Sleep apnoea: the common sleep disorder most people miss.
Sleep apnoea is a breathing disorder where the airway repeatedly narrows and/or collapses fully during sleep, disrupting normal sleep architecture and preventing the body from achieving the restorative sleep it needs to rest and repair. The most recognisable symptoms are loud, habitual snoring, pauses in breathing noticed by a partner, and gasping or choking during sleep.
Sleep apnoea is one of the most prevalent sleep disorders, and it can often hide behind what many people assume is the hallmark of being a "good" sleeper: the ability to fall asleep almost as their head hits the pillow. This creates a significant blind spot. Rather than recognising this indicator as a red flag for a potential sleep disorder, many people simply assume they are good sleepers who have the ability to fall asleep quickly at bedtime and if the opportunity allows during the day.
One of the biggest misconceptions about sleep issues is the assumption that the only people with a sleep problem are the ones who struggle to fall asleep. Lying awake night after night is easy to recognise as having some difficulty sleeping. This assumption can mean that sleep apnoea frequently remains undiagnosed for years despite deeper restorative sleep being repeatedly disrupted beneath the surface.
This is through no fault of our own as we live in a society that has come to judge healthy sleep largely on sleep duration, with more sleep often assumed to be better. This has meant we have neglected and undervalued the other integral components of healthy sleep, particularly sleep quality. We all understand that a healthy diet is about far more than simply consuming enough calories. We wouldn't consider someone having a healthy diet if they met their calorie requirements by eating nothing but burgers and fries. Yet up until recently much of the public conversation around sleep has focused almost exclusively on duration. Just like nutrition, healthy sleep depends on more than simply the total amount of sleep. Quality, timing and regularity are equally important, and recent research suggests they may matter more than duration when it comes to our long-term health (Windred et al., 2024).
Tired no matter how much you sleep? It could be sleep apnoea.
Falling asleep very quickly (in less than 5–10 minutes most nights) is not necessarily a sign of being a good sleeper. In fact, it often reflects that the body is carrying a significant sleep debt. It is a bit like when we are absolutely ravenous and almost ‘inhale’ a meal. In the same way, a brain that has become desperately hungry for sleep over time will often fall asleep very quickly.
Yet these same people often feel they need nine or ten hours of sleep to function, wake feeling unrefreshed despite a full night's sleep, or regularly fall asleep on the couch in the evening. Many also don't recognise how affected they are, having lived with poor-quality sleep for so long that it has simply become their normal. When this state becomes chronic, the nervous system often compensates by staying in a higher state of activation, allowing them to keep pushing through the day without registering the long-term cost, rather like pressing harder on the accelerator.
Why is sleep apnoea so often missed?
Sleep apnoea is one of the most common sleep disorders, yet it remains significantly under-recognised. Around 80% of people with obstructive sleep apnoea are estimated to remain undiagnosed (Sönmez et al., 2025). One reason sleep apnoea is so often missed is the stereotypical image many people still associate with the condition: an older man with a higher body weight who snores loudly. While age and body weight can influence risk, this stereotype – along with the stigma surrounding it – means many people who do not fit this profile are overlooked. Increased body weight does raise the risk, but jaw structure and airway anatomy mean that anyone can be affected, regardless of age, weight or fitness level.
Is snoring a sign of sleep apnoea?
Decades of cultural portrayals have also created the illusion that snoring is a sign of restful sleep, with the familiar image of a cartoon character snoring peacefully often used to represent someone who is sleeping soundly. In reality, snoring is a sign that the airway is narrowing and airway resistance is increasing, which can trigger the brain to sound an alarm to wake you from deeper sleep to take a breath. If someone gasped and laboured for air like that during the day, we would call an ambulance! Yet snoring has simply become normalised.
This can happen dozens, and sometimes hundreds, of times throughout the night. Most people are unaware it's happening, since each awakening is often only seconds long and we are not always fully awoken by it.
How does sleep apnoea affect your heart?
Every breathing disruption triggers a brief sympathetic nervous system response – essentially a small surge of adrenaline – causing a temporary increase in heart rate and blood pressure. When this happens repeatedly throughout the night, the body – particularly the cardiovascular system – is exposed to ongoing physiological stress rather than the restorative state it relies on during sleep. Over time, untreated sleep apnoea is particularly associated with an increased risk of high blood pressure, cardiovascular disease, and stroke.
Unfortunately, despite the serious health risks, many people are still held back by the assumption that getting a diagnosis will mean needing one of those ‘Darth Vader’ masks. But there are now multiple options for treating sleep apnoea. CPAP is one of them, and it can also be life-changing for many.
What are the symptoms of sleep apnoea?
The most recognisable symptoms are loud, habitual snoring, pauses in breathing noticed by a partner, and gasping or choking during sleep.
However, the symptoms people often miss are the less obvious clues: waking unrefreshed, morning headaches, excessive daytime sleepiness, brain fog, difficulty concentrating, memory difficulties, low mood, anxiety, or needing to get up repeatedly overnight to urinate.
