A sleep apnea disorder causes breathing interruptions during sleep. In such situations, your brain partially awakens you to help you resume breathing, disrupting your restorative sleep. Without prompt treatment, sleep disorders can lead to a variety of serious health complications. So, what are sleep apnea symptoms? The following article explores these details with CLM Sleep.

General Symptoms

There is often an overlap between obstructive and central sleep apnea symptoms, making it difficult to distinguish between them. Sleep apnea is characterized by the following symptoms:

See more: Sleep study Melbourne

Snoring

One of the most common signs of sleep apnea is snoring. 

Cause: The throat tissues vibrate when airflow is obstructed through the mouth and nose. Therefore, you may experience:

• Temporary choking, 
• Gasping 
• Cessation of breathing
• Oxygen deprivation
• Sleep disturbances
• Overall health problems

Characteristics: Loud snoring is often a key indicator of obstructive sleep apnoea, becoming more pronounced with the severity of the condition. The characteristics of snoring can also help differentiate the severity of sleep apnea.

• Mild sleep apnea: Occasional, soft snoring that causes minimal interruption.
• Moderate sleep apnea: Frequent, louder snoring, which may include pauses or gasps.
• Severe sleep apnea: Continuous, loud snoring and frequent, protracted pauses in breathing, which result in substantial oxygen loss and interrupted sleep.

See more: AHI index – Measures the severity of sleep apnea

Gasping for air

Gasping for air is the phenomenon in which the patient suddenly inhales sharply and wakes up startled due to the feeling of suffocation caused by an obstructed airway during sleep.  This is a common symptom of obstructive sleep apnea (OSA).

Cause:

During sleep, the airway can become narrow or completely blocked (due to the tongue falling back, soft tissue collapse, or relaxed respiratory muscles).  Therefore, the airflow into the lungs is also obstructed, causing a significant decrease in blood oxygen levels.  When there is a lack of oxygen in the blood, the brain sends signals to wake the body up to breathe harder, leading to gasping for air.

Characteristics

It’s easy to recognize if you are gasping for air or not, some signs will be:

• Suddenly waking up with a feeling of suffocation or lack of oxygen
• A sense of panic
• Rapid heartbeat
• Struggling to take a deep breath immediately after waking up.

This phenomenon is often accompanied by loud snoring and daytime sleepiness.

Cheyne-Stokes breathing

Cheyne-Stokes breathing (CSB) is a type of periodic breathing disorder.

Cause:

Cheyne-Stokes breathing is related to central sleep apnea (CSA), commonly seen in patients with heart failure, stroke, or neurological disorders. CSB occurs when signals from the brain that control breathing are unstable.

Characteristics

• Starts with shallow breathing, which gradually becomes deeper and faster.
• Once it peaks, breathing slows down and becomes shallower again.
• This is followed by a brief period of no breathing (apnea) before the cycle repeats.

Cheyne-Stokes breathing does not wake the patient. This irregular breathing pattern reduces sleep quality and blood oxygen levels, leading to daytime fatigue and memory impairment.

Breathing pauses

Breathing Pauses are one of the most important and characteristic symptoms of sleep apnea. This symptom occurs when breathing is completely interrupted for a certain period of time (usually 10 seconds or more) before the body starts breathing again.

Cause

There are three main mechanisms that cause sleep apnea symptoms:

Airway Obstruction: The muscles in the throat relax excessively, causing the airway to collapse and blocking airflow to the lungs, which is a characteristic of OSA.  As a result, it causes the patient to stop breathing for a period of time. Common signs include loud snoring, choking, sudden deep breaths, and frequent awakenings without awareness.

Respiratory Control Disorder: The condition of breathing pauses occurs when the brain does not send the correct signals to the respiratory muscles, commonly seen in CSA.  The accompanying signs will not include snoring, but may involve Cheyne-Stokes Breathing (CSB)

The combination of both symptoms is a mix of airway obstruction and respiratory control disorder, occurring when treating OSA with CPAP, but CSA symptoms persist.  The accompanying signs include fluctuations in breathing, which may involve both obstruction and neurological disorders.

Characteristics:

Breathing pauses lasting from a few seconds to over 30 seconds, repeating many times throughout the night.

After each pause in breathing, the following may occur:

• A strong inhalation or gasping for air.
• Choking or coughing sounds.
• The snoring is irregular, sometimes loud, sometimes soft, or it suddenly stops and then starts again.

Some individuals may twitch, startle, or shift positions as a physiological response.

Choking or coughing 

Choking or coughing is the feeling of a blocked or irritated airway, which causes coughing as the body tries to clear the airway. This is a common symptom of sleep apnea, a disorder in which breathing is interrupted multiple times during the night. These episodes of apnea can affect sleep quality and cause many health complications if left untreated.

Cause 

Choking or coughing also originates from underlying causes, including airway obstruction and respiratory control disorders. Additionally, it can occur due to acid reflux.

– Obstructive sleep apnea (OSA): The muscles in the throat relax excessively, blocking the airway and causing the body to try to breathe again, resulting in symptoms of choking or coughing

– Central sleep apnea (CSA): The brain has trouble sending signals to the respiratory muscles, leading to pauses in breathing. Although less common, CSA can also cause a feeling of suffocation.

