Symptoms of Sleep Apnea
Some of the symptoms of sleep apnea are obvious. You wake up in the middle of the night feeling you have been choked. Your sleeping partner takes to another room—or another home—to escape your loud snoring interrupting frighteningly long periods of your making no sound at all. Or you wake up every morning with a dry mouth, dry tongue, and horrendous halitosis, all caused by mouth breathing throughout the night.
If all sleep apnea symptoms were obvious, probably more people would get treatment. But because sleep apnea does not always involve apnea, breathlessness, but can also involve hypopnea, shallow breathing that does not supply enough oxygen to the bloodstream, apnea can present itself in complicated scenarios like these.
Becky and Jon were eagerly awaiting the arrival of their second child. During pregnancy with their first child, Ben, Becky had felt tired all the time during the her last trimester. After Ben was born, Becky she had suffered what her OB-GYN had termed “post-partum depression” for a full year, but she couldn’t really believe that the birth of her baby had made her depressed. This time, however, Becky was not only tired all the time, she also was dizzy whenever she stood up and had heartburn all the time.Long-distance truck driver Anton had spent the required eight hours in his sleep berth but it felt more like two. Heartburn from truck stop food, he thought, must be keeping him up all night. He was beginning to find falling asleep nearly impossible while lying down but sleeping behind the wheel a constant temptation. And he was beginning to experience a complete disruption of his circadian rhythm that made it difficult for him to distinguish night and day.Jillian had reached pinnacle of her profession, managing her own consulting firm that employed over 25 software engineers. In just six months after her forty-fifth birthday, however, she had been diagnosed with high blood pressure, cluster headache, diabetes, irritable bowel syndrome, and depression. Worst of all, she felt tired all the time.Sixty-seven year-old Henry started needing to go the bathroom 3 and 4 times every night. His doctor told him it was probably benign prostatic hyperplasia, but a finger exam and a PSA test didn’t find any evidence of prostate problems.
Sleep apnea has consequences on health 24/7. Patterns of symptoms can be a tip-off that obstructive sleep apnea or central sleep apnea is the underlying cause of a variety of health problems. Here are 10 common symptoms of apnea that are signs you may need the attention of a sleep doctor.
1. Your bed partner, family members, pets, and even neighbors flee your presence because you snore.
Everyone who has sleep apnea snores, but not everyone who snores has sleep apnea. Snoring that occurs without interruption of breath is not sleep apnea. Interruption of breathing may be sleep apnea even without audible snoring.
Typically, when a person has obstructive sleep apnea, there will be loud snoring followed by a period of silence. The period of breathless silence is broken by an even louder snort. These events will be very obvious to someone who is awake in the same room but the sleep apnea sufferer may be oblivious to them.
2. Choking during the middle of the night.
When the breathing passageways narrow, air pressure lowers and pulls the tongue into the throat. This causes choking. Snorting is usually much more common than choking.
3. Excessive daytime sleepiness.
Excessive daytime sleepiness is one of the most dangerous symptoms of sleep apnea. Every time a persons dozes off, memory processes have to be restarted. Daytime sleepiness can cause problems with short-term memory. The risk of accidents while driving, operating heavy machinery, working with power tools, or performing delicate procedures greatly increases. Excessive daytime sleepiness also induces mood swings.
Doctors in the USA use two different rating scales for excessive daytime sleepiness, the Epworth Sleepiness Scale (ESS) and the Multiple Sleep Latency Test (MSLT). It’s possible to be rated as sleepy on one scale and not having a problem with sleepiness during the day on the other.
4. Confusion and clumsiness that are worse in the morning.
Sleep apnea deprives the brain of oxygen overnight. Mental confusion and poor motor skills will be worst in the morning.
5. Sleeping medications make insomnia worse.
When sleeping pills result in feeling less rested rather than more rested, the underlying problem may be that you have obstructive sleep apnea. Every time breathing stops during the night, the brain has to send a signal to the muscles surrounding the throat and mouth to allow air passages to open. Sleeping pills and alcohol slow down this response and make the effects of oxygen deprivation overnight worse.
6. Heartburn that starts before breakfast but that improves through the day, laryngitis that is worst in the early morning but that improves during the day, and/or sore throat or nasal irritation that is worst in the morning but that improves during the day.
Early morning heartburn, laryngitis, and sore throat are signs of gastroesophageal reflux disease that can be triggered by sleep apnea. Only a reduced amount of air, or no air at all, gets into the throat during the night. The reduced air pressure causes suction on the lower esophageal sphincter, which keeps gastric acid in the stomach. The acid leaks upward and causes inflammation and irritation. It also dulls the nerve endings that tell the brain that collapse of the airway is imminent so it will send a message to tighten throat muscles to keep the throat open.
7. Need to urinate at night.
Everyone needs to go the bathroom in the middle of the night occasionally. But needing to urinate after going to bed on a regular basis is a sign of some kind of health problem. When the problem is sleep apnea, the reason there is an urge to go has to do with stress on the heart. Sleep apnea reduces the amount of oxygen in the bloodstream, so the heart beats harder and faster to get available oxygen to the brain. This increased blood pressure and blood flow also increases blood flow to the kidneys. They filter more blood and make more urine, even in the middle of the night.
8. Waking up in the middle of the night breathing heavily.
Waking up in the middle of the night gasping for breath is a sign of central sleep apnea, caused by a failure of the brain to send signals to the intracostal muscles to power the lungs, rather than of obstructive sleep apnea, caused by the tongue in the throat or closure of the palate over the airways from the nose. Central sleep apnea can occur when oxygen levels in the surrounding air are so low that the brain becomes deprived of oxygen. This occurs to visitors at night on tours of the Andes or Tibet. Central sleep apnea can also occur as a result of congestive heart failure, in which the heart muscle does not have enough strength to circulate blood to the brain.
9. A diagnosis of atrial fibrillation.
Atrial fibrillation is a heart disorder in which the upper chambers of the heart, or atria, beat much more rapidly than the lower chambers of the heart, or ventricles. Unlike some many other neurological disorders of the heart affect cardiac rhythm, atrial fibrillation is usually survivable, although ventricular fibrillation is not without restarting the heart. Sleep apnea can cause starts and stops of the heart that trigger atrial fibrillation. In some cases, people who have atrial fibrillation even have disordered breathing when they are awake.
10. Loss of interest in and ability to perform sex.
Most men who develop sleep apnea also develop erectile dysfunction if the condition is not treated. Many women who develop sleep apnea lose interest in and become less responsive during sex due to simple fatigue.
There is no 100% diagnostic quiz for sleep apnea, but some sets of symptoms are highly predictive of the condition.
People who snore loudly enough to be heard through a closed door and feel tired during the day have a 66% likelihood of having sleep apnea.People who have high blood pressure (whether it is treated or not) and who feel tired during the day also have 66% likelihood of having sleep apnea.Up to 43% of women who have menstrual problems have sleep apnea.A man who is over 50, more than 30% overweight, and has a collar size of 17 (43 cm) or higher has a 93% chance of having obstructive sleep apnea.
If you have any of these symptoms, we recommend that you consult a physician. You may also look into home testing for sleep apnea.