Sleep Apnea: Symptoms, Sleep Studies, and CPAP

Your partner says you snore loudly and sometimes stop breathing. You wake up tired even after a full night in bed, and you nod off in meetings or while watching TV. These are classic signs of sleep apnea. It is common, often missed, and treatable. This guide explains the symptoms, how sleep studies work, and how treatments compare.

What sleep apnea is

Obstructive sleep apnea (OSA) is a condition where the upper airway narrows or closes again and again during sleep [3]. Each pause in breathing lowers oxygen levels and briefly wakes the brain, often without you knowing. This can happen dozens of times an hour.

A less common type, central sleep apnea, happens when the brain does not send the signal to breathe. This guide focuses on obstructive sleep apnea.

Common symptoms

• Loud, frequent snoring
• Pauses in breathing seen by someone else
• Waking up gasping or choking
• Daytime sleepiness or fatigue
• Morning headaches
• Trouble concentrating or remembering
• Waking often to urinate at night
• Mood changes, such as irritability

Risk factors

• Excess weight, especially around the neck
• Older age
• Male sex, though risk rises in women after menopause
• A narrow airway, large tonsils, or a small jaw
• Family history
• Alcohol and sedatives at night
• Smoking

Untreated sleep apnea is linked to high blood pressure, heart rhythm problems, stroke, and car crashes from drowsy driving [3].

What your doctor looks at

Screening and questions

The USPSTF (US Preventive Services Task Force) found too little evidence to recommend for or against screening adults who have no symptoms [2]. This does not apply to people with symptoms. If you have signs of OSA, your clinician should evaluate you.

Clinicians often use short questionnaires, such as STOP-Bang, which asks about snoring, tiredness, observed pauses, blood pressure, body mass index, age, neck size, and sex. The American Academy of Sleep Medicine (AASM) says questionnaires alone should not be used to diagnose OSA without a sleep study [1].

Sleep studies

The AASM recommends one of two tests to diagnose OSA in adults [1]:

• Polysomnography (an overnight study in a sleep lab), which records breathing, oxygen, brain waves, heart rhythm, and leg movements
• A home sleep apnea test, which records breathing, oxygen, and heart rate while you sleep in your own bed

A home test is a good option for adults with signs of moderate to severe OSA who do not have significant heart, lung, or nerve conditions [1]. If the home test is negative or unclear but symptoms are strong, a lab study is recommended [1].

The AHI score

The main result is the AHI (apnea-hypopnea index), the average number of breathing pauses and shallow breaths per hour of sleep. Common severity levels are:

• Under 5: normal
• 5 to 14: mild
• 15 to 29: moderate
• 30 or more: severe

Your clinician also looks at how low your oxygen drops and how sleepy you feel during the day.

Canada and US notes

In Canada, access to sleep labs and home testing varies by province, and wait times can be long. Coverage for CPAP machines also differs between provinces and US insurance plans. Driving rules for people with untreated severe sleepiness differ between provinces and states.

Treatment options

CPAP

CPAP (continuous positive airway pressure) is a machine that blows air through a mask to keep your airway open during sleep. It is the main treatment for moderate to severe OSA [5]. CPAP:

• Reduces daytime sleepiness
• Improves quality of life
• Can lower blood pressure modestly

Using it most nights for at least 4 hours is a common goal. Many people need time and support to get used to it. Mask fit, humidifiers, and auto-adjusting machines can help.

Oral appliances

A mouthguard-like device made by a dentist pushes the lower jaw forward to keep the airway open. It is an option for mild to moderate OSA, or for people who cannot use CPAP.

Weight loss

Losing weight can lower the AHI and sometimes resolve mild OSA. In December 2024, the FDA approved tirzepatide (Zepbound) for moderate to severe OSA in adults with obesity, the first medication approved for OSA [4]. It is used with a reduced-calorie diet and more physical activity [4].

Other options

• Positional therapy, for people whose apnea happens mainly on their back
• Avoiding alcohol and sedatives before bed
• Hypoglossal nerve stimulation, an implanted device that moves the tongue forward during sleep, for some people who cannot use CPAP
• Surgery on the nose, throat, or jaw in selected cases

Questions to ask your clinician

• Do my symptoms suggest sleep apnea?
• Should I have a home sleep test or a lab study?
• What is my AHI, and what does it mean?
• Is CPAP the right treatment for me, or are there alternatives?
• How can I get help if CPAP is uncomfortable?
• Is it safe for me to drive?
• Would weight loss or medication help in my case?

When to get care quickly

Call 911 if you have chest pain, signs of a stroke such as face drooping or arm weakness, or severe shortness of breath. Do not drive if you feel very sleepy, and see your clinician soon if you have fallen asleep at the wheel or had a near miss.

Bottom line

Obstructive sleep apnea is common and often missed. Loud snoring, pauses in breathing, and daytime sleepiness are key signs. A home or lab sleep study confirms it, and CPAP is the main treatment for moderate to severe cases. Oral appliances, weight loss, and newer options help some people.

Primary AI can show you the guideline and study sources behind this topic in plain language, so you can bring better questions to your appointment.