Sleep apnoea: signs, risks and what to do

Important note: this article is for information only. Sleep apnoea is a medical condition that requires diagnosis and treatment by a healthcare professional. If you recognise the signs described here, consult your GP.

Obstructive sleep apnoea is perhaps the most underdiagnosed medical condition in Portugal. It is estimated that 1 in 4 adults has it to some degree — and most have no idea. What causes the harm is not just the discomfort of poor sleep. It is the cumulative impact on cardiovascular, metabolic and cognitive health.

What sleep apnoea is

During the night, the upper airway partially or completely closes, interrupting breathing. These pauses — lasting between 10 seconds and over a minute — can happen dozens or hundreds of times a night.

The brain detects the lack of oxygen and forces a micro-arousal to restart breathing. The person is usually unaware of these arousals — but deep, restorative sleep never actually happens.

The signs most people ignore

The most common signs:

  • Loud, chronic snoring — not all snoring is apnoea, but most apnoea is accompanied by snoring
  • Breathing pauses noticed by a partner — this is the most specific sign
  • Waking up gasping or choking for air
  • Daily tiredness even after 8 hours of sleep — the quality of sleep is poor, not the quantity
  • Morning headaches — a consequence of nighttime hypoxia
  • Difficulty concentrating and recent memory loss
  • Irritability and mood changes that are hard to explain
  • Frequent night-time urination (apnoea alters hormones involved in kidney function)
  • Dry mouth on waking — sleeping with the mouth open to compensate

Who is at greater risk

Factors that significantly increase the risk:

  • Excess weight (especially increased abdominal and neck circumference)
  • Men (3× more common than in women before menopause)
  • Post-menopause in women (loss of hormonal protection)
  • Age over 50
  • Family history
  • Anatomy (short, wide neck, prominent Adam's apple, large tonsils)
  • Regular alcohol or sedative use

The real risks

This is not a trivial condition. Untreated apnoea is associated with a significantly increased risk of:

  • High blood pressure (50% of people with apnoea have hypertension)
  • Stroke
  • Heart attack
  • Cardiac arrhythmias (nocturnal atrial fibrillation)
  • Type 2 diabetes (increased insulin resistance)
  • Depression and anxiety
  • Road accidents from daytime drowsiness (people with apnoea have a 7× higher risk)

How it is diagnosed

The only reliable method is polysomnography — a sleep study carried out in a clinic or (more recently) at home with simplified equipment. The test measures:

  • Breathing rate and oxygen saturation
  • Chest and abdominal movements
  • Brain activity
  • Heart rate

In Portugal, polysomnography is available through the public health service (with a referral from your GP) or at private clinics. The Portuguese Society of Pulmonology keeps a list of accredited centres.

What a mattress and pillow can (and cannot) do

Let's be clear: no mattress or pillow cures sleep apnoea. Anyone who tells you otherwise is not being honest with you.

What these products can do is marginally improve symptoms in mild apnoea:

  • A pillow that helps you stay on your side (rather than on your back) reduces airway collapse in mild cases
  • Raising the head of the bed by 10-15 cm reduces reflux and pressure on the airway
  • An ergonomic mattress helps someone diagnosed with apnoea stay on their side more easily

These measures are COMPLEMENTARY to medical treatment, not a substitute for it.

Effective medical treatments

After diagnosis, treatment options include:

  • CPAP (continuous positive airway pressure machine) — the gold standard for moderate to severe apnoea
  • Oral appliances — an alternative for mild to moderate apnoea
  • Surgery in specific cases (removal of large tonsils, septoplasty)
  • Weight loss — can resolve mild to moderate obesity-related apnoea
  • Lifestyle changes — avoiding alcohol, sleep position

When to act

If you recognise 2 or more of the signs above, especially if your partner notices breathing pauses, make an appointment with your GP. Referral to pulmonology or sleep medicine is straightforward and the test is not painful. The cost of not treating it is far higher than the cost of investigating it.

See also

Disclaimer: sleep apnoea is a medical condition. This article does not replace a medical consultation. For diagnosis and treatment, contact your doctor.

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