March 13, 2023 5 min read

Sleep apnea, medically known as obstructive sleep apnea, is a common but serious sleep disorder. It is characterized by episodic pauses in breathing or very shallow breathing during sleep. These episodes can repeat hundreds of times a night, leading to seriously fragmented sleep. Lack of proper sleep due to sleep apnea has serious consequences: sleepiness, a high risk of road traffic accidents, and even hypertension [1].


What is particularly worrying is that most sufferers aren’t aware they have it. According to a study screening hospital patients for sleep apnea, an estimated 20% of the population has this condition, 90% of which are undiagnosed [2]. One way to determine if you or a loved one might have sleep apnea is to know the signs. 

What Are the Warning Signs of Sleep Apnea?

If a doctor suspects you might have sleep apnea, they will use a number of screening tools. One of the most widely used screening tools for sleep apnea is the STOP-BANG questionnaire [3]. The below signs are taken from the aforementioned questionnaire:  

1. Snoring

Snoring loudly and frequently is a hallmark symptom of sleep apnea. The snoring is often louder than talking and loud enough to be heard through closed doors. Now, all snoring happens when there is an obstruction in the upper airway — such as the collapse of the tongue and soft palate often seen in sleep apnea patients. But although most sleep apnea sufferers snore, not all snorers necessarily have sleep apnea. 


Simple snoring without shallow or paused breathing can be a result of allergies, respiratory infections, anatomical abnormalities, sedative use and countless other factors. But if your snoring is accompanied by other symptoms, this can be a good indicator you’re not dealing with a simple case of snoring.

2. Tiredness

Are you often tired, exhausted or sleepy during the day? If you get the required 7 or more hours of sleep each night but don’t feel refreshed, something is likely interfering with the quality of your sleep. And for many sleep apnea sufferers, that something is being constantly woken up by low blood oxygen levels. 


Although sleep apnea sufferers are not aware as their apnea episodes happen, their brain does respond to dwindling oxygen levels during the night. This drop in oxygen triggers arousal from sleep that triggers the gasping reflex but not full waking [4]. This is known to disturb normal sleep architecture in those with sleep apnea, leading to fragmented sleep that doesn’t allow your body to recuperate. 

3. Breathing pauses

Has your bed partner or anyone else observed pauses in breathing during your sleep? Not breathing for over 10 seconds at a time followed by loud gasps and snorts is another hallmark sign of sleep apnea. Unfortunately, this isn’t something that the sufferer can observe themself, which makes diagnosis difficult for those who live alone.

If you don’t have anyone to observe your breathing at night, you can try recording yourself while you sleep. Your phone’s recording app is a great tool for this. Keep in mind that sleep apnea can manifest as both pauses in breathing as well as very shallow breathing that lasts 10 seconds or more [5]. Both are often followed by loud gasps. 

4. High blood pressure

If you’ve recently developed high blood pressure, this can also indicate problems with sleep. Being chronically sleep-deprived causes your body’s stress response system to go into overdrive, raising stress hormone levels that elevate blood pressure.

High blood pressure has no signs and symptoms, so many people don’t know they have it. The only way to tell if your blood pressure is normal or not is to have it measured. You can have your doctor measure your blood pressure or purchase a monitor at your local pharmacy. Many pharmacies also offer free blood pressure readings. Your blood pressure is considered elevated when your systolic reading is 130 mm Hg or higher and your diastolic reading is 80 mm Hg or higher [6]. 

5. You fit the profile

While anyone can have sleep apnea, some people are more at risk than others. The STOP-BANG questionnaire includes several objective measures for physicians to determine if you could be at risk: male sex, being over 50 years of age, having a large neck circumference (>40 cm), and being obese (BMI over 35).


Men are 2 to 3 times more at risk of having sleep apnea (and snoring) but the risk increases for women after menopause and with increased weight [7]. That may be due to the propensity of men and postmenopausal women to gain weight in the neck area, which can constrict the upper airways. 

Taking the Next Steps 

Sleep apnea has its hallmark signs and symptoms, but you need to have a sleep study to confirm or rule out sleep apnea. If you suspect your health problems and symptoms are due to sleep apnea, speak to your doctor who will order a sleep study. 


Also called polysomnography, this comprehensive test records your brain waves, blood oxygen levels, heart rate, breathing, and even eye and leg movements during sleep. If the test shows you have sleep apnea, you will probably be prescribed continuous positive airway pressure (CPAP) therapy. This involves wearing a mask or a nosepiece that pushes air into your airways with the help of a machine. It helps keep your airways open as you sleep. 


Besides CPAP, losing weight if you’re overweight, exercising, avoiding alcohol and sedatives, sleeping on your side and using oral appliances like the  Good Morning Snore Solution can also help manage your condition. Make sure to speak to your doctor about using alternatives to CPAP if you find this treatment difficult. 


References: 

  1. Jordan AS, McSharry DG, Malhotra A. Adult obstructive sleep apnoea.Lancet. 2014;383(9918):736-747.doi:10.1016/S0140-6736(13)60734-5

  1. Finkel KJ, Searleman AC, Tymkew H, et al. Prevalence of undiagnosed obstructive sleep apnea among adult surgical patients in an academic medical center.Sleep Med. 2009;10(7):753-758.doi:10.1016/j.sleep.2008.08.007

  1. Slowik JM, Sankari A, Collen JF. Obstructive Sleep Apnea. [Updated 2022 Jun 28]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from:https://www.ncbi.nlm.nih.gov/books/NBK459252/

  1. Kimoff RJ. Sleep fragmentation in obstructive sleep apnea.Sleep. 1996;19(9 Suppl):S61-S66.doi:10.1093/sleep/19.suppl_9.s61

  1. De Backer W. Obstructive sleep apnea/hypopnea syndrome.Panminerva Med. 2013;55(2):191-195.https://pubmed.ncbi.nlm.nih.gov/23676959/

  1. Palagini L, Bruno RM, Gemignani A, Baglioni C, Ghiadoni L, Riemann D. Sleep loss and hypertension: a systematic review.Curr Pharm Des. 2013;19(13):2409-2419.doi:10.2174/1381612811319130009

  1. High Blood Pressure Symptoms and Causes. National Center for Chronic Disease Prevention and Health Promotion, Division for Heart Disease and Stroke Prevention. Last Reviewed: May 18, 2021https://www.cdc.gov/bloodpressure/about.htm#:~:text=High%20blood%20pressure%2C%20also%20called,blood%20pressure%20(or%20hypertension).

  1. Sleep apnea. Mayo Clinic. Accessed February 2023. 

https://www.mayoclinic.org/diseases-conditions/sleep-apnea/symptoms-causes/syc-20377631



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