Nearly 30 million U.S. adults have sleep apnea, say experts. Roughly 80 percent of them don’t know it. If you keep your bed partner up with your snoring, wake up gasping for air in the middle of the night, fall asleep while stopped at red lights, or wake up with morning headaches, you may be one of them.

Sleep apnea 101

“Sleep apnea is a common problem where people stop breathing in their sleep,” says Atul Malhotra, research chief of pulmonary, critical care, and sleep medicine at the University of California, San Diego. Those pauses in breathing—the apneas—happen when the airway at the back of the throat collapses for brief periods of time.

Apneas are particularly common during rapid eye movement (REM) sleep, also known as dream sleep, says Virend Somers, a cardiologist at the Mayo Clinic. “You lose muscle tone during REM sleep to prevent you from acting out your dreams,” he explains. “But that makes it easier for the airway to collapse. And apneas are often worse when you are lying on your back because you’ve lost that muscle tone and gravity causes the tongue to fall backward into the airway. So sleeping on your side can help reduce snoring and apneas because you don’t have gravity pulling the tongue and lower jaw backward.”

“Apnea episodes, by definition, last at least 10 seconds,” notes Steven Feinsilver, director of the Center for Sleep Medicine at Northwell Lenox Hill Hospital in New York. “But you’re usually not aware of it. Someone watching you sleep might notice, but it’s not always obvious.”

Yet those repeated lapses in breathing do a number on our health. “One consequence is that when you stop breathing, you often wake up,” says Malhotra. You may not remember waking up, but those repetitive awakenings result in poor, fragmented sleep and sleepiness the next day.

“Think about sleep apnea as what it would be like if I repeatedly put a pillow over your head while you slept,” says Feinsilver. “You’re not just stopping breathing. You’re struggling to start breathing again, so blood oxygen levels can be surprisingly low. It’s brief, but that could be happening 20, 30, 40 times or more per hour, and you’re doing it every night over years.”

Why sleep apnea spells trouble for your health 

Sleep apnea is linked to both short- and long-term health problems. Over the short term, people may suffer from worse mood, difficulty concentrating, and lower quality of life because they don’t sleep well.

“Sleepy people can get into trouble,” says Feinsilver. Motor vehicle accidents, for example, are about two to five times more likely in people with untreated sleep apnea than in those without.

And night after night of disrupted breathing takes a toll on the body. “When you stop breathing, oxygen levels fall and carbon dioxide goes up,” explains Somers. That triggers the “fight or flight” response, which may also help you wake up so you start breathing again.

“The blood vessels tighten, which raises blood pressure,” adds Somers. “And if you have apnea for many years, those higher blood pressure levels start persisting into the daytime.”

And the problems don’t stop at high blood pressure. Sleep apnea is also linked to a higher risk of heart attacks, strokes, heart failure, and atrial fibrillation (an irregular heartbeat that raises the risk of a stroke).

Who’s at risk?

Many factors can put you at risk for sleep apnea. Some are outside your control. For example, your odds of developing sleep apnea rise with age. And men are roughly two to three times more likely than women to have it. “We don't know why, though it may be due to sex hormones like estrogen,” says Somers. “More women develop sleep apnea after menopause, when estrogen levels fall.”

A crowded airway

The shape of your airway—and the tissue that surrounds it—also matters. “A lot of your risk has to do with how much room you have in the back of your throat,” explains Feinsilver. “There’s a lot of soft tissue there that can collapse pretty easily.” And if you have a large tongue, a small jaw, or a long soft palate (the back of the roof of your mouth), the airway may be more crowded. “Sometimes it’s obvious,” says Feinsilver. “Usually, it isn’t.” 

“One of the best clues to having sleep apnea is neck size,” he notes. The condition is more common in women with a neck circumference of at least 16 inches and in men with a neck that’s 17 inches or more. “And it probably doesn’t matter whether it’s fat or muscle that gets in the way,” adds Feinsilver. “I had a patient who was a bodybuilder, and he had terrible sleep apnea.”

