Symptoms of Sleep Apnea

The following are some of the most common symptoms of sleep apnea. However, some people show few if any symptoms.

  • Vivid dreams (often running, chasing, being chased, drowning, etc.)
  • Acid reflux (heartburn)
  • Restless sleep
  • Wake up gasping for air
  • Sleep is often worse on back
  • Daytime sleepiness
  • Lack of energy
  • Weight gain
  • Depression
  • Heart Problems
  • Memory/Concentration Problems
  • Alzheimer's Disease
  • Need to urinate during the night

Health Issues Associated with Sleep Apnea

What health issues can be caused by sleep apnea? Let's put it another way. What parts of the body need oxygen?
SA (Sleep Apnea) can cause many different problems. Some problems are more common than others, but everyone is different. A person may have a health issue or issues that they think are a completely separate from the SA, but it may very well have been caused by or exasperated by the sleep apnea. Following are some of the more common health issues associated with SA. But, some people with SA show few, if any, symptoms.

  • Acid reflux (Heartburn, GERD, Gastroesophageal Reflux Disease) - This is a very common symptom. If you have OSA (Obstructive Sleep Apnea), the most common type of SA, the airway closes off and no air goes through. But, the lungs are still trying to suck in air, so stomach acid ends up getting sucked up into the esophagus. This can, over time, erode the lining of the esophagus (not good). Chronic Heartburn, over time, can cause cancer of the esophagus. You really don't want that.

  • Weight Gain - Many people think only overweight people get sleep apnea. But that is certainly not true. Sleep apnea can actually help cause weight gain. The daytime sleepiness & lack of energy means you get less exercise. Less exercise contributes to weight gain. Weight gain can make the sleep apnea worse. It can be a vicious cycle. But remember, not everyone with Sleep Apnea is overweight, many are not.

  • Cardiovascular Disease - When I started going to a cardiologist because of a heart problem, one of the first questions he asked me was about my sleep. He then referred me to a sleep doctor to get a sleep study done. That's how I was diagnosed with sleep apnea. My cardiologist knows that sleep apnea is one cause of heart problems & he screens his patients for symptoms.
    SA seems to target weak parts of the body. My heart has a slight oddity which caused me no problems whatsoever (I didn't even know about it) until my sleep apnea made it much worse. People may develop tachycardia, arrhythmia, stroke, or other heart conditions.

  • Depression - Depression can be mild or more severe.

  • Decrease in mental acuity - Lack of concentration, decrease in mental agility, forgetfulness. A lack of oxygen to the brain can cause a host of various problems with the brain. This can affect a persons work & livelihood, from poor performance progressing up to an inability to earn a paycheck.

  • Alzheimer's Disease - An estimated 70 to 80% of patients with Alzheimer's Disease have Sleep Apnea. Anyone with AD should definitely be tested for Sleep Apnea. It makes you wonder which came first, Alzheimer's Disease or the Sleep Apnea.

  • High Blood Pressure - A lack of oxygen in the blood causes the heart to work harder and the vessels leading to arms & legs constrict to try to force more blood to the brain. This can help contribute to high blood pressure.

  • Diabetes, Type 2 - Diabetes is another disease that is associated with sleep apnea.

  • Gout - There is also a very high correlation of people with gout having sleep apnea. An oxygen starved bloodstream causes the breakdown of cells which forms Uric acid, the enemy of Gout. Coupled in this low oxygen environment is carbon dioxide which causes the blood to increase in its acidity and also increases monosodium urate.

Types of Sleep Apnea

There are two basic types of Sleep Apnea, Obstructive Sleep Apnea or OSA, and Central Sleep Apnea or CSA. OSA is far more common than CSA.

Obstructive Sleep Apnea occurs when the airway closes off or collapses. The lungs are still trying to breath in, but can't get any air through the collapsed airway. Often this will cause acid reflux as the stomach acid gets sucked up into the esophagus. With no oxygen getting into the bloodstream, the brain will eventually wake up in order to breath. A person will often wake up so briefly that he or she doesn't remember. It might seem to be simply restless sleep.

