Sleep Apnea: Symptoms, Causes, Diagnosis, and Treatment Options

Sleep apnea is one of the most prevalent and most underdiagnosed chronic conditions in the United States. An estimated 30 million Americans have obstructive sleep apnea — and up to 80% of moderate to severe cases remain undiagnosed. If you snore loudly, wake up exhausted despite a full night in bed, or have been told you stop breathing while you sleep, you owe it to yourself to understand this condition and take it seriously.

As a licensed Registered Respiratory Therapist (RRT), I've worked with hundreds of sleep apnea patients. This guide covers everything you need to know — from what's happening in your airway to how to get diagnosed and treated effectively.

What Is Sleep Apnea?

Sleep apnea is a sleep disorder characterized by repeated interruptions in breathing during sleep. These interruptions, called apneas, can last anywhere from 10 seconds to over a minute and may occur dozens or even hundreds of times per night. Each event triggers a brief arousal — often so brief you don't remember it — that prevents you from reaching the deep, restorative stages of sleep your body needs.

There are three distinct types:

Obstructive Sleep Apnea (OSA)

The most common form. The muscles in the throat relax during sleep, causing the soft tissue at the back of the throat — including the tongue, soft palate, and uvula — to collapse and block the airway. The brain eventually signals the body to rouse enough to reopen the airway, and the cycle repeats. OSA is driven primarily by anatomical factors.

Central Sleep Apnea (CSA)

Less common. In CSA, the airway itself is open, but the brain fails to send the proper signals to the muscles that control breathing. This is a neurological issue rather than a mechanical one, and it requires different treatment than OSA.

Complex (Mixed) Sleep Apnea

Some patients present with a combination of both obstructive and central events, which is referred to as complex or mixed sleep apnea. This often requires more advanced PAP therapy to treat effectively.

Signs and Symptoms of Sleep Apnea

Sleep apnea symptoms can be surprisingly easy to normalize or attribute to other causes. Common warning signs include:

• Loud, chronic snoring — particularly snoring punctuated by gasping, choking, or silence
• Excessive daytime sleepiness — falling asleep during meetings, while reading, or even while driving
• Waking with headaches, especially in the morning
• Difficulty concentrating, memory problems, or "brain fog"
• Irritability, depression, or mood changes
• Frequent nighttime urination (nocturia)
• Dry mouth or sore throat upon waking
• Witnessed apneas — a bed partner observing you stop breathing

Not everyone with sleep apnea snores, and not everyone who snores has sleep apnea. The definitive test is a sleep study — not a symptom checklist.

Who Is at Risk?

Sleep apnea can affect anyone, but certain factors significantly increase your risk:

• Excess weight — fat deposits around the upper airway can narrow and obstruct it
• Male sex — men are 2–3 times more likely to have OSA than premenopausal women (though this gap narrows after menopause)
• Age — risk increases with age, particularly after 40
• Neck circumference — a neck circumference greater than 17 inches in men or 15 inches in women correlates with higher risk
• Anatomical factors — a narrow airway, enlarged tonsils, or recessed chin
• Family history — OSA has a genetic component
• Alcohol and sedative use — both relax throat muscles
• Nasal congestion — chronic congestion makes obstructive events more likely

Why Untreated Sleep Apnea Is Dangerous

This is not a benign condition. Untreated sleep apnea has been robustly linked to:

• Hypertension (high blood pressure) — each apnea event triggers a surge in adrenaline that raises blood pressure; over time this creates persistent hypertension
• Cardiovascular disease — including heart failure, coronary artery disease, and atrial fibrillation
• Type 2 diabetes — sleep fragmentation impairs insulin sensitivity
• Stroke — both ischemic and hemorrhagic stroke risk is elevated
• Motor vehicle accidents — daytime sleepiness is a major driver of impaired driving
• Cognitive decline — emerging research links chronic sleep apnea to accelerated neurodegeneration

Sleep apnea is not just about poor sleep quality. It is a systemic condition with cardiovascular consequences that can shorten your life.

How Is Sleep Apnea Diagnosed?

Polysomnography (In-Lab Sleep Study)

The gold standard for sleep apnea diagnosis is an overnight polysomnography conducted in a sleep lab. Sensors monitor your brain waves, eye movements, muscle activity, heart rhythm, blood oxygen, airflow, and chest movement simultaneously. A sleep technologist scores your study and a sleep physician interprets the results.

Home Sleep Apnea Test (HSAT)

For patients with a high pre-test probability of uncomplicated OSA, a home sleep test is now widely accepted and far more convenient. You wear a small device that monitors your airflow, oxygen levels, and effort during sleep in your own bed. The device is returned for analysis, and results are typically available within a few days.

Home tests are generally not appropriate for diagnosing central sleep apnea, complex sleep apnea, or sleep apnea in the context of other serious conditions like congestive heart failure or COPD.

The AHI: Your Key Diagnostic Metric

Your sleep study produces an Apnea-Hypopnea Index (AHI) — the number of apnea and hypopnea events per hour of sleep. The standard classification:

• Normal: AHI below 5
• Mild OSA: AHI 5–14
• Moderate OSA: AHI 15–29
• Severe OSA: AHI 30 or above

Treatment Options for Sleep Apnea

PAP Therapy (First-Line Treatment)

For moderate to severe OSA — and for mild OSA with significant symptoms — PAP therapy is the first-line, evidence-based treatment. It has the strongest evidence base of any sleep apnea intervention. CPAP, APAP, and BiPAP are the most common devices, each with specific indications. Read our detailed guide on types of PAP devices to understand the differences.

Oral Appliance Therapy (MAD)

Mandibular Advancement Devices are custom-fitted dental appliances that reposition the lower jaw forward during sleep, physically enlarging the airway. They are most effective for mild to moderate OSA and for patients who cannot tolerate PAP therapy. They must be fitted by a dentist trained in sleep medicine.

Positional Therapy

Some patients have primarily positional OSA — events that occur predominantly when sleeping on the back (supine position). Positional devices or simple techniques to encourage side sleeping can reduce AHI significantly in these patients.

Weight Loss

Clinically significant weight loss — particularly in the context of a medically supervised program or bariatric surgery — can meaningfully reduce OSA severity and in some cases resolve it entirely. That said, weight loss should be considered complementary to, not a substitute for, PAP therapy during the treatment period.

Surgical Options

Several surgical procedures exist for OSA, ranging from nasal surgery (to improve airflow) to upper airway stimulation (hypoglossal nerve stimulation, marketed as Inspire). Surgery is generally considered after PAP therapy failure and is evaluated case-by-case by ENT or sleep surgery specialists.

Starting Your Treatment Journey

If you've recently been diagnosed with sleep apnea, or you suspect you may have it, the next step is to get evaluated and get treated — promptly. This is a treatable condition. Effective PAP therapy typically produces noticeable improvements in energy, mood, concentration, and blood pressure within weeks.

At My Respiratory Company, we carry a full selection of CPAP, APAP, and BiPAP machines to help you start or upgrade your therapy. Browse our device catalog here. We also offer a licensed Respiratory Therapist consultation for $49.99 — if you're not sure which device is right for you or you need help interpreting your sleep study results, this is exactly the right next step.

Questions about how to pay for your device? See our guide on CPAP cash pay vs insurance.