In short
- In a 2014 study of 58 surgical patients, AHI rose after surgery in people with and without sleep apnea, and breathing problems during sleep peaked on the third night after surgery.
- The Society of Anesthesia and Sleep Medicine says patients with a diagnosis of obstructive sleep apnea should be considered at increased risk of complications around surgery.
- Anesthetic and pain drugs can affect the upper airway, arousal from sleep, muscle activation and breathing drive, according to a 2018 Society of Anesthesia and Sleep Medicine guideline.
- Up to 90% of people with moderate to severe sleep apnea may be undiagnosed, and most people with sleep apnea are undiagnosed when they arrive for surgery.
- If you use CPAP, the Society of Anesthesia and Sleep Medicine recommends that you keep using it during your hospital stay, before and after surgery, and that facilities either supply PAP equipment or have you bring your own.
- Unconsciousness, very small pupils, and slow or shallow breathing are signs of an opioid overdose, and NIDA says to call 911 immediately.
Snoring and sleep apnea can get worse for several nights after surgery, because anesthesia, opioid pain medicines and the stress of the operation all affect how you sleep and breathe. In one study, the worst night for breathing was the third night after surgery. For people with sleep apnea, diagnosed or not, it raises the risk of breathing problems, which is why anesthesia and sleep specialists ask surgical teams to plan for it.
Why does snoring get worse after surgery?
Snoring gets worse after surgery because the drugs and the operation change how your airway behaves during sleep. A 2018 guideline from the Society of Anesthesia and Sleep Medicine (SASM) says anesthetic and pain drugs can affect consciousness, sleep, the anatomy and function of the upper airway, the ability to wake up from sleep, muscle activation and the drive to breathe.
Anything that relaxes the throat muscles or blunts the response to a narrowing airway can make breathing during sleep worse. NHLBI makes this point about alcohol, which it says can relax the muscles of the mouth and throat and may close the upper airway. Our guide to how snoring happens explains the basic mechanics.
How long does it last?
Research: limited (what this means)Breathing problems during sleep can persist for several nights after surgery, and in the best study they peaked on the third night rather than the first. We rate the evidence as limited because it comes mostly from small observational studies and expert consensus rather than large trials.
The clearest study is a 2014 report in Anesthesiology. Researchers gave 58 surgical patients portable sleep studies before surgery and on nights 1, 3, 5 and 7 afterward. Thirty-eight had sleep apnea, with a median AHI of 18, and 20 didn't. What they found:
- AHI rose after surgery in both groups, including people without sleep apnea.
- The increase peaked on the third night. People with sleep apnea had a median AHI of 29 that night, compared with 8 in those without.
- Sleep efficiency, REM sleep and deep sleep dropped on the first night, then gradually recovered.
- Most of the increase in AHI (72%) came from hypopneas, which are partial blockages rather than complete pauses.
The authors concluded that sleep structure was most disturbed on the first night, while breathing problems during sleep were greatest on the third. So the hardest night for breathing may not be the first one. If AHI is unfamiliar, see what is AHI.
Why are opioids a concern?
Opioids are a concern because they slow breathing, and people with sleep apnea may be more sensitive to that effect. SASM's 2018 guideline says people with sleep apnea may be at increased risk of adverse breathing events from opioid medicines. It rates the evidence as low, and notes that high-quality studies are largely lacking.
The guideline describes several findings from observational research:
- Opioid use in people with sleep apnea appears to be a risk factor for critical breathing events after surgery.
- One study found a dose-dependent worsening of sleep-disordered breathing after surgery, though the effect may have been fairly small.
- In another study, lowering opioid doses significantly reduced central apneas and breathing events in people with sleep apnea.
- Repeated drops in oxygen and broken sleep may increase pain sensitivity and make opioids more potent in people with sleep apnea.
SASM also says patients with sleep apnea may be at increased risk from propofol used for procedural sedation, and that intravenous benzodiazepine sedatives should be used with caution. NHLBI separately notes that long-term use of prescribed opioid pain medicines can cause problems with how the brain controls sleep. Our guide to snoring and medications covers other drugs that can affect snoring.
None of this means you shouldn't take pain medicine you need. It means your team should know about your sleep apnea risk so it can plan pain relief and monitoring.
Why does sleep apnea raise surgical risk?
Sleep apnea raises surgical risk because it makes breathing problems during and after surgery more likely. SASM's 2016 guideline on preoperative screening recommends that patients with a diagnosis of obstructive sleep apnea be considered at increased risk of complications around surgery. It notes that two meta-analyses found a sleep apnea diagnosis was linked to more complications after surgery, and that sleep apnea may affect breathing outcomes and may be linked to heart rhythm problems such as atrial fibrillation.
SASM's 2018 guideline adds that known or suspected sleep apnea should be treated as a risk factor for a difficult breathing tube placement or difficult mask ventilation. It also says that, where it's an option, regional anesthesia (such as a nerve block or spinal) is preferable to general anesthesia for people with sleep apnea.
The bigger problem is that many people don't know they have it. SASM's 2016 guideline says up to 90% of people with moderate to severe sleep apnea may be undiagnosed, and that most people with sleep apnea are undiagnosed when they arrive for surgery. That's why screening matters.
The American Society of Anesthesiologists (ASA) also has a guideline on this, updated in 2014. As SASM summarizes it, the ASA guideline recommends screening before surgery to find undiagnosed sleep apnea, starting CPAP before surgery where possible, and monitoring people with sleep apnea after surgery.
What should you tell your surgical team?
