Loud snoring is often treated as a joke, but for many people it is a sign of obstructive sleep apnea, a condition in which breathing repeatedly stops and starts during sleep. Most people with sleep apnea do not know they have it. Left untreated, it raises the risk of high blood pressure, heart disease, stroke, diabetes and accidents. The good news is that it is easy to test for and very treatable.
What happens during sleep apnea
In obstructive sleep apnea (OSA), the muscles at the back of the throat relax during sleep and the airway narrows or closes. Breathing stops or becomes very shallow for ten seconds or longer. Oxygen levels drop, and the brain briefly wakes you to reopen the airway, often with a snort or gasp. This can happen dozens or even hundreds of times a night without you remembering.
Central sleep apnea is less common. The brain does not send the right signals to breathe. It is linked to heart failure, stroke, opioid medicines and high altitude.
Warning signs
At night:
- Loud, frequent snoring
- Pauses in breathing noticed by a partner
- Choking, gasping or snorting during sleep
- Restless sleep and waking often
- Getting up to urinate several times a night
- Night sweats
During the day:
- Excessive sleepiness, even after a full night in bed
- Falling asleep while reading, watching TV or driving
- Morning headaches
- Dry mouth or sore throat on waking
- Poor concentration and memory
- Irritability or low mood
Who is at risk
- Excess weight, particularly around the neck
- A large neck size (more than 17 inches in men or 16 inches in women)
- Male sex, though risk in women rises after menopause
- Older age
- Family history
- A narrow airway, large tonsils or a recessed jaw
- Alcohol and sedatives, which relax throat muscles
- Smoking
- Nasal congestion
- Conditions such as high blood pressure, type 2 diabetes, atrial fibrillation and polycystic ovary syndrome
Doctors often use a short questionnaire called STOP-BANG (Snoring, Tiredness, Observed pauses, Pressure, BMI, Age, Neck size, Gender) to estimate risk.
Why it matters
Repeated drops in oxygen and constant sleep disruption put stress on the body. Untreated moderate to severe sleep apnea is linked to:
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- High blood pressure, including blood pressure that is hard to control
- Heart attack, heart failure and atrial fibrillation
- Stroke
- Type 2 diabetes and insulin resistance
- Depression and memory problems
- A higher risk of car crashes from drowsy driving
How sleep apnea is diagnosed
Home sleep apnea testing is now common for adults with a high likelihood of moderate to severe OSA and no major heart or lung disease. You wear a small device overnight that records breathing, airflow and oxygen levels.
In-lab polysomnography is a more detailed overnight study in a sleep center. It is used when home testing is not suitable or results are unclear.
Results are reported as the apnea-hypopnea index (AHI), the number of breathing pauses or reductions per hour:
| AHI | Severity |
|---|---|
| Fewer than 5 | Normal |
| 5 to 14 | Mild |
| 15 to 29 | Moderate |
| 30 or more | Severe |
Treatment options
CPAP
Continuous positive airway pressure (CPAP) is the most effective treatment for moderate to severe sleep apnea. A small machine blows gentle air pressure through a mask, keeping the airway open. Many people notice better sleep and more energy within days or weeks. Getting used to the mask can take time. Trying different mask styles, using a heated humidifier and working with your equipment supplier makes a big difference. Most insurers, including Medicare, require evidence that you use the machine regularly in the first few months to continue coverage.
Oral appliances
Custom-made mouthguards that move the lower jaw forward can help with mild to moderate sleep apnea or for people who cannot tolerate CPAP. They are fitted by a dentist trained in sleep medicine.
Weight loss and medication
Losing weight can greatly reduce sleep apnea severity and sometimes resolve it. In December 2024, the FDA approved tirzepatide (Zepbound) for moderate to severe obstructive sleep apnea in adults with obesity, the first medicine approved for the condition.
Positional therapy
Some people have apnea mainly when sleeping on their back. Devices or techniques that keep you on your side can help.
Surgery and implants
Options include surgery to remove excess tissue in the throat or reposition the jaw, and hypoglossal nerve stimulation, an implanted device that gently moves the tongue forward during sleep. These are generally used when other treatments have not worked.
Self-help steps
- Avoid alcohol and sedatives in the evening
- Stop smoking
- Treat nasal congestion and allergies
- Keep a regular sleep schedule
- Do not drive if you feel drowsy
The bottom line
Loud snoring with pauses in breathing, gasping at night and heavy daytime sleepiness can be signs of sleep apnea. It is common, often undiagnosed, and linked to serious heart and metabolic problems. A home sleep test can usually confirm it, and CPAP, oral appliances, weight loss and newer treatments work well. Ask your doctor if you recognize the signs.
This article is for general information and does not replace medical advice.