Could It Be Sleep Apnoea? A Hidden Factor in Fibromyalgia and ME/CFS

Hi Friend

I hope you are well, this week I have seen 3 people who had been diagnosed with ME as they had extreme fatigue and “every test was normal.” After I had seen them I suspected sleep apnoea, and all 3 had this, 2 had severe sleep apnoea! I highly suspect this is something many of you need to consider if you are suffering from chronic fatigue.

If you live with fibromyalgia or ME/CFS, you probably know what it feels like to wake up tired — despite spending hours in bed. For many, poor sleep is accepted as just another symptom of these conditions. But what if, in some cases, the real culprit is undiagnosed sleep apnoea?

🌙 What Is Sleep Apnoea?

Sleep apnoea is a condition where your breathing repeatedly stops and starts during sleep. The most common type — Obstructive Sleep Apnoea (OSA) — happens when throat muscles relax and block the airway. This can cause loud snoring, choking sounds, and repeated awakenings — but not everyone notices these signs.

Untreated sleep apnoea leads to unrefreshing sleep, daytime fatigue, morning headaches, brain fog, and increased pain sensitivity — symptoms that overlap heavily with fibromyalgia and ME/CFS.

⚡ The Overlap — Why Misdiagnosis Happens

Many people with fibromyalgia and ME/CFS struggle for years with fatigue, poor sleep, and brain fog — all of which can also be explained by sleep apnoea. Unfortunately, these symptoms are often automatically attributed to the primary diagnosis.

Here’s why sleep apnoea can be missed:

• Silent symptoms: Not everyone with OSA snores loudly. Some have “silent apnoea” with minimal snoring but significant airway obstruction.

• Shared symptoms: Daytime sleepiness, brain fog, pain flares, and unrefreshing sleep all overlap.

• Assumptions: Healthcare providers may overlook sleep studies once fibromyalgia or ME/CFS is diagnosed.

• Weight stigma: Slim people can have sleep apnoea too, but it’s often wrongly assumed to be an issue only in people with higher body weight.

🔬 What Causes Sleep Apnoea?

Sleep apnoea can affect anyone — not just people who snore loudly or are overweight. Common causes and risk factors include:

• Anatomy: A naturally narrow airway, large tonsils, or a thick neck can increase the chance of airway collapse during sleep.

• Weight gain: Extra fat tissue around the neck and throat can narrow the airway.

• Ageing: Throat muscles naturally lose tone with age, making airway collapse more likely.

• Family history: Genetics can play a role in face and jaw shape, which can affect the airway.

• Nasal congestion: Chronic nasal blockage can increase the risk.

• Alcohol and sedatives: These relax the throat muscles even more, making apnoea episodes worse.

• Smoking: Smoking can cause airway inflammation and fluid retention in the throat.

These factors can overlap with life changes — for example, gaining weight after becoming less active due to chronic pain or fatigue can silently raise the risk of sleep apnoea.

⚠️ The Bigger Health Risks

Left untreated, sleep apnoea does more than ruin sleep — it increases the risk of weight gain, insulin resistance, and type 2 diabetes. Poorly treated OSA also raises the risk of high blood pressure, heart disease, stroke, and even early death.

How does this happen? Interrupted sleep and low oxygen levels trigger stress hormones, increase appetite, and disrupt how your body uses insulin — making it much harder to maintain a healthy weight and blood sugar balance. Over time, this puts extra strain on your heart and blood vessels.

🔍 Could This Be You?

You might want to consider a sleep apnoea assessment if:

• You wake up choking or gasping for air.

• Your partner notices you stop breathing or snore heavily.

• You wake with a dry mouth or headache.

• You feel exhausted despite “sleeping” all night.

• You often nap during the day or struggle to stay awake.

✅ What You Can Do

If you suspect sleep apnoea, talk to your doctor about:

• A referral for a sleep study — this can be done at home or in a sleep clinic.

• Tracking your sleep with a wearable or an overnight oximeter.

• Trying simple changes: side-sleeping, weight management (if relevant), avoiding alcohol and sedatives at night.

If diagnosed, treatment options like CPAP therapy, oral appliances, or positional therapy can be life-changing — not only improving sleep, but potentially reducing pain, fatigue, brain fog, and long-term health risks too.

🌟 Key Takeaway

Sleep apnoea is under-recognised — especially in people already diagnosed with complex conditions like fibromyalgia and ME/CFS. If your sleep still leaves you feeling exhausted, it’s worth asking: could this be sleep apnoea?

If you want more information please feel free to watch the podcast I recorded with a world leading sleep apnoea expert with some amazing advice.

As always I hope this was useful for you.

Best Wishes

Dr Ahmed