other symptoms) include:

Ignoring Sleep Apnea Symptoms May Put More Than Your Own Health at Risk

Sleep apnea symptoms can be similar to symptoms of lots of other medical conditions, or may be ignored and chalked up to things like work stress, having a busy schedule, or having a lot going on with the family. But doctors urge people not to overlook or disregard symptoms.

If it’s not sleep apnea, your doctor may be able to help correctly diagnose another medical problem if there is one — or help you find ways to deal with stressors in your life that cause you to feel the way you do.

And if it is sleep apnea, your doctor can help diagnose the problem and help you get the treatment you need before the condition starts causing complications — and before the sleepiness and fatigue associated with sleep apnea leads to an accident that could harm you or others.

“When sleep apnea is untreated, an individual has a two-and-a-half-times increased risk of having a motor vehicle accident,” says James Rowley, MD, a professor of medicine at Wayne State University School of Medicine in Detroit and a member of the board of directors of the American Academy of Sleep Medicine (AASM). That’s according to data published in the March 2015 issue of the journal Sleep.

 “It’s the equivalent of driving drunk,” Dr. Rowley says.
Truck drivers are known to be at a particularly high risk for sleep apnea. In part that’s because certain factors that characterize a high number of truck drivers, such as being middle-aged, male, and obese, are also risk factors for sleep apnea, according to previous research.

Research published in May 2016 in the journal Sleep specifically looked at truck drivers’ accident risk. Those with sleep apnea who didn’t follow their recommended treatments were five times more likely to crash than drivers without sleep apnea.

It’s a serious problem, many sleep medicine experts, public health officials, and others have said, because commercial automobile accidents tend more often to be fatal or serious than noncommercial automobile accidents, according to an article published in January 2016 in the Journal of Clinical Sleep Medicine.

“Truck drivers with untreated obstructive sleep apnea are at dramatically greater risk of serious, preventable truck crashes, consistent with the greatly increased risk of motor vehicle crashes among automobile drivers with untreated obstructive sleep apnea,” said one of the study's coauthors, Charles A. Czeisler, PhD, MD, the chief of the division of sleep and circadian disorders at Brigham and Women’s Hospital and the Baldino Professor of Sleep Medicine at Harvard Medical School in Boston, in a press release when the study was published.

Despite these risks, the current guidelines for screening truck drivers and other commercial vehicle operators are lax. In a November 2017 letter to the Federal Motor Carrier Safety Administration (FMCSA) and the Federal Railroad Administration (FRA), AASM urged the two agencies to improve current guidelines and sleep-apnea screening procedures for drivers and other personnel who hold positions that can affect public safety in highway and rail transportation. The Federal Aviation Administration has in recent years implemented requirements to screen their pilots for sleep apnea.

Yet, in January 2017, the U.S. Preventive Services Task Force (USPSTF) released a recommendation against screening for obstructive sleep apnea (OSA) in asymptomatic adults (even when those asymptomatic individuals were at high-risk for sleep apnea), citing insufficient evidence to do so.

In response, the AASM, which recommends screening patients who have a high risk for OSA even if they don’t report any sleep-related symptoms, said that primary care providers should identify patients who have a high risk for OSA (such as people who have type 2 diabetes, obesity, or hypertension) and should screen them for OSA, not only to improve the quality of life and health outcomes for those individuals, but also to benefit the public.

AASM noted that diagnosing and treating every patient in the United States who has OSA would save an estimated $100 billion a year.

Should You Get Screened?

Whether or not you have a job that can affect public safety, doctors say there are clear benefits to seeing your doctor to rule out sleep apnea if you suspect you may have symptoms. And even if you aren’t sure if you have any symptoms, you may want to speak to your doctor about being screened for sleep apnea if one or more of these categories apply to you.

