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Sleep apnea influences millions of individuals across the globe, and a staggering 85% of sleep apnea patients continue to be undiagnosed. This condition does not simply lead to loud snoring—it is a primary medical condition that can result in life-threatening consequences if left untreated. Recognizing the symptoms of sleep apnea is essential for safeguarding your health and improving your quality of life.
Obstructive sleep apnea (OSA) is defined by periodic complete (apnea) or partial (hypopnea) collapse of the upper airway, leading to reduced oxygen saturation or arousal from sleep. During these events, victims will stop breathing for ten seconds or longer, which may occur hundreds of times a night.
OSA affects 17% of women and 34% of men in the U.S., making it one of the most common forms of a sleep disorder. However, the number of cases is likely even higher given the level of underdiagnosis that exists.
We spoke with Dr. Michael Grandner, Sleep Expert and Professor of Neuroscience and Physiological Sciences, about the impact that undiagnosed sleep apnea potentially has on health outcomes. He notes: "The sleep apnea creates a cascade of physiological stress that affects almost every organ system in the body; therefore, early recognition of treatment is imperative for long-term health outcomes."
Research shows that 85% of sleep apnea cases remain undiagnosed, making awareness of symptoms critically important.
Loud, Disrupted Snoring Other symptoms include loud and disrupted snoring, witnessed apneas, and excessive daytime sleepiness. While not everyone who snores has sleep apnea, if loud snoring occurs repeatedly and is accompanied by breathing pauses of gasping/choking, it is likely a sign of sleep apnea.
Snoring that occurs in the presence of sleep apnea is not the same as simple snoring, as sleep apnea is characterized by clinically observable pauses in breathing as well as snoring. In these cases of interrupted breathing, the cessation of breathing can last from 10 seconds to upwards of 30 seconds or more before gasping or choking occurs as a resumption of breathing.
Witnessed Breathing Interruptions Obstructive sleep apnea episodes of interrupted breathing are most often observed/first noted by family and/or sleep partners who report experiencing the following actions of the sleeping individual:
If your partner reports these symptoms or experiences these events, take them seriously and speak to your doctor.
Excessive Daytime Sleepiness Another common and immediate symptom of sleep apnea is excessive daytime sleepiness, which can sometimes be mistakenly viewed as simple fatigue and is reported by only 15%-50% of individuals with sleep apnea in the general population. While excessive daytime sleepiness is one of the common symptoms of sleep apnea, you might consider this to be an important piece of information, as there is often a disconnect whereby individuals experience excessive sleepiness but simply don't consider this excessive compared to their previous days or weeks of excessive sleepiness.
Excessive daytime sleepiness that is due to sleep apnea can present in the following ways:
Is it possible to wake up tired and 'not rested' from a full night of sleep? The sleep architecture presented as sleep apnea or non-restorative sleep may prevent you from achieving deep stages of sleep characterized by slow wave sleep (SWS) where restoration of body systems occur.
Morning Headaches Another common symptom of sleep apnea includes headaches in the mornings. Morning headaches frequently relate to sleep apnea because the repeated episodes of cessation of breathing create low oxygen in the blood and retention of carbon dioxide in the blood, which can create headaches. The vascular alterations that develop may initiate headaches that are usually:
Cognitive and Mood Changes Sleep apnea can significantly alter brain functions, which can lead to:
Why the cognitive symptoms? Because this disrupted sleep leads to fragmented, nonrestorative sleep and does not allow the brain to successfully perform important maintenance operations during sleep.
We asked Dr. Suzanne Gorovoy, a Sleep Expert, Clinical Psychologist, and Behavioral Sleep Medicine and Specialist, for insight into recognizing more subtle symptoms of sleep apnea. She states: "Many patients are completely unaware that their daily afternoon energy crashes, difficulty concentrating, or increased irritability are manifestations of sleep apnea. They simply adapted to this feeling of malaise so long ago that it is now their normal."
Sleep apnea presents serious risks to heart health. OSA is present in 40% to 80% of patients diagnosed with hypertension, heart failure, coronary artery disease, pulmonary hypertension, atrial fibrillation, and stroke.
