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6 Warning Signs of Sleep Apnea

This serious health condition has some surprising effects on everything from your blood pressure to your sex life

woman in bed, sitting up and yawning
Peter Dazeley/Getty Images

Sleep apnea — a condition in which breathing during sleep continually stops and starts — is common as you age. Research shows that up to 20 percent of older adults experience it — and many don’t know they have it.

2018 study published in the Journal of the American Geriatrics Society found that while over half of all people 65 and older are at high risk for sleep apnea, only about 8 percent were tested for it.

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One reason may be that sleep apnea symptoms tend to be more subtle in older adults. “When we think of sleep apnea, we think of people snoring, but that’s not always the case,” says Adam Sorscher, M.D., sleep health director at Alice Peck Day Memorial Hospital in Lebanon, New Hampshire. “As we age, fat tissue replaces muscular tissue in the throat and neck. This causes our airways to become more collapsible.”

When this happens during sleep, it makes it harder to breathe, cutting off oxygen to your body — and causing a host of other symptoms beyond the all-too-audible one. Untreated sleep apnea has been linked to high blood pressure, type 2 diabetes, stroke and heart attack. Research even shows that older adults with sleep apnea are more than twice as likely to die prematurely than those who don’t have it.

Here are six warning signs to look out for:  

1. Uncontrolled high blood pressure

Up to half of all people with hypertension (or high blood pressure) also have sleep apnea, according to the American College of Cardiology. “Every time someone with sleep apnea has a pause in their breathing during sleep, their sympathetic nervous system becomes activated and their blood pressure spikes,” explains Meir Kryger, M.D., a professor emeritus of sleep medicine at the Yale School of Medicine in New Haven, Connecticut.

Your body also releases stress hormones, which can raise blood pressure. “A red flag is what we call resistant hypertension, which means that you can’t get your blood pressure under control despite being on at least two high blood pressure medications,” Kryger says.

The good news is that when these patients’ sleep apnea is diagnosed and treated with continuous positive airway pressure, or CPAP — a machine that uses mild air pressure to keep airways open during sleep — their blood pressure usually improves.

2. Morning headache

About 30 percent of people with sleep apnea report having a headache when they wake up in the morning. It’s unclear exactly what causes the headache, though it may simply be due to decreased oxygen in the blood that occurs each time you gasp for breath, as well as dilations of blood vessels in your brain to try to compensate, says Beth Malow, M.D., director of the Vanderbilt Sleep Division at the Vanderbilt University Medical Center in Nashville, Tennessee.

These types of headaches tend to occur frequently, on both sides of the head (rather than on one side as with a migraine), and generally resolve on their own within a few hours of waking.

3. Impotence

It’s a little-known fact, but one sign of sleep apnea can be trouble getting and maintaining an erection, notes Kryger. In fact, one study presented in 2020 at the Sexual Medicine Society of North America found that almost two-thirds of all men seeking treatment for erectile dysfunction also had obstructive sleep apnea.

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“Men with sleep apnea usually have lower testosterone levels, which they need for sexual activity,” explains Kryger. “Sleep apnea itself may also cause high blood pressure, which is also linked to impotence. And if you’re sleep deprived, you are less likely to be in the mood for sex in general.”

4. Restless nights

If you have sleep apnea, you may notice that you wake frequently throughout the night, which can lead you to think you have insomnia when you really don’t, says Kryger. “We see this a lot, especially in women — they go to their doctor and complain that they have trouble staying asleep, and they’re diagnosed with anxiety and given sleeping pills, which can actually make their apnea worse,” he adds.

This is especially true around perimenopause, a time when some women develop sleep apnea, he says.

Malow adds, “Physicians assume their sleep problems are due to hot flashes, and don’t look for the underlying cause.”

Another common sign is waking up frequently to urinate. “Some men make an appointment with a urologist, because they think they have a bladder problem because they get up to use the bathroom five times a night,” says Sorscher. “Their bladders are actually fine. Once their apnea is diagnosed and treated, and they are sleeping more deeply, they don’t notice these sensations and don’t have any more nocturnal bathroom visits.”

5. Dry mouth

About 30 percent of people with obstructive sleep apnea report having a dry mouth when they wake up in the morning. This may simply be because their apnea forces them to breathe through the mouth, which dries it out, says Malow. But it’s also seen more commonly among people with sleep apnea than it is with those who are just habitual snorers.

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6. Exhaustion

Let’s face it, many of us are sleep deprived and feel tired. In fact, an estimated 30 percent of American adults report trouble sleeping, a new study in JAMA Network Open finds.

But with sleep apnea, you’re still wiped, even if you get a full night of sleep, says Malow. Experts say that in such cases, sleep apnea can be hurting the quality of your sleep, even if you don’t realize it. You also may find yourself nodding off while doing activities you enjoy, like reading or watching TV. “If you find yourself falling asleep in situations where you should be alert, during Zoom meetings, or even while driving, that’s often a red flag sign,” says Kryger. You also may find yourself more irritable and snapping at others.

Know your treatment options

If you notice any of these signs, Kryger recommends asking your doctor for a referral to a sleep specialist. (You can also take a screening test online, which will give you what’s called the STOP-BANG score for obstructive sleep apnea.) The gold standard treatment for sleep apnea is the CPAP machine, and now, with multiple forms of therapy and masks, most patients can find a comfortable option.

2022 study published in the European Respiratory Journal found that while sleep apnea itself accelerates your body’s biological aging, using a CPAP machine for just four hours a night was able to partially reverse it. “The good news is, when people are treated for their sleep apnea, most of their symptoms disappear,” Kryger says.

While a significant share of sleep apnea patients stop using their CPAP machine over time for a variety of reasons, a big one being discomfort, Kryger encourages people with sleep apnea to stay the course. “There are so many different models of CPAP masks out there, that it’s unusual to find a patient who can’t tolerate one at all,” he says. “They are also more convenient — they’re much quieter and smaller than they used to be.”

If you truly can’t tolerate a CPAP, there’s another option: The Inspire upper airway stimulation system, which is inserted surgically while you’re under general anesthesia. “It’s like a pacemaker: It delivers mild stimulation to the hypoglossal nerve, which controls the movement of tongue muscles,” Kryger explains. This allows your airway to remain open during sleep. 

You may also wonder if wearable sleep trackers, like the Oura Ring, can help you diagnose and manage your sleep apnea. While these devices claim to measure your heart and breathing rates, as well as your blood oxygen levels, they aren’t approved by the Food and Drug Administration for these purposes, Kryger notes. “At best, they suggest that you may need further testing, like a sleep study,” he says.

Editor’s Note: This story, originally published Sept. 14, 2021, has been updated to reflect new information.