– Gastroesophageal reflux disease (GERD): People with sleep apnea are at high risk of acid reflux, which can irritate the throat and lead to coughing or choking at night.

Symptoms and Manifestations

• Sudden choking or coughing episodes during sleep
• Feeling like the airway is blocked or restricted
• Waking up gasping for air
• Persistent dry throat or sore throat upon waking
• Snoring with irregular patterns, sometimes stopping and resuming suddenly

Recognizing these symptoms is essential for early diagnosis and treatment. If you or someone you know experiences frequent choking or coughing at night, consulting a healthcare provider is recommended.

Daytime symptoms

Excessive Daytime Sleepiness belongs to the group of daytime symptoms, which also includes morning headaches, difficulty concentrating, and mood disturbances.Therefore, they all share the same causes, which include disrupted breathing during sleep, poor sleep quality and a lack of oxygen in the body. These issues can cause significant impacts on physical, mental, and cognitive aspects. However, these symptoms also have differences and various effects on the body.

Excessive Daytime Sleepiness

Excessive Daytime Sleepiness (EDS) is a physical symptom that causes individuals to feel persistently drowsy, leading to significant impacts on the body. Some of the main effects include:

• Decreased alertness and reflexes, thereby increasing the risk of traffic accidents and mistakes in studying and working.
• Weakened immune system, making the body more susceptible to illness due to prolonged lack of sleep.
• Metabolic disorders increase the risk of obesity, insulin resistance, and diabetes.

Cause

Each time breathing stops, even if it lasts only a few seconds or even up to a minute, it disrupts the sleep cycle, preventing the body from entering deep sleep. The patient may not be fully aware of these awakenings. From there, we can identify the main cause of EDS:

• The body and brain do not have enough time to recover, which prevents them from entering deep and REM sleep.
• Chronic sleep deprivation due to continuous interrupted sleep
• The brain is not alert due to reduced oxygen levels.

Characteristics

• Always feeling sleepy even after getting enough sleep.
• Very difficult to stay awake during the day.
• Feeling exhausted, lacking energy.

Manifestations

• Falling asleep during daytime activities such as driving, working, or watching TV
• Struggling to stay focused or awake during meetings or events
• Decreased work performance and loss of motivation.

Morning headaches

Morning headaches are a physical symptom, you may feel a headache as soon as you wake up, accompanied by a sense of tension and discomfort. This symptom also affects your mood, making you feel less positive when starting the new day.

Causes

• Increased pressure on the brain, due to reduced oxygen levels at night causing blood vessels to dilate.
• Headaches triggered, due to poor sleep quality leading to CO2 accumulation.
• Muscle tension due to an uncomfortable sleeping position or mouth breathing.

Characteristics

• It appears right after waking up and lasts for a few hours.
• Dull pain, a feeling of heaviness in the forehead or temples.
• Often accompanied by dry mouth or sore throat.

Symptoms

• Waking up with a heavy head, feeling fatigued.
• Often have to take painkillers in the morning.
• Having difficulty starting the new day due to prolonged discomfort.

Waking up with a headache is common and may indicate problems related to sleep quality or be a symptom of sleep apnea since there are low oxygen levels and disturbed sleep. Discomfort usually results from being kept awake at night, as well as from low oxygen that accompanies the disturbance, leaving one feeling achy and tired in the morning.

Difficulty Concentrating

Difficulty concentrating is a cognitive issue that affects memory and information processing speed.

Causes

• Cognitive decline due to interrupted sleep
• Reduced brain processing speed due to a lack of oxygen
• Decreased ability to concentrate and make decisions due to chronic fatigue and insomnia

Characteristics

• Difficulty absorbing new information.
• Forgetfulness and difficulty organizing tasks
• Slower reaction times than usual

Symptoms

• Struggling to complete tasks that require concentration
• Easily forgetting appointments and important schedules
• Making frequent mistakes in work and daily life

Mood disturbances

Mood disorders primarily affect emotions and mental health, making patients prone to irritability or depression.

Causes

• Imbalance of neurotransmitters, affecting emotions, caused by sleep deprivation.
• Increased cortisol levels (the stress hormone) due to poor sleep quality
• Mood instability due to inadequate blood oxygen levels

Characteristics

• Easily irritable or annoyed
• Increased feelings of anxiety and frustration
• Difficulty controlling emotions and stress

Symptoms

• Frequent anger toward family members and colleagues
• Frequent mood swings, easily agitated
• Feeling sluggish, lacking motivation and having difficulty controlling negative emotions.

Possible additional symptoms

Dry mouth or sore throat

The condition of dry mouth or sore throat is a physical symptom that appears immediately upon waking and gradually decreases or disappears after a short period of time.

Causes:

• Dry mouth and sore throat are often the result of mouth breathing during sleep, which leads to dryness and throat irritation.
• Mouth breathing commonly occurs due to nasal congestion that prevents normal nose breathing.
• It is more commonly seen in people with sleep apnea.
• It can also occur in individuals with sleep apnea who use a CPAP machine without a humidifier.

