Sign up for CNN’s Sleep, But Better newsletter series. Our seven-part guide has helpful hints to achieve better sleep.
If you snore the house down, you may be suffering from obstructive sleep apnea, or OSA — a potentially dangerous condition in which people stop breathing for 10 seconds or more at a time.
The condition has been linked to smaller brain volume, damage to the white matter communication pathway in the brain and even a three times higher risk of dying from any cause. If left untreated, obstructive sleep apnea puts you at higher risk for hypertension, heart disease, type 2 diabetes, depression and even an early death, according to the American Academy of Sleep Medicine.
Yet even if you’re a rock star at snoring, you may not know you have obstructive sleep apnea unless someone tells you about your nocturnal roars. That’s why it’s important for partners and friends to speak up and encourage snorers to get professional help.
But what if you have an odd or quirky symptom besides snoring? You and your loved ones may have no idea that you are in danger, and the condition could go undiagnosed for years.
“Greater than 30 million people have sleep apnea in the United States, yet it’s often underdiagnosed or misdiagnosed,” said sleep specialist and pulmonologist Dr. Raj Dasgupta, an associate professor of clinical medicine at the University of Southern California’s Keck School of Medicine.
“It’s really misdiagnosed in women versus men because women may not present with the classic, heroic snoring that men often show,” he said.
Here are five weird signs of obstructive sleep apnea to watch for, according to Dasgupta.
There are many reasons people may sweat at night. It could be too hot, especially with the persistent heat waves in the past few years due to the climate crisis. Certain medications can cause night sweats, as can cancer, thyroid issues, the flu and bacterial infections, and the onset of menopausal symptoms, according to the Mayo Clinic.
But research has shown that about 30% of people with obstructive sleep apnea have reported night sweats, Dasgupta said.
“It’s because your body isn’t getting enough oxygen you fall into this sympathetic fight-or-flight mode, which triggers night sweats,” he said. “The research showed people with OSA that had night sweats were also more likely to have really low oxygen levels on top of having obstructive sleep apnea.”
Many people get up at night to empty their bladders — it can be caused by alcohol overindulgence, diabetes, edema, high blood pressure, certain medications, pregnancy, prostate issues and even drinking too many fluids before bed, according to the Cleveland Clinic.
But getting up at least two times a night to urinate — which is called nocturia — can also be a sign of obstructive sleep apnea, Dasgupta said.
“One study found about 50% of patients with OSA had nocturia, and they noted that treatment for the sleep disorder did cut back on awakenings,” he said.
Nevertheless, frequent nighttime urination is not commonly asked about in screening questionnaires on sleep apnea in primary provider offices, Dasgupta said.
Grinding or clenching teeth while sleeping is called bruxism, and it too may be a sign of obstructive sleep apnea, Dasgupta said.
“Certainly, anxiety and other factors can cause bruxism, but a common cause is obstructive sleep apnea,” he said. “There’s a theory on why — the airway becomes obstructed, so the muscles in the mouth and jaw move to try to free the blocked airway. That’s not been proven, but it is an interesting hypothesis.”
Most people who grind or clench their teeth use a mouthguard suggested by their dentist for protection, but it won’t protect the jaw, Dasgupta said.
“So, a person might also develop TMJ (dysfunction), which is pain in the temporomandibular joint, and that may also lead to other issues, such as headaches,” he said.
Studies have found a link between having obstructive sleep apnea and waking up with a headache, Dasgupta said.
“They typically occur daily or most days of the week and may last for several hours after awakening in the morning,” he said. “The cause of the headaches is not well-established and may be multifactorial.”
Headaches caused by obstructive sleep apnea don’t appear to lead to nausea or increased sensitivity to light and sound. Instead, they seem to be a pressing sensation on both sides of the forehead that lasts about 30 minutes, according to a June 2015 study.
Depression, fatigue and insomnia
Some symptoms of obstructive sleep apnea can disguise themselves as issues of mental health, brain fog or other sleep problems, Dasgupta said.
“Sleep affects our ability to think, react, remember and solve problems,” he said. “Women especially have a tendency to underreport atypical symptoms such as insomnia, fatigue and depression.”
If obstructive sleep apnea awakens you, it may be hard to go back to sleep. A person may suspect insomnia, not realizing that a different issue may be triggering the awakenings.
Symptoms of daytime fatigue include a lack of motivation to accomplish everyday tasks, a lack of productivity at work, memory problems and a low interest in being social, Dasgupta said. Those are also signs of depression, so if the sleep issues aren’t brought up at a health visit, the underlying cause may be missed.
For more CNN news and newsletters create an account at CNN.com