By Sharon Brock, MS, MEd

Obstructive sleep apnea (OSA) is a sleep disorder in which the airway becomes momentarily blocked by the tongue or soft tissue at the back of the throat, causing pauses in breathing (called apnea), as well as snoring, gasping, and multiple brief awakenings throughout the night.

Estimates show that nearly 30 million adults in the U.S. struggle with OSA, although the vast majority don’t recognize snoring as a sign of illness and therefore don’t seek treatment. But, OSA not only causes daily fatigue, the reduction in oxygen over time can cause serious health problems such as depression, high blood pressure, heart disease, Type 2 diabetes, and stroke.

“If you snore, awaken with a dry mouth, feel fatigued or unrefreshed during the day, or have repeated awakenings in the night, these may be symptoms of sleep apnea, and it’s important to seek assessment and treatment,” says behavioral sleep psychologist Natalie Solomon, PsyD, who treats patients at the Stanford Sleep Health and Insomnia Program. “The good news is, there are multiple treatment options, and I’ve seen patients experience both short-term and long-term benefits.”

Some people who suffer from OSA also have insomnia, and it’s important to understand the difference. Sleep apnea refers to obstruction of the airway, resulting in pauses in breathing and awakenings in the night. Insomnia refers to having trouble falling asleep and/or lying awake for prolonged periods of time. In other words, OSA wakes you up, but insomnia keeps you awake.

“Having both sleep apnea and insomnia is common, and it’s important to remember that they are two different disorders which have two different treatments,” says Dr. Solomon. “Attempting to adjust to CPAP while also navigating untreated insomnia can be a challenge. So, simultaneous treatment of insomnia could help facilitate successful treatment of sleep apnea.”

Causes and Symptoms of Obstructive Sleep Apnea

There are various causes of OSA, and they can be different for each person. Some inherit a small jaw or narrow airway, increasing the chance of obstruction. For others, blockages of the airway can occur when the soft tissue of the throat becomes relaxed and/or inflamed. Lastly, as we age, our muscles naturally weaken. Specifically, when women go through the menopause transition, declining estrogen and progesterone levels can reduce overall muscle strength, including muscles of the throat. Perimenopause and menopause can also cause weight gain in women, which can also narrow the airway.

Causes of Obstructive Sleep Apnea:

• Tongue falling back and partially obstructing the airway
• Relaxed throat muscles (caused by ingesting alcohol or other muscle-relaxants)
• Weak throat muscles (caused by advanced age and/or perimenopause in women)
• Inflammation of soft tissue in the throat (caused by cigarette smoking, allergies, congestion, and/or consuming dairy and other inflammatory foods)
• Inherited craniofacial structural traits (such as a small or recessed jaw, a narrow neck or airway, and/or having enlarged tonsils or adenoids)
• Excess weight in the neck

“OSA is more common in men than women; however, after menopause, the rates become about equal,” says Dr. Solomon. “Also, OSA presents itself differently among men and women. Snoring is the most common symptom for men, while for women OSA is more likely to present as non-refreshing sleep and ongoing fatigue, therefore OSA is under diagnosed and under treated in women.”

OSA symptoms at night can include snoring or gasping for air, awakening with a dry mouth, moving a lot during sleep, and needing to go to the bathroom frequently. During the day, OSA can cause additional symptoms related to disrupted sleep or decreased oxygen levels, such as morning headaches, daytime sleepiness, difficulty concentrating, memory problems, and/or mood changes.

“It’s important to note that not all people who snore have sleep apnea,” says Dr. Solomon. “But if you experience a number of these symptoms, I recommend asking your doctor for a sleep study to test for sleep apnea. Taking a sleep study is the only way to diagnose OSA accurately.”

Treatments for Obstructive Sleep Apnea

After you’ve been diagnosed with OSA, there are a variety of ways to treat it. The most common treatment is the use of a CPAP, which stands for continuous positive airway pressure. The CPAP machine keeps the airway open through the night by pumping air through a face mask. Despite the efficacy of CPAP treatment, especially for those with moderate-to-severe OSA, some have trouble with adherence since the machines can be loud, and masks can be uncomfortable.

“Some people struggle to adjust to CPAP therapy. It can take time and adjustments to obtain the correct CPAP mask and settings,” says Dr. Solomon. “Many measures have been introduced to improve adherence to CPAP therapy, such as smaller and quieter machines, more comfortable masks, educational and supportive efforts, and cognitive behavioral therapy.”

For those with less severe OSA, another treatment to consider is an oral appliance that brings the lower jaw forward, holding the tongue in place so that it doesn’t fall back and block the airway. These appliances, created by dentists, can be considered as a first-line therapy for mild-to-moderate OSA or as an alternative for patients who cannot tolerate CPAP.

There is also a range of surgical options for sleep apnea, including those that increase the passages in the nose and throat, such as the removal of tonsils and adenoids. Surgeons can also implant a device that provides electrical stimulation to the hypoglossal nerve to keep the airway open.

Lastly, there are several medications that can reduce sleep apnea, such as those that target airway edema, nasal congestion, neuromuscular control, or residual daytime sleepiness. Also, the GLP-1 weight-loss medication tirzepatide (Zepbound brand) has been approved by the FDA to treat OSA. Another medication, which increases muscle tone in the throat, is scheduled to be approved by the FDA in 2026.

“Since there are many factors involved in OSA, an individualized treatment approach is important,” says Dr. Solomon. “From the severity of apnea, to identifying the cause, to figuring out the best treatment, it’s essential for OSA patients to collaborate with a health-care provider who can create a treatment plan tailored for their specific needs.”