Signs and symptoms of obstructive sleep apnea include:

• Excessive daytime sleepiness (hypersomnia)
• Loud snoring
• Observed episodes of breathing cessation during sleep
• Abrupt awakenings accompanied by shortness of breath
• Awakening with a dry mouth or sore throat
• Morning headache
• Frequent urination at night
• Difficulty staying asleep (insomnia)

When to see a doctor
Consult a medical professional if you experience, or if your partner observes, the following:

• Snoring loud enough to disturb your sleep or that of others
• Shortness of breath that awakens you from sleep
• Intermittent pauses in your breathing during sleep
• Excessive daytime drowsiness, which may cause you to fall asleep while you're working, watching television or even driving a vehicle

Many people don't think of snoring as a sign of something potentially serious, and not everyone who has sleep apnea snores. But be sure to talk to your doctor if you experience loud snoring, especially snoring that's punctuated by periods of silence. With sleep apnea, snoring typically is loudest when you sleep on your back, and it quiets when you turn on your side.

Ask your doctor about any sleep problem that leaves you chronically fatigued, sleepy and irritable. Excessive daytime drowsiness (hypersomnia) may be due to other disorders, such as narcolepsy.

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Obstructive sleep apnea occurs when the muscles in the back of your throat relax too much to allow normal breathing. These muscles support structures including the soft palate, the uvula — a triangular piece of tissue hanging from the soft palate, the tonsils and the tongue.

When the muscles relax, your airway narrows or closes as you breathe in and breathing may be inadequate for 10 to 20 seconds. This may lower the level of oxygen in your blood. Your brain senses this inability to breathe and briefly rouses you from sleep so that you can reopen your airway. This awakening is usually so brief that you don't remember it.

You can awaken with a transient shortness of breath that corrects itself quickly, within one or two deep breaths, although this sequence is rare. You may make a snorting, choking or gasping sound. This pattern can repeat itself five to 30 times or more each hour, all night long. These disruptions impair your ability to reach the desired deep, restful phases of sleep, and you'll probably feel sleepy during your waking hours.

People with obstructive sleep apnea may not be aware that their sleep was interrupted. In fact, many people with this type of sleep apnea think they sleep well all night.

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Anyone can develop obstructive sleep apnea. However, certain factors put you at increased risk:

• Excess weight. More than half of those with obstructive sleep apnea are overweight. Fat deposits around your upper airway may obstruct your breathing. However, not everyone who has sleep apnea is overweight and vice versa. Thin people can develop the disorder, too.
• Neck circumference. The size of your neck may indicate whether or not you have an increased risk of obstructive sleep apnea. That's because a thick neck may narrow the airway and may be an indication of excess weight. A neck circumference greater than 17 inches (43 centimeters) for men and 15 inches (38 centimeters) for women is associated with an increased risk of obstructive sleep apnea.
• High blood pressure (hypertension). Obstructive sleep apnea is relatively common in people with hypertension.
• A narrowed airway. You may inherit a naturally narrow throat. Or your tonsils or adenoids may become enlarged, which can block your airway.
• Chronic nasal congestion. Obstructive sleep apnea occurs twice as often in those who have consistent nasal congestion at night, regardless of the cause. This may be due to narrowed airways.
• Diabetes. Obstructive sleep apnea is three times more common in people who have diabetes.
• Being male. In general, men are twice as likely to have sleep apnea.
• Being black, Hispanic or a Pacific Islander. Among people under age 35, obstructive sleep apnea is more common in blacks, Hispanics and Pacific Islanders.
• Being older. Sleep apnea occurs two to three times more often in adults older than 65.
• Menopause. A woman's risk appears to increase after menopause.
• A family history of sleep apnea. If you have family members with sleep apnea, you may be at increased risk.
• Use of alcohol, sedatives or tranquilizers. These substances relax the muscles in your throat.
• Smoking. Smokers are nearly three times more likely to have obstructive sleep apnea.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

Sleep apnea is considered a serious medical condition. Complications may include:

• Cardiovascular problems. Sudden drops in blood oxygen levels that occur during sleep apnea increase blood pressure and strain the cardiovascular system. About half the people with sleep apnea develop high blood pressure (hypertension), which raises the risk of heart failure and stroke. The more severe the obstructive sleep apnea, the greater the risk of high blood pressure. Patients with sleep apnea are much more likely to develop abnormal heart rhythms such as atrial fibrillation. If there's underlying heart disease, these repeated multiple episodes of low blood oxygen (hypoxia or hypoxemia) can lead to sudden death from a cardiac event.
• Daytime fatigue. The repeated awakenings associated with sleep apnea make normal, restorative sleep impossible. People with sleep apnea often experience severe daytime drowsiness, fatigue and irritability. They may have difficulty concentrating and find themselves falling asleep at work, while watching TV or even when driving. Children and young people with sleep apnea may do poorly in school, have reduced mental development or have behavior problems. Treatment of sleep apnea can improve these symptoms, restoring alertness and improving quality of life.
• Complications with medications and surgery. Obstructive sleep apnea also is a concern with certain medications and general anesthesia. People with sleep apnea may be more likely to experience complications after major surgery because they're prone to breathing problems, especially when sedated and lying on their backs. Before you have surgery, tell your doctor that you have sleep apnea. Undiagnosed sleep apnea is especially risky in this situation.
• Sleep-deprived partners. Loud snoring can keep those around you from getting good rest and eventually disrupt your relationships. It's not uncommon for a partner to choose to sleep in another room. Many bed partners of people who snore are sleep deprived as well.

