Obstructive sleep apnoea (OSA)

Expert reviewer, Dr Richard Russell, Consultant Chest Physician
Next review due August 2023

Obstructive sleep apnoea is a condition that causes frequent pauses in your breathing when you're asleep, interrupting your sleep. This can make you feel extremely sleepy the next day. There are many things you can do to improve your symptoms, and several treatment options that can help.

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About obstructive sleep apnoea

When you’re asleep, the muscles in your upper airways (mouth, nose and throat) relax. If you have obstructive sleep apnoea (OSA), this relaxation of the muscles can cause your airways to completely close, stopping you from breathing for a short time (10 or more seconds). You may temporarily wake up and might feel like you’re choking or gasping for breath. Usually, you fall asleep again very quickly so you may not even remember it in the morning.

This cycle can happen many times (sometimes hundreds of times) during the night, affecting how well you sleep. As a result, you may be very sleepy the following day because your brain is trying to catch up with sleep. People with OSA often find that they doze off during the day at inappropriate times – for example, when talking to people or even when driving.

Causes of obstructive sleep apnoea

Obstructive sleep apnoea (OSA) happens if your airways become too narrow while you’re asleep. There are several things that can make this more likely to happen. These include if you:

  • are obese – this is the strongest risk factor
  • have a large neck (collar size) – more than 43cm (17 inches) circumference
  • are male (women do get OSA, but the risk is greater for men)
  • are middle-aged or older – you can get it at any age, but it’s more common as you get older
  • have a family history of sleep apnoea
  • smoke
  • drink alcohol to excess, especially before you go to bed
  • take drugs that have a sedative effect
  • sleep on your back

Certain conditions that affect your jaw, nose, tongue or airway, including an underactive thyroid (hypothyroidism), acromegaly and Down's syndrome, can also make you more likely to develop OSA. Children may develop OSA if they have enlarged adenoids and tonsils.

Symptoms of obstructive sleep apnoea

Symptoms of obstructive sleep apnoea (OSA) include:

  • excessive sleepiness during the day
  • snoring
  • frequent pauses in breathing or choking noises when you’re asleep – it may be that a partner or someone else in the house has noticed this
  • getting up at night to pee more than normal
  • feeling unrefreshed by sleep when you get up in the morning
  • having a headache or possibly a sore throat or dry mouth when you wake up

The disturbed sleep is likely to affect your day-to-day life in different ways. You may find it hard to concentrate and notice changes in your personality or feel depressed. It might have an impact on your performance at work and in your relationships. You may find that you're falling asleep when you don’t mean to – for example, while reading or watching television. Never drive if you feel sleepy, and stop immediately if you do. For more information, see our FAQ about driving with sleep apnoea.

Bear in mind that many of these symptoms can be caused by problems other than sleep apnoea. But if you’re having these symptoms, see your GP for advice.

Diagnosis of obstructive sleep apnoea

Your GP will ask about your symptoms and examine you. They’ll ask you some questions to check if there’s anything else that could be making you feel sleepy or other reasons for your symptoms. They’ll want to know how your symptoms are affecting your daily life – including your work, ability to drive and relationships. If a partner has noticed problems with your breathing while you’re asleep, it can be useful for them to come to your appointment too.

Your GP may ask you to complete a questionnaire, called the Epworth Sleepiness Scale, to assess how severe your symptoms are. This questionnaire asks how likely you are to fall asleep in different situations, such as when you’re watching television, reading or in the car. They may also arrange for you to have blood tests, to check for any possible underlying causes (such as underactive thyroid).

Seeing a specialist

If your GP thinks you might have obstructive sleep apnoea (OSA), they’ll refer you to a specialist in sleep disorders or a sleep centre for further investigation. You'll need to be monitored while you're asleep to make a diagnosis of OSA. This involves taking various measurements, such as the amount of oxygen in your blood, your heart rate, airflow, brain activity, eye movements and muscle tone. Often, you’ll be given equipment to monitor yourself while you’re asleep at home. But sometimes, you may need to stay overnight in a sleep centre, where your doctor can monitor you.

Self-help for obstructive sleep apnoea

There may be lifestyle changes you can make to improve your symptoms. Your GP may discuss this with you. Steps you can take include:

  • losing excess weight if you’re overweight or obese
  • reducing the amount of alcohol you drink, especially in the evening
  • stopping smoking
  • not using sedative medication in the evenings
  • sleeping on your side, rather than your back

It’s important to follow a good sleep routine too.

Treatment of obstructive sleep apnoea

In addition to the self-help lifestyle changes, a variety of treatments are available that can help with obstructive sleep apnoea (OSA). These are outlined below. Your sleep specialist will talk you through all your treatment options. You may need to try a few different options until you find the one which suits you the best.

Continuous positive airway pressure

Continuous positive airway pressure (CPAP) is usually the most effective treatment for OSA. CPAP involves using a machine at night that blows pressurised air into your upper airways via a mask over your nose or face.

CPAP is a long-term treatment: you’ll usually need to keep using it every night. Using the machine may take some getting used to. But it does help you get the sleep you need, so try to persevere and speak to your sleep specialist team for advice and support. For more information, see our FAQ on CPAP equipment.

