How do I know if I have sleep apnea? The warning signs

There are multiple warning signs and symptoms of sleep apnea, which may occur during sleep and in the daytime. During sleep, the following warnings signs of obstructive sleep apnea may occur and may first be noticed by your sleep partner:

• Snoring
• Pauses in breathing during sleep
• Gasping or choking sounds during sleep or when waking
• Frequent nighttime awakenings
• Restless sleep and poor sleep quality
• Frequent bathroom trips overnight
• Nighttime sweating

Daytime warnings signs can include:

• Waking up with a headache which may be due to lack of oxygen from apnea
• Dry mouth upon waking or sore throat
• Excessive daytime sleepiness, which can lead to accidents at work, school or while driving
• Irritable mood
• Trouble with memory, paying attention or concentration

Other warning signs may include: erectile dysfunction, loss of sex drive, and depression. People with OSA often have high blood pressure, as well.

If you experience any of these signs or symptoms, it is important to contact your healthcare provider for further evaluation.

What are the types of sleep apnea?

There are 2 main types of sleep apnea: obstructive sleep apnea (OSA) and central sleep apnea.

Obstructive sleep apnea (OSA) is a serious breathing disorder characterized by complete or partial collapses of the upper airway during sleep. This can lead to pauses in breathing and shallow breathing, waking from sleep and a potential decrease in blood oxygen saturation. Snoring, fatigue and excessive daytime sleepiness can be key symptoms and may occur in patients with obesity.

• OSA occurs when your airways become blocked by large tonsils, a large tongue, or excess tissue in the airway. Excessive tissue occurs frequently in people who are overweight or obese. When the airway muscles relax during sleep, the extra tissue can block the breathing passages.

Central sleep apnea occurs when the area of the brain that controls breathing, called the brain stem, is damaged by an infection or stroke. Other causes include medical conditions such as heart failure, being older than 40, or use of opioids.

How is sleep apnea diagnosed?

Sleep studies performed at home (the type most commonly used today) or a sleep study (polysomnogram) in a sleep center is used to diagnose obstructive sleep apnea.

• At a sleep center, sensors are placed on your fingers, scalp or chest to monitor blood oxygen levels, heart rate, brain waves, breathing patterns and nighttime awakenings during sleep.
• At home, sensors can monitor oxygen levels, breathing patterns and airflow, and heart rate. In many cases, the equipment and directions you need can be mailed to your home. Home sleep studies are not as extensive as sleep center studies but may be sufficient to evaluate your symptoms.
• The results can help to determine if you have sleep apnea or another sleep disorder and the level of severity.

Your healthcare provider may also use a questionnaire called the STOP-BANG questionnaire to assess your symptoms, like snoring, daytime fatigue, high blood pressure or breathing pauses during sleep.

What are the risk factors for sleep apnea?

• The most significant factor risk for developing obstructive sleep apnea is being overweight or obese (BMI >30), although not all people with OSA are overweight or obese.
• Having excessive tissue in the neck area (men >17 inches, women >15 inches) can lead to airway collapse and OSA development. Crowding of tissues in the back of the throat, like the tongue and jaw area (oropharyngeal crowding) can also lead to difficulties with breathing during sleep. Prominent tonsillar or adenoid tissue can also crowd the back of the throat.
• Being male, and being older (over 40 years of age typically) can increase your risk for OSA..
• Using alcohol, sedatives, opioids, and smoking can also worsen sleep apnea.
• Some people may find that their sleep apnea symptoms worsen when they lay flat on their back (supine position) to sleep. Speak with your doctor, who may recommend options to help you sleep on your side, like a wedge pillow, if needed.

How do you treat obstructive sleep apnea (OSA)?

CPAP

There are several treatments for obstructive sleep apnea (OSA). The first-line treatment is typically the use of continuous positive airway pressure (CPAP).

• A CPAP device is composed of a mask that fits over your nose and mouth or nose only. It works by providing a stream of air that helps to force your airways open to allow easier breathing and better oxygen delivery.
• CPAP is the most common type of positive airway pressure (PAP) therapy used for moderate-to-severe OSA. Other types of PAP include auto-adjusting PAP (APAP) and bilevel PAP (BPAP).

