You sleep seven or eight hours every night. You go to bed at a reasonable time, you do not drink excessively, and you are not under any more stress than usual. Yet you wake up exhausted, you struggle to concentrate through the afternoon, and you feel as though you have never quite recovered from a tiredness that started months or years ago. Your GP has run blood tests. They were normal. You have been told it is probably stress.
It may not be stress. It may be your airway collapsing while you sleep.
What Sleep Apnoea Actually Is
Obstructive sleep apnoea (OSA) is a condition in which the soft tissue at the back of the throat relaxes during sleep, partially or fully blocking the airway. Breathing stops, sometimes for 10 seconds, sometimes for longer. The brain registers falling oxygen levels and briefly rouses you to restart breathing. This can happen 5, 30 or over 100 times per hour. You almost never remember these arousals. You simply wake in the morning feeling as though you have not slept at all, because in any meaningful restorative sense, you have not.
OSA affects an estimated 1 in 4 men and 1 in 9 women in the UK, though most cases are undiagnosed. It is particularly prevalent in middle-aged adults, people who are overweight, and those with a larger neck circumference. But it also occurs in people with none of these risk factors, which is one reason it is missed.
Why It Gets Mistaken for Burnout
The symptoms of untreated sleep apnoea and occupational burnout are almost identical: persistent fatigue that does not improve with rest, difficulty concentrating, low mood, reduced motivation, irritability and impaired decision-making. Both affect performance at work. Both are more common in high-pressure professionals. And both are blamed on stress by a system that has 10 minutes to reach a conclusion.
The critical difference is the mechanism. Burnout is driven by a chronic mismatch between demand and resources. Sleep apnoea is driven by oxygen deprivation occurring hundreds of times a night. Burnout responds to rest, boundary-setting and sometimes psychological support. Sleep apnoea responds to a device worn during sleep that keeps the airway open. Getting these two confused costs people months or years of unnecessary exhaustion.
The Signs to Look For
Sleep apnoea does not always announce itself loudly. A partner who reports loud snoring and witnessed pauses in breathing is the clearest indicator, but many people with OSA sleep alone or have partners who sleep through it. Other signs include:
- Waking unrefreshed regardless of how long you slept
- Significant daytime sleepiness, particularly in sedentary situations such as meetings or reading
- Waking during the night with a dry mouth, sore throat or a sense of gasping
- Morning headaches, particularly across the forehead
- Nocturia — waking to urinate more than once per night is frequently caused by OSA and often goes unrecognised as such
- Difficulty concentrating, memory problems and mood disturbance
- High blood pressure that is difficult to control despite medication
The STOP-BANG Questionnaire
STOP-BANG is the validated clinical screening tool used by GPs and sleep clinicians to assess the likelihood of OSA. Each letter stands for a risk factor:
- Snoring — do you snore loudly?
- Tired — do you often feel tired, fatigued or sleepy during the day?
- Observed — has anyone observed you stop breathing during sleep?
- Pressure — do you have or are you being treated for high blood pressure?
- BMI — is your BMI over 35?
- Age — are you older than 50?
- Neck — is your neck circumference over 40cm?
- Gender — are you male?
A score of 3 or more indicates moderate to high risk of OSA. A score of 5 or more indicates high risk. But even a score of 1 or 2 does not exclude OSA, particularly in younger women where the condition is systematically under-recognised because it does not fit the classic profile.
The Epworth Sleepiness Scale
The Epworth Sleepiness Scale asks you to rate the likelihood of falling asleep in eight everyday situations — sitting reading, watching television, as a passenger in a car for an hour, and so on. A score above 10 suggests excessive daytime sleepiness warranting investigation. A score above 16 indicates severe daytime sleepiness. Dr Schoinas uses the Epworth alongside STOP-BANG during the consultation to quantify the degree of impairment and the urgency of referral.
How Sleep Apnoea Is Confirmed
Clinical screening identifies risk but does not diagnose OSA. Diagnosis requires a sleep study. This used to mean a night in a sleep laboratory wired to multiple sensors. Most NHS and private sleep studies now use a home sleep apnoea test: a small device worn on the wrist and finger overnight that records oxygen levels, heart rate, movement and breathing effort. It is accurate, comfortable and can be done in your own bed. Results are interpreted by a sleep physician and, if OSA is confirmed, treatment is initiated.
What Treatment Looks Like
The standard treatment for moderate to severe OSA is Continuous Positive Airway Pressure (CPAP) — a mask worn during sleep that delivers a gentle flow of air to keep the airway open. CPAP has an excellent evidence base. Most people who use it consistently report a dramatic improvement in daytime energy and concentration within the first two weeks. Mild OSA may be managed with weight loss, positional adjustments or a mandibular advancement device fitted by a dentist. The appropriate treatment depends on OSA severity and individual circumstances, and is determined by the sleep physician following the study.
Why Seeing a GP First Matters
Sleep apnoea does not exist in isolation. Untreated OSA significantly increases the risk of hypertension, atrial fibrillation, type 2 diabetes, stroke and cardiovascular disease. It impairs driving reaction times to a degree comparable to drink-driving. A GP assessment before referral ensures that blood pressure, cardiovascular risk and metabolic markers are checked at the same time, giving the sleep physician a complete clinical picture rather than a single isolated complaint.
At AristoGP, Dr Schoinas includes sleep apnoea screening in every burnout and fatigue assessment, alongside a full blood panel, physical examination and resting ECG. If the clinical picture warrants it, referral for a home sleep study is arranged at the same appointment. GP consultation from 150 pounds. Same-day appointments available at 1-5 Portpool Lane EC1N, four minutes from Chancery Lane.