Sleep Apnea: Recognising the Signs and Getting the Right Treatment

Obstructive Sleep Apnea (OSA) is a common but significantly underdiagnosed condition in which the upper airway repeatedly collapses during sleep, causing pauses in breathing. These pauses — called apnoeic episodes — can occur hundreds of times a night, disrupting sleep architecture and depriving the body of oxygen.

Despite being extremely common, OSA often goes unrecognised for years. Many patients attribute their symptoms to stress, overwork, or simply not sleeping well — unaware that an underlying medical condition is the cause.

Why is Sleep Apnea Dangerous?

Untreated sleep apnea is not merely a nuisance. It carries significant health risks:

• High blood pressure (hypertension)
• Increased risk of heart attack and stroke
• Type 2 diabetes and metabolic syndrome
• Cognitive impairment and memory problems
• Mood disorders including depression and anxiety
• Increased risk of road accidents due to excessive daytime sleepiness
• Worsening of existing lung conditions such as COPD or asthma

Signs and Symptoms of Sleep Apnea

Symptoms Reported by Bed Partners

• Loud, persistent snoring
• Witnessed pauses in breathing during sleep
• Gasping, choking, or snorting sounds during sleep
• Restless, disturbed sleep

Symptoms Experienced by the Patient

• Waking with a headache, dry mouth, or sore throat
• Excessive daytime sleepiness — falling asleep at inappropriate times
• Difficulty concentrating and poor memory
• Mood changes, irritability, or depression
• Waking frequently during the night to urinate (nocturia)
• Feeling unrefreshed despite a full night of sleep

Who is at Risk?

• Overweight or obese individuals — excess fat around the neck and throat can narrow the airway
• Men — OSA is more common in men, though risk increases in women after menopause
• Age over 40
• Large neck circumference — greater than 40 cm in women, greater than 43 cm in men
• Structural factors — a narrow throat, enlarged tonsils, or a receding jaw
• Family history of sleep apnea
• Alcohol and sedative use — these relax the throat muscles
• Nasal congestion — chronic blockage increases airway resistance

How is Sleep Apnea Diagnosed?

Diagnosis is confirmed through a sleep study (polysomnography). This test monitors your breathing, oxygen levels, heart rate, brain activity, and body movements during sleep. It can be performed in a sleep laboratory or with a home sleep testing device.

The Apnea-Hypopnea Index (AHI) — the number of breathing interruptions per hour of sleep — is used to classify severity:

• Mild: 5–14 events per hour
• Moderate: 15–30 events per hour
• Severe: More than 30 events per hour

Treatment Options

CPAP Therapy — The Gold Standard

Continuous Positive Airway Pressure (CPAP) therapy is the most effective treatment for moderate to severe OSA. A CPAP machine delivers a continuous stream of pressurised air through a mask worn over the nose or mouth during sleep, keeping the airway open and preventing collapses.

Most patients notice a dramatic improvement in sleep quality, energy levels, and mood within the first few nights of CPAP use.

Lifestyle Modifications

• Weight loss — even modest reductions can significantly reduce OSA severity
• Sleeping on your side instead of your back
• Avoiding alcohol and sedatives, especially in the evening
• Treating nasal congestion
• Maintaining a regular sleep schedule

Other Devices and Interventions

• Mandibular advancement devices — dental appliances that reposition the jaw to keep the airway open
• BiPAP (Bi-level Positive Airway Pressure) — used for patients who find CPAP difficult to tolerate, or for complex sleep-disordered breathing
• Surgery — considered in specific structural cases