Characteristics: 

The symptoms of dry mouth or sore throat are very noticeable and may include:

• A dry, uncomfortable sensation in the mouth or throat upon waking
• Slight morning hoarseness

Symptoms:

• Feeling thirsty immediately after waking.
• Slight sore throat or a burning sensation when swallowing.

Nocturia

Nocturia is a condition in which a person wakes up multiple times during the night to urinate, disrupting their sleep.

Causes

Besides issues related to the bladder, prostate, diabetes, high blood pressure, or the use of diuretics, nocturia is a symptom of sleep apnea. Sleep apnea occurs, disrupting sleep and stimulating the body to secrete the hormone ANP (Atrial Natriuretic Peptide), causing the kidneys to produce more urine.

Characteristics

Frequently waking up in the middle of the night to urinate (1–2 times or more).

Interrupted sleep, affecting sleep quality.

Symptoms

Fatigue during the day due to poor sleep

It may be accompanied by dry mouth due to mild dehydration.

Insomnia and Restless sleep

Insomnia and Restless sleep are conditions characterized by tossing and turning, difficulty falling asleep, frequently changing positions, and waking up multiple times during the night. This disrupts sleep to be interrupted, making it difficult to maintain deep sleep and leaving one feeling as if they haven’t slept at all.

Cause

Insomnia and restless sleep can occur due to many causes, typically:

• Stress, anxiety, depression.
• Unscientific habits such as using a phone before sleeping, consuming caffeine, tea, or alcohol in the evening.
• Breathing interruptions during sleep

When you stop breathing, the brain will detect a lack of oxygen in the blood, which will wake you up and disrupt your sleep.Additionally, people with sleep apnea are always in a state of anxiety and stress, making it very difficult for them to fall asleep.

Characteristics:

• Difficulty falling asleep or waking up in the middle of the night.
• Sleep is not deep, restless, tossing and turning a lot.

Symptoms:

• Feeling unrested after waking up.
• Sleepy during the day, poor concentration.
• Mood changes (e.g., irritable, anxious).
• Morning headache
• Tired, lacking alertness after waking up.

Specific to OSA

Obstructive Sleep Apnea (OSA) is an all too common condition; it involves the obstruction of air flowing into the body during sleep, and consequently, breathing stops, and oxygen in the blood goes down. Symptoms of OSA awake breathing difficulties are only one type. Below is a classification of these signs sleep apnea:

Sleep apnea symptoms when awake

• Fatigue or Exhaustion: Despite getting enough sleep, you still feel tired upon waking.
• Daytime Sleepiness: This can lead to drowsiness while driving or during other activities.
• Mood Changes: Commonly experienced symptoms include depression and anxiety.
• Cognitive Dysfunction: This sign may include memory loss, difficulty concentrating, and other mental issues.
• Headaches: Frequent headaches upon waking.
• Insomnia: Difficulty maintaining continuous sleep.
• Sexual Dysfunction: Decreased libido or sexual ability.

Sleep apnea symptoms when asleep

• Snoring: Frequent snoring, though not always present.
• Awakening During the Night: Recognizing the reason for waking may be challenging.
• Observed Apnea Episodes: A spouse or family member may notice you stop breathing during sleep.
• Night Sweats: Feelings of dampness and discomfort during sleep.
• Restlessness During Sleep: Frequent movement and difficulty maintaining a comfortable sleeping position.
• Waking with Shortness of Breath: Feelings of choking or difficulty breathing upon waking. This is also one of the common infant sleep apnea symptoms.

If you experience these sleep apnea symptoms, consult a doctor for timely evaluation and treatment.

Specific to CSA

Central Sleep Apnea (CSA) is a form of sleep apnea symptoms in which the brain fails to send the necessary signals to control the respiratory muscles, leading to breathing cessation. The specific symptoms of CSA include:

• Apnea: Episodes of breathing cessation occur during sleep, typically without accompanying snoring.
• Severe Morning Headaches: Headaches upon waking, often due to oxygen deprivation.
• Dry Mouth: Frequent dryness in the mouth upon waking.
• Irritability: Mood may become irritable and easily frustrated.
• Difficulty Concentrating: Reduced attention span and focus in daily activities.

If you have CSA, you may suddenly awaken at night without an apparent reason. The person living with you may notice that you are restless and move around a lot during sleep. If you experience these symptoms, consult a doctor for timely diagnosis and treatment.

Conclusion

Sleep apnea is a common condition that causes interruptions in breathing during sleep. If left untreated, this condition can lead to severe complications. Therefore, recognizing sleep apnea symptoms is crucial for seeking timely intervention and improving overall health. If you experience loud snoring, gasping for air during sleep, excessive daytime sleepiness, or difficulty concentrating, consult a healthcare provider for appropriate diagnosis and treatment.

The most effective treatments for sleep apnea include the CPAP machine (Continuous Positive Airway Pressure). This device provides a continuous air flow to keep the airway open, preventing apnea episodes and improving sleep quality. To achieve optimal results, it is essential to use the CPAP machine every night. If you encounter difficulties maintaining this routine, consult your doctor to find suitable solutions for better sleep.

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