Excess weight

“There’s a stereotype that people with sleep apnea are older men with obesity, but many people don’t fit that stereotype,” Malhotra points out. Plenty of women and lean men also have sleep apnea.

That said, “obesity is the most common risk factor for sleep apnea that’s reversible,” he adds. “For every excess pound you gain, your risk for sleep apnea goes up a little bit.” In one study, researchers found that a 10 percent increase in weight was linked to a six-fold higher risk of moderate-to-severe sleep apnea. And where you carry the weight is more important than how much you weigh: Those with a larger midsection are at greater risk than those who hold their weight in their hips and thighs. That might explain why men, who tend to put on weight around the belly, have a higher risk.

How might excess weight trigger sleep apnea? “When you’re lying down, weight around the belly is pushing against the diaphragm, which makes it a little harder to breathe,” says Malhotra.

But it’s not just weight in the midsection that matters. “One of the places that humans deposit fat is in the neck,” says Feinsilver, “and the airway may be very sensitive to even small changes in the amount of fat surrounding it.”

How do you know if you have sleep apnea?

While there’s no surefire sign or symptom that will tell you if you have sleep apnea, “if you snore at night and you’re sleepy during the daytime, see your doctor,” says Feinsilver. 

Roughly half of U.S. adults report snoring, which occurs when tissues in the back of the throat relax and vibrate during sleep. 

While most people with sleep apnea snore, not everybody who snores has sleep apnea. “But snoring is a clue,” notes Feinsilver, “because some people who snore completely close off the back of the throat and stop breathing.”

And those lapses in breathing, repeated dozens—or hundreds—of times per night, mean that you may wake up with a headache or struggle to feel energized the next day.

“If you’re falling asleep at inopportune times like at red lights or if you’re drinking coffee all day to stay awake, that’s not normal,” says Malhotra. “Go see your doctor.”

Your physician can decide if it makes sense to do a sleep test, which records oxygen levels, breathing patterns, heart rate, and more while you’re asleep. Some sleep tests are done in a sleep lab, though technology has improved so much that many people can now do them at home. The test can determine if you have sleep apnea and how severe it is.

“The typical metric for severity is the apnea-hypopnea index,” explains Malhotra. “Apneas are lapses in breathing and hypopneas are reductions in breathing. If you add those up per hour of sleep, that gives you a yardstick of severity. Up to five is considered normal. Five to 14 is mild, 15 to 29 is moderate, and 30 or more is severe.

How to treat sleep apnea

“The treatments for sleep apnea have a reputation of being cumbersome or intolerable,” says Malhotra. “That’s not true. There are good treatments out there.” Here are some of the best.

Continuous positive airway pressure, or CPAP

“CPAP is considered the first-line treatment for obstructive sleep apnea,” says Malhotra.

“CPAP is a simple machine,” explains Feinsilver. “It’s a little box that you plug into the wall, and it generates just enough air pressure to keep the airway from collapsing.” (CPAPs don’t deliver oxygen or breathe for you.)

And CPAPs have come a long way. The machines are smaller than they used to be, and they make almost no noise, says Feinsilver. And for most people, gone are the days of wearing a mask that covers your nose and mouth. “Most people use what looks like a flat, flexible tube that sits under the nostrils.”

Another bonus: “CPAPs have gotten so smart that the machine measures how you’re breathing and adjusts the pressure as needed,” adds Feinsilver.

“The hard part is getting used to having something on your face when you sleep. But once you have a mask that fits, if you have significant apnea, a CPAP improves your sleep so much that that’s not a hard sell.”

“CPAP has a bad rap,” says Malhotra. “But we’ve published data showing that using modern technology that provides real-time feedback and coaching for patients, along with patient education and troubleshooting, results in over 80 percent of patients sticking with their CPAP. So the majority of people will do well with it.”

Feinsilver’s approach: “I tell people, ‘When you see this machine, you know it must work because nobody would sleep with this stupid-looking thing otherwise.’” Give yourself a month or so to get used to it, he suggests.

