When to think about sleep apnoea
Eight risk factors for sleep apnoea, how to tell it apart from insomnia, and why taking sleeping pills when you have apnoea makes it worse.
Key points
- Sleep apnoea is a disease of the airway rather than of sleep, but it shatters sleep and is very easily mistaken for insomnia.
- The eight commonly used risk factors: loud snoring, daytime sleepiness, witnessed breathing pauses, high blood pressure, obesity (high BMI), age over 50, a large neck, male sex.
- ⛔ Taking sleeping pills when you have sleep apnoea is dangerous: the medication relaxes the airway muscles and suppresses the arousal reflex, which is the reflex rescuing you each time the airway closes.
- Diagnosis requires measurement, by polysomnography or a home sleep test. No questionnaire replaces that.
The eight risk factors
The more factors present, the higher the likelihood. The first three are symptoms you or whoever sleeps next to you can observe; the other five are physical characteristics and accompanying conditions.
- Loud snoring, loud enough to be heard through a closed door, or to drive your partner into another room.
- Fatigue or daytime sleepiness despite spending enough hours in bed.
- Someone has witnessed you stop breathing, gasp or choke during sleep. This is the strongest of the eight.
- High blood pressure, or being treated for it.
- Overweight or obesity.
- Age over 50.
- A large neck circumference.
- Male sex. The risk is higher than in women, though the gap narrows after the menopause.
Why telling these apart matters
Someone who snores loudly, carries extra weight, wakes repeatedly each night and is wrecked during the day very easily concludes they have insomnia and goes out to buy sleeping pills. That direction is both wrong and unsafe. Sleeping pills relax the muscles of the throat so the airway collapses more readily, and at the same time make it harder to rouse, when each of those brief arousals is the mechanism reopening the airway. The result is longer apnoeas and deeper falls in oxygen saturation.
About the copyright of this questionnaire
This page lists risk factors published in the medical literature, in the clinic's own words. It is NOT the STOP-BANG questionnaire. STOP-BANG's terms of use are considerably narrower than they are usually described: the free portion covers EDUCATIONAL use only, while every other use, CLINICAL use included, requires a licence. Risk factors are public medical facts rather than copyrighted property; a standardised questionnaire is not.
Frequently asked questions
- I am thin. Can I still have sleep apnoea?
- Yes. Obesity is a strong risk factor but not a requirement. Jaw and facial structure, large tonsils, a deviated septum and some endocrine conditions also cause it in thin people.
- Is there a questionnaire that can settle it?
- No. Every questionnaire only stratifies risk in order to decide whether to measure. The conclusion requires a sleep study.
References
- Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea - American Academy of Sleep Medicine, 2017 · DOI 10.5664/jcsm.6506
- Sleep Apnea - National Heart, Lung, and Blood Institute (NIH), 2026
- About Sleep - Centers for Disease Control and Prevention, 2026
- Boxed warning about complex sleep behaviors with eszopiclone, zaleplon, and zolpidem (Drug Safety and Availability) - U.S. Food and Drug Administration, 2019