Obstructive sleep apnoea (OSA)

Your health expert: Mr Jonathan Hughes, Consultant Ear, Nose and Throat/Head and Neck/Thyroid Surgeon
Content editor review by Rachael Mayfield-Blake, February 2023
Next review due February 2026

Obstructive sleep apnoea is when you frequently stop and start (pause) breathing when you're asleep, which interrupts your sleep. This can make you feel extremely sleepy the next day. There are things you can do to improve your symptoms, and several treatment options that can help.

About obstructive sleep apnoea

When you’re asleep, the muscles in your mouth, nose and throat (upper airways) relax. If you have obstructive sleep apnoea (OSA), this can cause your airways to narrow or completely close, which stops 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, and affect how well you sleep. As a result, you may be very sleepy the next day. 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 of getting obstructive sleep apnoea
have a large neck (collar size) – more than 41cm (16 inches) circumference
are middle-aged or older – you can get it at any age, but it’s more common as you get older
are male (women do get obstructive sleep apnoea, but the risk is greater for men)
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 can also make you more likely to develop obstructive sleep apnoea. These include:

an underactive thyroid (hypothyroidism)
acromegaly (a rare condition where the body produces too much growth hormone, which causes body tissues and bones to grow more quickly)
Down's syndrome

Children may develop obstructive sleep apnoea if they have enlarged adenoids and tonsils.

Symptoms of obstructive sleep apnoea

Obstructive sleep apnoea (OSA) symptoms include:

excessive sleepiness or tiredness 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 notices
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

Your 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 relationships or your performance at work. 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 driving immediately if you do.

Many of these symptoms can be caused by problems other than sleep apnoea. But if you’re having these symptoms, see a GP for advice.

Diagnosis of obstructive sleep apnoea

A 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.

A 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. It generates an obstructive sleep apnoea score. A GP may also arrange for you to have blood tests, to check for any possible underlying causes (such as an underactive thyroid).

Seeing a specialist

If a GP thinks you might have obstructive sleep apnoea, they’ll refer you to a specialist in sleep disorders or a sleep centre. They'll monitor you while you're asleep to make a diagnosis of obstructive sleep apnoea. This will involve 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 a doctor can monitor you.

Self-help for obstructive sleep apnoea

There may be lifestyle changes you can make to improve your symptoms. Your GP can discuss this with you. Here are just some of the steps you can take:

lose excess weight if you’re overweight or obese
reduce the amount of alcohol you drink, especially in the evening
stop smoking
don’t use sedative medicines in the evenings
sleep on your side, rather than on your back

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

Treatment of obstructive sleep apnoea

There are a variety of treatments that can help with obstructive sleep apnoea (OSA), which are outlined below. A sleep specialist will talk you through your options. You may need to try a few different obstructive sleep apnoea treatments until you find the one that suits you the best.

Continuous positive airway pressure (CPAP)

Continuous positive airway pressure (CPAP) is usually the treatment that works best for obstructive sleep apnoea. CPAP involves using a machine at night that blows pressurised air into your mouth, nose and throat (upper airways) through a mask over your nose or face.

CPAP is a long-term treatment. You’ll usually need to use it every night, sometimes for the rest of your life. It can take some time to get used to the machine. But it will 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 use CPAP, you may be able to try an oral device at night. You put this in your mouth to help keep your airways open. An example is a mandibular advancement splint – you wear this over your teeth, a bit like a gum shield.

A doctor will refer you 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. And they can cause problems with your jaw joint. But they can help to improve the quality of your sleep.

Surgery

Obstructive sleep apnoea surgery is usually only an option if other treatment options have completely failed or there’s a clear reason for surgery – for example, to remove 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 treatment for people who have moderate to severe obstructive sleep apnoea. 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 enough good evidence yet 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’ll be closely monitored. Your doctor will let you know if this is an option for you.

Complications of obstructive sleep apnoea

If you have obstructive sleep apnoea (OSA), it may increase your chance of getting conditions that affect your heart and circulation. These include:

If you don’t get enough sleep, it can also affect your mental health and can lead to depression.

Treatments for obstructive sleep apnoea should reduce 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 the section on driving if you have obstructive sleep apnoea below.

