Sleep apnoea is a sleep disorder in which breathing repeatedly stops and starts throughout the night. It affects an estimated one in four Australian adults to some degree, yet it remains one of the most underdiagnosed conditions in the country. Many people write off the symptoms as ordinary tiredness, never realising there is a treatable medical cause behind them.
What actually happens during sleep apnoea
During a normal night's sleep, your airway stays open and air flows freely to your lungs. In people with sleep apnoea, this airway narrows or closes entirely, cutting off breathing for anywhere from a few seconds to over a minute. The brain registers the drop in oxygen and jolts the body into a lighter stage of sleep to reopen the airway. This can happen dozens, sometimes hundreds, of times each night. The person rarely wakes up fully, but sleep quality is severely disrupted every time it occurs.
The most common form is obstructive sleep apnoea (OSA), where the throat muscles relax too much and physically block the airway. A less common form, central sleep apnoea, happens when the brain fails to send the right signals to the muscles that control breathing. Some people have a combination of both, known as complex or mixed sleep apnoea.
Recognising the symptoms
The classic warning signs of sleep apnoea include loud, persistent snoring, gasping or choking sounds during sleep (usually noticed by a partner), and waking up with a dry mouth or headache. During the day, people with undiagnosed sleep apnoea often feel excessively tired no matter how many hours they spend in bed. Difficulty concentrating, irritability, and low mood are also common complaints. Because these symptoms overlap with so many other conditions, including stress and poor sleep habits, the link to sleep apnoea is easy to miss.
Not everyone who snores has sleep apnoea, and not everyone with sleep apnoea snores loudly. Some people experience quiet, shallow breathing interruptions that go entirely unnoticed by those around them. This is particularly common in women, whose symptoms often present differently to the textbook descriptions written around male patients. It is one reason women are historically underdiagnosed with the condition.
Who is at risk
Several factors increase the likelihood of developing sleep apnoea. Excess weight is the strongest risk factor, particularly when fat deposits accumulate around the neck and narrow the airway. A neck circumference above 40cm in men and 37cm in women is considered a risk marker. Age also plays a role, as throat muscles lose tone over time. Men are roughly twice as likely as women to be diagnosed with OSA, though the gap narrows significantly after menopause.
Other risk factors include smoking, alcohol consumption close to bedtime, nasal congestion, a naturally narrow airway or recessed jaw, and a family history of the condition. People with type 2 diabetes, high blood pressure, or a history of stroke have higher rates of sleep apnoea, and the relationship goes both ways: untreated sleep apnoea contributes to all of those conditions in turn. Given what we know about how chronic stress affects the body, the compounding health burden of poor sleep is significant.
How sleep apnoea is diagnosed
The standard test for sleep apnoea is a sleep study, known as polysomnography. Traditionally, this meant spending a night in a sleep clinic wired up to monitoring equipment. That remains the gold standard, but home sleep tests have become increasingly common and are now accepted for diagnosing straightforward OSA. A home test typically involves wearing a small device that measures breathing patterns, oxygen levels, heart rate, and body movement overnight.
A GP is the right first stop if you suspect sleep apnoea. They will assess your symptoms, take a history, and refer you for a sleep study if warranted. Many sleep studies in Australia are covered under Medicare, depending on the referral pathway and the type of study ordered.
Treatment options available in Australia
The most widely recommended treatment for moderate to severe OSA is continuous positive airway pressure therapy, commonly known as CPAP. A CPAP machine delivers a steady stream of pressurised air through a mask worn over the nose or mouth during sleep. The air pressure keeps the airway open, preventing the interruptions that define the condition. Most people notice significant improvements in daytime alertness and energy within the first few weeks of regular CPAP use.
For those who find CPAP uncomfortable or cannot tolerate the mask, alternatives exist. Mandibular advancement splints are custom-fitted mouthguards that reposition the jaw slightly forward to keep the airway open. They are generally recommended for mild to moderate OSA. Positional therapy, which simply involves training yourself to sleep on your side rather than your back, can reduce symptoms in some people whose apnoea is position-dependent.
Lifestyle changes form an important part of treatment at any severity level. Losing even a modest amount of weight can produce substantial improvements in OSA severity. Cutting back on alcohol, particularly in the evening, and quitting smoking both help. Treating nasal congestion with saline sprays or prescribed medication can also make a meaningful difference.
In some cases, surgery is considered. Procedures range from removing the tonsils or adenoids (especially relevant in children with OSA) to more involved upper airway surgery. A newer implantable device called hypoglossal nerve stimulation, which prompts the tongue muscle to contract during sleep and keep the airway clear, has shown promising results for people who cannot use CPAP. Surgical options are typically reserved for specific anatomical causes or situations where other treatments have failed.
The importance of treating it properly
Untreated sleep apnoea carries serious long-term health consequences. The repeated oxygen drops and sleep fragmentation put sustained stress on the cardiovascular system, raising the risk of high blood pressure, heart disease, stroke, and irregular heart rhythms. There are also well-documented links to metabolic conditions including insulin resistance and type 2 diabetes. Beyond physical health, the chronic tiredness associated with untreated sleep apnoea affects concentration, memory, reaction time, and mental wellbeing in ways that mirror the effects described in research on poor sleep hygiene more broadly.
The good news is that treatment genuinely works. People who adhere to CPAP therapy consistently report major improvements not just in sleep quality but in overall quality of life, including better mood, sharper thinking, and reduced cardiovascular risk over time. If you suspect sleep apnoea in yourself or someone close to you, speaking to a GP is the clearest first step. This is one condition where getting a proper diagnosis can make a profound difference.