Sleep Apnea: Symptoms, Testing and Treatment

Quick answer: Sleep apnea is a sleep disorder in which your breathing repeatedly stops or becomes shallow while you sleep. The most common type, obstructive sleep apnea, affects nearly 30 million Americans, and about 80% of them don't know they have it, according to the American Academy of Sleep Medicine. A sleep study is the only way to diagnose it, and many adults can now take that test at home. Once it is diagnosed, sleep apnea is very treatable.

Advanced Sleep Medicine Services has tested patients for sleep apnea in California since 1994. Our board-certified sleep physicians read every study, and we ship home sleep tests anywhere in the state. This page covers the symptoms, who is at risk, how testing works and what treatment looks like.

What is sleep apnea?

During sleep apnea, your airflow stops (an apnea) or drops sharply (a hypopnea) again and again through the night. Each event lowers the oxygen in your blood and briefly wakes your brain so you start breathing again. You usually don't remember these awakenings, but they break your sleep into pieces. That's why people with untreated sleep apnea can spend eight hours in bed and still wake up exhausted.

In severe cases, breathing can stop several hundred times a night.

Obstructive, central and mixed sleep apnea

• Obstructive sleep apnea (OSA) is by far the most common type. The soft tissue at the back of your throat relaxes and blocks your airway while you sleep. Your body keeps trying to breathe, which is why OSA often comes with loud snoring, snorting or gasping.
• Central sleep apnea happens when your brain doesn't send the signal to breathe. It is less common and is often linked to other conditions, such as heart failure or certain medications.
• Mixed (or complex) sleep apnea includes both obstructive and central events.

A sleep study shows which type you have, and that matters because the treatments differ.

Sleep apnea symptoms

The signs often show up at night, so a bed partner is usually the first to notice. Common symptoms include:

• Loud, frequent snoring
• Pauses in breathing that someone else sees
• Waking up gasping, choking or snorting
• Feeling sleepy or tired during the day even after a full night in bed
• Morning headaches, dry mouth or sore throat
• Trouble concentrating, poor memory or irritability
• Waking up often to use the bathroom at night

Not everyone who snores has sleep apnea, and not everyone with sleep apnea snores. If several of these sound familiar, take our sleep apnea self-assessment and share the result with your doctor.

Who is at risk for sleep apnea?

Sleep apnea can affect anyone, including women and children. The American Heart Association estimates that about 34% of middle-aged men and 17% of middle-aged women meet the criteria for obstructive sleep apnea. Your risk is higher if you have:

• Excess weight. Obesity is the one major risk factor you can change, and risk rises with body mass index.
• Male sex and older age. Both raise your risk.
• A family history of sleep apnea.
• Facial or jaw structure that narrows the airway, such as a small or set-back jaw.
• Heart and blood vessel conditions. Sleep apnea is found in 40 to 80% of people with high blood pressure, heart failure, coronary artery disease, atrial fibrillation or a previous stroke.

Alcohol close to bedtime and sleeping on your back can make obstructive events worse for some people.

Why untreated sleep apnea matters

Repeated drops in oxygen and constant awakenings strain your heart, blood vessels and metabolism. The American Heart Association links obstructive sleep apnea to:

• High blood pressure, including blood pressure that's hard to control with medication
• Atrial fibrillation and other heart rhythm problems
• Heart failure and coronary artery disease
• Stroke
• Type 2 diabetes and metabolic syndrome
• A higher risk of job-related and car accidents

The AHA recommends screening for sleep apnea in people with resistant or poorly controlled high blood pressure, and in people whose atrial fibrillation returns after cardioversion or ablation. If one of those describes you, ask your doctor about a sleep study.

How sleep apnea is diagnosed

A diagnosis needs two things: symptoms, such as snoring, gasping, breathing pauses or daytime sleepiness, and a sleep study that records 5 or more breathing events per hour. Your doctor orders the study after reviewing your history and symptoms, either in person or by telemedicine.