Driving if you have obstructive sleep apnoea (OSA)

Obstructive sleep apnoea (OSA) can affect your ability to drive safely. 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, don’t drive.
If you’re diagnosed with moderate or severe obstructive sleep apnoea, stop driving and inform the DVLA straight away.
You’ll be able to drive again once a doctor can confirm that your condition is under control, that you’re continuing your treatment and that your sleepiness has improved. You’ll have to have a review at least once every three years.
If you’re experiencing sleepiness and are waiting for a diagnosis, or you have confirmed mild obstructive sleep apnoea, you need to stop driving. But you don’t need to inform the DVLA straight away.
You can start driving again as soon as your symptoms are under control. But if your symptoms aren't under control within three months, you need to inform the DVLA.

The same rules apply to car, motorcycle, bus and lorry drivers. But if you’re a commercial driver (for example, you drive a lorry, bus or coach), it's worth mentioning this to a 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 if you have obstructive sleep apnoea.

Obstructive sleep apnoea (OSA) is serious enough to get treatment but it isn’t immediately life-threatening. Although the pauses in breathing that happen during obstructive sleep apnoea may sound scary, your brain senses these and automatically wakes you up. But, obstructive sleep apnoea has been linked to coronary heart disease and stroke so it’s important to get treatment.

See our complications of obstructive sleep apnoea section for more information.

Obstructive sleep apnoea (OSA) symptoms include feeling very sleepy during the day as you don’t get a good night’s sleep. When you’re asleep, you may snore or make choking noises – if you have a partner they’ll probably be the one that notices. This disturbed sleep can affect you the next day as you may find it hard to concentrate, and it can affect your work and relationships.

See our symptoms of obstructive sleep apnoea section for more information.

There isn’t usually a cure for obstructive sleep apnoea but there are treatments that can help with symptoms. These include continuous positive airway pressure (CPAP), in which a machine blows pressurised air into your mouth, nose and throat through a mask over your nose or face. You’ll need to keep using these treatments to keep your symptoms under control. If there’s a clear reason for your sleep apnoea, such as if you have enlarged tonsils, surgery may ‘cure’ the problem.

See our treatment of obstructive sleep apnoea section for more information.

Certain things can increase your risk of obstructive sleep apnoea (OSA). OSA happens if your airways become too narrow while you’re asleep. If you’re obese, for example, this is the strongest risk to getting obstructive sleep apnoea. Excess weight creates fat deposits in your neck and this can block your airway while you sleep.

See our causes of obstructive sleep apnoea section for more information.

It depends on how severe your sleep apnoea is and if it's making you feel sleepy. And, if you’re having treatment to control your symptoms. The Driver and Vehicle Licensing Agency (DVLA) has rules for people with obstructive sleep apnoea and when you need to inform them. Obstructive sleep apnoea can affect your ability to drive safely and if you do have an accident, by law, tiredness isn’t an excuse.

See our driving if you have obstructive sleep apnoea (OSA) section for more information.

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Obstructive sleep apnoea syndrome. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised November 2021
Obstructive sleep apnoea/hypopnoea syndrome and obesity hypoventilation syndrome in over 16s. National Institute for Health and Care Excellence (NICE). www.nice.org.uk, published 20 August 2021
Obstructive sleep apnoea in adults. BMJ Best Practice. bestpractice.bmj.com, last reviewed 27 September 2022
Obstructive sleep apnoea syndrome. Patient. patient.info/doctor, last edited 24 September 2021
Respiratory medicine. Oxford handbook of general practice. Oxford Academic. academic.oup.com, published June 2020
Acromegaly. BMJ Best Practice. bestpractice.bmj.com, last reviewed 26 September 2022
CPAP machines for OSA. Asthma and Lung UK. www.blf.org.uk, last medically reviewed November 2021
Hypoglossal nerve stimulation for moderate to severe obstructive sleep apnoea. National Institute for Health and Care Excellence (NICE). www.nice.org.uk, published 22 November 2017
Assessing fitness to drive – a guide for medical professionals. Driver and Vehicle Licensing Agency (DVLA). gov.uk, published May 2022
Tiredness can kill. Driver and Vehicle Licensing Agency (DVLA). gov.uk, published 2019
Obstructive sleep apnea (OSA). Medscape. emedicine.medscape.com, updated 15 September 2020

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