Sleep apnea

Obstructive sleep apnea is a condition in which the muscles at the back of the throat relax too much during sleep, so the airway repeatedly narrows or closes, briefly stopping breathing. Each pause dips the blood oxygen and jolts the brain enough to restart breathing — often with a gasp or snort — fragmenting sleep dozens or hundreds of times a night, usually without the person fully waking. The result is loud snoring, witnessed pauses in breathing, and unrefreshing sleep with pronounced daytime sleepiness, poor concentration and irritability. It is strongly linked to being overweight, a large neck, alcohol, and anatomy, and is more common in men and with age. Beyond the impact on daily life and driving safety, untreated sleep apnea raises the long-term risk of high blood pressure, heart rhythm problems, heart disease, stroke and type 2 diabetes. It is diagnosed with a sleep study, and is very treatable — often transforming energy and health.

• Diagnosis is by a sleep study — measuring breathing, oxygen and sleep overnight (at home or in a lab); there is no blood test that diagnoses it.
• Haemoglobin and haematocrit — can be raised (secondary polycythaemia) from repeated low oxygen.
• HbA1c / fasting glucose — checked because sleep apnea associates strongly with insulin resistance and type 2 diabetes.
• TSH — hypothyroidism can contribute and is worth excluding.
• Blood pressure — often raised, and part of the associated cardiovascular risk. Screening questionnaires (e.g. STOP-Bang, Epworth sleepiness scale) help decide who needs a sleep study.

• Loud, chronic snoring
• Pauses in breathing during sleep, often noticed by a partner
• Waking with a gasp or choking sensation
• Unrefreshing sleep and waking tired despite a full night
• Excessive daytime sleepiness, falling asleep easily during the day
• Poor concentration, memory problems, irritability, low mood
• Morning headaches, dry mouth
• Needing to pass urine at night; reduced libido