Sleep apnoea: the signs people miss for years

Of everything covered in this section, this is the one where reading an article can genuinely change what happens to you. Most sleep advice offers marginal gains — an extra twenty minutes, a slightly easier evening. Obstructive sleep apnoea is different. It is common, it is treatable, and left alone it does measurable damage to the cardiovascular system over years.

The catch is that its central symptom happens while you are unconscious, and the daytime symptom is so ordinary that almost nobody takes it to a doctor.

What is actually happening

During sleep, the muscles holding the upper airway open relax. In obstructive sleep apnoea, they relax enough for the airway to narrow or close completely. Breathing stops or becomes shallow, blood oxygen dips, and the brain briefly rouses you enough to restore muscle tone and reopen the airway.

Then it happens again. In moderate cases this cycle repeats fifteen or more times an hour, all night, every night.

You almost never remember any of it. The arousals are too brief to be laid down as memory, which is the whole reason the condition hides so well. What you experience is not “I stopped breathing forty times last night” but “I slept eight hours and I am exhausted.”

How many people this describes

NICE estimates that around 5% of UK adults have undiagnosed obstructive sleep apnoea/hypopnoea syndrome — more than 2.5 million people. Internationally, estimates of the undiagnosed proportion among those who have it run as high as 80 to 90%.

Those figures are worth pausing on. This is not a rare disorder that a few unlucky people have. It is a common condition that most people who have it do not know they have.

The signs

Some you can spot yourself; the most reliable ones need someone else in the room.

What a partner notices. Loud, habitual snoring. Pauses in breathing. Gasping or choking sounds that end a silence. If someone has told you that your breathing stops at night, that is not a joke to be laughed off — it is the single most specific sign there is.

What you notice. Excessive daytime sleepiness, which is the core symptom and the one most often misread. Not tiredness — sleepiness. The difference matters: tiredness is wanting to rest, sleepiness is struggling not to fall asleep. Dozing off in front of the television, in meetings, or, most seriously, at the wheel.

Morning headaches are commonly reported. So is waking repeatedly to use the bathroom, waking with a dry mouth or sore throat, and irritability or low mood that has no obvious cause.

What raises the odds. Being male, being over about fifty, carrying excess weight around the neck and abdomen, a large collar size, high blood pressure, and a family history. Alcohol in the evening makes it worse in anyone predisposed, because it relaxes exactly the muscles involved.

Being slim does not rule it out. Neither does being a woman, though women are diagnosed later and more often have their symptoms attributed to something else.

Checking, before you decide it is nothing

There is a validated screening questionnaire called STOP-Bang, freely available online. Eight yes-or-no questions covering snoring, tiredness, observed breathing pauses, blood pressure, BMI, age, neck circumference and sex. A score of three or more indicates elevated risk.

A meta-analysis found the questionnaire performs well as a screening tool in the general population, with high sensitivity — meaning its real strength is ruling the condition out. A low score is genuinely reassuring. A score of three or more is not a diagnosis, it is a reason to make an appointment.

Diagnosis itself requires a sleep study, which in most cases now means a device you take home and wear overnight rather than a night in a hospital.

Why this belongs on a site about living longer

Untreated obstructive sleep apnoea is associated with hypertension, cardiovascular disease, cognitive decline, depression, and increased all-cause mortality. It is also an independent risk factor for stroke — independent meaning the association holds after accounting for the fact that people with apnoea also tend to carry the other classic risk factors.

Set against the rest of what we write about here, that puts it in unusual company. Most longevity levers are gradual and probabilistic: eat this way for twenty years, move this much, and shift your odds slightly. Diagnosing sleep apnoea is closer to a switch. The main treatment, CPAP — a machine delivering gently pressurised air through a mask — holds the airway open mechanically, and people who use it consistently often describe the change in daytime alertness within days.

Nobody wants to sleep in a mask. It is worth weighing that against a decade of nightly oxygen desaturation.

If any of this sounds familiar

Take it to your GP, and take the specifics: the snoring, what your partner has witnessed, how sleepy rather than tired you are during the day. If you drive, mention it — daytime sleepiness has legal implications as well as medical ones, and your doctor can tell you what your obligations are.

The thing to avoid is the explanation almost everyone reaches for first, which is that this is simply what being in your fifties feels like. Sometimes it is. But it is worth ruling out the version that is treatable before accepting the version that is not.

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This article is for general information and is not medical advice. If you think you may have sleep apnoea, speak to your GP.

Sources

1. NICE. Obstructive sleep apnoea/hypopnoea syndrome and obesity hypoventilation syndrome in over 16s. NICE guideline NG202, 2021. https://www.nice.org.uk/guidance/ng202
2. Sleep Apnoea Trust. NICE guideline background and UK prevalence estimates. https://sleep-apnoea-trust.org/healthcare-professional/nice-national-institute-clinical-excellence-sleep-apnoea/
3. Greater Manchester Neuro Rehab and Integrated Stroke Delivery Network. Obstructive sleep apnoea: symptoms, prevalence and stroke risk. https://gmnisdn.org.uk/professionals/obstructive-sleep-apnoea/
4. Pivetta B, et al. Validation of the STOP-Bang questionnaire for screening of obstructive sleep apnea in the general population and commercial drivers: a systematic review and meta-analysis. Sleep and Breathing, 2021. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8590671/
5. Ebrahim IO, Shapiro CM, Williams AJ, Fenwick PB. Alcohol and sleep I: effects on normal sleep. Alcoholism: Clinical and Experimental Research, 2013;37(4):539–549.