Central Sleep Apnea occurs when the lungs don't get the signal to breath. Either the brain stops telling the lungs to breath, or the signal is lost before getting to the lungs. Breathing can stop completely or just slow down or the breaths get more shallow. If the breathing stops entirely that's an apnea. If it just slows down or gets too shallow that's called a hypopnea. A hypopnea is usually defined as an abnormal reduction in airflow of 50% or more.

Some people will often have a mixture of OSA and CSA with OSA usually being the more predominant.

Here's a video showing Obstructive Sleep Apnea.

Measurement of Sleep Apnea

The most common measurement of Sleep Apnea is the AHI (Apnea Hypopnea Index). This is the average number of apneas and hypopneas per hour. Apneas being the number of times breathing has stopped for 10 seconds or more, and hypopneas being the number of times the airflow has been reduced by 50% or more for 10 seconds or more.

Often apneas will be indexed separately from the hypopneas. AI would be the Apnea Index (number of apneas per hour). The HI would be Hypopnea Index (number of hypopneas per hour). AHI = AI + HI.

An AHI of under 5 is generally considered normal. This would seem to indicate that an AHI of 5 or more could be treated. But, insurance companies have various policies on how high it needs to be before they will pay for treatment. With some companies, AHI values between 5 & 15 are only treated if accompanied by other defined symptoms.

In a sleep lab, they can tell if an apnea is an obstructive apnea or central apnea. The sleep lab uses a large number of sensors in addition to just air sensors over your nose and mouth. They measure your blood oxygen saturation (oximeter), they chart your heartbeats (EKG), they chart your brainwaves (EEG), chest expansion, they even have sensors on your legs to measure how many times you kick during the night.

The most important measurements used for Sleep Apnea are the AHI, and the blood oxygen saturation.

Overnight sleep study & titration

So, what's a sleep study like? You stay in a room that looks kind of like a sterile hotel room. They hook up sensors in your hair, on your chest, legs, finger, nose, mouth. There are dozens of wires snaking from you off the bed. If that isn't enough they have an inferred camera & they film you all night. You're not allowed to sleep on your stomach. If you move around too much you'll mess up the sensors & someone will come in & wake you up to fix them. So, after they get you all hooked up & tell you all this they turn off the lights & tell you good night.... Yeah, right.

If the sleep study shows you have sleep apnea, you get to come back again for the cpap titration. That means you come back & do it all over again but this time with air blowing up your nose while they figure out how much pressure you need.... Good Night...

In spite of all that, when it was over, it really wasn't as bad as I thought it would be. I *would* recommend you ask your doctor for a sleeping pill so if you can't sleep you have a backup.

I waited for years because I dreaded going in for a sleep study. Read some of the forums online ( is a great one) it's amazing how many people have similar stories. They don't want to see a doctor. Family members tell them to get help, but for one reason or another they don't. "It's not a big deal." "It's a minor issue." "Sleep Apnea is just people that snore, right?" Almost all the people with those stories say the same thing, "I wish I could have those years back." Everyone regrets not doing something about it sooner.

A lot of doctors don't know much about sleep apnea, some will dismiss you because you don't have the right physique (i.e. you're not fat enough), or you're a woman. Don't give up, insist on a referral to a sleep specialist. Not everyone with sleep apnea is a middle aged, overweight guy.

I guess I got a little off-topic. Whatever it takes, get help.

Here's a video showing what having a sleep study is like.


Topics of Discussion:

Health issues
Types of Sleep Apnea
Measurement of Sleep Apnea
Overnight study & titration
Before you see the doctor
CPAP selection
Mask selection
Getting your machine
DMEs, insurance, online stores, auctions, etc.
Adjusting to using CPAP
Setup, hints, and tips
Traveling with CPAP
Problems & Solutions
Definitions & Acronyms