Sleep Apnoea: Symptoms, Tests and Treatment (UK)

What is sleep apnoea?

“Apnoea” means a pause in breathing. In sleep apnoea, the pauses happen again and again through the night. Each time, your brain briefly wakes you, or pulls you into lighter sleep, so you start breathing again. You usually don’t remember these awakenings, but they break up your sleep and can leave you exhausted the next day.

NICE describes the obstructive type as a condition where the upper airway narrows or closes when the muscles relax during sleep, causing under-breathing (hypopnoea) or stopped breathing (apnoea). That is why doctors often call it obstructive sleep apnoea/hypopnoea syndrome, or OSAHS.

Obstructive vs central sleep apnoea

Some people have a mix of both. The rest of this guide focuses on obstructive sleep apnoea, as it is the type most people mean when they talk about sleep apnoea.

Sleep apnoea symptoms

Many of the signs happen while you are asleep, so a partner or family member often notices them first. The NHS suggests taking someone who has seen your symptoms with you to the GP. A phone recording of your snoring and breathing can help too.

At night

• breathing that stops and starts
• gasping, snorting or choking noises
• loud snoring
• waking up a lot, or restless, broken sleep
• getting up to pee in the night

During the day

• feeling very tired or sleepy, even after a full night in bed (see why you wake up tired)
• difficulty concentrating, poor memory or brain fog
• mood swings or low mood
• a headache when you wake up
• nodding off when you sit still, such as watching TV or as a passenger

NICE tells doctors to assess for sleep apnoea when someone has two or more of these features: snoring, witnessed pauses in breathing, unrefreshing sleep, waking headaches, unexplained sleepiness or fatigue, waking to urinate, choking during sleep, broken sleep or insomnia, and problems with memory or thinking.

Not everyone with sleep apnoea feels sleepy. Some people mainly notice poor concentration or simply feel they never sleep well, which is easy to mistake for insomnia, stress or getting older. If you are always tired and you snore, it is worth asking about.

How do I know if I have sleep apnoea?

You can’t be sure without a sleep study, but you can spot the warning signs and take good evidence to your GP. Work through these steps.

1. Ask the person you share a bed or room with. Have they heard you stop breathing, then gasp, snort or choke? The NHS suggests taking someone who has seen your symptoms with you to the GP.
2. Record yourself. A free sound recording app or a phone video left running overnight can catch loud snoring with pauses. Play a few minutes to your GP.
3. Check your days. Do you wake unrefreshed, with a headache, nod off when you sit still, or struggle to concentrate? Tiredness that doesn’t lift after a full night is a key clue (see why you wake up tired).
4. Notice your nights. Waking many times, getting up to pee or lying awake in the small hours can all go with sleep apnoea, and are easy to mistake for middle insomnia.
5. Try the two questionnaires doctors use. The Epworth Sleepiness Scale scores how likely you are to doze off in 8 everyday situations. The STOP-Bang questionnaire asks 8 yes or no questions about snoring, tiredness, observed pauses, blood pressure, BMI, age, neck size and gender, and a score of 5 or more points to a high risk of moderate to severe sleep apnoea. Neither one diagnoses it.
6. See a GP. If the signs fit, your GP can refer you to an NHS sleep clinic for a home sleep study, explained below.

NICE tells doctors not to rely on the Epworth score alone, because not everyone with sleep apnoea feels sleepy. So if your partner hears pauses but you don’t feel especially tired, still get checked. A smartwatch alert is a reason to talk to your GP, not a diagnosis.

What does sleep apnoea sound like?

The classic pattern is loud snoring that suddenly goes quiet, then a snort, gasp or choking sound as breathing restarts, before the snoring builds again. It can repeat many times an hour, all night.

• Snoring: usually loud and heavy, rather than a soft, steady purr.
• Silence: the pause is the apnoea itself. On a sleep study an apnoea is a complete pause in breathing of 10 seconds or more, NICE explains. To a partner it can feel much longer.
• Gasp or snort: as oxygen falls, the brain briefly wakes you and you restart breathing with a gasp or snort, Evelina London children’s hospital explains. Most people have no memory of it.
• Restlessness: tossing, turning or half waking around the noisy moments.

