The commonest signs of sleep apnoea are snoring, pauses in breathing that someone else notices, choking or gasping in the night, waking unrefreshed, morning headaches and sleepiness in the day. NICE, which sets UK clinical guidance, advises a sleep assessment when two or more of these are present. A sleep study confirms the diagnosis.
What are the signs?
NICE lists nine features. If you have two or more, a doctor should take a sleep history and assess you for sleep apnoea (NICE NG202).
- Snoring.
- Pauses in breathing seen by someone else.
- Sleep that does not leave you refreshed.
- Waking with a headache.
- Sleepiness, tiredness or fatigue in the day that you cannot explain.
- Waking in the night to pass urine.
- Choking during sleep.
- Broken sleep, or insomnia.
- Poor concentration or memory.
Not everyone is sleepy. NICE advises against relying on a sleepiness score alone, because not all people with sleep apnoea have excessive sleepiness (NICE NG202). Someone who shares your room is often the best witness, since the pauses happen while you are asleep.
Who is more likely to have it?
Men are affected more often than women. In a Wisconsin study, 24% of men and 9% of women aged 30 to 60 had at least 5 breathing events an hour (Young, 1993). Using modern recording methods, a Swiss study of adults aged 40 and over found moderate or severe sleep-disordered breathing in 49.7% of men and 23.4% of women (Heinzer, 2015).
NICE also notes that sleep apnoea is more common in people with excess weight, high blood pressure that resists treatment, type 2 diabetes, atrial fibrillation, previous stroke or mini-stroke, heart failure, moderate or severe asthma, polycystic ovary syndrome and an underactive thyroid (NICE NG202).
Can I check myself?
Two short questionnaires give a sense of risk. The Epworth Sleepiness Scale asks how likely you are to doze in eight everyday situations (Johns, 1991). STOP-Bang scores snoring, tiredness, observed pauses, blood pressure, weight, age, neck size and sex. A score of 0 to 2 suggests low risk of moderate to severe sleep apnoea, and 5 to 8 suggests high risk (Chung, 2016).
Neither can diagnose sleep apnoea. American guidance is clear that questionnaires should not be used to diagnose it without a sleep test (AASM, 2017). A smartwatch alert has the same limit, as we explain in can a smartwatch detect sleep apnoea.
Why does it matter?
In a ten-year study of men in Spain, those with untreated severe sleep apnoea had more than three times the rate of fatal heart attack or stroke of healthy men, 1.06 against 0.3 events per 100 people a year. Men treated with CPAP had a rate close to that of simple snorers (Marin, 2005). It was an observational study, so it shows a link rather than proof.
Driving is the other risk. A review found people with sleep apnoea have a raised risk of road crashes (Tregear, 2009), and a second review found the risk fell after treatment with CPAP (Tregear, 2010).
When should I be seen quickly?
If you have fallen asleep or nearly fallen asleep while driving, stop driving now and get assessed. UK rules require you to tell the DVLA if you are diagnosed with moderate or severe sleep apnoea with excessive sleepiness, and not to drive until it is under control (GOV.UK). NICE also prioritises people who drive for a living, work in safety-critical jobs, are pregnant, are awaiting major surgery or have unstable heart disease (NICE NG202).
How is it tested and treated?
NICE recommends a home respiratory study as the first test, and a full overnight study if the home result is negative but symptoms continue (NICE NG202). We compare the two in home sleep study or overnight sleep study.
Treatment depends on severity. Everyone is offered advice on weight, smoking, alcohol and sleep habits. CPAP, a mask that keeps the airway open with gentle air pressure, is offered for moderate or severe sleep apnoea and for mild disease that affects daily life. A dentist-made mouth splint that holds the lower jaw forward is an option for mild sleep apnoea when CPAP is not tolerated (NICE NG202).
Getting tested at The Wellness
Our Sleep Clinic starts with a Sleep Consultation at £450, a 60-minute consultation with a doctor, ending with a clear answer on whether you need a sleep study and which one. The Home Sleep Study is £1,395. The Sleep Clinic programme is £2,995 and is what most people choose, because it takes you from the study to a consultant, blood tests chosen for your sleep and a treatment plan reviewed at three months. If your history points to a more complex picture, the Attended Overnight Sleep Study is £3,450.
The cost of leaving it is real, from tired days to the heart and road risks above. Book a sleep consultation and get a measured answer.
This article is general information and does not replace a consultation. If you are falling asleep at the wheel, stop driving until you have been assessed. If you have chest pain, severe breathlessness or signs of a stroke, call 999.
Frequently asked questions
What are the first signs of sleep apnoea?
Snoring, pauses in breathing that a partner notices, choking in the night, waking unrefreshed, waking with a headache and sleepiness in the day. NICE advises a sleep assessment when two or more of these are present.
Can you have sleep apnoea without feeling sleepy?
Yes. NICE warns against using a sleepiness score alone to decide whether to refer someone, because not everyone with sleep apnoea is excessively sleepy.
Is sleep apnoea dangerous?
Severe sleep apnoea that is not treated has been linked with a higher rate of heart attack and stroke, and people with sleep apnoea have a higher risk of road crashes. In studies, treatment with CPAP was linked with a lower risk of both.
Do I have to tell the DVLA if I have sleep apnoea?
You must tell the DVLA if you have confirmed moderate or severe obstructive sleep apnoea with excessive sleepiness. You must not drive until the sleepiness has gone or is under control with treatment.
Do sleep apnoea signs differ in women?
Women are affected less often than men in population studies, but it is still common. In one Swiss study using modern sleep tests, 23.4% of women aged 40 and over had moderate or severe sleep-disordered breathing. The signs NICE lists are the same for women and men.
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