Home sleep apnea test or in-lab study?

• Where: Home sleep apnea test: Your own bed; In-lab sleep study (polysomnography): A sleep center, overnight
• What it records: Home sleep apnea test: Breathing, oxygen level, heart rate, effort and position; In-lab sleep study (polysomnography): All of that plus brain waves, sleep stages and leg movements
• Best for: Home sleep apnea test: Adults whose doctor suspects moderate to severe obstructive sleep apnea without other complicating conditions; In-lab sleep study (polysomnography): People with significant heart or lung disease, suspected other sleep disorders, or an inconclusive home test
• Typical cost to you: Home sleep apnea test: Often a lower quoted price; In-lab sleep study (polysomnography): Often a higher quoted price

The AASM says a home sleep apnea test is an alternative to an in-lab study for uncomplicated adults with signs of moderate to severe obstructive sleep apnea. It also says a board-certified sleep physician must read the raw data, not just software. Because a home test doesn't measure actual sleep time, it can underestimate how severe your apnea is. If a home test is negative or inconclusive and you still have symptoms, the AASM guideline recommends an in-lab study.

Read more about how our home sleep apnea test works.

What your AHI number means

Your report includes an apnea-hypopnea index (AHI) or respiratory event index (REI): the average number of breathing events per hour. Sleep physicians generally use cutoffs of 5, 15 and 30 events per hour to describe mild, moderate and severe sleep apnea. Your physician weighs that number alongside your oxygen levels and symptoms. For a plain-English guide to the rest of your report, see what AHI, RERA, arousal and RDI mean.

Sleep apnea treatment options

Treatment depends on the type and severity of your sleep apnea, your anatomy and what you can stick with every night. Your sleep physician may suggest one option or a combination.

CPAP and other positive airway pressure

CPAP (continuous positive airway pressure) uses a gentle, steady stream of air through a mask to keep your airway open. It is the frontline treatment and is recommended for most patients. Masks and machine settings can be adjusted, so tell your care team early if it feels uncomfortable. Problems like ears popping during CPAP are common and usually fixable.

Oral appliance therapy

An oral appliance fits over your teeth like a mouthguard. It holds your tongue in place or moves your lower jaw forward to keep your airway open. Some patients prefer it to CPAP. For a side-by-side comparison, see oral appliance vs. CPAP.

Positional therapy and weight management

If your apnea happens mostly when you sleep on your back, a positional device can keep you on your side. Because excess weight is the main risk factor you can change, weight loss is part of treatment for many people.

Medication for some adults with obesity

On December 20, 2024, the FDA approved Zepbound (tirzepatide) as the first medication for moderate to severe obstructive sleep apnea in adults with obesity, used with a reduced-calorie diet and more physical activity. It works mainly by lowering body weight. You can read more about GLP-1 medications and sleep apnea.

Upper airway stimulation and surgery

For some people who can't use CPAP, an implanted nerve stimulator moves the tongue forward during sleep. To see who qualifies, read about Inspire sleep apnea therapy. Surgery on the nose, throat or jaw, or weight loss surgery, may also be options.

Getting tested for sleep apnea in California

If you think you might have sleep apnea, testing is the first step, and you may not need to leave home for it.

1. Your doctor orders the test. Ask your doctor to fax the order to (877) 855-6227 or email orders@sleepdr.com. Don't have a doctor's order yet? Call us at (877) 775-3377 and we will help.
2. We verify your coverage. We accept 100+ insurance plans, including Medicare, most California HMOs and PPOs, many Medi-Cal HMOs and TriWest. Check your insurance.
3. We ship the device. A home sleep test arrives by USPS Priority Mail anywhere in California.
4. You sleep in your own bed. The test runs for one or two nights, depending on the device.
5. A board-certified sleep physician reads your study. The report typically goes to your doctor within 5 to 7 business days after we receive usable data.

Request a home sleep test or call (877) 775-3377, Monday to Friday, 9am to 4pm Pacific.