That said, “CPAP is not for everybody,” says Malhotra. “There are some people who just don’t tolerate it.”

Hypoglossal nerve stimulation

A CPAP keeps the airway open with air pressure. Another approach, for people with moderate-to-severe sleep apnea who can’t tolerate the device, is to stimulate the hypoglossal nerve, which controls the tongue. That’s the premise behind Inspire, the only FDA-approved device that does that.

In an outpatient procedure, a surgeon implants a battery-powered pacemaker into the chest, a breathing sensor that activates the device when you inhale, and a lead that connects to the hypoglossal nerve. While Inspire is generally well tolerated, infections can occur. And surgery is sometimes needed to remove or reposition the device.

“It’s a pacemaker,” explains Feinsilver. It works on the same principle as a cardiac pacemaker that stimulates the heart muscle. Inspire “delivers gentle pulses that move your tongue out of the way each time you take a breath, keeping your airway open while you sleep soundly,” says the company’s website.

In a company-funded trial of 126 adults with obstructive sleep apnea, the number of complete or partial breathing lapses fell by nearly 70 percent, from roughly 29 per hour to just 9, after a year of using Inspire.

“You turn it on with a remote before you go to bed,” says Feinsilver, “and it usually has about a half-hour delay, so you’re asleep before it starts pulsing. It typically works well, but it’s not for everyone. It requires an operation, and that will turn some people off.”

Oral devices

There are “oral devices” that you can wear that help keep your airway open. One popular type “has a top and a bottom piece that anchors your teeth, and it holds your lower jaw slightly forward compared to the upper jaw,” says Feinsilver.

“By just pulling the jaw forward a little bit, you’re also pulling the tongue forward, so it gives you more room in the back of the throat. It’s a simple thing, and people like it because it’s easy for travel and nobody sees that you’re using it.” 

But an oral device isn’t for everyone. “It works pretty well for mild apnea,” says Feinsilver, “but it’s usually not enough to treat severe apnea.”

What’s more, the devices have to be custom made by a dentist. “If you want to try an oral device, have an experienced dentist do it,” cautions Feinsilver. “You can really mess up the jaw joint if you do it wrong.”

Weight loss

For people with obesity, studies show that “the more weight you lose, the less sleep apnea you have,” notes Malhotra. In one analysis of 27 studies by Malhotra and his colleagues, lapses and reductions in breathing fell by 36 percent in people who lost 10 percent of their original weight. Those who lost even more weight saw a greater reduction in their sleep apnea, though the benefits started to level off once people lost more than 20 percent of their starting weight.

(The review was funded by Eli Lilly, which makes tirzepatide, sold as Zepbound for weight loss and Mounjaro for type 2 diabetes. Like semaglutide, which is sold as Ozempic or Wegovy, tirzepatide must be injected weekly.)

Malhotra looked at tirzepatide’s impact on sleep apnea in people with obesity in two recent studies also funded by Eli Lilly. “In trial one, 234 people who couldn’t tolerate CPAP were randomized to get tirzepatide or a placebo,” he explains. In the second trial, 235 people who used a CPAP got tirzepatide or a placebo.

After one year, the number of lapses or reductions in breathing per hour in the tirzepatide takers dropped by about 55 percent compared to the placebo takers in those using a CPAP and by 48 percent in those not using a CPAP. What’s more, in the tirzepatide groups, “we saw a nearly 20 percent reduction in weight, and improvements in systolic blood pressure and high-sensitivity C-reactive protein, a cardiovascular risk marker,” says Malhotra. And the tirzepatide takers scored better on surveys that asked about alertness during the day and sleep disturbances at night. “Plus, patients felt better.”

Apnea improved so much, in fact, that around half of the tirzepatide takers in the second study may no longer need a CPAP. Does that mean that they were “cured” of their sleep apnea? “Where are they in 5 or 10 years?” asks Malhotra. “We’d need to see if the results are sustained long term before we can use that word.”