Sleep apnoea: the signs your partner notices before you do

By Dr. Gabriel Grabowski, specialist in internal medicine and pulmonology

I see this often in my practice: someone feels they sleep reasonably well, yet their partner describes loud snoring, sudden silence and then a snort or gasp. The person sleeping may remember none of it. This difference in what each person notices can be an important starting point when assessing possible sleep apnoea.

Sleep apnoea means that breathing repeatedly stops or becomes significantly reduced during sleep. In the most common form, obstructive sleep apnoea, the upper airway narrows or closes temporarily. These episodes can interrupt restful sleep without causing an awakening that you remember.

What your partner may notice

Snoring is common, and snoring alone does not establish a diagnosis of sleep apnoea. However, certain patterns deserve closer attention, particularly when they happen regularly.

A partner may describe:

• Loud, uneven snoring rather than a steady sound.
• Repeated pauses in breathing, followed by a gasp, snort or choking sound.
• Restless sleep or frequent changes of position.
• Breathing that seems more disturbed when you lie on your back.

A sleeping partner cannot reliably judge the severity of the problem by listening alone. Some people with sleep apnoea do not snore prominently, and the loudness of snoring does not necessarily reflect the number of breathing interruptions.

If your partner has noticed pauses, I suggest bringing that observation to a medical appointment. A brief description of how often it happens and whether gasping follows is useful. There is no need for your partner to stay awake monitoring you.

Signs you may notice during the day

Daytime sleepiness is another important clue. This is more than feeling a little tired after a busy afternoon. You may struggle to stay awake while reading, watching television, sitting in a meeting or travelling as a passenger.

Other possible signs include:

• Waking without feeling refreshed, despite enough time in bed.
• Morning headaches or a dry mouth.
• Difficulty concentrating or increased irritability.
• Waking repeatedly, sometimes to pass urine.

Not everyone experiences obvious sleepiness. Some people mainly describe low energy, poor sleep or reduced mental sharpness. These symptoms also have other possible explanations, including insomnia, medication effects and other medical conditions.

In people over 50, I take care not to dismiss these changes as simply part of getting older. Sleep apnoea becomes more common with age, but it is not an inevitable feature of ageing. It can occur in people of different body sizes, although excess weight is one risk factor.

If you feel sleepy at the wheel, do not drive. Arrange another way to travel and seek prompt medical advice. Sleepiness during tasks that require alertness is a practical safety concern, whatever its cause.

How I assess possible sleep apnoea

The assessment starts with a conversation, not just a test. I ask about snoring, witnessed breathing pauses, sleep habits, daytime alertness, alcohol use and medication. Your medical history also matters, including high blood pressure, heart or lung disease and previous sleep problems.

If you agree, your partner's observations can help fill in details you cannot notice while asleep. A sleepiness questionnaire may also be useful, but it cannot confirm or exclude sleep apnoea by itself.

An examination and an appropriate sleep recording help determine what is happening. The choice of test depends on your symptoms and other health conditions. Not every person who snores needs the same investigation.

What polygraphy can tell us

Respiratory polygraphy is an overnight test often carried out at home with a portable recording device. It usually measures airflow, breathing effort, blood oxygen levels and pulse. Depending on the equipment, it may also record snoring and body position.

You receive instructions on fitting the sensors before sleeping in your usual surroundings. The recording is then reviewed to look for breathing disturbances and changes in oxygen levels.

Polygraphy generally does not measure brain activity, so it cannot identify sleep stages or actual sleep time as precisely as a full sleep-laboratory study, called polysomnography. This means it can underestimate breathing disturbances. If the result is unclear, technically inadequate or does not explain convincing symptoms, further testing may be needed.

When to arrange a consultation

Repeated witnessed breathing pauses, disruptive snoring with daytime sleepiness, or persistent unrefreshing sleep are reasonable reasons to arrange an assessment. Untreated sleep apnoea is associated with cardiovascular problems, including high blood pressure, but an individual's situation requires careful evaluation rather than assumptions.

I encourage you to bring a medication list and a few notes about your sleep. If sleep apnoea is diagnosed, the next discussion concerns its severity and suitable management options for your circumstances.

Consultations are possible at the three practices in Nürnberg, La Cala de Mijas and Estepona.

This article is general information and does not replace a personal medical consultation.