Surprising Signs and Symptoms of Untreated Sleep Apnea

Obstructive sleep apnea may have some surprising signs and symptoms of the condition. You may expect it in someone who is overweight, snores loudly, and repeatedly wakes up gasping out of sleep. However, there may be other symptoms that suggest the presence of the disorder. Consider some of these alternative signs and whether the underlying cause might be due to untreated sleep apnea.

Depression

There is a lot of overlap between problems with sleep and problems with mood. Depression, in particular, has a strong association with sleep apnea. This might manifest as feeling down or sad, even episodes of crying, but there can be other findings in depression as well. There may be a loss of interest in activities that were previously pleasurable. Some people experience feelings of guilt about things that they have done or have failed to do. Low energy levels and poor concentration may also occur. Appetite may be reduced or increased, leading to weight loss or gain, respectively. There may even be thoughts of hurting oneself or others. When any of these symptoms occur, treating sleep apnea may help, but some people may additionally require the use of antidepressant medication or therapy.

Problems Thinking

Sleep apnea can have profound effects on your ability to think clearly during the day. This is sometimes called "brain fog." The repeated episodes of disrupted breathing that occur at night fragment sleep. As a person with sleep apnea falls into a deep sleep, the airway collapses, and a brief awakening occurs to restore breathing. This fragmentation results in frequent arousals and poor quality sleep.

One of the major functions of sleep is to clear away debris in the pathways of the brain, including the neurotransmitter adenosine. When this maintenance work is disrupted, sleep is not as refreshing. This may make someone with sleep apnea feel like their thinking is hazy. As a result, difficulties with poor concentration, attention issues (like ADHD or ADD), and short-term memory problems may occur.

Impotence

Difficulty achieving or maintaining an erection may be a sign of sleep apnea in men. This impotence can occur due to compromised blood flow or changes in the nervous system that affect the penis. There are multiple instances in which sleep apnea is known to have cardiovascular consequences. It may contribute to high blood pressure, heart failure, and even hyperlipidemia (high cholesterol). It is believed that sleep apnea causes systemic inflammation. The stress of repeated episodes of breathing disruption at night, with drops in the oxygen levels, increases markers of inflammation. This may affect blood vessels directly. In addition, there may be effects on the autonomic nervous system that controls blood flow.

Uncontrolled High Blood Pressure

Sleep apnea contributes to the risk of developing high blood pressure. This condition, also called hypertension, can lead to adverse consequences like a heart attack or stroke. As described above, the repeated episodes of disrupted breathing during sleep leads to drops in blood oxygen levels, spikes in the heart rate, and increased blood pressure. The resulting inflammation affects the whole body.

When blood pressure is difficult to control with lifestyle changes or medication, sleep apnea should be investigated as a potential cause with a sleep study.

Fortunately, treatment with continuous positive airway pressure (CPAP) can be as effective as one medication to reduce blood pressure.

Waking to Urinate

If you find yourself getting up at night to urinate, this may also be a sign of sleep apnea. This condition, called nocturia, may occur in various situations: excessive fluid intake near bedtime, the use of diuretic medications such as Lasix (furosemide), or in men with benign prostatic hypertrophy (BPH). It also occurs with sleep apnea.

The fragmentation of sleep that occurs may interrupt the release of anti-diuretic hormone (ADH). Normally, this hormone prevents us from peeing at night. When it is not released, more frequent trips to the bathroom may occur. In addition, sleep apnea may cause lighter sleep that leads to more awareness of how full the bladder is at night, also prompting urination. There is also evidence that strain on the heart due to negative pressures in the chest impacts the release of urine to reduce what is perceived as a volume overload state. Treatment may decrease the need to urinate overnight.

Teeth Grinding

Clenching or grinding of the teeth at night may be a sign of sleep apnea. Also known as bruxism, teeth grinding is relatively common and may affect up to 10 percent of the population. In some people, it may occur subconsciously in sleep in order to tighten the muscles of the airway and keep the jaw from moving backward. This prevents the tongue, which is attached to the lower jaw, from falling into and blocking the airway. In combination, the collapse of the airway can be combatted, and this may lead to fewer awakenings secondary to sleep apnea.

Unrefreshing Sleep

When sleep is not refreshing, no matter how much is obtained, this could be indicative of sleep apnea. Insufficient sleep quantity often causes symptoms of sleep deprivation. However, when the quality of sleep is compromised due to fragmentation from sleep apnea, similar problems can occur.

Excessive daytime sleepiness typically occurs in sleep apnea. This may make it easy to take naps. It often makes it easy to fall asleep at night, and people with sleep apnea may fall asleep within seconds to minutes. This can also be dangerous, especially if the drowsiness leads to falling asleep while driving.

Heartburn

Nighttime heartburn or acid reflux can be a sign of sleep apnea. Many people who experience these episodes also have daytime gastro-esophageal reflux disease (GERD). There is a muscular ring of tissue called the lower esophageal sphincter that prevents the contents of the stomach, including stomach acid, from entering the esophagus. The esophagus is the muscular tube that leads from the throat to the stomach. When the sphincter is weak, it cannot close the tube completely and this leads to reflux and heartburn.

Sleepwalking

This may be one of the strange signs of sleep apnea. One of the abnormal sleep behaviors, or parasomnias, sleepwalking can be a sign of sleep apnea. In fact, other occurrences like sleeptalking (somniloquy), sleep eating, and other behaviors and movements may suggest sleep apnea. As an example, periodic limb movements may indicate attempts to resume breathing and often go away with sleep apnea treatment.

The more complex behaviors may occur when the state of consciousness becomes fractured. Rather than being all awake or all asleep, the brain may have a mixed state in which wakefulness and sleep occur simultaneously. The part of the brain that controls consciousness and memory may remain asleep while that which controls movement, such as walking, may be active. As a result, a person with sleepwalking may get up and leave the bedroom (or even the house) with no recollection. Sleep apnea can fragment the sleep state, more likely causing these mixed states and leading to these complex behaviors.

Dry Mouth and Drooling

Two contradictory findings may both suggest sleep apnea: dry mouth and drooling. Dry mouth often occurs when the nasal passage is blocked and mouth breathing occurs. This may be due to allergies, a deviated nasal septum, or even because of a cold. If you wake up with a dry mouth or sleep with a glass of water on your nightstand, this may suggest you are at risk for sleep apnea. Breathing through the mouth often leads to loud snoring and may contribute to the collapse of the airway in sleep. Somewhat unexpectedly, drooling in your sleep may suggest the same situation. Drooling often occurs because the mouth is open during sleep, with saliva free to drip from the corners of the mouth onto a pillow. Therefore, both a dry mouth and drooling may indicate the presence of mouth breathing and risk for sleep apnea.

A Word From Verywell

Sleep apnea is a very common condition that compromises the quality of sleep and may lead to both expected and unexpected consequences. These signs may not be the ones you first think of with sleep apnea, but they can indeed suggest the condition is present. Fortunately, effective treatments are available that may help you to sleep and feel better. If you are concerned, get evaluated by a board-certified sleep physician to undergo testing and start treatment.