People with obstructive sleep apnea may also complain of memory problems, morning headaches, mood swings or feelings of depression, and a need to urinate frequently at night (nocturia).

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

If you suspect that you have obstructive sleep apnea, you'll likely first see your family doctor or a primary care doctor. However, in some cases when you call to set up an appointment, you may be referred immediately to a sleep specialist.

Because appointments can be brief, and there's often a lot of ground to cover, it's a good idea to be well prepared for your appointment. Here's some information to help you get ready for your appointment, and what to expect from your doctor.

What you can do

• Be aware of any pre-appointment requests. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as keeping a sleep diary. In a sleep diary, you record your sleep patterns — bedtime, number of hours slept, nighttime awakenings and awake time — as well as your daily routine, naps and how you feel during the day. You may be asked to record a sleep diary for one to two weeks.
• Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
• Write down key personal information, including new or ongoing health problems, major stresses or recent life changes.
• Make a list of all medications, as well as any vitamins or supplements, that you're taking. Include anything you've taken to help you sleep.
• Take your bed partner along, if possible. Your doctor may want to talk to your partner to learn more about how much and how well you're sleeping.
• Write down questions to ask your doctor. Your time with your doctor is limited, so preparing a list of questions helps you make the most of your time together.

For insomnia, some basic questions to ask your doctor include:

• What is likely causing my symptoms?
• Other than the most likely cause, what are other possible causes for my symptoms?
• Is my condition likely temporary or chronic?
• What kinds of tests do I need?
• Should I go to a sleep clinic? What will that cost, and will my insurance cover it?
• What is the best course of action?
• What are the alternatives to the primary approach that you're suggesting?
• Are there any restrictions that I need to follow?
• I have these other health conditions. How can I best manage them together?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment.

What to expect from your doctor
A key part of the evaluation of obstructive sleep apnea is a detailed history, meaning your doctor will ask you many questions. These may include:

• When did you first begin experiencing symptoms?
• Have your symptoms been continuous or occasional?
• Do you snore or wake up gasping or out of breath?
• How refreshed do you feel when you wake up?
• Are you tired during the day?
• Do you doze off or have trouble staying awake while sitting quietly or driving?
• Do you nap during the day?
• Do you use tobacco or drink alcohol?
• Do you worry about falling asleep or staying asleep?
• Do you have any family members with sleep problems?
• What medications do you take?

What you can do in the meantime

• Try to sleep on your side. Most forms of sleep apnea are milder when you sleep on your side.
• Avoid alcohol close to bedtime. Alcohol worsens obstructive sleep apnea.
• If you're drowsy, avoid driving. If you have sleep apnea you may be abnormally sleepy, which can put you at higher risk of motor vehicle accidents. At times, a close friend or family member might tell you that you appear sleepier than you feel. If this is true, try to avoid driving at all.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

Your doctor may make an evaluation based on your signs and symptoms or may refer you to a sleep disorder center. There, a sleep specialist can help decide whether you need further evaluation. The evaluation may involve overnight monitoring of your breathing and other body functions during sleep. Tests to detect sleep apnea include:

• Nocturnal polysomnography. During this test, you're hooked up to equipment that monitors your heart, lung and brain activity, breathing patterns, arm and leg movements, and blood oxygen levels while you sleep. This can help your doctor rule out other conditions — such as periodic limb movements or narcolepsy — that can also cause excessive daytime sleepiness, but require different treatment.
• Oximetry. This screening method involves using a small machine that monitors and records your blood oxygen level while you're asleep. A simple sleeve fits painlessly over one of your fingers to collect the information overnight at home. If you have sleep apnea, the results of this test will often show drops in your blood oxygen level during apneas and subsequent rises with awakenings. If the results are abnormal, your doctor may have you undergo polysomnography to confirm the diagnosis. Oximetry doesn't detect all cases of sleep apnea, so your doctor may still recommend a polysomnogram even if the oximetry results are normal.
• Portable cardiorespiratory testing. Under certain circumstances, your doctor may provide you with at-home tests to diagnose sleep apnea. These tests usually involve oximetry, measurement of airflow and measurement of breathing patterns.

