Snoring, Tired and Foggy? Could It Be Sleep Apnoea?

A practical guide to the symptoms of obstructive sleep apnoea, who is at risk, how it is diagnosed and what actually helps

Snoring is common.

Sleep apnoea is different.

Obstructive sleep apnoea — usually shortened to OSA — happens when the upper airway repeatedly narrows or closes during sleep. Breathing may partly or completely stop for short periods, then restart when the brain briefly wakes the person enough to reopen the airway.

This can happen many times through the night without the person being aware of it.

The result may be:

• loud snoring;
• broken sleep;
• daytime tiredness;
• poor concentration;
• morning headaches;
• irritability;
• feeling “foggy” despite apparently spending enough hours in bed.

The important question is:

“Am I simply a snorer, or is my breathing repeatedly being interrupted while I sleep?”

What does sleep apnoea actually look like?

Some people with OSA snore very loudly.

A partner may notice:

• pauses in breathing;
• choking;
• gasping;
• snorting;
• restless sleep.

The person with OSA may notice very little overnight.

Instead, they may wake feeling:

• unrefreshed;
• dry-mouthed;
• headachy;
• mentally slow.

During the day they may struggle with:

• concentration;
• memory;
• irritability;
• low energy;
• falling asleep while watching television;
• nodding off as a passenger;
• difficulty staying awake during meetings.

Does everyone who snores have sleep apnoea?

No.

Snoring can occur without OSA.

The concern increases when snoring occurs together with features such as:

• witnessed breathing pauses;
• choking or gasping;
• marked daytime sleepiness;
• obesity;
• high blood pressure;
• increasing age;
• a larger neck circumference.

The overall pattern matters more than snoring alone.

What increases the risk?

Important risk factors include:

• excess weight;
• increasing age;
• male sex;
• upper-airway anatomy;
• nasal obstruction;
• alcohol;
• some sedating medicines.

OSA is also more common in people with conditions such as:

• hypertension;
• type 2 diabetes;
• atrial fibrillation;
• cardiovascular disease.

Can thin people get sleep apnoea?

Yes.

Obesity is a major risk factor, but it is not the only one.

A person can have OSA because of:

• jaw or facial structure;
• a relatively narrow airway;
• enlarged tonsils;
• nasal obstruction;
• other upper-airway anatomy.

So:

“I am not overweight”

does not automatically rule it out.

What about women?

OSA is often thought of as a problem affecting middle-aged men.

That stereotype can delay diagnosis.

Women can also develop OSA and may sometimes present with less obvious symptoms such as:

• fatigue;
• insomnia;
• headaches;
• poor concentration;
• mood disturbance.

Risk also increases with age.

The diagnosis should depend on the overall clinical picture, not whether someone fits the classic stereotype.

What about children?

Children can also develop OSA, although the causes and assessment differ from adults.

Clues may include:

• loud snoring;
• restless sleep;
• mouth breathing;
• witnessed pauses;
• behavioural or attention problems during the day.

Enlarged tonsils or adenoids are common contributors.

This guide mainly focuses on adult OSA.

Can sleep apnoea cause “brain fog”?

Yes.

Repeated breathing interruptions can fragment sleep.

Even if someone technically spends seven or eight hours in bed, sleep may repeatedly be interrupted by brief arousals.

That can cause:

• reduced concentration;
• slower thinking;
• memory problems;
• poor motivation;
• irritability.

This is one reason OSA can sometimes be confused with:

• depression;
• anxiety;
• ADHD;
• chronic fatigue;
• simply “getting older”.

Why does sleep apnoea matter?

OSA is not just about annoying snoring.

Untreated OSA can affect:

• daytime alertness;
• quality of life;
• driving safety;
• blood pressure;
• cardiovascular health.

The practical importance depends on how severe the OSA is, how sleepy the person is and what other health conditions they have.

What other health problems are linked with OSA?

OSA is commonly associated with:

• difficult-to-control high blood pressure;
• type 2 diabetes;
• atrial fibrillation;
• other cardiovascular disease.

That does not mean OSA is the only cause of those conditions.

But if someone has loud snoring or daytime sleepiness together with hypertension, atrial fibrillation or other cardiometabolic disease, OSA becomes more important to consider.

What questions might my GP ask?

A practical assessment often starts with questions such as:

• Do you snore loudly?
• Has anyone seen you stop breathing?
• Do you wake choking or gasping?
• Do you feel refreshed in the morning?
• Are you excessively sleepy during the day?
• Have you ever nodded off while driving?
• Do you have high blood pressure?
• Has your weight increased?
• Do you drink alcohol near bedtime?
• Are you taking sedating medicines?

Your partner’s observations can be extremely useful because they may have seen things you never notice yourself.

What are STOP-BANG, OSA50 and Epworth?