  • Obesity People who are overweight are at greater risk of having OSA. “When you gain weight, the lateral fat pads in the throat leave less room to breathe,” Dr. Chervin says. During sleep, the relaxation of the muscles and soft tissue in the throat make the throat even narrower, making it more difficult to get enough air.
  • Family History of Sleep Apnea Researchers have found evidence that having a family history of sleep apnea can increase your risk for the condition. Studies have shown that sleep apnea may be hereditary, and that traits that affect sleep apnea such as face and skull shape or how the brain controls breathing during sleep, as well as genes that may be associated with obesity and inflammation, may run in families.
  • Medical Condition or Illness That Raises Your Risk of Developing Sleep Apnea Conditions such as asthma, congestive heart failure, high blood pressure, type 2 diabetes, and stroke all increase your risk of sleep apnea.
  • Unhealthy Habits Harmful habits like smoking and eating an unhealthy diet can put you at greater risk for sleep apnea. Smoking can not only cause inflammation in your airways, which can affect your breathing, but it can also have a negative effect on how your brain communicates with your body during sleep and how well it controls your breathing. An unhealthy diet can lead to obesity, which is a leading risk for OSA.
  • Alcohol Consumption Alcohol can increase relaxation of the muscles in the mouth and throat, causing the upper airway to become narrow or close. It can also affect how the brain controls sleep or the muscles involved in breathing during sleep.
  • Use of Medications Such as Opioids Medications like benzodiazepinies and opioids can affect how well the brain regulates breathing and increase the risk of sleep apnea. Research published in October 2016 in the journal Chest showed that opioids may reduce airway muscle activation and increase risk for OSA.

Editorial Sources and Fact-Checking

  • Watson NF. Health Care Savings: The Economic Value of Diagnostic and Therapeutic Care for Obstructive Sleep Apnea. Journal of Clinical Sleep MedicineAugust 2016.
  • Sleep Apnea: NHLBI Sheds Light on an Underdiagnosed Disorder. National Heart, Lung, and Blood Institute. August 22, 2017.
  • Obstructive Sleep Apnea: Overview. InformedHealth.org. July 22, 2011.
  • Sleep Apnea Information Page. National Institute of Neurological Disorders and Stroke. May 24, 2017.
  • Sleep Apnea. Mayo Clinic. March 9, 2018.
  • Obstructive Sleep Apnea: Adults. MedlinePlus. March 5, 2018.
  • Watson NF, Badr MS, Balenky G, et al. Recommended Amount of Sleep for a Healthy Adult: A Joint Consensus Statement of the American Academy of Sleep Medicine and Sleep Research Society. Journal of Clinical Sleep Medicine. June 2015.
  • Central Sleep Apnea. MedlinePlus. March 5, 2018.
  • Karimi M, Hedner J, Habel H, et al. Sleep Apnea Related Risk of Motor Vehicle Accidents Is Reduced by Continuous Positive Airway Pressure: Swedish Traffic Accident Registry Data. Sleep. March 1, 2015.
  • Gurubhagavatula I. Does the Rubber Meet the Road? Addressing Sleep Apnea in Commercial Truck Drivers. Sleep. November 1, 2012.
  • Burks SV, et al. Nonadherence With Employer-Mandated Sleep Apnea Treatment and Increased Risk of Serious Truck Crashes. Sleep. May 1, 2016.
  • Colvin LJ, Collop NA. Commercial Motor Vehicle Driver Obstructive Sleep Apnea Screening and Treatment in the United States: An Update and Recommendation Overview. Journal of Clinical Sleep MedicineJanuary 15, 2016.
  • Crash Risk Soars Among Truck Drivers Who Fail to Adhere to Sleep Apnea Treatment. American Academy of Sleep Medicine. March 21, 2016.
  • Fact Sheet — Sleep Apnea in Aviation. Federal Aviation Administration. February 2, 2015.
  • Screening for Obstructive Sleep Apnea in Adults: U.S. Preventive Services Task Force Recommendation Statement. JAMA. January 24–30, 2017.
  • AASM Response to “Screening for Obstructive Sleep Apnea in Adults: Evidence Report and Systematic Review for the US Preventive Services Task Force.” American Academy of Sleep Medicine. January 24, 2017.
  • Van Ryswyk E, Antic NA. Opioids and Sleep-Disordered Breathing. Chest. October 2016.
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