If you snore, chances are you’re well aware of it. That’s either because your partner has probably given you a shove in the middle of the night, asking you to roll over or fix your pillows, or perhaps you’ve woken yourself up from the noise.
There are a few different types of sleep apnea: obstructive, central and mixed, said Joseph Dzierzewski, vice president of research and scientific affairs at the National Sleep Foundation. “Obstructive sleep apnea (OSA) means there’s something getting in the way of the normal breathing that happens while you’re sleeping, similar to a pinch in an air tube. Central sleep apnea (CSA) means the signal to keep breathing from your brain is paused without an obstruction. Mixed sleep apnea is a combination of both of these conditions.”
Snoring is a big symptom of sleep apnea, but it’s not the only one. Read on for the early warning signs of sleep apnea, especially if you don’t snore or sleep alone.
You wake up frequently to use the bathroom.
“This doesn’t mean waking up once to go to the bathroom, which many adults do as they get into midlife,” said Dr. Kin Yuen, a sleep medicine specialist at the University of California San Francisco and member of the American Academy of Sleep Medicine. “This means regularly waking up to use the bathroom two to five times a night.”
Here’s why it’s concerning: Yuen explained that the kidneys don’t produce much urine in the first half of the night. What is happening is that labored breathing episodes like gasping are making the chest cavity work overtime. “One mechanism is for the brain to decrease the volume of the pressure swing,” Yuen said. Urination is one of these mechanisms, as is sweating ― more on that below.
You have night sweats.
Night sweats impact 30% of adults with OSA, according to research. “The hypothesis is that to rescue the body from these repeated assaults from not breathing and low oxygen, the brain has to have some way of getting the body out of a jam,” Yuen said. “In addition to increased urination, one way is by waking us up abruptly through sweating.”
It can be difficult to pinpoint why you are sweating, particularly if you’re a woman in perimenopause or menopause. Pay attention to the frequency of your night sweats in combination with other signs outlined here.
Waking up with a headache.
Frequent morning headaches are often associated with OSA; according to research in JAMA Internal Medicine, they can last up to 30 minutes.
“OSA episodes cause drops in oxygen at night, so the body moves all the oxygen to the core of the brain,” Yuen said. “The blood vessels around the outside of the brain or the blood vessels elsewhere constrict until the person wakes up. Repeated constricting and dilating of the blood vessels can cause a headache when waking up in the morning.”
You have trouble staying or falling asleep.
“There is a strong relationship between sleep apnea and insomnia,” Dzierzewski explained.
Even if you do fall asleep easily, you may be experiencing microarousals that cause brain fog, fatigue, irritability, and difficulty concentrating, according to Yuen.
“You still might be getting the same general amount of sleep that someone without sleep apnea is getting, but you’re not progressing normally through all the stages of sleep,” Dzierzewski said. “You’re not having good, high-quality restorative sleep.”
You wake up with a dry mouth.
People with OSA often sleep with their mouths open to help increase oxygen flow. Yuen said if you wake up with a cotton mouth feeling or a sore throat, it may be from snoring or mouth breathing from sleep apnea. This can be a helpful symptom to note if you sleep alone and don’t have someone telling you that you gasp, stop breathing or snore in your sleep.
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What to do if you experience these early warning signs:
Many of these signs can happen for a number of reasons, but Dzierzewski said that it’s important to note the frequency and if these things are happening even while you maintain healthy sleep habits, like maintaining a consistent sleep schedule, avoiding alcohol and nicotine before, and establishing a nightly wind-down routine. If these signs consistently occur with a healthy lifestyle and sleep habits, it’s a good idea to see a sleep specialist.
“If it’s been about a month and there’s no acute life stressors, mood disorders, or existing health concerns, these signs could indicate a sleep disorder,” Yuen said. “Also, pay attention to how you feel the next day in different sleeping positions. If you sleep on your back and feel foggy and fatigued compared to a night when you sleep on your side, this could be a tip-off to having a breathing problem.”
It’s important to be aware of your personal risk factors, too. Men and women who are overweight are at a higher risk, especially if that weight sits in the neck or chest area. Dzierzewski said that men tend to display higher rates of sleep apnea, while Yuen noted that certain hormonal disorders like polycystic ovary syndrome (PCOS) can increase the risk for women because of weight gain. Other risk factors include teeth or jaw-structured challenges (Yuen said your dentist may flag this for you) and people who suffer from acid reflux.
Finally, “if you’re pregnant and experiencing any of these symptoms (including snoring in the first trimester) mention it to your health care provider immediately,” Yuen said. It’s important to treat sleep apnea in pregnancy early on to prevent other health conditions later for the mother and baby.”