Tell your surgical team if you have sleep apnea, if you use CPAP or another treatment, or if you snore loudly and have other warning signs. SASM recommends that the patient, surgeon, anesthesiologist and wider team all know about a sleep apnea diagnosis before the procedure. This table sums up what to share and why.
| What to share | Why it matters |
|---|---|
| A sleep apnea diagnosis, or loud snoring with pauses, gasping or sleepiness | SASM says a diagnosis means higher risk, and undiagnosed people can be picked up with screening such as STOP-Bang |
| Your sleep study results and CPAP pressure setting | SASM suggests obtaining these before surgery, since they can guide monitoring, opioid use and CPAP settings |
| Whether you'll bring your CPAP | SASM suggests facilities either have PAP equipment available or have you bring your own |
| Other treatments, such as an oral appliance or nerve stimulator | SASM encourages people to keep using these around surgery |
| Medicines you take, including weight loss injections | The FDA says people taking tirzepatide should tell their providers about planned surgeries or procedures |
The tirzepatide point is worth knowing. The FDA lists pulmonary aspiration, breathing stomach contents into the lungs, during general anesthesia or deep sedation among the drug's warnings. If you take a weight loss medication, see weight loss drugs for sleep apnea.
If you're not sure whether you might have sleep apnea, the STOP-Bang questionnaire is the screening tool SASM describes as the most validated in surgical patients. Bring your answers to your pre-surgery appointment. SASM says there isn't enough evidence to cancel or delay surgery just to do a sleep study, unless there are signs of other uncontrolled problems, so being flagged as high risk doesn't automatically mean a delay.
Should you keep using CPAP after surgery?
You should keep using CPAP during your hospital stay and once you're home, unless your team tells you otherwise. NHLBI says to use CPAP every time you sleep, including naps. SASM recommends that patients continue wearing their PAP device at appropriate times in hospital, both before and after surgery. It notes that stopping CPAP in people who use it regularly has been shown to bring sleep apnea and its symptoms back within one to three days.
Settings may need adjusting because of facial swelling, airway swelling, fluid shifts and medication, according to SASM. It also stresses that CPAP isn't a substitute for proper monitoring. Our guide to CPAP when traveling has tips on packing your machine.
When should you call for help?
Call 911 straight away if someone recovering from surgery can't be woken, or their breathing is very slow, shallow or stops. NIDA lists these signs of an opioid overdose:
- Unconsciousness
- Very small pupils
- Slow or shallow breathing
- Vomiting
- Being unable to speak
- A faint heartbeat
- Limp arms and legs
- Pale skin
- Purple lips and fingernails
NIDA says naloxone should be given to anyone who shows signs of an opioid overdose or when an overdose is suspected, and that people should still call 911 immediately, because naloxone wears off in 30 to 90 minutes.
For less urgent changes, call your surgical team or doctor if snoring after surgery comes with breathing pauses, choking or gasping, or if you're much sleepier than expected. NHLBI lists breathing that starts and stops, loud snoring and gasping for air as signs of sleep apnea. If snoring that started after surgery hasn't settled once you've recovered, ask your doctor whether a sleep study makes sense; our list of sleep apnea warning signs can help. A blocked nose that won't clear, or surgery during pregnancy, are also worth raising with your clinician. This article is general information, not medical advice.
Read next
Common questions
Why am I snoring after surgery?
Anesthesia, pain medicine and the surgery itself can all disturb sleep and breathing for several nights. A 2014 study found AHI rose after surgery even in people without sleep apnea, peaking on the third night. Opioid pain medicines can also depress breathing. New snoring with pauses or gasping should be reported to your care team.
Can general anesthesia make sleep apnea worse?
It can for a while. A 2018 Society of Anesthesia and Sleep Medicine guideline says anesthetic and pain drugs can affect the upper airway, arousal responses, muscle activation and breathing drive. In a 2014 study, breathing disturbances during sleep were worst on the third night after surgery, after the anesthetic itself had worn off.
Should I bring my CPAP to the hospital?
Usually yes, but check with the hospital. The Society of Anesthesia and Sleep Medicine suggests facilities either have PAP equipment available or have patients bring their own, and recommends that patients keep using PAP during their stay. It notes stopping PAP can bring sleep apnea symptoms back within one to three days.
Do opioids make sleep apnea worse?
They can. A 2018 Society of Anesthesia and Sleep Medicine guideline says people with sleep apnea may be at higher risk of breathing problems from opioid medicines, though high-quality evidence is limited. It found studies linking opioid use in people with sleep apnea to serious breathing events after surgery, and that lower opioid doses reduced breathing events in one study.
Should I tell my surgeon I snore?
Yes. Most people with sleep apnea don't know they have it when they come in for surgery, according to the Society of Anesthesia and Sleep Medicine. Loud snoring, observed breathing pauses or daytime sleepiness can prompt your team to screen you with a questionnaire such as STOP-Bang and plan your care and pain relief with that risk in mind.
Sources
- Postoperative changes in sleep-disordered breathing and sleep architecture in patients with obstructive sleep apnea
- Society of Anesthesia and Sleep Medicine guidelines on preoperative screening and assessment of adult patients with obstructive sleep apnea
- Society of Anesthesia and Sleep Medicine guideline on intraoperative management of adult patients with obstructive sleep apnea
- Practice guidelines for the perioperative management of patients with obstructive sleep apnea: an updated report by the American Society of Anesthesiologists Task Force on Perioperative Management of patients with obstructive sleep apnea
- Naloxone DrugFacts
- FDA approves first medication for obstructive sleep apnea
- Sleep apnea: causes and risk factors
- CPAP
- Sleep Apnea - Symptoms
About this article
- Research
- 9 published sources, listed above.
- Evidence
- Limited. How we rate it
- Last checked
- November 1, 2026
- Funding
- Paid partner of Titan Recovery. Their ads are labeled.
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* This content is for informational and educational purposes only and is not medical advice. It is not intended to diagnose, treat, cure or prevent any disease or health condition. Talk to a qualified healthcare provider about your health.