Snoring, choking or gasping: when to get tested for sleep apnea

You've just drifted off to sleep and suddenly, you're awakened by your spouse's loud gasping. They settle right back into slumber, but you're left awake, listening to them snore. Or perhaps you're the one waking up with a dry throat, morning headache, and crushing fatigue — despite spending 8 hours in bed.

Your sleep partner's nighttime habits are not only annoying — they could also be signs of a serious medical condition: obstructive sleep apnoea (OSA).

Sleep apnoea affects an estimated 30% of adults in Singapore, yet most remain undiagnosed. Here's what you need to know about symptoms, risks, and getting tested.

What is sleep apnoea?

Obstructive sleep apnoea is a disorder where your throat muscles relax repeatedly during sleep, blocking your airway. Each blockage — or apnoea — can last 10 seconds or more, sometimes hundreds of times per night.

When your airway closes, your brain detects falling oxygen levels and briefly wakes you to resume breathing. You may not remember these awakenings, but they fragment your sleep, preventing deep, restorative stages.

The result: you wake up feeling unrefreshed, no matter how many hours you spent in bed.

The classic symptoms: more than just snoring

Loud, frequent snoring is the most well-known symptom, but not everyone who snores has sleep apnoea — and not everyone with sleep apnoea snores. Look for these signs:

• Loud, disruptive snoring (often worse when lying on your back)
• Witnessed pauses in breathing, choking, or gasping during sleep
• Waking up with a dry mouth, sore throat, or headache
• Morning fatigue and excessive daytime sleepiness (falling asleep at work, while driving, or watching TV)
• Difficulty concentrating, memory problems, or irritability
• Waking up frequently to urinate (nocturia)
• Teeth grinding (bruxism) or night sweats

If you have several of these symptoms — especially if your partner has witnessed you stop breathing — see a doctor.

The health risks of untreated sleep apnoea

Sleep apnoea isn't just about feeling tired. Untreated, it significantly increases your risk of:

• High blood pressure (the repeated oxygen drops stress your cardiovascular system)
• Heart disease, heart attack, and stroke (2–3x higher risk)
• Type 2 diabetes (sleep apnoea worsens insulin resistance)
• Atrial fibrillation (irregular heartbeat)
• Car and workplace accidents (due to daytime sleepiness)
• Depression and anxiety
• Cognitive decline and memory problems

The good news: treating sleep apnoea can reverse many of these risks.

Risk factors: who gets sleep apnoea?

Sleep apnoea can affect anyone, but certain factors increase your risk:

• Excess weight (especially around the neck) — The most significant risk factor
• Large neck circumference (17+ inches for men, 16+ for women)
• Male gender (men are 2–3x more likely)
• Age (risk increases after 40)
• Family history of sleep apnoea
• Nasal congestion, deviated septum, or large tonsils
• Smoking and alcohol use (both worsen airway collapse)

In Singapore, the high prevalence of obesity and metabolic syndrome contributes to rising rates of sleep apnoea.

How is sleep apnoea diagnosed?

If your doctor suspects sleep apnoea, they will refer you for a sleep study. In Singapore, you have two main options:

In-lab polysomnography (gold standard)

You spend a night in a sleep laboratory (available at SGH, NUH, CGH, and private sleep centres). Sensors monitor your brain waves, eye movements, heart rate, breathing, oxygen levels, and body movements.

Pros: Most accurate, can diagnose other sleep disorders (narcolepsy, restless legs). Cons: More expensive (SGD 800–1500), requires sleeping in an unfamiliar environment.

Home sleep apnoea test (HSAT)

You take home a portable device that monitors your breathing, oxygen levels, and heart rate while you sleep in your own bed.

Pros: More convenient, less expensive (SGD 300–500), comfortable. Cons: Less comprehensive, may miss mild cases or other disorders.

Your doctor will recommend the appropriate test based on your symptoms and risk factors.

Treatment options: from lifestyle to CPAP

Sleep apnoea is highly treatable. The right treatment depends on severity (mild, moderate, or severe).

Lifestyle changes (for mild cases)

Weight loss (even 10% can significantly reduce symptoms)

Positional therapy (avoid sleeping on your back)

Avoiding alcohol and sedatives before bed

Treating nasal congestion (nasal sprays, strips, or allergy treatment)

Oral appliances

Custom-fitted mouthpieces (like a sports mouthguard) that reposition your jaw or tongue to keep your airway open. Best for mild to moderate apnoea.

CPAP (Continuous Positive Airway Pressure)

The gold standard for moderate to severe sleep apnoea. A small mask delivers pressurised air that keeps your airway open while you sleep.

CPAP is highly effective — but only if you use it. Many people struggle with mask discomfort, noise, or claustrophobia. Modern CPAP machines are quieter and more comfortable than older models, and there are many mask styles.

Surgery

Reserved for specific anatomical problems (large tonsils, deviated septum) or when other treatments fail. Options include tonsillectomy, jaw advancement, or Inspire (a surgically implanted nerve stimulator).

The Singapore context

Sleep apnoea is a growing health concern in Singapore. A 2023 study estimated that 30–40% of middle-aged Singaporean men have moderate to severe sleep apnoea, many undiagnosed.

Why so high? Contributing factors include:

• High rates of obesity and metabolic syndrome
• Asian facial anatomy (smaller jaw, higher Mallampati scores)
• Long working hours that discourage seeking medical care
• Lack of awareness (many think loud snoring is normal)

The good news: Singapore has excellent sleep medicine services at public hospitals and private clinics. Medisave and some insurance plans cover sleep studies and CPAP machines.

What about snoring without apnoea?

Not all snorers have sleep apnoea. "Primary snoring" (snoring without oxygen desaturation or sleep disruption) is generally harmless, though it can still disturb your partner.

Options for primary snoring include:

• Weight loss and exercise
• Avoiding alcohol and sedatives before bed
• Sleeping on your side (try a tennis ball sewn into a shirt pocket)
• Nasal strips or dilators
• Oral appliances (if lifestyle changes aren't enough)

The only way to know whether you have sleep apnoea is to get tested.

How to talk to your doctor

Many people hesitate to bring up sleep problems with their doctor. Here's how to start the conversation:

• "I'm always tired no matter how much I sleep. My partner says I snore loudly and sometimes stop breathing."
• "I wake up with headaches and a dry mouth most mornings."
• "I've fallen asleep at my desk / while driving / while watching TV, even after a full night's sleep."

Your GP can perform a simple screening questionnaire (STOP-BANG) and refer you to a sleep specialist if needed.

The bottom line

Sleep apnoea is common, serious, and treatable. Loud snoring, witnessed pauses in breathing, and excessive daytime sleepiness are red flags that deserve medical attention.

Don't dismiss your symptoms as "just snoring" or "being tired." A proper diagnosis could save your health — and your life.

If you suspect sleep apnoea, see your doctor. A sleep study is a small inconvenience for a lifetime of better sleep, better health, and better days.