Sleep apnea symptoms: night, day and the ones people miss

What’s going on

In obstructive sleep apnea, your airway closes off again and again while you sleep. Breathing stops or gets shallow until your brain wakes you just enough to breathe again.

You rarely remember those wake-ups. That’s why many symptoms show up during the day, or get noticed by someone else first. The National Heart, Lung, and Blood Institute (NHLBI) puts it simply: you may not know you have symptoms until someone tells you.

No single symptom proves you have sleep apnea, and some people have few symptoms. A physician makes the diagnosis, usually with a sleep test.

Signs at night

According to the American Academy of Sleep Medicine (AASM) and the NHLBI, common night signs are:

• Loud or frequent snoring
• Breathing that stops and starts
• Choking or gasping sounds
• Restless, unrefreshing sleep
• Waking often during the night
• Getting up often to urinate
• A dry mouth when you wake

Snoring is the most common symptom, the AASM says. But not everyone who snores has sleep apnea. Snoring is more likely to mean sleep apnea when it’s followed by silent pauses and then choking or gasping.

Signs during the day

• Feeling sleepy or tired even after a full night in bed
• Dozing off without meaning to
• Morning headaches
• Trouble concentrating, or memory slips
• Irritability or low mood
• Lower sex drive, or trouble keeping an erection

These come from the AASM and NHLBI symptom lists. Daytime sleepiness is common, but the American Dental Association (ADA) notes it isn’t present in everyone who has sleep apnea.

Signs a partner notices

Partners often spot sleep apnea first. Things they may see or hear:

• Snoring that stops, goes quiet, then restarts with a snort or gasp
• You seeming to struggle or choke in your sleep
• Tossing and turning
• Very loud snoring, night after night

If you’re the partner, try recording a few minutes of their breathing on your phone. A recording can help their physician. Don’t try to diagnose it from the recording yourself.

Signs that are often missed in women

The NHLBI says sleep apnea symptoms can differ in women. Women more often have:

• Insomnia, or waking up often
• Tiredness and daytime sleepiness
• Headaches, especially in the morning
• Anxiety or depression

Because some women don’t snore much, they may not think of sleep apnea at all. These symptoms also overlap with other conditions, so it’s easy to look elsewhere.

Risk changes with life stage. The NHLBI says risk rises during pregnancy and during and after menopause, partly because of hormone changes. Menopause can also cause insomnia, headaches and fatigue on its own, which can make sleep apnea harder to recognize.

If these symptoms sound familiar, ask your doctor directly about sleep apnea. Naming it helps.

Signs a dentist may notice

Some features of sleep apnea show up in the mouth. The ADA says dentists can screen for them during a checkup, then refer you to a physician.

None of these proves you have sleep apnea. They’re clues.

• A scalloped tongue. Wavy dents along the sides of the tongue can mean it’s large for the space. In one study, scalloping was more common in people with sleep apnea (70%) than without it (58%). That overlap is why it’s only a clue.
• A large tongue or tonsils, or a soft palate and uvula that are hard to see.
• A small or set-back lower jaw, or a narrow, high-arched palate.
• Worn teeth and grinding. Worn or flattened teeth can come from grinding at night, which sometimes appears alongside sleep apnea. A dental sleep medicine review notes that tooth wear isn’t a proven sign of grinding. It also found the link between grinding and sleep apnea isn’t settled. Acid reflux and diet can also wear teeth.

If your dentist mentions any of these, bring it up with your physician. More on the grinding link in teeth grinding and snoring.

What about my watch or ring?

Some wearables can flag possible sleep apnea. Apple’s sleep apnea notification feature, for example, is FDA-cleared for over-the-counter use to flag breathing patterns that suggest moderate to severe sleep apnea. It doesn’t diagnose it.

Treat an alert as a reason to see a physician. And treat no alert as no answer at all: a quiet watch doesn’t mean you don’t have sleep apnea. The AASM warns that apps and sleep trackers that claim to detect sleep apnea can be unreliable.

What a dentist or doctor can do

If you have these symptoms, start with a physician, in person or by video. They’ll ask about your sleep and health, and may order a home sleep test or an in-lab study. Read snoring or sleep apnea? for how testing works.

If you’re diagnosed, treatment often starts with CPAP Strong. If CPAP doesn’t suit you, a custom oral appliance Some is an option. A dentist trained in dental sleep medicine makes it. Weight loss Strong helps many people with overweight or obesity.

Don’t use an over-the-counter snoring mouthpiece to manage suspected sleep apnea. None is cleared for it.