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Pronounced daytime sleepiness with microsleep — especially at the wheel — is a warning sign and should be assessed quickly. Do not drive yourself in this state and raise it actively at your practice.
In sleep apnoea, breathing repeatedly stops for seconds during sleep or becomes markedly shallower. „Apnoea“ literally means a cessation of breathing. These breathing pauses can recur dozens to hundreds of times a night without those affected being consciously aware of it. Each pause causes the oxygen level in the blood to drop and the brain to trigger a brief arousal in order to get breathing going again. You usually do not notice these so-called arousals in the morning — but they chop sleep into many small pieces.
The tricky part: the actual disorder happens at night, while you sleep. Anyone who sleeps alone often notices nothing of the breathing pauses for years. What usually becomes noticeable first is the daytime consequence: a persistent tiredness and exhaustion that does not improve with a lie-in at the weekend. Often it is partners who notice the loud snoring with the observed breathing pauses and thereby prompt an assessment.
Why is fragmented sleep so consequential? Restorative sleep needs undisturbed deep-sleep and dream phases. When the brain wakes briefly hundreds of times a night to rescue breathing, the body never reaches these restorative phases. At the same time, the recurrent drops in oxygen strain the heart and circulation: blood pressure rises, the heart has to work harder, and the metabolism is thrown off balance. Because this unfolds gradually over years and during sleep, sleep apnoea is often recognised late — even though it is very treatable.
Not every breathing pause in sleep arises in the same way. For diagnosis and treatment it is crucial to distinguish the types — because the treatment differs depending on the cause.
| Type | What happens | Typical |
|---|---|---|
| Obstructive sleep apnoea (OSA) | The upper airway collapses during sleep, but the breathing effort continues | By far the most common type; loud snoring; often excess weight |
| Central sleep apnoea (CSA) | The respiratory centre in the brain briefly sends no breathing drive — the effort stops | Rarer; often with heart failure, after a stroke or on certain medications |
| Mixed sleep apnoea | A combination of both mechanisms within one breathing pause | Starts central, turns into an airway obstruction |
In obstructive sleep apnoea — by far the most common variant — the throat muscles relax during sleep. The tongue and soft tissues sink back and narrow or close off the airway. The body keeps trying to breathe but cannot get air past the obstruction. The loud, irregular snoring with sudden pauses and subsequent gasping for air is the classic picture. You can picture it like a straw that collapses when you suck on it: the more flaccid the tissue and the narrower the throat, the more easily it happens.
In central sleep apnoea, the problem lies not in the throat but in the control: the respiratory centre in the brain briefly stops and sends no impulse to breathe. During this pause there is no breathing effort and usually no snoring. This type occurs more often in people with heart failure, after a stroke or on strongly sedating medications (such as opioids). Because the causes — and therefore the treatment — differ, the precise classification during diagnostic work-up is so important.
The complaints of sleep apnoea fall into two groups: night-time signs, which others usually notice, and daytime symptoms, which those affected feel themselves. Precisely because the night goes unnoticed, it is important to consider both sides together.
At night (often noticed by the partner):
During the day (felt yourself):
Important: not everyone who snores has sleep apnoea — and not everyone with sleep apnoea snores loudly. The decisive difference from harmless snoring is the breathing pauses and the pronounced daytime sleepiness. When the two come together, an assessment is worthwhile — even if you yourself „notice nothing“ at night.
Obstructive sleep apnoea arises when the upper airway collapses too easily during sleep. Whether and how strongly this happens depends on several factors that often add up.¹
Central sleep apnoea has different roots: it is often linked to advanced heart failure, to diseases or injuries of the brain, or to the long-term use of strongly sedating painkillers. A central breathing disorder can also occur at high altitude. Because an underlying condition lies in the background here, the treatment depends heavily on that cause — another reason why the sleep-medicine work-up must cleanly distinguish the two types.
