There is a condition that affects a substantial number of people, has significant health consequences, is treatable, and routinely goes undetected for a long time.
Obstructive sleep apnoea.
It goes undiagnosed largely because its most obvious sign happens while you are asleep, which means you are the one person who cannot observe it.
A note on scope before we start. We are a physiotherapy clinic. We do not diagnose or treat sleep apnoea. This article exists because it is common in the patients we see, it affects recovery, and recognising it is the first step toward something that belongs with your doctor.
How Common It Is in People With Pain
A meta-analysis examining sleep disturbance in people with chronic pain found obstructive sleep apnoea in 32 per cent of them.
Roughly one in three.
The same analysis found insomnia in 72 per cent and restless legs syndrome in 32 per cent.
And research in older adults with chronic low back pain found that risk of obstructive sleep apnoea was associated with both pain intensity and functional disability.
Which means that if you have persistent pain and disturbed sleep, this is a realistic possibility rather than an obscure one.
What Actually Happens
During sleep, the muscles of the upper airway relax. In obstructive sleep apnoea, they relax enough that the airway narrows or closes.
Breathing becomes shallow or stops briefly. Oxygen levels dip. The brain partially rouses you enough to reopen the airway, you take a gasping breath, and sleep resumes.
This can happen repeatedly through the night, in some cases many times an hour.
And crucially, you generally do not remember any of it. The arousals are brief and do not reach full wakefulness.
Which produces the characteristic situation: somebody spends eight hours in bed, has no memory of waking, and feels exhausted.
The Signs
What a partner might notice, and this is usually how it gets identified:
Loud, habitual snoring.
Pauses in breathing, followed by a gasp or a snort.
Restless, disturbed sleep.
What you might notice:
Waking unrefreshed despite adequate hours in bed.
Significant daytime sleepiness, particularly dozing off when sitting still, reading, or watching something.
Morning headaches.
A dry mouth or sore throat on waking.
Difficulty concentrating, or memory problems.
Low mood or irritability.
Waking needing to pass urine more than usual.
That last one surprises people and it is a recognised feature.
Why It Matters Beyond Feeling Tired
This is the part that justifies taking it seriously.
Untreated obstructive sleep apnoea is associated with a range of significant health conditions, including high blood pressure, heart problems, stroke risk, type 2 diabetes and metabolic problems.
Which is particularly relevant here, given that Bermuda has a diabetes prevalence of around 13 per cent of adults, more than twice the OECD average, and notable rates of obesity.
There is also a daytime safety issue. Excessive sleepiness affects driving and operating machinery, and that is a genuine risk rather than a theoretical one.
And from our perspective, it undermines recovery. Sleep is when tissue repair and adaptation occur, poor sleep lowers pain thresholds, and somebody who is chronically unrested will struggle to engage with any rehabilitation programme.
Who Is More Likely to Have It
Recognised risk factors include:
Excess weight, particularly around the neck.
Being male, though it occurs in women and is frequently under recognised in them.
Increasing age.
A large neck circumference.
Nasal congestion or structural narrowing of the airway.
Family history.
Alcohol and sedative use, both of which relax the airway muscles further.
Smoking.
And it is more common after the menopause in women, which is one reason it gets missed in that group.
Important: it occurs in people without any of these features, so their absence does not rule it out.
What to Do About It
This is a conversation with your doctor.
What to bring:
Your symptoms, specifically.
Observations from whoever shares your bed, which are frequently the most useful information available.
How sleepy you are during the day, and in what situations.
Your other health conditions, particularly blood pressure, diabetes and heart problems.
What might follow: screening questionnaires are commonly used, and diagnosis typically involves a sleep study, which may be done at home or in a sleep unit depending on what is available and what is appropriate.
Treatment options exist and are effective. Continuous positive airway pressure, commonly called CPAP, is the most established for moderate to severe cases. Other options including mandibular advancement devices, positional approaches and weight management may be appropriate depending on severity and individual circumstances.
All of which belongs with your medical team rather than with us.
What You Can Do Alongside
A few things that are within your control and generally advised, though they are supportive rather than a substitute for proper assessment.
Sleeping position. Symptoms are frequently worse lying on the back, and side sleeping helps some people. This is worth testing.
Alcohol, particularly in the evening, since it relaxes the airway muscles.
Sedating medication, which is a conversation with your doctor rather than something to adjust yourself.
Weight management where relevant, which has a genuine effect and is best approached with your doctor or a dietitian rather than independently.
And nasal congestion, which is worth addressing if it is a regular problem.
Why We Raise It
Three practical reasons.
It affects everything we are trying to help with. Pain, recovery, energy for exercise, and tolerance for discomfort.
It is common in exactly the population we see, particularly people with persistent pain.
And it frequently goes undetected for years, because the signs occur while you are unconscious and daytime tiredness gets attributed to age, work, stress or the pain itself.
If somebody has told you that you snore heavily or stop breathing, please take that to your doctor. It is one of the more consequential things you can act on.
Seek Medical Attention For
Loud snoring with witnessed pauses in breathing or gasping.
Waking unrefreshed despite adequate time in bed.
Excessive daytime sleepiness, particularly if you drive.
Morning headaches with unrefreshing sleep.
And seek urgent medical care for waking gasping or choking with chest pain or significant breathlessness.
If you are falling asleep unintentionally during the day, particularly while driving, that needs prompt medical attention and you should not drive until it has been assessed.
Let Us Help With the Part We Can
We cannot diagnose or treat sleep apnoea, and we can help with the musculoskeletal reasons people struggle to get comfortable, and with building the strength and activity that supports better sleep generally.
InTouch Therapy offers a free discovery visit at no cost and no obligation. You will get a thorough assessment, practical guidance on the physical contributors to your disturbed nights, and honest signposting when what you describe belongs with your doctor.