These are screening tools used to estimate the likelihood of sleep apnoea or daytime sleepiness.

STOP-BAN
This considers features such as:

• Snoring;
• Tiredness;
• Observed apnoeas;
• high blood Pressure;
• BMI;
• Age;
• Neck circumference;
• Gender/sex.

OSA50
OSA50 is another commonly used Australian screening tool.

Epworth Sleepiness Scale
This estimates how likely you are to doze off in common daytime situations.

In Australian general practice, these tools can also help determine whether someone meets criteria for a Medicare-funded sleep study.

But screening questionnaires do not diagnose OSA.

They help decide who needs further assessment.

Do I need a sleep study?

If OSA is suspected, often yes.

A sleep study measures what happens to your breathing while you sleep.

Depending on the type of study, measurements can include:

• airflow;
• breathing effort;
• oxygen levels;
• heart rate;
• body position;
• snoring;
• sleep stages.

The result helps determine whether OSA is present and how severe it is.

Can I do the test at home?

Often.

Many adults with suspected uncomplicated OSA can have an appropriate home sleep study rather than spending the night in a sleep laboratory.

Home testing may record:

• breathing;
• oxygen levels;
• heart rate;
• airflow;
• body position.

A laboratory sleep study may be more appropriate when:

• the diagnosis is uncertain;
• another sleep disorder is suspected;
• there are important medical conditions;
• a more detailed study is needed.

The right test depends on the clinical situation.

What does “mild, moderate or severe” mean?

Sleep studies often report an apnoea-hypopnoea index, or AHI.

This estimates how many episodes of complete or partial airway obstruction occur per hour of sleep.

The number helps classify severity.

But treatment should not depend on the AHI alone.

Symptoms, oxygen disturbance, cardiovascular risk and driving safety also matter.

Someone with moderate OSA and severe daytime sleepiness may have a very different problem from someone with a similar AHI who feels completely well.

What if my sleep study is negative but I still feel exhausted?

Then the job is not finished.

Fatigue and daytime sleepiness can have many causes, including:

• insufficient sleep;
• insomnia;
• depression;
• anxiety;
• medicines;
• alcohol;
• anaemia;
• thyroid disease;
• restless legs;
• another sleep disorder.

A sleep study answers a particular question.

It does not explain every case of fatigue.

What is CPAP?

CPAP — continuous positive airway pressure — delivers air through a mask while you sleep.

The pressure acts like an air splint, helping keep the upper airway open.

CPAP is a highly effective treatment, particularly for symptomatic moderate-to-severe OSA and for some people with symptomatic mild OSA.

Does CPAP actually work?

When used consistently and fitted properly, CPAP can substantially reduce obstructive breathing events.

People may notice improvement in:

• sleep quality;
• daytime alertness;
• snoring;
• concentration;
• morning headaches.

But CPAP only works when it is actually being used.

A machine sitting beside the bed is not treatment.

What if I hate CPAP?

Do not give up after one bad night.

Common reasons people struggle include:

• an uncomfortable mask;
• air leak;
• nasal congestion;
• dry mouth;
• pressure discomfort;
• claustrophobia.

Many of these problems can be fixed.

Options include:

• another mask style;
• better mask fitting;
• humidification;
• treating nasal obstruction;
• pressure adjustment;
• gradually getting used to the equipment.

Sometimes the correct conclusion is not:

“CPAP doesn’t work for me.”

It is:

“This setup isn’t working for me yet.”

Are there alternatives to CPAP?

Yes.

Depending on the person, options may include:

• weight loss;
• a mandibular advancement splint;
• positional therapy;
• selected upper-airway surgery.

A mandibular advancement splint is a dental device that moves the lower jaw forward during sleep and can help keep the airway open.

The right alternative depends on:

• OSA severity;
• anatomy;
• symptoms;
• treatment preference.

Does losing weight help?

Often, yes.

Weight loss can substantially improve OSA when excess weight contributes to upper-airway obstruction.

But weight loss should not be used as a reason to leave important sleep apnoea untreated while waiting months or years to become lighter.

CPAP or another appropriate treatment may still be needed during weight loss.

What about GLP-1 weight-loss medicines?

Weight-loss medicines can improve OSA by producing significant weight reduction in people with obesity.

There is now also an Australian indication for tirzepatide (Mounjaro) for obstructive sleep apnoea in adults with obesity.

That does not mean:

• everyone with OSA should take tirzepatide;
• CPAP has become obsolete.

It means that for selected adults with obesity and OSA, treating the obesity itself can become an important part of treating the sleep apnoea.

See:

• Weight-Loss Medicines: Who They Help, Who They Don’t and What to Expect
• GLP-1 Weight-Loss Medicines: Benefits, Side Effects and Long-Term Use

What can make OSA worse?

Several things can make sleep-disordered breathing or daytime impairment worse.

