Odds Are, You’re Ignoring These 7 Subtle Signs of Sleep Apnea

Snoring might be an obvious symptom, but it’s not the only one to pay attention to.

If you or your partner had sleep apnea, you’d know it ... right? Sleep apnea is a breathing disorder in which your airway repeatedly becomes completely or partially obstructed while you sleep, according to the American Academy of Sleep Medicine. The most obvious sign is—you guessed it—heavy snoring. About 90 million Americans snore, and as many as half of them may have sleep apnea, reports Sleep.org. And if you have sleep apnea you may often feel tired during the day even if you get a full night of sleep.

But snoring and daytime sleepiness aren’t the only red flags for sleep apnea. According to the doctors HealthiNation interviewed, a wide range of symptoms can indicate sleep apnea, and it’s easy for subtle ones to be overlooked or misdiagnosed for other issues.

“Untreated, sleep apnea has been linked to an increased risk of stroke, heart attack, diabetes, dementia, and sudden death,” says Gerard Joseph Meskill, MD, a neurologist and sleep disorders specialist in Houston. Even a side effect such as excessive daytime sleepiness isn’t as innocent as it sounds—it’s been flagged as a factor in major train crashes, as well as countless motor vehicle accidents, says Dr. Meskill. The importance of proper diagnosis and treatment of obstructive sleep apnea cannot be understated, our experts insisted.

If some of these sleep apnea symptoms seem familiar to you or someone you love, talk to your doctor about getting your sleep evaluated.

1. You're grumpy for no obvious reason

The most common kind of sleep apnea is called obstructive sleep apnea. In people with OSA, the airway doesn’t stay open properly during sleep, so breathing pauses repeatedly for short bursts of time during the night. This prevent the brain from getting enough oxygen, which kicks your body’s adrenal system into high gear so more blood can flow to the brain. This begins a cascade of reactions, starting with the hormone adrenaline surging through your body.

Adrenaline increases heart rate, which boosts blood pressure to help increase blood flow and oxygen to the brain. “That jolt of adrenaline slightly wakes you up—called a microarousal—so you never get a sound deep sleep,” explains Edward A. Alvarez, DDS, a New York-based dentist who focuses on treating his patients’ sleep issues. The lack of deeper stages of sleep from constantly waking up may lead to moodiness, irritability, and even an increased risk of depression, he says.

According to a 2015 Australian study, 73% of sleep apnea patients had depression-like symptoms when they were first diagnosed. After they were treated for three months with standard sleep apnea therapy known as a CPAP machine, which helps keep the airway open during sleep, only 4% continued to have depression symptoms. However, it’s not entirely clear whether sleep apnea causes depression or whether there are common underlying factors that make people prone to both depression and sleep apnea.

2. You take multiple middle-of-the-night bathroom breaks

Nocturia, or waking up to pee during the night, can also be a less obvious, but increasingly important, symptom that helps doctors diagnose sleep apnea. Sleeping less deeply—and therefore waking up frequently in the night—may make you more aware of the need to use the bathroom.

But it also appears that physiologic changes that occur during sleep apnea cause the body to release more urine. A Japanese study found that 70% of patients who came to a urology clinic because of nighttime urination had sleep-disordered breathing; treating them with CPAP therapy cut down their nighttime bathroom trips.

3. You wake up with a headache

There’s a well-known link between headaches and sleep problems; headache sufferers are two to eight times more likely than other people to be at risk of a sleep disorder, according to the American Migraine Foundation. (These are other headache triggers you should know about.) While doctors are still learning about the role sleep plays in the development of headache pain, research suggests there’s a clear link between sleep apnea and morning headaches.

In fact, a 2015 study in the Journal of Headache Pain found that about 20% of patients with sleep apnea are prone to morning head pain. One reason is that sleep apnea could lead to you to inadvertently clench your teeth—a condition known as bruxism—in an attempt to keep the airway open, says Dr. Meskill. “If you grind or clench your teeth at night, wake up with temporal headaches or TMJ pain, or you have been told you’re wearing down your teeth, consider seeing a sleep specialist,” he says.

4. Your mouth is dry and your throat is sore

People with sleep apnea often sleep with their mouths open to help make breathing easier. But this habit can dry out the mouth and throat. In a study published in the Journal of Sleep Research, researchers compared incidences of dry mouth in people who had sleep apnea with people who snored but did not have sleep apnea. They found that dry mouth was twice as common in people with sleep apnea as it was in the other group, and even concluded that “dry mouth upon awakening appears as a significant symptom of obstructive sleep apnea.”

5. You experience night sweats

Waking up in the middle of the night drenched in sweat can also be a sneaky symptom of sleep apnea. When your body is fighting for air, the flight-or-fight response is activated, which causes your body temperature to rise, explains Joseph Krainin MD, a sleep doctor and neurologist in Mount Pleasant, South Carolina. A study published in 2013 in the journal BMJ Open found that frequent night sweats (more than three times a week) occurred in about 30% of men with sleep apnea and about 33% of women with sleep apnea, compared to just 9% of men and 12% of women in the general population. The authors suggest that doctors should consider the possibility of sleep apnea in people who complain about nighttime sweating.

6. You have acid reflux

It’s easy to write off that sour, burning taste in your mouth from reflux as the result of an overindulgent dinner. But if you frequently feel the effects of reflux in the morning when you wake up, sleep apnea might be to blame. One explanation suggests that sleep apnea changes the pressure in your airway, which makes stomach acid more likely to back up into the esophagus and cause those telltale acid reflux symptoms. A University of Mississippi study published in the Journal of Clinical Sleep Medicine found that 78% of sleep apnea patients also had symptoms of acid reflux when they were first diagnosed. Sticking to sleep apnea treatment led to a significant reduction in their heartburn symptoms.

7. Your brain feels foggy

You know when your brain feels flightier than usual: maybe you forgot to RSVP to a kid’s birthday party or two, or you’re constantly misplacing your cell phone around your home. “Forgetfulness and memory problems can occur because of poor oxygenation to the brain as well as due to sleep deprivation,” says Susan Besser, MD, a primary care doctor with Mercy Personal Physicians at Overlea in Baltimore.

Being treated for sleep apnea may also keep your brain healthy over time. A study in the journal Neurology found that people with sleep apnea who treated their sleep breathing problems with a continuous positive airway pressure machine (CPAP) were diagnosed with memory and thinking problems about 10 years later than people whose sleep apnea was not treated.

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