Oral devices

If your symptoms are very mild or you can’t get on with CPAP, you may be able to try using an oral device at night. You put these in your mouth to help keep your airways open. An example is a mandibular advancement device – you wear this over your teeth, a bit like a gum shield.

You’ll be referred to a specialist, and the device will be made to fit you. These devices can have some side-effects; for instance, they may increase the amount of saliva you produce. But they can help to improve the quality of your sleep.


Surgery is usually only an option if other treatment options have completely failed or there’s a clear reason for surgery – for example, removing enlarged tonsils. Other types of surgery aim to remove any excess tissue in your throat that might be causing your sleep apnoea.

Hypoglossal nerve stimulation

This is a newer, experimental treatment for people who have moderate to severe OSA. It involves having a device implanted under the skin in your chest. The device sends electrical impulses to a nerve under your tongue to make your tongue contract and stop it falling backwards. This may help to keep your airway open.

There's not yet enough good evidence to say how safe or effective this procedure is, so it’s not currently available in routine practice. It is only available in some settings as part of a research trial where you will be closely monitored. Your doctor will let you know if this is an option for you.

Complications of obstructive sleep apnoea

Obstructive sleep apnoea (OSA) is also associated with an increase in conditions that affect your heart and circulation. These include:

Not getting enough sleep can also affect your mental health badly and may eventually lead to depression.

Treatments for OSA are effective in reducing the risk of these complications. For instance, continuous positive airway pressure (CPAP) has been shown to reduce blood pressure.

Feeling sleepy during the day can also make you more likely to have accidents at home or at work. For more information about driving safely, see ‘Driving if you have obstructive sleep apnoea’.

Driving if you have obstructive sleep apnoea (OSA)

Obstructive sleep apnoea (OSA) is strongly associated with an increased risk of driving accidents. People who are sleepy and less alert at the wheel of a vehicle are more likely to cause road traffic accidents. Whether you can drive will depend on several factors, including:

  • how severe your sleep apnoea is
  • if it's making you feel sleepy
  • if you’re having treatment to control your symptoms

If you do have an accident, tiredness is not an excuse that can be used by law. So, if you tend to fall asleep easily during the day and generally feel tired, don’t drive.

The Driver and Vehicle Licensing Agency (DVLA) has the following rules for people with obstructive sleep apnoea (OSA).

  • If you've been feeling sleepy during the day, you mustn’t drive.
  • If you have a diagnosis of moderate or severe OSA, you need to stop driving and inform the DVLA straight away. You’ll be able to continue driving again once your doctor can confirm that your condition is under control, that you’re sticking to treatment and that your sleepiness has improved. You’ll have to have a review at least once every three years.
  • If you have sleepiness and you're waiting for a diagnosis, or you have confirmed mild OSA, you need to stop driving, but you don’t need to inform the DVLA straight away. You'll be able to start driving again as soon as your symptoms are under control. If your symptoms aren't under control within three months though, you will need to inform the DVLA.

The same rules apply to car, motorcycle, bus and lorry drivers. However, if you’re a commercial driver (for example, you drive a lorry, bus or coach), it's worth mentioning this to your GP. They may be able to request that you’re referred and receive treatment urgently, so that you can get back to work as soon as possible.

Continuous positive airway pressure (CPAP) may reduce the risk of having a driving accident.

Frequently asked questions about obstructive sleep apnoea

  • Although the pauses in breathing that you have during obstructive sleep apnoea (OSA) may sound scary, your brain senses these and automatically wakes you up. You might make snorting or choking noises as you wake and start breathing again.

    OSA has been linked to various conditions that affect your heart and circulation such as coronary heart disease and stroke. You're also at greater risk of having a car accident if you have OSA. 

    The good news is that treatment for OSA has been shown to reduce these complications, including the risk of dying from cardiovascular disease. So, it’s really important to make sure you seek help for your symptoms and get the treatment you need.

  • If you’re finding it hard to use your continuous positive airway pressure (CPAP) equipment, ask your sleep clinic to help. Simple adjustments can be made to the set-up to make it more comfortable and work better. The air pressure of your CPAP machine needs to be just right for it to help stop your sleep apnoea. If it doesn’t seem to be helping, the pressure may need adjusting. Many machines now have automatic adjustment for this.

    Other problems that some people have with CPAP machines, especially when they first start using them, include:

    • the mask not fitting properly
    • a runny or irritated nose
    • getting a dry nose or bleeding from your nose
    • having an irritated throat
    • feeling claustrophobic
    • difficulty breathing
    • sleep disturbance

    There is much that can be done to help with these problems. Your sleep clinic may adjust your mask or suggest trying a different type to see if this helps. You may be able to have a corticosteroid nasal spray to help prevent irritation to your nose. If you’re getting a dry nose, a humidifier to make the air warmer and damper may help with this. If claustrophobia is a problem, a course of cognitive behavioural therapy may help.

    CPAP is usually very effective for OSA, so it's worth trying to address any problems you’re having and sticking with it if you can.

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Related information

Tools and calculators

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      Helpline: 0300 003 0555
    • British Snoring & Sleep Apnoea Association
    • Driver and Vehicle Licensing Agency (DVLA)
      DVLA drivers' medical enquires: 0300 790 6806
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  • Reviewed by Pippa Coulter, Freelance Health Editor, August 2020
    Expert reviewer, Dr Richard Russell, Consultant Chest Physician
    Next review due August 2023