Sleep apnea is often first noticed because of a very concrete detail: snoring that worries a loved one, fatigue that does not go away, or startling awakenings that one gradually comes to take for granted. I am Dr Solène Vo Quang, an oral surgeon in Paris, at 7 rue Marbeau. My role includes referral, oral assessment and discussion of an oral appliance when this sleep disorder is suspected.

My aim here is to help you understand the signs, diagnosis and possible treatments, without dramatising or oversimplifying. Several approaches are available, each with their merits, and the right decision always depends on your personal situation.

What is sleep apnea?

Sleep apnea is a breathing disorder in which breathing stops at times or repeatedly becomes shallower during the night. In the most common form, OSAHS (obstructive sleep apnea-hypopnea syndrome), airflow through the upper airways is partly or completely blocked.

This is often caused by relaxation of the tissues of the pharynx, the area at the back of the throat. When air passes through less easily, snoring occurs and may sometimes be followed by a pause in breathing. The brain responds with very brief, often unremembered awakenings to restart breathing.

Apnea, hypopnea, micro-awakening: terms to understand

An apnea is when breathing stops for more than 10 seconds, sometimes much longer. A hypopnea is a reduction in airflow without a complete stop, but it may affect oxygenation and sleep quality.

A micro-awakening is a brief reaction of the brain. You generally do not remember it, but repeated micro-awakenings fragment sleep and explain significant fatigue despite what seems like a long night's sleep.

Obstructive and central sleep apnea: an important distinction

Obstructive sleep apnea is linked to a mechanical obstruction to airflow, most often in the pharynx. In this setting, assessment of the mouth, jaw and occlusion is particularly relevant when considering an oral appliance.

Central sleep apnea is different: it concerns how the nervous system controls breathing. It requires specific medical assessment, and management is not limited to an oral device.

Sleep apnea: symptoms that should prompt attention

Patients often ask me how to tell whether they have sleep apnea. A single symptom is not enough, but a combination of signs should prompt a consultation, especially when relatives observe pauses in breathing.

This concern is entirely understandable: you sense that something is wrong without knowing whether it relates to stress, age or a genuine breathing disorder.

Signs observed at night

At night, the most suggestive signs are worth listing clearly. Here are the ones to mention during a consultation:

• Loud, regular snoring
• Pauses in breathing observed by a loved one
• Repeated startling awakenings
• Unusual night sweats
• Frequent urge to urinate at night

The person who shares your bedroom often plays an essential role. Their account does not replace an examination, but it provides information that you cannot notice on your own.

I always take seriously what a loved one observes while you sleep.

Signs felt during the day

During the day, sleepiness is an important sign: dozing off in front of a screen, in a meeting or on public transport. Fatigue, morning headaches, concentration or memory problems may also be part of the picture.

Some patients describe irritability that feels unlike them, or a more depressed mood. These signs are not specific, but when associated with snoring and pauses in breathing, they warrant medical advice.

Causes and risk factors for sleep apnea

There is rarely a single cause. In my practice, I take care not to reduce a person to their weight, age or lifestyle. These factors may increase the likelihood of the disorder, but they do not sum up either your history or the management needed.

Being overweight, age, certain family histories, alcohol, tobacco, certain medicines or sleeping on the back can encourage narrowing of the airways. People who are not overweight can also have sleep apnea, particularly for anatomical reasons.

Why the airways close during sleep

During sleep, the muscles relax. In some people, this relaxation narrows airflow through the pharynx too much, rather like a corridor whose walls move closer together. If the passage narrows further, breathing decreases or stops; the brain then triggers a micro-awakening to restore airflow.

Weight, alcohol, tobacco, sleep position: possible levers

Several everyday adjustments may be discussed as useful measures. I often recommend that my patients note their sleep schedules, usual position, awakenings and comments from those around them for two weeks before the consultation.

These measures do not systematically replace medical treatment. They form part of an overall approach, especially when a sleep recording confirms a significant breathing disorder.

When should you seek advice, and how is sleep apnea diagnosed?

Seeking advice is reasonable when snoring is significant, pauses in breathing are observed, or fatigue affects your daily life. Diagnosis is based not only on what you feel, but also on a sleep recording.

The care pathway often begins with your GP and may then involve a sleep specialist. My role is referral, oral assessment and discussion of a mandibular advancement device when that option is being considered.

Polygraphy or polysomnography: what are these tests for?

A overnight respiratory polygraphy is a recording focused on breathing, often carried out at home. It measures breathing parameters and oxygenation during the night.