Alcohol
Alcohol can increase upper-airway collapse and worsen:

• snoring;
• sleep quality;
• daytime tiredness.

Sedating medicines
Sleeping tablets, benzodiazepines, opioids and other sedating medicines may worsen breathing or daytime impairment in some people.

Do not stop prescribed medicines abruptly, but review them with your GP if OSA is suspected.

Nasal obstruction
A blocked nose does not usually explain OSA by itself.

But it can worsen snoring and make CPAP harder to tolerate.

Treating chronic nasal obstruction or allergic rhinitis may improve comfort and CPAP adherence.

Is surgery the answer?

Sometimes.

Surgery may be useful where there is a clear anatomical problem or when other treatments are unsuitable.

But for many adults, the first steps remain:

• confirm the diagnosis;
• assess severity;
• consider CPAP or an oral appliance;
• address weight, alcohol and other contributing factors.

Sleep apnoea and driving

This is one of the most important safety issues.

OSA can cause significant daytime sleepiness.

That can affect driving.

If you have:

• repeatedly nodded off behind the wheel;
• almost fallen asleep driving;
• had near misses because of tiredness;
• uncontrollable sleepiness;

do not dismiss it as ordinary fatigue.

If you are too sleepy to drive safely, do not drive until the problem has been medically assessed.

Can I still drive if I have sleep apnoea?

A diagnosis of OSA does not automatically mean you can never drive.

The important issues include:

• degree of sleepiness;
• OSA severity;
• whether treatment is effective;
• licence type;
• whether you drive commercially.

Specific Austroads fitness-to-drive requirements may apply.

If driving safety is a concern, discuss it directly with your GP or sleep specialist.

What if I feel fine despite severe OSA?

That can happen.

Some people underestimate how sleepy they are because tiredness has become normal.

Others genuinely have little daytime sleepiness.

Treatment decisions may still need to consider:

• oxygen disturbance;
• cardiovascular risk;
• driving;
• severity;
• personal circumstances.

The sleep-study number should not be interpreted in isolation.

What can my GP do?

Your GP can help by:

• taking a sleep history;
• asking about snoring and witnessed apnoeas;
• assessing daytime sleepiness;
• reviewing weight and blood pressure;
• using appropriate screening tools;
• considering other causes of fatigue;
• reviewing alcohol and sedating medicines;
• assessing driving safety;
• arranging an appropriate sleep study;
• referring to a sleep or respiratory physician where needed;
• helping manage weight, nasal symptoms and cardiovascular risk.

This is a good example of why:

“I’m tired all the time”

sometimes deserves more than simply ordering a broad set of blood tests.

A common misconception

MYTH: If I snore, I must have sleep apnoea.

REALITY: Snoring is common.

OSA becomes more likely when snoring occurs with:

• witnessed pauses;
• choking or gasping;
• daytime sleepiness;
• obesity;
• high blood pressure;
• other risk factors.

Another common misconception

MYTH: CPAP is only for people with extremely severe sleep apnoea.

REALITY: Treatment depends on the whole problem.

Symptoms, oxygen levels, OSA severity, cardiovascular risk and driving safety all matter.

And another

MYTH: If I lose weight, sleep apnoea will definitely disappear.

REALITY: Weight loss can substantially improve OSA in many people, but anatomy and other factors also matter.

Some people still need treatment after significant weight loss.

If your weight changes substantially, it may be appropriate to reassess rather than simply assume the OSA has gone.

The question I would ask

If someone tells me:

“I sleep eight hours but I’m still exhausted,”

I would ask:

“Does anyone hear you snore, choke, gasp or stop breathing while you’re asleep?”

That one question can completely change the direction of the consultation.

The bottom line

Obstructive sleep apnoea is common and often missed.

Think about it if you have:

• loud snoring;
• witnessed breathing pauses;
• choking or gasping at night;
• unrefreshing sleep;
• morning headaches;
• daytime sleepiness;
• concentration problems;
• high blood pressure;
• obesity.

Diagnosis usually requires a sleep study, which can often be performed at home in appropriate patients.

Effective treatments include:

• CPAP;
• weight loss where relevant;
• mandibular advancement devices;
• positional treatment;
• reducing alcohol;
• treating contributing nasal or upper-airway problems.

And in selected adults with obesity and OSA, tirzepatide now also has an Australian OSA indication.

The aim is not simply to stop snoring.

It is to improve:

breathing → sleep → daytime function → safety → long-term health.

If you are snoring, exhausted and struggling to think clearly despite spending enough time in bed, it is worth asking your GP:

“Could this be sleep apnoea?”

Related Q Guides

• Weight-Loss Medicines: Who They Help, Who They Don’t and What to Expect
• GLP-1 Weight-Loss Medicines: Benefits, Side Effects and Long-Term Use
• Could It Be ADHD? What an Assessment Actually Involves