SymptomLungs & breathing
Sleep Apnea Symptoms
Sleep apnea symptoms are the signs that breathing repeatedly stops or becomes shallow during sleep. The classic ones are loud snoring, pauses in breathing noticed by a bed partner, choking or gasping awake, and daytime sleepiness despite a full night in bed. Morning headaches, waking to urinate and poor concentration are common too. Many people do not know they have it, so a partner's report or a screening questionnaire is often the first clue. A sleep test confirms it.
Also called: Pauses in breathing during sleep, apneic episodes, breathing stops during sleep, signs of sleep apnea
At a glance
- Night signs
- Loud snoring, breathing pauses, choking or gasping, restless sleep, waking to urinate.
- Day signs
- Excessive sleepiness, morning headaches, dry mouth, poor focus, irritability, low mood.
- Who is at risk
- Overweight, larger neck, men, after menopause, older age, enlarged tonsils, family history, alcohol or sedatives.
- In children
- Snoring, mouth breathing, bedwetting, hyperactivity, poor school performance.
- Next step
- A home sleep test or overnight lab study, arranged through your doctor.
When to get help
Call 911 or go to the ER
- Falling asleep while driving or nearly crashing because of sleepiness (stop driving and get assessed)
- Blue lips, severe breathlessness at rest or confusion on waking
See a doctor within a day or two
- Pauses in breathing at night with new leg swelling, breathlessness or chest pain
- A child with long breathing pauses, struggling to breathe in sleep or poor growth
- Severe daytime sleepiness in someone whose job involves driving or safety-critical work
Book a routine appointment
- Loud snoring with witnessed pauses or gasping
- Daytime sleepiness, morning headaches or waking unrefreshed most days
- Snoring with high blood pressure that is hard to control, atrial fibrillation or type 2 diabetes
- A child who snores most nights
Usually safe to manage at home
- Occasional light snoring with no pauses, no daytime sleepiness, especially during a cold or after alcohol
Night-time signs of sleep apnea
- Loud, habitual snoring, often louder than talking and heard through a closed door
- Pauses in breathing seen by someone else, typically 10 seconds or longer, ending with a snort or gasp
- Waking up choking or gasping for air
- Restless, broken sleep and frequent awakenings
- Getting up to urinate two or more times a night (nocturia)
- Night sweats and a racing heart on waking
- Dry mouth or sore throat on waking from mouth breathing
Most people are unaware of the pauses because the brain rouses only briefly, then falls back asleep.
Daytime symptoms
- Excessive sleepiness, dozing while reading, watching TV or as a passenger
- Waking unrefreshed even after 7 to 9 hours in bed
- Morning headaches that fade within hours
- Poor concentration and memory
- Irritability, low mood or anxiety
- Low libido and erectile dysfunction
- High blood pressure that is difficult to control
Sleep apnea symptoms in women
Women are underdiagnosed, partly because they snore less loudly and their symptoms are less "classic". They more often report:
- insomnia and difficulty staying asleep
- fatigue and low energy rather than sleepiness
- morning headaches
- depression or anxiety
- restless legs
Risk rises markedly after menopause and during pregnancy, especially with high blood pressure or gestational diabetes.
Sleep apnea in children
Up to a few percent of children have obstructive sleep apnea, most often from enlarged tonsils and adenoids. Signs include:
- snoring on most nights, with pauses or gasps
- breathing through the mouth, restless sleep in odd positions with the neck stretched back
- bedwetting after being dry
- daytime hyperactivity, inattention or behavior problems rather than sleepiness
- poor growth in severe cases
The American Academy of Pediatrics recommends that doctors ask about snoring at every well-child visit.
Do I have sleep apnea? A quick self-check
The STOP-BANG questionnaire is widely used. Give yourself a point for each yes:
- Snoring loudly?
- Tired or sleepy during the day?
- Observed to stop breathing during sleep?
- high blood Pressure?
- BMI over 35?
- Age over 50?
- Neck circumference over 40 cm (about 16 inches)?
- Gender male?
A score of 3 or more suggests an increased risk, and 5 or more a high risk of moderate to severe obstructive sleep apnea. This is a screening tool, not a diagnosis.
Snoring vs sleep apnea
| Simple snoring | Sleep apnea | |
|---|---|---|
| Sound | Steady, regular | Loud, with silences followed by snorts or gasps |
| Breathing pauses | No | Yes |
| Daytime sleepiness | Usually not | Common |
| Health risks | Mainly social | High blood pressure, heart rhythm problems, stroke, accidents |
See snoring for more.
Other causes of similar symptoms
- Insufficient sleep: the most common cause of daytime sleepiness
- Narcolepsy: sudden sleep attacks, sometimes with muscle weakness triggered by laughter
- Insomnia, depression and hypothyroidism: fatigue and poor sleep
- Restless legs and periodic limb movements: disturbed sleep
- Central sleep apnea: pauses without snoring, linked to heart failure, stroke or opioids
How sleep apnea is diagnosed
Your doctor will ask about symptoms, check your weight, neck size, blood pressure, nose and throat, and may use a questionnaire such as the Epworth Sleepiness Scale. The diagnosis needs a sleep test:
- Home sleep apnea test: a small device worn overnight records breathing, oxygen levels and heart rate. Suitable for many adults with a high likelihood of obstructive sleep apnea.
- Polysomnography: an overnight study in a sleep lab that also records brain waves, eye and leg movements. Used for children, suspected central apnea, other sleep disorders or significant heart or lung disease.
Results are expressed as the apnea-hypopnea index (AHI): the number of pauses and shallow breaths per hour. In adults, 5 to 14 is mild, 15 to 29 moderate and 30 or more severe. See sleep apnea for types, risks and treatment.
What you can do now
- Avoid alcohol and sedatives in the evening, which relax throat muscles.
- Sleep on your side rather than your back.
- Lose weight if overweight. Even a 10 percent loss can reduce severity.
- Treat nasal congestion.
- Do not drive when drowsy.
Frequently asked questions
What are the first signs of sleep apnea?
Early signs are usually loud snoring, a bed partner noticing pauses in your breathing, waking up gasping, and feeling tired during the day despite enough time in bed. Morning headaches, a dry mouth on waking and needing to urinate at night are also common.
How do I know if I stop breathing in my sleep?
Most people only find out from someone who sleeps nearby, or because they wake choking or gasping. Recording your snoring with a phone app can show pauses. The only way to confirm sleep apnea is a home sleep test or an overnight study in a sleep lab.
What are sleep apnea symptoms in women?
Women more often have insomnia, fatigue, morning headaches, anxiety and depression rather than loud snoring and obvious sleepiness. Risk increases after menopause and during pregnancy. Because symptoms are less typical, women are frequently underdiagnosed.
Can you have sleep apnea without snoring?
Yes. Some people with obstructive sleep apnea snore little, and central sleep apnea, where the brain fails to signal breathing, often causes no snoring. Daytime sleepiness, unrefreshing sleep or witnessed pauses deserve a sleep test even without snoring.
Is sleep apnea dangerous?
Untreated moderate to severe sleep apnea raises the risk of high blood pressure, atrial fibrillation, heart failure, stroke, type 2 diabetes and car crashes from sleepiness. Treatment, most often CPAP, reduces symptoms and lowers several of these risks.
Sources
This guide was written from current patient and clinical guidance, including:
- American Academy of Sleep Medicine: Sleep apnea (sleepeducation.org)
- National Heart, Lung, and Blood Institute: Sleep apnea
- MedlinePlus: Sleep apnea
- American Academy of Pediatrics: Clinical practice guideline, childhood obstructive sleep apnea
- NHS: Sleep apnoea