Snoring or sleep apnea?

What happens in sleep apnea

In simple snoring, the airway narrows and vibrates, but air keeps flowing. In obstructive sleep apnea, it narrows so much that it collapses: breathing slows (a hypopnea) or stops (an apnea) for ten seconds or more, oxygen levels dip, and the brain briefly wakes you to reopen the airway. You usually don't remember these awakenings, but they can happen dozens of times an hour.

Apnea

A pause in breathing of 10 seconds or more during sleep.

Hypopnea

A partial reduction in breathing of 10 seconds or more, with a drop in oxygen or an awakening.

AHI

The apnea-hypopnea index: how many apneas and hypopneas happen per hour of sleep. 5 to 14 is mild, 15 to 29 moderate, and 30 or more severe.

Sleep study

A test that records breathing, oxygen and sleep overnight. Polysomnography is done in a sleep lab; a home sleep apnea test uses a smaller device in your own bed.

The signs to look out for

	Simple snoring	Possible sleep apnea
Breathing	Steady snoring	Snoring that stops, then a gasp, snort or choke
Daytime	You feel fine	Very sleepy, nodding off without meaning to, poor concentration
Mornings	Maybe a dry mouth	Often headaches or feeling unrefreshed
Health	No related problems	Often high blood pressure; often extra weight around the neck

In the Sleep Heart Health Study of 5,615 adults, people who reported habitual snoring, loud snoring and frequent breathing pauses were 3 to 4 times more likely to have moderate or worse sleep apnea. Being male, older, heavier and having a thicker neck also counted, though less ³. Loudness matters too: in more than 1,100 people tested in a sleep lab, louder snoring went with more breathing disturbances ⁵.

How common is sleep apnea?

More common than most people think. In a Wisconsin study of middle-aged workers, 24% of men and 9% of women had at least mild sleep-disordered breathing, and 4% of men and 2% of women had the full syndrome with daytime sleepiness ⁶. Later estimates for the United States put moderate to severe sleep-disordered breathing at 10% of men aged 30 to 49, 17% of men aged 50 to 70, 3% of women aged 30 to 49 and 9% of women aged 50 to 70 ⁷. Worldwide, an analysis estimated that almost a billion adults aged 30 to 69 have at least mild obstructive sleep apnea ⁸.

Most of them don't know. In one study of almost 5,000 adults, researchers estimated that 93% of women and 82% of men with moderate to severe sleep apnea had never been diagnosed ⁴.

How it is diagnosed

The American Academy of Sleep Medicine recommends that sleep apnea be diagnosed with polysomnography or a home sleep apnea test, and not with questionnaires or prediction tools alone ¹. A doctor will usually ask about your snoring, your sleepiness and your health, and then arrange a sleep study. A partner's description, or a few recordings of your snoring, can help explain what happens at night.

If sleep apnea is found, there are good treatments: a CPAP machine for many people, an oral appliance for mild to moderate cases, and sometimes surgery. See medical treatments.

Sources

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