Sleep apnea: signs, risks and what to do

Important note: this article is for informational purposes only. Sleep apnea is a medical condition that requires diagnosis and treatment by a healthcare professional. If you recognise the signs described here, consult your family doctor.

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

What is sleep apnea

During the night, the upper airways partially or completely close, interrupting breathing. These pauses — lasting between 10 seconds and more than a minute — can happen dozens or hundreds of times per night.

The brain detects the lack of oxygen and forces a micro-awakening to restart breathing. Generally, the person is unaware of these awakenings — but deep sleep never occurs in a restorative way.

The signs that most people ignore

The most common signs:

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

Who is at greater risk

Factors that significantly increase the risk:

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

The real risks

This is not a trivial condition. Untreated apnea is associated with a significant increase in risk for:

  • High blood pressure (50% of apneic patients have hypertension)
  • Stroke (CVA)
  • Myocardial infarction
  • Cardiac arrhythmias (nocturnal atrial fibrillation)
  • Type 2 diabetes (increased insulin resistance)
  • Depression and anxiety
  • Road accidents due to daytime sleepiness (apneic patients have 7× higher risk)

How it is diagnosed

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

  • Respiratory rate and oxygen saturation
  • Thoraco-abdominal movements
  • Brain activity
  • Heart rhythm

In Portugal, polysomnographies are available through the SNS (with a referral from a family doctor) or in private clinics. The Portuguese Society of Pulmonology has a list of accredited centres.

What mattresses and pillows can (and cannot) do

Let's be clear: no mattress or pillow cures sleep apnea. If someone sells you that idea, they are lying.

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

  • Pillows that encourage side sleeping (not on the back) reduce airway collapse in mild cases
  • Elevating the head of the mattress by 10-15cm reduces reflux and pressure on the airways
  • Ergonomic mattresses help those diagnosed with apnea to 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) — gold standard for moderate to severe apnea
  • Oral appliances — an alternative for mild to moderate apnea
  • Surgery in specific cases (excision of large tonsils, septoplasty)
  • Weight loss — can resolve mild to moderate apnea related to obesity
  • Lifestyle modifications — avoiding alcohol, sleep position

When to act

If you recognise 2 or more signs from the list above, especially if your partner notices breathing pauses — make an appointment with your family doctor. Referral to pulmonology or sleep medicine is simple, and the examination is not painful. The cost of not treating is much greater than the cost of investigating.

See also

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

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