A single jolt and gasp as you drift off, then quiet sleep, is more likely a hypnic jerk. Steady snoring with no pauses is usually ordinary snoring. It is the cycle of snore, silence and gasp that is worth taking to a GP.

Sleep apnoea vs snoring

Snoring is very common and usually harmless. The NHS says it can sometimes be a sign of sleep apnoea, which can be serious if not treated. The difference is whether your breathing is actually interrupted.

iIf snoring is your only symptom, our guide on how to stop snoring covers what the NHS recommends. If you notice pauses, gasping or real daytime sleepiness, see a GP rather than trying gadgets. That includes mouth taping, which is not a fix for suspected sleep apnoea.

Causes and risk factors

Sleep apnoea happens when your airway becomes too narrow while you sleep. Anything that narrows the throat, or relaxes its muscles more than usual, raises the risk. The NHS lists these risk factors:

• being overweight or obese, which Asthma + Lung UK says is closely linked
• a large neck, as extra tissue presses on the airway
• older age, although children and young adults can get it too
• a family history of sleep apnoea
• drinking alcohol
• smoking
• large tonsils or adenoids
• sleeping on your back
• COPD (a long-term lung condition)

Alcohol, sleeping pills and sedatives

Alcohol relaxes the muscles that hold your throat open. A 2018 University of Nottingham review of 21 studies found that higher alcohol intake was linked with a 25% higher risk of sleep apnoea. The NHS also advises avoiding sleeping pills unless a doctor recommends them, as sedating medicines can relax the airway in the same way. If you take any prescribed medicine that makes you drowsy, don’t stop it on your own: ask your GP or pharmacist.

Women and the menopause

Sleep apnoea is more common in men, but the gap narrows after the menopause. In a large US population study, sleep apnoea was rare in premenopausal women, while postmenopausal women not taking HRT had a rate much closer to men’s, and the authors concluded menopause is a significant risk factor. Weight gain around this time adds to the risk (see menopause weight gain). If your sleep has changed in midlife, snoring, gasping or heavy daytime tiredness are worth mentioning to your GP alongside the more familiar perimenopause sleep problems such as night sweats.

Health conditions that often go with it

NICE says sleep apnoea is more common in people with obesity, type 2 diabetes, high blood pressure that is hard to control, atrial fibrillation and other heart rhythm problems, heart failure, a past stroke, moderate or severe asthma, polycystic ovary syndrome, an underactive thyroid and Down’s syndrome.

How common is sleep apnoea?

Very common, and mostly undiagnosed. A 2019 analysis in The Lancet Respiratory Medicine estimated that about 936 million adults aged 30 to 69 worldwide have mild to severe obstructive sleep apnoea, and about 425 million have moderate to severe sleep apnoea. Many people with it have never been tested, often because they put the tiredness down to busy lives.

In children, Great Ormond Street Hospital says it affects about 1 to 3 in every 100.

Is sleep apnoea dangerous?

It can be if it is not diagnosed and treated, which is why the NHS says it needs treatment. Repeated drops in breathing put strain on the body night after night. The NHS links untreated sleep apnoea with:

• high blood pressure
• a higher chance of stroke
• type 2 diabetes
• heart disease
• depression or mood changes
• a higher risk of serious accidents caused by tiredness, including car crashes
• difficulty concentrating at work or school
• strain on relationships, often from snoring and separate bedrooms (see sleep divorce)

The good news: once it is diagnosed, effective treatment is available on the NHS. Long-term poor sleep has its own effects too, which we cover in sleep deprivation.

How to get a sleep apnoea test in the UK

The usual route is through your GP, who can refer you to an NHS sleep clinic. Take along anyone who has seen you sleep, or a recording of your snoring and breathing.

Step 1: questionnaires at the GP

• Epworth Sleepiness Scale. You rate how likely you are to doze off in 8 everyday situations, such as watching TV, sitting after lunch or stopped in traffic. Asthma + Lung UK says a total of 11 to 24 might suggest you are unusually sleepy during the day.
• STOP-Bang questionnaire. Eight yes or no questions: Snoring, Tiredness, Observed pauses, blood Pressure, BMI, Age, Neck size and Gender. A score of 0 to 2 suggests low risk of moderate to severe sleep apnoea, and 5 to 8 suggests high risk.