The diagnosis rests on three building blocks: the conversation about the complaints, a simple self-test for daytime sleepiness and a night-time measurement of breathing. Sleep apnoea cannot be established by feeling alone — this requires objective measurements.¹,²
A proven aid is the Epworth Sleepiness Scale (ESS). In this short questionnaire you rate, on a scale from 0 to 3, how likely you would be to nod off in eight typical everyday situations — for example while reading, as a passenger in a car or sitting quietly after lunch. The points are added up. A total score above about 10 out of a possible 24 points suggests notable daytime sleepiness and is a reason to look more closely. The test does not replace a measurement, but it is a good first filter.
The AHI is the central metric: roughly, a value of 5 to 15 counts as mild, 15 to 30 as moderate and over 30 as severe sleep apnoea. But the number alone is not everything — it counts just as much how strong the daytime complaints are and which co-existing conditions are present. Both together determine whether and how intensively treatment is given.
The most important and most effective treatment of moderate to severe obstructive sleep apnoea is CPAP therapy (continuous positive airway pressure). Here you wear a mask at night that delivers a gentle stream of air through a quiet compressor. This slight positive pressure acts like a „pneumatic splint“: it holds the airway open from the inside so that it no longer collapses. The breathing pauses disappear, oxygen stays stable, and sleep becomes continuously restorative again.¹
For many, the idea of a mask takes some getting used to at first. In practice, though, many of those affected report that they feel noticeably more alert after the first few well-slept nights — and that is precisely what motivates them to keep at it. The key to success is regular, nightly use: CPAP works only in the nights in which the mask is actually worn. The first weeks are a period of getting used to it, during which the mask, pressure and handling are adjusted.
CPAP is the mainstay in pronounced sleep apnoea — but accompanying measures reinforce the effect, and in milder forms they can even be enough. They target the modifiable causes and are an important part of any treatment.¹
In selected cases, further procedures come into question: operations on the nose, tonsils or throat can help with certain anatomical narrowings, and for individual patients with CPAP intolerance there is a so-called tongue pacemaker (stimulation of the hypoglossal nerve). These options are assessed individually at the sleep-medicine centre. In central sleep apnoea, by contrast, the focus is on treating the underlying condition — such as heart failure — sometimes supplemented by special forms of ventilation.
brite reminds you about the mask, follow-up appointments and accompanying measures and documents how rested you feel — ready for the next talk with your doctor.
Untreated sleep apnoea is more than just disruptive snoring — over the years it strains the whole body. The recurrent drops in oxygen and arousals put the cardiovascular system under constant stress. This is why treatment is not only a question of daytime form, but also of long-term health risk.¹
| Area | Connection |
|---|---|
| High blood pressure | Sleep apnoea is one of the most important causes of hard-to-control high blood pressure, especially when the values do not drop at night |
| Heart & rhythm | Increased risk of heart failure, coronary heart disease and heart rhythm disturbances such as atrial fibrillation |
| Metabolism | Unfavourable influence on blood sugar and weight; close link to diabetes and excess weight |
| Accident risk | Markedly increased risk of microsleep and road accidents due to the daytime sleepiness |
Particularly close is the connection with high blood pressure. With every breathing pause the body releases stress hormones and drives up blood pressure. Over the years the pressure remains elevated during the day too. Not infrequently, sleep apnoea is only spotted because high blood pressure cannot be controlled despite several medications — once the sleep apnoea is then treated, the blood pressure values can often be controlled more easily.
The strain on the heart is considerable too: sleep apnoea increases the risk of heart failure and of rhythm disturbances such as atrial fibrillation. Conversely, sleep apnoea is particularly common in people with these heart conditions — which is why they are specifically screened for it. Consistent treatment of sleep apnoea is thus also a building block of heart protection.
Not to be underestimated is the accident risk: the pronounced daytime sleepiness can lead to microsleep — most dangerous at the wheel. Anyone who can barely stay awake during the day should be assessed quickly and should not drive themselves in this state. After successful therapy, alertness usually improves markedly, and fitness to drive generally returns.
Record in brite how tiredness, blood pressure and sleep quality develop under therapy — ideal for the next talk with your doctor.
Treating sleep apnoea takes place for the most part at home — night after night. A few habits make the difference between an effective and an ineffective therapy:
Sleep apnoea is treated not over weeks but over years — night after night with CPAP and accompanying measures. The therapy only works if it runs reliably and the progress stays in view. That is exactly where brite supports you.
