Sleep Apnea

Obstructive sleep apnea is the repeated collapse of the airway during sleep — not a narrowing that makes noise, but a closure that stops airflow, often for ten seconds or more, potentially hundreds of times a night.

It is common, it is very treatable, and it goes undiagnosed for years because its main symptom happens while the patient is unconscious.

The signs

What someone else can see: breathing that stops, then resumes with a gasp, snort or choke. Snoring that stops and restarts rather than running continuously. Visible effort, sudden movement, heavy sweating.

What you notice yourself: waking unrefreshed regardless of hours in bed, morning headaches, a very dry mouth, getting up repeatedly to urinate, difficulty concentrating, low mood, and daytime sleepiness — particularly while driving.

Physical risk factors: higher neck circumference, higher BMI, age over 50, male sex, and hard-to-control blood pressure.

The eight-question risk check · how sleepy are you really · what to watch for in a partner

It presents differently in women

Substantially underdiagnosed, because the classic picture was built on male patients.

Women more often report insomnia, fatigue rather than obvious sleepiness, morning headaches, anxiety and low mood — symptoms that overlap almost entirely with stress and perimenopause, which is exactly why the airway question goes unasked. More.

How it is diagnosed

By a sleep study interpreted by a clinician. Nothing else diagnoses it — not a symptom checklist, not an app, not a wearable.

Home sleep apnea tests are now the usual route for uncomplicated cases. They are convenient and they systematically underestimate severity, because they divide events by total recording time rather than actual sleep time. A negative home test does not rule apnea out if symptoms persist. What a test involves

In-lab polysomnography is required where there is significant heart or lung disease, neuromuscular weakness, suspected hypoventilation, chronic opioid use, a history of stroke, or severe insomnia.

Wearables are screening prompts at best. Only a few consumer devices carry FDA clearance for detecting signs of apnea, and Apple's validation testing flagged apnea correctly about 66% of the time — meaning a missing notification is not reassurance. What wearables can and cannot do

What untreated apnea does

Repeated oxygen drops and sympathetic surges, night after night, drive hypertension — particularly the treatment-resistant kind — along with coronary disease, atrial fibrillation, stroke risk, insulin resistance and cognitive problems.

And one risk that is immediate rather than cumulative: crash risk while driving. The full picture

Treatments

CPAP is the most effective, and most abandonment is caused by fixable mask, pressure and leak problems rather than genuine intolerance. The first month · solving mouth leak

Custom oral appliances — dentist-made and titratable — are supported for snoring and mild-to-moderate apnea, and for severe apnea in people who cannot tolerate CPAP. Compared

Positional therapy, where your sleep study shows apnea is much worse on your back. How

Weight treatment, including the first drug ever approved for the condition — tirzepatide, approved December 2024 for moderate-to-severe apnea in adults with obesity, with a mean AHI reduction of 27.4 events per hour against 4.8 on placebo. The trial

Surgery, site-specific and only after the obstruction has been located. The operations

Hypoglossal nerve stimulation for people who have failed CPAP, within specific criteria. Who qualifies

All the alternatives compared honestly

What does not treat it

No product sold without a prescription. Not nasal strips, not mouth tape, not chin straps, not anti-snore pillows, not an over-the-counter mouthpiece.

Mouth taping deserves specific mention: a systematic review in PLOS One covering ten studies and 213 patients did not recommend it for moderate-to-severe obstructive sleep apnea and flagged asphyxiation risk where the nose is obstructed. The detail

For partners

You are the only person who can observe the main symptom. That makes your account genuinely diagnostic.

What to watch for · how to record it · what to tell the doctor · when they will not go

If it is not apnea

That is genuinely useful, and it opens up a much wider field of things that work.

Can you snore without sleep apnea · what kind of snorer are you · how to stop snoring