NICE recommends the Epworth scale and suggests considering STOP-Bang as well. Importantly, it says the Epworth score should not be used alone to decide on referral, because not everyone with sleep apnoea feels sleepy.

Step 2: a home sleep study

Most people are tested at home. NICE recommends home respiratory polygraphy, where you wear small sensors overnight that record your breathing, oxygen levels and heart rate, typically a finger clip, belts around the chest and tummy and a small tube under the nose. Where that isn’t available, a simpler home oximetry test (finger clip only) may be used. If results are unclear but symptoms are significant, you may have a more detailed study, sometimes as an overnight stay in hospital (polysomnography).

You may be seen more quickly if you drive for a living, have a safety-critical job, are pregnant, are due for major surgery or have unstable heart problems. Tell your GP if any of these apply.

Step 3: your result

The test counts how many times an hour your breathing stops or becomes very shallow. This is the apnoea-hypopnoea index (AHI).

Private home tests are also sold in the UK. If you go private, choose one reported by a qualified sleep physician, and share the results with your GP so your care is joined up.

What helps sleep apnoea? CPAP and other treatments

The things that help most are a CPAP machine for moderate or severe sleep apnoea, losing weight if you are overweight, drinking less alcohol, stopping smoking and sleeping on your side. A custom mouth device is the main alternative if CPAP doesn’t suit you. What you are offered depends on how severe it is and how much it affects your day, and NICE says lifestyle advice should be offered at every level of severity.

The sleep apnoea machine: CPAP

CPAP stands for continuous positive airway pressure. A quiet bedside machine gently pumps air through a mask over your nose, or nose and mouth, which keeps your airway open as you sleep. The NHS says you will be given one free if you need it, and that it works best when used every night. It can take time to get used to. If the mask leaks, your nose gets dry or it feels uncomfortable, tell your sleep clinic: different masks, humidifiers and settings are available.

Mouth devices (mandibular advancement devices)

These look like a gum shield and hold your lower jaw slightly forward to keep the airway more open. NICE recommends a customised or semi-customised one as an alternative for adults who can’t tolerate or don’t want CPAP, as long as their teeth and gums are healthy. They are usually fitted by a specially trained dentist. Ask your sleep clinic before buying one online. If you also clench or grind at night, mention it, as it can affect which device suits you (see teeth grinding).

Other options

• Positional devices that stop you rolling onto your back. NICE says these can be considered for mild or moderate sleep apnoea that mainly happens on your back, if other treatments are unsuitable or not tolerated, and are unlikely to work in severe sleep apnoea.
• Surgery. NICE suggests considering removing the tonsils for people with large tonsils blocking the airway and a BMI under 35. Other throat surgery is only considered for severe sleep apnoea when CPAP and a mouth device haven’t worked.
• Mouth and throat muscle exercises, which the NHS lists as another option.
• Weight-loss medicines. In two year-long trials in adults with obesity and moderate to severe sleep apnoea, published in 2024, people given tirzepatide had about 20 to 24 fewer breathing events an hour than those given a placebo. Whether a weight-loss medicine is right for you is a decision for your GP or specialist, and it is not a reason to stop CPAP.

Pillows, chin straps and anti-snoring sprays sold online are not proven treatments for sleep apnoea. Nor is mouth taping.

New treatments: hypoglossal nerve stimulation (Inspire and Genio)

Hypoglossal nerve stimulation is an implant that gently stimulates the nerve controlling your tongue while you sleep, so the tongue doesn’t fall back and block your throat. The best-known systems are Inspire, which has a small unit implanted in the chest, and Genio, which uses a small implanted electrode activated by a unit worn outside the body during sleep.

• It is not a first-line treatment. NICE’s guidance covers moderate to severe obstructive sleep apnoea, and the main trial of the chest-implanted type involved people who had difficulty accepting or sticking with CPAP.
• NICE’s position in the UK: its guidance says the evidence on safety and effectiveness is limited in quantity and quality, so it should only be used with special arrangements for clinical governance, consent and audit or research. Patient selection and the procedure should be done by clinicians with specialist expertise in sleep apnoea. The guidance dates from 2017 and is now listed as HealthTech guidance 455.
• What the studies found: in a 12-month study of the chest-implanted type and a 6-month study of the Genio system, breathing events per hour fell on average, though results varied between people and not everyone responded.