Your doctor may also refer you to an ear, nose and throat doctor (otolaryngologist) to rule out any anatomic blockage in your nose or throat.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

For milder cases of obstructive sleep apnea, your doctor may recommend lifestyle changes, such as losing weight or quitting smoking. If these measures don't improve your signs and symptoms or if your apnea is moderate to severe, a number of other treatments are available. Certain devices can help open up a blocked airway. In other cases, surgery may be necessary.

Therapies

• Positive airway pressure. If you have moderate to severe sleep apnea, you may benefit from a machine that delivers air pressure through a mask placed over your nose while you sleep. The most common type is called continuous positive airway pressure, or CPAP (SEE-pap). With this treatment, the pressure of the air breathed is continuous and somewhat greater than that of the surrounding air, which is just enough to keep your upper airway passages open. This prevents apnea and snoring.

  Although CPAP is the most consistently successful and most commonly used method of treating sleep apnea, some people find it cumbersome and uncomfortable. With some practice, most people learn to adjust the mask to obtain a comfortable and secure fit. You may need to try different types to find a suitable mask. If you're having particular difficulties tolerating pressure, there are machines that have special adaptive pressure functions to improve comfort. Some people also benefit from using a humidifier along with their CPAP system.

  Don't stop using the CPAP machine if you experience problems. Check with your doctor to see what adjustments you can make to improve its comfort. In addition, contact your doctor if you still snore despite treatment or begin snoring again. If your weight changes, your doctor may need to adjust the pressure settings.

• Mouthpiece (oral device). Another option is wearing a mouthpiece designed to keep your throat open. While positive airway pressure is nearly always an effective treatment, oral appliances are a successful alternative for some patients. Some are designed to open your throat by bringing your jaw forward, which can sometimes relieve snoring and mild obstructive sleep apnea. Others hold your tongue in a different position. If you and your doctor decide to explore this option, you'll need to see a dentist experienced in dental sleep medicine appliances for the fitting and follow-up therapy.

  A number of devices are available from your dentist. You may need to try different devices before finding one that works for you. Because oral appliances aren't as consistently effective as CPAP, close follow-up is needed to ensure successful treatment of sleep apnea.

Surgery or other procedures
The goal of surgery for sleep apnea is to remove excess tissue from your nose or throat that may be vibrating and causing you to snore, or that may be blocking your upper air passages and causing sleep apnea. Surgical options may include:

• Surgical removal of tissue. Uvulopalatopharyngoplasty (UPPP) is a procedure in which your doctor removes tissue from the rear of your mouth and top of your throat. Your tonsils and adenoids are commonly removed as well. This type of surgery may be successful in stopping throat structures from vibrating and causing snoring. UPPP usually is performed in a hospital and requires a general anesthetic.
• Jaw correction. In this procedure, called maxillomandibular advancement, the upper and lower parts of your jaw are moved forward from the rest of your facial bones. This enlarges the space behind the tongue and soft palate, making obstruction less likely. This procedure may require an oral surgeon and an orthodontist, and at times may be combined with another procedure to improve the likelihood of success.
• Surgical opening in the neck. You may need this form of surgery if other treatments have failed and you have severe, life-threatening sleep apnea. In this procedure, called a tracheostomy, your surgeon makes an opening in your neck and inserts a metal or plastic tube through which you breathe. You keep the opening covered during the day. But at night you uncover it to allow air to pass in and out of your lungs, bypassing the blocked air passage in your throat.
• Implants. The Pillar procedure is a minimally invasive treatment that involves placement of three tiny polyester rods in the soft palate. These inserts stiffen and support the tissue of the soft palate and reduce upper airway collapse and snoring. This treatment is recommended only for people with mild to moderate obstructive sleep apnea.

Removing tissues in the back of your throat with a laser (laser-assisted uvulopalatoplasty) or with radiofrequency energy (radiofrequency ablation) are procedures that doctors sometimes use to treat snoring. However, these procedures aren't recommended for treating obstructive sleep apnea.

Other types of surgery may help reduce snoring and sleep apnea by clearing or enlarging air passages:

• Nasal surgery to remove polyps or straighten a crooked partition between your nostrils (deviated nasal septum)
• Surgery to remove enlarged tonsils or adenoids

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

In many cases, self-care may be the most appropriate way for you to deal with obstructive sleep apnea. Try these tips:

• Lose weight. Even a slight loss in excess weight may help relieve constriction of your airway.
• Avoid alcohol and medications such as tranquilizers and sleeping pills. These relax the muscles in the back of your throat, interfering with breathing.
• Sleep on your side or abdomen rather than on your back. Sleeping on your back can cause your tongue and soft palate to rest against the back of your throat and block your airway. To prevent sleeping on your back, try sewing a tennis ball in the back of your pajama top.
• Keep your nasal passages open at night. If you have congestion, use a saline nasal spray to help keep your nasal passages open. Talk to your doctor about using nasal decongestants or antihistamines, because, unlike saline sprays, these medications are generally recommended only for short-term use.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.