Sleep apnoea — symptoms, causes and treatment
Sleep apnoea is one of the most common and most underdiagnosed sleep disorders. Here are the symptoms to know, what causes it, and what treatment involves.
Contents
You sleep eight hours and wake up exhausted. Your partner complains about the snoring. Morning headaches are a regular feature. And through the day you fight a sleepiness you can’t quite explain.
This isn’t “just tiredness.” These are classic signs of sleep apnoea — a condition in which breathing repeatedly stops during sleep, affecting a substantial share of adults, many of whom don’t know they have it.
What sleep apnoea is
Sleep apnoea is a sleep disorder marked by repeated pauses in breathing during sleep, caused either by physical blockage of the upper airway (obstructive sleep apnoea, OSA) or by the brain temporarily failing to send breathing signals (central sleep apnoea). Obstructive sleep apnoea is far more common, accounting for the large majority of cases.
During an apnoea episode, airflow to the lungs stops — anywhere from a few seconds to over a minute. Blood oxygen levels fall. The body responds with a micro-arousal: muscle tone increases, the airway reopens, you take a deep, snorting breath — and fall back asleep without consciously noticing. This cycle can repeat itself hundreds of times a night.
The result is sleep that never reaches its deep, restorative stages. You “sleep” for eight hours, but the body and brain never properly rest.
Who is affected
Sleep apnoea affects people of all ages, but is most common in:
- Men over 40 (though it affects women more often than commonly assumed — underdiagnosis in women is a recognised problem)
- People who are overweight (fat tissue around the neck can compress the airway)
- People with a thick neck, a recessed jaw, or enlarged tonsils
- Smokers and frequent alcohol users
- People with a family history of sleep apnoea
Women are underdiagnosed in part because their symptoms tend to be more diffuse: fatigue, low mood and headaches are prominent, while the classic snoring pattern is often less pronounced.
Symptoms to recognise
Nighttime symptoms:
- Loud, irregular snoring, often interrupted by silent pauses followed by a gasp
- A partner noticing pauses in breathing
- Frequent waking (sometimes without being aware of it)
- Needing to urinate during the night
- Sweating and restlessness during sleep
Daytime symptoms:
- Extreme tiredness despite apparently adequate sleep
- Morning dry mouth and headaches
- Difficulty concentrating and memory problems
- Mood swings and irritability
- Reduced interest in sex
The consequences of untreated sleep apnoea
Sleep apnoea isn’t just a sleep problem — it’s a cardiovascular risk factor. Repeated drops in oxygen and stress responses during sleep place strain on the heart and blood vessels over time.
Documented consequences of untreated sleep apnoea include an increased risk of high blood pressure, heart attack, stroke, type 2 diabetes, and road traffic accidents — sleepiness at the wheel is a significant cause of serious accidents.
Getting a diagnosis
Sleep apnoea is diagnosed with polysomnography, a sleep study that records breathing movements, oxygen levels, heart rate and sleep stages. This can be done at home with a simple overnight monitoring device, or in a sleep laboratory for more complex cases.
Your doctor is the first step — ask about a sleep study if you recognise these symptoms in yourself.
Treatment options
CPAP (Continuous Positive Airway Pressure) is the gold standard. A mask over the nose and/or mouth connects to a small pump that keeps the airway open with steady pressure during sleep. The effect is immediate and dramatic for most people, though many find the adjustment period challenging at first.
A mandibular advancement device pushes the lower jaw forward to keep the airway open. Less effective than CPAP for severe apnoea, but easier to use and better tolerated by many people with mild to moderate apnoea.
Lifestyle changes can have a real effect in mild sleep apnoea: weight loss (even a modest reduction can roughly halve apnoea episodes in people who are overweight), cutting back on alcohol, quitting smoking, and sleeping position — sleeping on your back tends to worsen apnoea, so side-sleeping is worth trying.
Surgery is an option in select cases, primarily where there’s a clear anatomical cause such as enlarged tonsils.
Sleep apnoea and your dreams
Untreated sleep apnoea disrupts dreaming in a specific way. Because the body never reaches the deep sleep stages and REM sleep is repeatedly interrupted by micro-arousals, dreams tend to be fragmented, unsettled and poorly remembered.
Many people with sleep apnoea report that they rarely or never dream — which is actually a sign of significant REM deprivation, not an absence of dreaming sleep. Starting CPAP treatment often brings a period of intense, “excessive” dreaming in the first weeks, known as REM rebound, as the brain catches up on lost dreaming sleep.
What to take away
Sleep apnoea is common, serious, and highly treatable:
- Repeated breathing pauses fragment sleep and prevent the deep, restorative stages
- Classic signs: snoring with pauses, morning tiredness, difficulty concentrating despite apparently enough sleep
- Left untreated, it raises the risk of cardiovascular disease, diabetes and road accidents
- CPAP is the gold standard and brings immediate improvement for many people
- See a doctor if these symptoms sound familiar — they can arrange a sleep study
Sources and further reading
- NHS — “Sleep apnoea”
- NHS — “Sleep and tiredness”
- CDC — “About Sleep”