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MADs

A dental mandibular advancement device (MADs) may be used as an alternative for people who cannot tolerate CPAP or who have mild-to-moderate OSA.

• A MAD is a fitted dental device
• During sleep the muscles that hold our jaws forward may relax. This can result in closing of the airway and cause sleep apnea.
• People who are eligible for this device may be able to better tolerate MADs compared to CPAP.

Prescription Zepbound (tirzepatide)

Lifestyle changes like losing weight can significantly improve OSA. Being overweight or obese is a major risk factor for having OSA. Losing weight can lessen the amount of tissue around the airways and dramatically improve airflow and oxygen delivery.

In December 2024, Eli Lilly’s Zepbound (tirzepatide) was approved by the FDA for treatment of moderate-to-severe obstructive sleep apnea (OSA) in adults with obesity. It is the only prescription medicine for this indication. In addition to improved sleep apnea, patients also lost about 50 lbs on average during treatment.

Approval for OSA was based on the SURMOUNT-OSA Phase 3 studies. Zepbound was evaluated for the treatment of OSA in adults with obesity, with and without positive airway pressure (PAP) like CPAP therapy over one year.

• The primary objective was to demonstrate that Zepbound was superior in change in apnea-hypopnea index (AHI) from baseline at 52 weeks as compared to placebo (an injection with no medicine).
• The apnea-hypopnea index (AHI) measures the severity of OSA and looks at the number of times per hour during sleep that breathing stops (apnea) or becomes significantly reduced (hypopnea).
• Results in patients not using PAP showed that Zepbound led to 25 fewer breathing disruptions per hour compared to 5 fewer disruptions with placebo. With PAP, Zepbound led to 29 fewer breathing disruptions per hour compared to 6 fewer disruptions with placebo. After one year, 42% or 50% of adults on Zepbound experienced remission or mild, non-symptomatic OSA, compared to 16% or 14% on placebo.
• In addition to improved OSA symptoms, adults on Zepbound lost an average of 45 lbs (18%) of their body weight, while adults on Zepbound and PAP therapy lost an average of 50 lbs (20%) of their body weight, compared to 4 lbs (2%) and 6 lbs (2%) on placebo, respectively.

Common side effects with Zepbound include stomach-related issues like nausea, diarrhea, vomiting, constipation, abdominal pain, belching, heartburn and indigestion. Injection site reactions, fatigue, allergies to the medicine, and hair loss were also reported. These are not all the possible side effects of Zepbound.

Learn more: How does Zepbound help treat sleep apnea?

Surgery

Surgery is usually a last-line therapy when other treatments are not successful. Surgery may involve removing excessive tissue in the back of the throat to open the airway for improved breathing. Nasal, tongue and palatal (the roof of the mouth) surgeries can be performed.

Inspire Implantable Device

Another surgical option for moderate-to-severe sleep apnea is an FDA-approved device called Inspire. The device is implanted during a minimally-invasive outpatient surgery and most patients go home the same day. Most insurance companies will cover the cost of Inspire for eligible patients.

This device stimulates the hypoglossal nerve, a cranial nerve which helps to control the muscles of the tongue. Inspire works by monitoring your breathing and stimulates your nerves around the tongue when needed to prevent your airway from collapsing. The device battery lasts about 10 years and can be replaced during a brief outpatient procedure.

Bottom Line

• Warning signs of obstructive sleep apnea (OSA) include loud snoring, pauses in breathing during sleep, gasping or choking sounds during sleep and frequent awakenings at night. Often, a sleep partner may notice these signs at night.
• People with OSA may also have a morning headache due to lack of oxygen, a dry mouth or sore throat upon waking, and excessive daytime sleepiness, which can increase the risk of motor vehicle or other accidents.
• Obstructive sleep apnea is a serious breathing disorder. If you exhibit these warning signs for sleep apnea, contact your healthcare provider who can evaluate your symptoms and suggest an appropriate treatment plan, if needed. Continuous positive airway pressure (CPAP) is typically the treatment of first choice.

This is not all the information you need to know about obstructive sleep apnea (OSA) and does not take the place of your doctor’s directions. Discuss any medical questions you have with your doctor or other health care provider.