Sleep apnea: symptoms, screening, and treatment in Quebec

Sleep apnea is a respiratory disorder that occurs at night, often without the person being aware of it. Thousands of Quebecers suffer from it without knowing it. Chronic fatigue, morning headaches, and loud snoring reported by a bed partner are sometimes the only clues. However, untreated, sleep apnea increases the risk of cardiovascular disease, diabetes, and drowsy driving accidents.

This page explains what sleep apnea is, how to recognize it, how it is screened for, and what treatment options are available in Quebec.

What is sleep apnea?

Sleep apnea is defined by repeated breathing cessations during sleep, lasting at least ten seconds, occurring several times per hour. These respiratory pauses disrupt sleep quality and deprive the brain and organs of an adequate oxygen supply.

There are three main forms:

• Obstructive sleep apnea (OSA) — the most common. It occurs when the throat muscles relax too much during sleep, partially or completely blocking the upper airway.
• Central sleep apnea — and rarer. The brain doesn't send the correct signals to the respiratory muscles. Often associated with heart or neurological diseases.
• Mixed apnea — a combination of the two previous forms.

Severity is classified based on the apnea-hypopnea index (AHI): mild, moderate, or severe, depending on the number of respiratory events per hour of sleep.

Who is at risk?

Obstructive sleep apnea can affect anyone, but certain factors increase the risk:

• Male sex (men are more affected, although the risk increases in women after menopause)
• Overweight or obesity, especially with fat accumulation in the neck and throat area
• Anatomy of the upper airway: thick neck, receded jaw, enlarged tonsils
• Alcohol or sedative consumption, which relaxes the throat muscles more
• Smoking
• Family history of sleep apnea
• Chronic nasal congestion or deviated septum
• Certain medical conditions: hypothyroidism, PCOS, acromegaly

Children can also be affected, often in connection with enlarged tonsils or adenoids.

Symptoms to recognize

The difficulty with sleep apnea is that the affected person sleeps during the episodes and often has no memory of them. It is frequently bed partners or family members who are the first to notice.

Nighttime symptoms

• Loud and irregular snoring, sometimes interrupted by silences (pauses)
• Breaths observed by a third party
• Sudden awakenings with a feeling of choking or suffocation
• Restless sleep, frequent position changes
• Nocturia
• Excessive nighttime transpiration
• Bruxism (teeth grinding)

Daytime symptoms

• Significant fatigue upon waking, even after a full night's sleep
• Excessive daytime sleepiness – tendency to fall asleep while driving, at the office, in front of the TV
• Morning headaches
• Difficulty concentrating, memory problems
• Irritability, mood swings
• Dry mouth upon waking

The consequences of untreated sleep apnea

Sleep apnea is not just an inconvenience. If left untreated, it is associated with serious health risks:

• High blood pressure — repeated drops in oxygen stimulate the sympathetic nervous system and increase blood pressure
• Cardiovascular diseases, including heart arrhythmias, heart failure, and an increased risk of heart attack and stroke
• Type 2 diabetes — insulin resistance is aggravated by sleep deprivation and repeated nocturnal hypoxia
• Road accidents — drowsy driving is a direct consequence of insufficient restorative sleep
• Depression and anxiety — chronic sleep disorders have a direct impact on mental health

How is sleep apnea diagnosed?

Initial medical consultation

The starting point is a consultation with a doctor, who will assess your symptoms using standardized questionnaires (such as the Epworth Sleepiness Scale or the STOP-Bang questionnaire). A physical examination of the throat, nose, and neck completes the assessment.

Home overnight respiratory polygraphy

In many cases in Quebec, screening is done with a portable device that the person uses at home overnight. This device measures airflow, chest movements, oxygen saturation, and heart rate. It is less comprehensive than in-lab polysomnography, but is often sufficient to confirm a diagnosis of moderate to severe obstructive sleep apnea.

In-lab polysomnography

The gold standard test is polysomnography conducted in a sleep clinic. It records sleep, breathing, brain activity (EEG), and muscle movements in detail. It is recommended when the diagnosis is uncertain, when central apnea is suspected, or when CPAP titration needs to be performed simultaneously. Waiting times in the Quebec public system can be long—private options exist.

Available treatments

The standard treatment for moderate to severe obstructive sleep apnea is continuous positive airway pressure (CPAP). Worn at night, a nasal or full-face mask is connected to a small machine that keeps the airways open with a continuous stream of air. Once adapted to, it is well-tolerated, eliminates apneas, improves oxygen saturation, and restores sleep quality. The effects on fatigue, concentration, and blood pressure can be remarkable.

In Quebec, the RAMQ partially covers CPAP devices for individuals with a confirmed diagnosis who meet certain criteria. Specific conditions apply—your doctor can inform you about your eligibility.

For mild to moderate sleep apnea, a custom-made oral appliance fabricated by a dentist or orthodontist can reposition the jaw and tongue forward during sleep, thus reducing obstruction. It is less effective than CPAP for severe apnea but is better tolerated by some individuals.

Weight loss, when possible and clinically relevant, can significantly reduce the severity of apnea. Avoiding alcohol and sedatives in the evening, sleeping on your side rather than on your back, and treating chronic nasal congestion are useful complementary measures.

In selected cases, surgical interventions on the upper airway structures (tonsillectomy, uvulopalatopharyngoplasty, nasal surgery, maxillomandibular advancement) may be considered, especially when a specific anatomical abnormality is identified or when CPAP is not tolerated. Surgery is not recommended as a first-line treatment for the majority of patients.

Sleep apnea and mental health

Chronic fatigue, difficulty concentrating, and repeated nighttime awakenings directly impact mood and mental health. Depression and sleep apnea frequently coexist—sometimes in both directions: depression disrupts sleep, and untreated apnea worsens depression. If you are experiencing symptoms of both conditions, it is important to address them with your doctor.

Sleep apnea and driving

Excessive daytime sleepiness related to untreated sleep apnea poses a real risk to road safety. In Quebec, the Société de l’assurance automobile du Québec (SAAQ) requires physicians to report patients whose medical condition may affect their ability to drive. A diagnosis of untreated severe apnea can lead to temporary restrictions on a driver's license until effective treatment is in place.

When to see a doctor

Consult a health professional if you or your partner notice:

• Loud, regular snoring
• Breathing pauses during sleep
• Persistent fatigue despite sufficient hours of sleep
• Excessive daytime sleepiness that interferes with your functioning
• Frequent headaches upon waking
• Waking up with a feeling of suffocation

Do not minimize these symptoms. Sleep apnea is a treatable condition — and treatment can transform quality of life.

Our doctors can assess your symptoms, complete a screening questionnaire with you, and refer you to appropriate tests or specialists. A teleconsultation is available if you wish to discuss your situation from home—our service points in Quebec offer access to healthcare tailored to your daily life.

Teleconsultation in Quebec — Private Online Doctor | Omicron Clinic