Although loud snoring and excessive daytime sleepiness remain the more typical presentation, sleep apnoea has several recognised phenotypes, and some can resemble another sleep disorder. We are also not a good judge of our own sleep quality and so often, it is a bed partner who notices loud snoring, pauses in breathing or episodes of gasping during the night. For people who sleep alone, these clues can easily go unnoticed, meaning important signs of a breathing disorder may be missed.
This variability, combined with symptoms that can be relatively non-specific, means many people normalise what they are experiencing, compensate around it, or attribute it to stress, hormones, lifestyle or simply getting older.
The risk is that sleep apnoea can remain unrecognised for years while the body continues to experience repeated physiological stress throughout the night. Over time, this can take a significant toll on the body.
Is it insomnia or sleep apnoea?
For some people, sleep apnoea can present more like sleep maintenance insomnia. They may fall asleep easily but wake repeatedly throughout the night. For people whose sleep is more sensitive to disruption, these brief surges of sympathetic activation can be enough to fully wake them. They may wake with a racing heart, feeling startled, anxious or suddenly alert, without ever realising that the awakening was triggered by a breathing disturbance. But insomnia is more of a symptom than a diagnosis, much like a fever is when we are fighting an infection. Having the symptom of insomnia doesn't explain the underlying driver for the individual, so having a thorough sleep assessment that screens for other sleep disorders, such as obstructive sleep apnoea, that can produce similar symptoms is important.
Sleep apnoea can resemble insomnia because repeated breathing disruptions fragment sleep. In some people, though not everyone, these disruptions are enough to fully wake them, leading to frequent awakenings and difficulty maintaining sleep. Over time, these repeated awakenings can create the conditions for chronic insomnia to develop. Waking repeatedly in a physiologically activated state can provide an ongoing opportunity for rumination during the night and that can lead to a learned pattern of wakefulness to develop.
Sleep apnoea and insomnia are different disorders, but they frequently occur together. This combination is now recognised as COMISA (comorbid insomnia and sleep apnoea), and a diagnosis of one should never rule out investigating the other. This is why treating one problem while overlooking the other can lead to incomplete improvement.
Do women get sleep apnoea?
Sleep apnoea is significantly under-recognised in women, partly due to having a different presentation and also due to the stereotype of it being a men's issue.
Women also often present differently from the classic symptom pattern seen in men. Rather than the classic picture of loud snoring and excessive daytime sleepiness, symptoms may include fatigue, insomnia-like sleep disruption, and changes in weight or metabolism. These symptoms are frequently attributed to hormones, stress or lifestyle factors, when an underlying breathing disorder may also be contributing.
Around menopause, rates of sleep apnoea in women begin to approach those seen in men (Young et al., 2003). Unfortunately, many of the symptoms overlap with those commonly experienced during perimenopause and menopause, meaning sleep apnoea can be overlooked or mistakenly attributed to hormonal changes alone.
How is sleep apnoea diagnosed in New Zealand?
Diagnosing sleep apnoea requires an overnight sleep study arranged through a sleep clinic. This is now usually completed at home using portable monitoring equipment and interpreted by a sleep physiologist.
While some apps and consumer sleep trackers can raise suspicion that sleep apnoea may be present, they cannot diagnose the condition. A clinical sleep study is still required to confirm the diagnosis, determine severity and guide appropriate treatment. At Autonomy we can refer our patients for this sleep study.
Should you get tested for sleep apnoea?
At Autonomy, we believe investigation should come before assumptions. If someone is exhausted, waking unrefreshed or experiencing poor sleep, the important question is "what is driving this?" Because if breathing is disrupting sleep hundreds of times each night, no amount of sleep advice, supplements or behavioural strategies alone will address the physiological airway instability.
Understanding the cause is the first step towards finding the right treatment and restoring truly restorative sleep.
Kate Blyth
Sleep Coach, Autonomy Health
Medically reviewed by Dr Ula Heywood, MBChB, FACEM. Published 24 July 2026.
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References:
Sönmez, I., Vo Dupuy, A., Yu, K. S., Cronin, J., Yee, J., & Azarbarzin, A. (2025). Unmasking obstructive sleep apnea: Estimated prevalence and impact in the United States. Respiratory Medicine, 248, 108348.https://doi.org/10.1016/j.rmed.2025.108348
Young, T., Finn, L., Austin, D., & Peterson, A. (2003). Menopausal status and sleep-disordered breathing in the Wisconsin Sleep Cohort Study. American Journal of Respiratory and Critical Care Medicine, 167(9), 1181–1185.https://doi.org/10.1164/rccm.200209-1055OC
Windred, D. P., Burns, A. C., Lane, J. M., Saxena, R., Rutter, M. K., Cain, S. W., & Phillips, A. J. K. (2024). Sleep regularity is a stronger predictor of mortality risk than sleep duration: A prospective cohort study. Sleep, 47(1), zsad253. https://doi.org/10.1093/sleep/zsad253
