Sleep apnoea is a condition in which the upper airway narrows or closes during sleep as the muscles relax, causing under-breathing or a complete pause in breathing. Untreated, it causes exhaustion, poor concentration, irritability and low mood, so it is often mistaken for depression, insomnia or ADHD.
Key points
- Sleep apnoea is a physical condition, not a mental health one: the upper airway narrows or closes in sleep, so breathing stops and starts.
- Untreated, it causes exhaustion, poor concentration, irritability and low mood, so it is often mistaken for depression, insomnia or ADHD.
- The person notices the daytime effects; a bed partner notices the snoring, gasping and pauses in breathing.
- Obstructive sleep apnoea is the most common form and affects about 1 in 20 people.
- Testing starts with a GP and the sleep study is usually done at home. NICE recommends CPAP as the main treatment, with a mandibular advancement splint as the alternative.
Symptoms
- Waking unrefreshed, a headache on waking, excessive sleepiness or fatigue during the day, difficulty concentrating.
- A bed partner notices loud snoring, breathing that stops and starts, gasping or choking noises, restless sleep.
- Low mood, mood changes or irritability.
Causes and risk factors
- Higher prevalence in people with obesity or overweight, treatment-resistant high blood pressure, or type 2 diabetes.
- Older age, being male, a large neck, large tonsils, smoking, alcohol, back-sleeping and family history.
- Being slim, or not feeling sleepy, does not rule it out.
Treatment
- Lifestyle advice for everyone: losing weight, stopping smoking, reducing alcohol, better sleep habits.
- CPAP (continuous positive airway pressure), a machine that pumps air through a mask to hold the airway open, is the main treatment for moderate and severe cases.
- A mandibular advancement splint is considered for adults who cannot tolerate CPAP or decline it.
When to speak to a professional
- Someone has told you that your breathing stops and starts at night, or you snore loudly and wake unrefreshed.
- You have been treated for depression or insomnia and remain exhausted - mention snoring, witnessed pauses in breathing or morning headaches.
- You must tell the DVLA if you have confirmed moderate or severe obstructive sleep apnoea with excessive sleepiness.
If you need help now: Samaritans, call 116 123, free, 24/7. Shout, text SHOUT to 85258. NHS 111, then choose the mental health option. Call 999 if anyone is in immediate danger.