If you have tried CPAP and a mouth device and neither has worked, ask your sleep clinic whether you might be assessed for surgery or an implant. Most people will be offered CPAP, a mouth device and lifestyle changes first.

Is there a cure for sleep apnoea?

Sometimes. For some people it resolves, or improves enough not to need a machine, most often after losing a lot of weight or having large tonsils removed. For many others it is a long-term condition that is managed rather than cured, a bit like high blood pressure: CPAP controls it while you use it, but doesn’t cure it.

The best long-term evidence comes from a US trial in adults with type 2 diabetes, overweight and sleep apnoea. After 10 years, sleep apnoea had gone in 34% of those on an intensive weight-loss programme, compared with 22% of those given standard diabetes education. That is real, but it also shows that most people still had it.

• Weight loss. Losing weight is one of the first things the NHS recommends, because excess weight is so closely linked to sleep apnoea, and it can improve it. Don’t stop CPAP on your own because you have lost weight: talk to your sleep clinic first.
• Sleeping position. Sleeping on your side can help when breathing pauses mainly happen on your back. Our guide to the best sleeping position has tips for staying on your side.
• Cutting down on alcohol and stopping smoking both help, according to the NHS and NICE.
• Surgery to remove large tonsils can help some adults, and Asthma + Lung UK says that in children, surgery combined with lifestyle changes can cure it.

Be wary of anything sold as a “cure” online, including pillows, sprays and supplements. They don’t replace a proper assessment.

How to prevent sleep apnoea (and stop it getting worse)

You can’t change some risk factors, such as getting older, being male, your family history or having large tonsils. But several of the biggest ones are in your hands. NICE says lifestyle and sleep habit changes can help to prevent mild sleep apnoea from getting worse, and the NHS and NICE recommend:

• Keeping to a healthy weight, as excess weight around the neck narrows the airway. See sleep and weight loss for how the two feed each other.
• Drinking less alcohol, especially in the hours before bed, because it relaxes the throat muscles. Our guide to alcohol and sleep explains when to stop.
• Stopping smoking.
• Avoiding sleeping pills and sedatives unless a doctor recommends them. If you take a prescribed medicine that makes you drowsy, don’t stop it on your own: ask your GP or pharmacist.
• Sleeping on your side. The NHS suggests a tennis ball taped to the back of your sleepwear, or a special pillow or wedge. See the best sleeping position for more ideas.
• Exercising regularly, which the NHS says can improve symptoms.
• Keeping a regular sleep schedule and good sleep hygiene.
• Getting a blocked nose checked, as NICE advises assessing people with sleep apnoea and nasal congestion for rhinitis.

None of these guarantees you won’t get it, and they don’t replace a sleep test if you already have symptoms.

A note on supplements: no supplement treats or prevents sleep apnoea, including ours. If you use any sleep aid, from herbal teas to natural sleep supplements, mention it to your GP or sleep clinic, and don’t use one to mask daytime tiredness that might have a medical cause.

Sleep apnoea and driving

Sleepiness at the wheel is dangerous, and there are clear rules. The government’s guidance on excessive sleepiness and driving says you must tell the DVLA if you have confirmed moderate or severe obstructive sleep apnoea syndrome with excessive sleepiness. You must also tell them about any other sleep condition, including suspected or confirmed mild sleep apnoea, that has caused excessive sleepiness for at least 3 months.

• Car or motorcycle licence: tell the DVLA online, or fill in form SL1.
• Bus, coach or lorry licence: fill in form SL1V.
• You must not drive until you are free from excessive sleepiness, or your symptoms are under control and you are following any treatment you need.
• You can be fined up to £1,000 if you don’t tell the DVLA about a medical condition that affects your driving.

Whatever your diagnosis, never drive if you feel sleepy. Pull over somewhere safe and rest. The rules focus on sleepiness rather than the diagnosis itself: the NHS says that if excessive sleepiness has been confirmed, you must not drive until symptoms like feeling very tired are under control.