For the last two decades, the scientific literature has provided definitive evidence to support the causal association of OSA in systemic hypertension development. The mechanism is based on:
The literature estimates that the unadjusted odds ratio for developing hypertension was 4.5 in patients with an apnea-hypopnea index greater than 15, compared to those without the diagnosis of sleep apnea.
Patients with obstructive sleep apnea are estimated to be 2 to 4 times more likely to develop cardiovascular heart arrhythmias (abnormal heart rhythms) than those without sleep apnea. Arrhythmias may include:
The cardiovascular burden is substantial: Sleep apnea contributes 140% more likelihood to heart failure and 30% increase in coronary heart disease likelihood.
Knowing your risk factors may help you to determine when you need to seek evaluation:
You should see a doctor when you have:
We asked Dr. Shiyan Yeo, Internal Medicine Physician and Sleep Medicine Specialist, when patients should seek evaluation. She warned: "Don't wait until symptoms are severe. Sleep apnea is easily diagnosed and treated, and treating it can prevent serious cardiovascular consequences and significantly improve quality of life."
The impact of sleep apnea goes far beyond feeling tired:
There is an increasing body of evidence linking obstructive sleep apnea (OSA) to various cardiovascular conditions such as hypertension, type 2 diabetes mellitus, coronary artery disease, heart failure, and various arrhythmias.
The pathophysiology involves:
Sleep apnea disrupts metabolic regulation leading to:
Chronic sleep fragmentation affects:
Excessive daytime sleepiness or "microsleeps," when you doze off for very short episodes during the day (which can be hazardous when driving or operating equipment), is a dangerous safety consideration. Studies show that people with untreated sleep apnea have increased accident rates.
Recent studies have highlighted the ramifications of sleep apnea on cardiovascular disease. The association between obstructive sleep apnea and cardiovascular disease is supported by evidence showing that management of sleep apnea with continuous positive airway pressure (CPAP) has a significant effect on lowering systolic blood pressure, improving left ventricular systolic function, and diminishing platelet activation.
A key paper published in the European Respiratory Journal shows that there is considerable evidence that supports an independent association between obstructive sleep apnea syndrome (OSAS) and cardiovascular disease, particularly for systemic arterial hypertension and ischaemic heart disease, and increasingly for stroke, heart failure, atrial fibrillation, and sudden cardiac death.
The associations between sleep apnea and cardiovascular disease are complex, and multiple mechanisms are likely responsible: sympathetic nervous system over-activity; selective activation of pathways leading to inflammatory molecules; endothelial dysfunction; abnormalities of coagulation; and metabolic dysregulation, especially involving insulin resistance and disordered lipid metabolism.
This research indicates that sleep apnea must be appreciated and treated, not only for improved sleep quality, but also for serious cardiovascular complications.
If you identify these warning signs in yourself or a loved one:
Sleep apnea is a serious medical condition that affects millions of people, yet is frequently undiagnosed. Understanding the warning signs—from obvious signs like loud snoring and witnessed episodes of interrupted breathing to less obvious warnings (early-morning headaches, changes to cognition, etc.)—is the first step to getting help.
Untreated obstructive sleep apnea can lead to hypertension, heart disease, depression, and death. Recognition and treatment can dramatically reduce these risks.
Do not ignore the warning signs; your health—and your life—may depend on it. If you are experiencing sleep apnea symptoms, speak to your healthcare provider about evaluation. Early diagnosis and treatment can change your sleep, your health, and your quality of life.
For more information on improving your sleep health naturally, please explore our guides on natural sleep remedies and sleep hygiene tips. If you are struggling with sleep anxiety and frequent awakenings in the night, our resources will help you understand the problems more fully and address them.
Remember, good sleep is not a luxury; it is a requirement to be your best self.
Dr. Shiyan Yeo
Dr. Shiyan Yeo is a medical doctor with over a decade of experience treating patients with chronic conditions. She graduated from the University of Manchester with a Bachelor of Medicine and Surgery (MBChB UK) and spent several years working at the National Health Service (NHS) in the United Kingdom, several Singapore government hospitals, and private functional medicine hospitals. Dr. Yeo specializes in root cause analysis, addressing hormonal, gut health, and lifestyle factors to treat chronic conditions. Drawing from her own experiences, she is dedicated to empowering others to optimize their health. She loves traveling, exploring nature, and spending quality time with family and friends.
