The symptoms of sleep apnea vary greatly in their intensity. There are some individuals who have severe sleep apnea and very few symptoms, or may not be aware of any symptoms at all, whereas other individuals may have very mild or even no sleep apnea and yet have loud and frequent snoring. Snoring that occurs with gasps or choking episodes is almost always associated with some degree of sleep apnea. Regular rhythmical snoring without any significant change in intensity is less likely to be associated with obstructive sleep apnea syndrome. When snoring occurs that is loud and interspersed with quiet episodes, this is almost certainly associated with the presence of obstructive sleep apnea. The quiet episodes are typically episodes of cessation of breathing that occur when the patient is unable to move air in or out of the lungs.
Apnea, which means cessation of breathing, typically occurs when the upper airway collapses and the person struggles to bring air into the lungs but is unable to do so until the upper airway opens. The presence of these apneic episodes during sleep is an important sign that always warrants further investigation. When even a few apneic episodes are evident, it usually reflects a more severe underlying condition. Often the apneic episodes will be noticed at the beginning of the night when they are less likely to occur, whereas in the middle of the latter half of the night the apneic episodes may become more severe and more frequent.
In addition to snoring and apneic episodes during sleep, the other major symptom is excessive daytime sleepiness. Often it will come on very gradually so that the individuals themselves may be somewhat unaware of the severity of their sleepiness. Other family members usually notice it. Not uncommonly, the affected individual will tend to doze or fall asleep when relaxing, watching television or when reading in the evening. Often the individual is not aware of having fallen asleep for a few minutes, but it may be evident to other family members. Of particular concern is excessive sleepiness when driving or in the workplace. Individuals with obstructive sleep apnea syndrome are five times more likely to have a motor vehicle accident than those without sleep apnea. Sleepiness may also cause inattention at work that may lead to work-related accidents. Tiredness and sleepiness leads to impaired school or work performance and can contribute to social embarrassment, memory and concentration difficulties, depression, impaired quality of life, and marital problems.
Another symptom of obstructive sleep apnea syndrome is the need to urinate frequently during the night. The individual may awaken to go to the bathroom several times through the night, is often aware of having a dry mouth, and may get some water to drink at those times. Typically, the person with significant obstructive sleep apnea syndrome will be very tired upon awakening in the morning.
Symptoms in Children
Sleep apnea is common in children, particularly those with enlarged tonsils. Noisy breathing during sleep is often a feature, but children may or may not demonstrate excessive sleepiness. Some younger children will tend to be hyperactive rather than sleepy. Children with severe sleep apnea often assume irregular body positions in sleep and may tend to sleep on their knees in bed.
Upper Airway Obstruction
People with obstructive sleep apnea syndrome commonly will have some impairment of their nasal breathing ability. Some degree of deviation of the nasal septum is a common finding in patients with sleep apnea. Usually it is only mild or moderate and does not require any specific treatment. However, in some cases it may be severe and surgery on the deviation of the nasal septum may be required. In children, the presence of enlarged adenoids at the back of the nose and enlarged tonsils in the throat can contribute to the upper airway obstruction, thereby leading to sleep apnea. Removal of the adenoids or tonsils may be necessary. Patients with sleep apnea who have frequent nasal allergies or sinus problems should have these treated since reduction of the inflamed tissue in the nose will help prevent upper airway obstruction.