Is sleep apnoea a disability in the UK? Can you get PIP?

It depends on how it affects you, not on the diagnosis alone. This is a quick guide to the official rules, not benefits advice.

The Equality Act 2010

Under the Equality Act 2010, you are disabled if you have a physical or mental impairment that has a substantial and long-term negative effect on your ability to do normal daily activities. Gov.uk explains that substantial means more than minor or trivial, and long-term means 12 months or more. Some people with sleep apnoea will meet this and many won’t, especially once treatment is working. The full definition is on gov.uk.

Personal Independence Payment (PIP)

PIP is not awarded for having a particular condition. According to gov.uk, you need a long-term physical or mental health condition or disability and difficulty doing certain everyday tasks or getting around because of it, most of the time, which means on more than half the days over a 12-month period. The assessment looks at whether you can do each task safely, how long it takes and whether you need help. In Scotland, you apply for Adult Disability Payment instead.

To check the rules for your situation, read the PIP pages on gov.uk or get free, independent help from Citizens Advice.

Sleep apnoea in children and toddlers

Children, including toddlers, can get obstructive sleep apnoea too, most often because of enlarged tonsils or adenoids. Some snoring is normal in children and doesn’t usually cause problems, Evelina London explains; what matters is snoring with pauses, gasps or snorts. Great Ormond Street Hospital lists these signs:

• snoring, often with pauses or gasps
• restless sleep, unusual sleeping positions or brief waking
• daytime sleepiness, or trouble concentrating that affects school
• waking tired or grumpy
• in younger children, hyperactivity or aggressive behaviour rather than sleepiness
• poor growth or weight gain

If you are worried, see your GP. A video of your child sleeping, including any pauses, can help. Diagnosis is based on what you have seen, an examination and sometimes an overnight sleep study. Children with simple snoring or very mild sleep apnoea often need no treatment, while the most common treatment for more severe cases is removing the tonsils and/or adenoids. Never give adult sleep products or supplements to children. Our products are for adults only.

When to see a GP

The NHS recommends seeing a GP if you or someone else notices:

• your breathing stops and starts while you sleep
• you make gasping, snorting or choking noises
• you always feel very tired during the day

Also see a GP if snoring is having a big impact on you or your partner, you nod off at the wheel or at work, or you wake with headaches. Other things can cause similar tiredness, such as low iron, an underactive thyroid or waking at 3am every night, so a check-up is worthwhile either way.

A smartwatch or ring can’t diagnose sleep apnoea. Find out what sleep trackers can and can’t tell you.

Sleep apnoea can also be linked to sleepwalking, so mention any episodes to your GP.

iSee also morning headaches: causes and when to see a GP.

Related guides

• How alcohol affects snoring and sleep apnoea.
• Waking in the small hours and lying awake? See why you wake in the night and can’t get back to sleep.
• Untreated sleep apnoea is one of the triggers for night terrors.
• Some studies link severe sleep apnoea with tinnitus: see tinnitus at night.
• Sleep apnoea, sleep and weight loss.
• For a blocked nose, dry mouth and open-mouth sleeping, see how to stop mouth breathing at night.
• Coughing at night: when to see a GP.
• Waking up to pee at night is a common clue to sleep apnoea; see waking up to pee at night (nocturia) for the other causes.
• A single jolt and gasp as you fall asleep is usually a hypnic jerk; repeated gasping through the night is different.
• Waking briefly from REM sleep is one theory for why sleep paralysis happens more on your back.
• Needing long naps every day despite a full night in bed is one sign worth mentioning to your GP; see what a healthy nap looks like.
• If you are on Mounjaro and sleeping badly, see why you can’t sleep on Mounjaro.
• Sleep apnoea and dementia risk.
• Men’s health checks this Movember, from sleep to prostate and testicular checks.
• Heavy, tired eyes all the time.
• Broken sleep from apnoea can change how you dream; see can vivid dreams be a sign of illness?
• Broken sleep can bring on other night-time habits too; see why people talk in their sleep.
• Sleep apnoea becomes more likely with age. For other sleep changes after 50, see sleep as you get older.
• Waking up a lot is one sign the NHS lists; if it’s noise or light waking you instead, see why am I a light sleeper?