Quick answer
What is sleep apnoea?
Obstructive sleep apnoea (OSA) means your airway repeatedly collapses during sleep, causing breathing pauses, snoring, and fragmented sleep. You may feel exhausted despite sleeping, with morning headaches and poor concentration. It is common in overweight men but affects women too — especially after menopause. CPAP is the main NHS treatment; weight loss often helps.
Sleep apnoea — when snoring becomes serious
Obstructive sleep apnoea (OSA) is one of the most underdiagnosed conditions in the UK. It means your upper airway repeatedly collapses during sleep — breathing stops for 10 seconds or more, sometimes hundreds of times nightly. Each pause drops oxygen and triggers a micro-arousal — you may not fully wake, but sleep is shattered.
The result: profound daytime tiredness despite spending hours in bed — and long-term risks to heart and brain if untreated.
Who gets it
Classic profile: overweight middle-aged man with loud snoring. But OSA affects:
- women — especially after menopause (hormone changes affect airway tone)
- people of normal weight with structural factors — large tonsils, small jaw, narrow airway
- children with enlarged adenoids/tonsils
- those with Down syndrome, acromegaly, or hypothyroidism
Prevalence: estimated 1 in 8 adults — majority undiagnosed.
Symptoms — what to look for
During sleep (often reported by partner):
- loud snoring — not universal but very common
- breathing pauses followed by snort or gasp
- restless sleep, frequent waking
- nocturia — waking to urinate (pressure changes affect kidneys)
During the day:
- excessive sleepiness — falling asleep in meetings, while watching TV, or while driving (dangerous)
- unrefreshing sleep — waking tired despite 7 to 8 hours
- morning headaches
- poor concentration, memory problems, irritability
- depression — bidirectional link with OSA
Not everyone with OSA snores loudly — central sleep apnoea and upper airway resistance syndrome present differently.
Why it matters — health risks
Repeated oxygen dips and sleep fragmentation cause:
- hypertension — OSA causes resistant high blood pressure; CPAP lowers it
- atrial fibrillation and heart failure
- stroke and heart attack risk
- type 2 diabetes — insulin resistance worsens with OSA
- worsening obesity — tiredness reduces activity; hormonal appetite changes
Driving: Excessive sleepiness from OSA is a notifiable condition to DVLA. You must not drive until symptoms controlled on treatment. Commercial drivers (HGV, bus) face stricter rules.
Diagnosis
GP assessment:
- Epworth Sleepiness Scale questionnaire
- BMI, neck circumference, blood pressure
- Examination — tonsils, jaw, nasal obstruction
Sleep study:
- Home oximetry — finger probe records oxygen dips overnight — suitable for high-probability moderate OSA
- Polysomnography (PSG) — full sleep lab study — EEG, airflow, chest movement, oxygen — for unclear cases or suspected central apnoea
Severity (AHI — apnoea-hypopnoea index):
| AHI per hour | Severity |
|---|---|
| Under 5 | Normal (in most scoring) |
| 5 to 14 | Mild |
| 15 to 30 | Moderate |
| Over 30 | Severe |
Treatment
CPAP — gold standard
Continuous positive airway pressure — mask (nasal or full-face) connected to a machine delivering gentle air pressure that splints the airway open.
- Highly effective — abolishes apnoeas when used
- Challenges: mask comfort, claustrophobia, dry nose — modern machines have humidifiers; many adapt within weeks
- Must use most nights, most of the night — partial use gives partial benefit
Weight loss
10% body weight loss can reduce AHI by 30 to 50% — sometimes curing mild OSA. See our weight loss guide.
Lifestyle
- Avoid alcohol and sedatives before bed — worsen airway collapse
- Sleep on side — positional OSA improves off the back (tennis ball in pyjama trick, positional trainers)
- Stop smoking — airway inflammation
- Treat nasal congestion — steroids spray if rhinitis
Mandibular advancement devices (MAD)
Custom gum shield pulling lower jaw forward — for mild to moderate OSA or CPAP intolerance. Provided by dentist with sleep service oversight.
Surgery
Rare first-line — tonsillectomy in selected children/adults, uvulopalatopharyngoplasty (UPPP) — limited long-term success. Bariatric surgery for severe obesity improves OSA substantially.
Sleep apnoea and other conditions
- ED — improves with CPAP in many men
- Depression — treat both; mood improves with sleep
- Atrial fibrillation — screen for OSA before ablation; CPAP improves outcomes
- Pregnancy — gestational OSA linked to pre-eclampsia — specialist care
Living with CPAP
Initial adjustment is hard — persistence pays off. Tips:
- start with short daytime practice wearing mask
- use heated humidifier for dry nose
- clean mask and tubing regularly
- follow-up with sleep service for pressure adjustments (APAP machines auto-titrate)
Most people feel dramatically better within days to weeks of consistent use.
Sleep apnoea is treatable — the barrier is usually recognition. If your partner says you stop breathing at night, or you fight sleepiness daily, ask your GP for assessment.
Common questions
- What are the symptoms of sleep apnoea?
- Loud snoring, breathing pauses witnessed by partner, waking gasping or choking, unrefreshing sleep, excessive daytime sleepiness, morning headaches, poor concentration, irritability, and needing to urinate at night. Not everyone who snores has OSA — but pauses and daytime sleepiness suggest it.
- What causes sleep apnoea?
- Obstructive sleep apnoea happens when throat muscles relax too much during sleep — the airway narrows or closes. Risk factors include obesity (especially neck circumference over 43cm in men), large tonsils, small jaw, alcohol before bed, sedatives, and sleeping on your back. Central sleep apnoea is r different — brain signalling problem — less common.
- How is sleep apnoea diagnosed?
- GP assessment then referral for sleep study — home oximetry (finger probe overnight) for suspected moderate cases, or full polysomnography in a sleep clinic for complex cases. Apnoea-hypopnoea index (AHI) measures events per hour — mild 5 to 14, moderate 15 to 30, severe over 30.
- Does CPAP cure sleep apnoea?
- CPAP keeps the airway open with pressurised air through a mask — it treats symptoms effectively while used but does not cure underlying anatomy. Weight loss may reduce or eliminate mild OSA. Mandibular advancement devices (gum shields) help some mild cases.
- Can sleep apnoea cause erectile dysfunction?
- Yes — OSA is independently linked to ED through reduced oxygen, inflammation, and hormonal changes. Treating OSA with CPAP often improves ED alongside other health benefits.
- Is sleep apnoea dangerous?
- Untreated moderate-to-severe OSA increases cardiovascular risk — hypertension, atrial fibrillation, heart failure, stroke. Daytime sleepiness causes road accidents — you must inform DVLA if excessive sleepiness affects driving; there are rules for commercial drivers.