Snoring or sleep apnea? How to tell the difference

What’s going on

Snoring is a sound. Relaxed tissue at the back of your throat vibrates as air moves past it. The airway narrows, but air keeps flowing.

Obstructive sleep apnea is a breathing problem. Your airway becomes blocked again and again during sleep, so breathing stops or gets very shallow. The American Academy of Sleep Medicine (AASM) says this can happen a few times a night or, in severe cases, several hundred times.

Each time, your brain wakes you just enough to breathe again. You usually don’t remember it. But your sleep is broken up, and your oxygen level dips.

How they overlap

Snoring is the most common symptom of sleep apnea, the AASM says. But not everyone who snores has sleep apnea. And the American Dental Association notes that snoring isn’t always present in people who have it.

So loudness alone doesn’t tell you much. What matters is what comes with it.

The warning signs

Snoring is more likely to be sleep apnea when you have any of these:

• Pauses in breathing. Someone sees you stop breathing, then restart with a snort or gasp.
• Choking or gasping that wakes you or your partner.
• Tiredness after a full night. You feel unrefreshed, sleepy during the day, or you nod off without meaning to.
• Morning headaches.
• Waking often to urinate at night.
• Trouble concentrating, memory slips or irritability.

These come from the AASM’s list of common symptoms. See sleep apnea symptoms for the full picture, including signs in women that are easy to miss.

If you’ve fallen asleep while driving, or nearly have, don’t wait. Talk to a physician soon, and don’t drive drowsy.

Who’s at risk

The AASM lists these common risk factors:

• Excess weight. It’s the biggest one, though slim people get sleep apnea too.
• A large neck. 17 inches or more for men, 16 inches or more for women.
• Being male, and for women, reaching menopause.
• Middle age. It can happen at any age, but it’s more common from young adulthood to middle age.
• High blood pressure.
• Alcohol or sedating medicines, which make it harder to wake up and breathe.
• Airway features such as a deviated septum, nasal polyps, large tonsils, a large tongue, or a small or set-back jaw.
• A family member with sleep apnea.

Heart conditions matter too. An American Heart Association statement says sleep apnea affects as many as 40% to 80% of people with high blood pressure, heart failure, atrial fibrillation or stroke.

How testing works

Only a physician can diagnose sleep apnea. The usual path looks like this:

1. See a physician, in person or by video. They ask about your sleep, symptoms and health history. It helps to bring a partner’s report, or a phone recording of your breathing at night.
2. The physician orders a sleep test if your symptoms point to sleep apnea.
3. You do the test, either at home or in a sleep lab.
4. A sleep physician reads the results and goes over them with you, along with treatment options if you need them.

Home test or lab?

A home sleep apnea test is a small monitor you wear for a night in your own bed. It measures your breathing and oxygen level. The AASM says it suits people who very likely have moderate to severe sleep apnea and have no other significant medical conditions.

An in-lab sleep study means a night at a sleep center with sensors that also record brain waves. It gives the most complete picture.

Your physician may choose it if you have lung disease, heart failure or a neuromuscular condition. It’s also the better choice if setting up a device alone would be hard.

A home test has limits. Cleveland Clinic notes it can’t diagnose central sleep apnea, a less common type where the brain doesn’t signal the breathing muscles.

And a negative home test doesn’t rule sleep apnea out if your symptoms still fit, the AASM says. You may need a lab study.

More detail is in our guide to the home sleep apnea test.

Why an over-the-counter mouthpiece isn’t the answer here

Over-the-counter snoring mouthpieces are FDA-cleared to reduce snoring in adults. No over-the-counter mouthpiece is cleared for sleep apnea. Their labels exclude people with central sleep apnea or severe breathing disorders.

There’s a practical reason too. A mouthpiece could quiet the snoring without dealing with the breathing pauses. You’d lose your most obvious warning sign, and the problem underneath would still be there.

What a dentist or doctor can do

If testing shows sleep apnea, the physician will talk through treatment. CPAP Strong, a mask that gently blows air to keep your airway open, is the standard first choice.

For people who can’t use CPAP or prefer something else, a custom oral appliance Some is an option. The AASM guideline suggests it be made by a qualified dentist and followed up with a repeat sleep test. That’s a different thing from a store-bought mouthpiece.

Weight loss Strong helps many people with overweight or obesity. Sleeping on your side Some helps some people whose apnea is worse on their back. See CPAP alternatives for the other options.

If testing shows plain snoring, good news: you can work through the fixes in how to stop snoring.