A polysomnography is more comprehensive and is often performed in a sleep centre. It examines more parameters, which is useful when diagnosis is complex or other associated disorders are present.

How do you fit the device used to test for sleep apnea?

This is a common and entirely legitimate question. The device should be fitted according to the instructions of the medical team or provider, with respiratory sensors and oxygen measurement. I always recommend asking for a demonstration if anything is unclear. Do not alter the set-up on your own: recording quality determines how reliable the result will be.

Understanding the AHI without getting lost in the numbers

The AHI (apnea-hypopnea index) is the number of breathing events per hour of sleep. It helps classify the severity of the disorder. The usual reference points are: 5 to 14 for mild sleep apnea, 15 to 30 for moderate sleep apnea, and above 30 for severe sleep apnea. These thresholds may vary according to the framework used, and interpretation always takes symptoms and medical context into account.

Sleep apnea treatment: CPAP, oral appliance and everyday measures

Treatment is not simply a matter of automatically choosing a device. The decision depends on severity, your symptoms, your tolerance and what is realistic in your everyday life.

CPAP is often preferred for severe sleep apnea and some moderate forms. A mandibular advancement device may be offered for certain patient profiles or when CPAP is poorly tolerated, after medical and oral assessment.

CPAP: understanding the device and mask

Continuous positive airway pressure (CPAP) delivers air through a mask to keep the airways open during the night. Getting used to it may take time. Mask comfort, dryness or discomfort at night should be discussed with the follow-up team, without giving up too quickly or feeling guilty.

Mandibular advancement device: an option to assess case by case

A mandibular advancement device (MAD) is worn in the mouth and moves the lower jaw slightly forward to help air pass through. It is not a universal solution, but it may be relevant for some patients. Whether it is indicated depends on several factors:

• AHI value and symptom severity
• Cardiovascular context
• Condition of the teeth and gums
• Health of the jaw joint
• Likely tolerance of the device

My role is to assess the mouth, occlusion and functional constraints, then coordinate the discussion with the sleep specialist.

Associated measures: weight, physical activity and sleep position

Everyday measures still have a real role when relevant: weight loss when indicated, physical activity, reducing tobacco and alcohol, and a preference for sleeping on one's side. They may improve respiratory factors and sleep quality.

I present them as support, not as a substitute for CPAP or a MAD. Sleep apnea illustrates the need to link breathing, metabolism, alertness and quality of life in coherent care.

Risks, life expectancy and everyday safety

Questions about life expectancy or the risk of dying in one's sleep reflect a concern I fully understand. Sleep apnea should not be approached as an immediate fear, but as a disorder that can have real health consequences if it is neither diagnosed nor monitored.

It is associated with cardiovascular and metabolic risks, whose extent depends on each patient's medical context. This justifies appropriate diagnosis and follow-up, particularly where high blood pressure, type 2 diabetes or cardiovascular history are present.

Can sleep apnea be fatal?

I prefer to answer calmly: the main issue is not to live in fear of a sudden event at night. The issue is to recognise a disorder which, if it persists, may affect quality of life, memory and concentration, and may be associated with complications depending on the medical context.

The right approach is to seek advice when signs are present. An accurate diagnosis helps remove uncertainty and makes it possible to discuss proportionate care.

Sleepiness, driving and alertness: an often underestimated issue

Daytime sleepiness is not merely an inconvenience. It can become a safety issue when driving, at work or in any situation requiring sustained alertness. If you fall asleep involuntarily or have difficulty staying awake in unusual circumstances, speak to a doctor. It is important to name this without shame, because it can change how urgently assessment is needed.

Care to build together

Sleep apnea rarely calls for a single answer. Management is built on your account, observations from those around you, the sleep recording, the AHI, your symptoms and your tolerance of treatment.

In this approach, I place great importance on diagnostic accuracy and coordination between the different professionals involved. Depending on the situation, the GP, sleep specialist and oral surgeon each have a clearly defined role.

The role of the oral surgeon in referral and oral appliances

As an oral surgeon, I can identify certain anatomical or functional factors, assess oral health and discuss the feasibility of a mandibular advancement device. This assessment covers the teeth, gums, jaw, occlusion and likely tolerance of the device.

I do not present an oral appliance as an automatic answer, but as an option to integrate into a coordinated care pathway, with the person at its centre. If you recognise several of these signs in everyday life, a good first step is to discuss them during a consultation. If necessary, we can arrange a sleep assessment and then discuss possible options together, without rushing.

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