Sleep apnea can sneak up on you, and it often goes undiagnosed. Untreated, it can damage your heart and wreak havoc with your hormone levels.Certain risk factors raise your risk of obstructive sleep apnea symptoms, including excess weight; having a thicker neck; being older; and using alcohol or tobacco. Common symptoms include waking up multiple times a night; snoring; feeling short of breath or as though you are choking; and insomnia.

1. Difficulty Falling Asleep

Sleep apnea can make it hard to fall asleep. It can also wake you up repeatedly throughout the night, which makes it difficult to return to sleep. These repeated awakenings can cause headaches that resemble migraines or make it harder to concentrate and perform at work or school.

People who have obstructive sleep apnea experience repeated episodes of breathing stopping or becoming shallow while they are sleeping. They may not remember the pauses, but they can wake up feeling short of breath or like they are choking.

Obstructive sleep apnea can affect anyone, but some factors increase the risk. These include being overweight, having a thick neck or large tonsils, being male, and using alcohol, sedatives or tranquilizers. It is also more common in older adults.

2. Sleep Disruption

When you have sleep apnea, your breathing stops and starts repeatedly during sleep. This can cause low levels of oxygen in your blood. It can also affect the heart. Symptoms of this include loud snoring, restless sleep, and excessive daytime sleepiness.

The muscles that support the back of the throat relax, narrowing or closing the airway. This causes a vacuum in the airway, which creates vibrations that are heard as snoring. This can also trigger a choking sensation or gasping.

Untreated sleep apnea can lead to a variety of health problems, including high blood pressure, heart disease and diabetes, which can increase your risk for stroke. It can also affect the brain and mood. Some people with untreated sleep apnea are at increased risk for death from sudden cardiac arrest.

3. Snoring

Although not everyone who snores has sleep apnea, if the snoring is loud and interrupted with pauses in breathing or sounds of choking, it is a major sign that should not be ignored. These pauses in breathing reduce the quality of your sleep and prevent you from reaching deep, restorative phases of sleep, which can have many serious health effects over time.

The interruptions in sleep also cause extreme fatigue and daytime drowsiness, which can impact your ability to function at work, drive, or complete other tasks safely and effectively. Eventually, these symptoms can lead to depression or other mental health problems. They can also affect your interpersonal relationships and increase the risk of accidents or injuries while driving or working at certain jobs.

4. Shortness of Breath

When you have sleep apnea, your breathing stops and becomes shallow. These pauses last from seconds to minutes and occur 30 times or more per hour. This can cause low oxygen levels in your blood and can cause your heart to pump harder to get the needed amount of air.

Your brain senses the lack of oxygen and briefly awakens you from a deep sleep. This is called a central or apneic event and is usually so short-lived you don’t remember it.

Sleep apnea can cause a variety of problems that spill over into your daytime activities. These include feeling tired and exhausted, even after a full night’s sleep. You may also experience snoring and mood changes such as depression and anxiety. These symptoms can lead to serious health problems such as high blood pressure, stroke and heart disease.

5. Insomnia

Sleep apnea often results in jerking body movements that make you choke or gasp. This happens repeatedly throughout the night and can interfere with your ability to reach deep, restful sleep.

You might have trouble staying asleep or wake up too frequently during the night, especially if you are sleeping with a partner. You might feel groggy and unfocused during the day. You might have mood swings or lose interest in sex.

Obstructive sleep apnea can be caused by many factors, including excess weight (because fat deposits around the upper airway can obstruct breathing), a large tonsil or changes in hormone levels during puberty and menopause. Certain health conditions like diabetes and heart disease, as well as medications such as narcotics or antidepressants, also can raise your risk for obstructive sleep apnea.