Waking Up At Night? Exhausted In The Morning? It Might Be Sleep Apnea

If you snore, frequently wake up with a headache and would often describe yourself as dead tired, you could be experiencing sleep apnea. 

About 5.4 million Canadians live with the sleep disorder, characterized by interrupted breathing during sleep. “About 80 percent of people don’t even know they have it,” says Dr. Douglas Bradley, a respirologist and sleep physician at the University Health Network’s Centre for Sleep Health and Research in Toronto. 

Here’s everything you need to know about the sleep condition.

What is sleep apnea?

Obstructive sleep apnea (OSA), which affects the vast majority of sleep apnea patients, happens when the nose, mouth or throat are restricted or become too narrow, blocking your airway, says Bradley. “When you fall asleep, the lack of activity in those muscles narrows the throat and makes it more susceptible to collapse,” he says. (The other, much less common type, central sleep apnea, is caused by a signalling problem in the nervous system that interrupts breathing.)

People with sleep apnea experience short pauses in their breathing while they sleep that can last from 10 to 30 seconds (or even longer) and this can happen dozens or even hundreds of times every night. This disrupted breathing often causes gasping and snoring, two telltale symptoms of sleep apnea. 

Who gets sleep apnea?

Cases of sleep apnea are reported in twice as many men compared to women, says Dr. Najib Ayas, a professor in the division of critical care medicine and respiratory medicine at the University of British Columbia and medical director of the UBC Hospital Sleep Disorders Program. But this may be due to underreporting.

“If you look at individuals who go to sleep clinics to get tested for sleep apnea, the ratio is more like three or four men to one woman, so it seems like we’re not really recognizing it as much in women,” he says, “and a lot of them probably aren’t getting tested or treated.”

Sleep apnea can occur at any age, but the risk of OSA increases as you get older because fatty tissue can build up in your throat and tongue as you age. Some people are genetically predisposed to developing sleep apnea—if you have large tonsils or a narrow upper airway, for example. A health condition like kidney failure can also increase your risk, since it can cause fluid to build up in your neck and block your airway.  

What are the signs of sleep apnea?

Snoring is the hallmark of sleep apnea, but it’s a symptom that’s more often reported in men. It’s also possible to have sleep apnea and not snore. Women may complain more of insomnia and fatigue, says Ayas. Women also experience morning headaches as a symptom more frequently. “We don’t know why, but it’s quite common,” says Bradley.   

Statistics show that people who are overweight or obese are more likely to have OSA. There is also a strong link between the sleep disorder and women with polycystic ovary syndrome, a condition that happens when the ovaries produce excess hormones. And restless legs syndrome (a distinct disorder on its own) is more common in women who experience OSA during times of major hormonal change, such as pregnancy and menopause. Sleep apnea tends to worsen in menopause as well, adds Ayas.

People with OSA also often report daytime irritability, trouble remembering things and daytime tiredness in the extreme. If you suspect that you might have sleep apnea, talk to your doctor about whether you might benefit from a sleep study (more on that below).

Wearable tech may also be able to alert you if your breathing changes while sleeping. Newer models of the Apple Watch, for instance, can send you an alert if your breathing patterns overnight indicate that you may be experiencing sleep apnea. This can be useful data to bring to your doctor.

How does sleep apnea affect your overall health?

The immediate concern with sleep apnea is the danger posed by being overtired, says Bradley. “People with sleep apnea have three to four times the risk of a motor vehicle accident because of their lack of alertness,” he says. They are also more at risk of workplace and household accidents. 

In the long run, untreated sleep apnea may also contribute to a range of diseases and disorders, including heart disease and type 2 diabetes. We don’t, however, have solid research showing whether women experience the same increase in health risks as their male counterparts.

Of the research that has been done, studies have linked OSA to prenatal high blood pressure during pregnancy and pregnancy-related diabetes. And new research has shown an increase in the risk of dementia for women with untreated OSA. 

How is sleep apnea diagnosed and treated?

Sleep apnea is diagnosed with a physical exam (to look at the throat and mouth for obstructions), a review of your medical history (to flag possibly relevant heart issues, indicative sleep habits such as night waking and morning sleepiness, and family history of sleep apnea) and a sleep study. The latter is conducted overnight in a lab or using a portable home monitoring device. 

If you are diagnosed with sleep apnea, there are a few treatments available. The most common and effective treatment for severe OSA is a device that uses continuous positive airway pressure (CPAP) to keep your airway open during sleep. Using a CPAP machine is safe for treating sleep apnea during pregnancy, too. Another option is a mouthpiece to push the lower jaw forward during sleep. And for some people, surgery—like a tonsillectomy, which removes the tonsils—is an option, too.

If you have obesity, your doctor may also recommend taking steps to reduce your weight. Some studies show that people who lose five to 10 percent of their body weight can see improvement in their sleep apnea symptoms. And new research on the weight loss drug Zepbound—one of the brand names for a medication called tirzepatide—by its pharmaceutical manufacturer, Eli Lilly, has found that it may help people with sleep apnea.

If your sleep apnea is mild, some small lifestyle changes can sometimes be enough to keep you breathing normally through the night. These could include avoiding alcohol and sedatives that can relax your throat muscles too much and sleeping on your side instead of your back.