Sleep Apnea: Symptoms, Diagnosis, and Treatment Options

What is sleep apnea?

Sleep apnea is a sleep disorder in which breathing repeatedly stops and starts during the night. According to Mayo Clinic, when this happens, oxygen levels in the blood drop, and the brain briefly wakes the body just enough to resume breathing — often so briefly that the person has no memory of it happening.

More than 18 million American adults have sleep apnea, and a substantial share of cases remain undiagnosed, largely because the person experiencing it isn't usually the one who notices. It's often a bed partner who first flags the loud snoring, gasping, or choking sounds that prompt someone to see a doctor.

The two main types of sleep apnea

Obstructive sleep apnea (OSA) is by far the more common form. It happens when the muscles at the back of the throat relax during sleep, allowing soft tissue to narrow or block the airway. This is the type most people mean when they say "sleep apnea," and it's strongly associated with loud snoring.

Central sleep apnea (CSA) is less common and works differently — instead of a physical blockage, the brain temporarily fails to send the signals needed to control breathing muscles. People with central sleep apnea are less likely to snore loudly but may wake up short of breath or have trouble falling or staying asleep. A 2025 American Academy of Sleep Medicine (AASM) guideline update emphasizes that CSA isn't one single disorder — it's a group of conditions with varying causes, often linked to heart failure, and treatment needs to be individualized rather than following a single standard protocol.

Some people have a combination of both, sometimes called complex sleep apnea syndrome.

Warning signs to watch for

Beyond loud, disruptive snoring and witnessed breathing pauses, sleep apnea can show up in ways that don't obviously point to a sleep problem. Common signs include waking up abruptly feeling short of breath, morning headaches, dry mouth or sore throat on waking, and daytime sleepiness that doesn't improve with an early bedtime.

Less obvious symptoms — insomnia, trouble concentrating, and mood changes — are also associated with the condition, according to Mayo Clinic Health System. If sleep apnea goes untreated for a long time, it's linked to a higher risk of high blood pressure, heart disease, stroke, and drowsy-driving accidents, which is part of why getting evaluated matters even if the symptoms feel manageable day to day.

How sleep apnea is actually diagnosed

Sleep apnea can't be confirmed by symptoms alone — it requires a sleep study, which measures breathing patterns, oxygen levels, and other data while you sleep. Depending on how straightforward the case appears, this can happen either in a sleep lab overnight or, increasingly, through a home sleep apnea test using an approved take-home device.

The result of a sleep study is typically expressed as the apnea-hypopnea index (AHI) — the number of breathing disruptions per hour. Generally, fewer than 5 events per hour is considered normal, 5 to 15 is mild, 15 to 30 is moderate, and more than 30 is considered severe. This number, combined with your symptoms and overall health, helps guide which treatment approach makes sense.

CPAP: the standard treatment, but not the only one

Continuous positive airway pressure (CPAP) therapy remains the primary treatment for moderate to severe obstructive sleep apnea. A CPAP machine delivers steady air pressure through a mask, keeping the airway open through the night. According to Mayo Clinic Press, for many people, CPAP therapy reduces breathing interruptions to fewer than five per hour, and research links it to fewer car crashes, better blood pressure control, and improved quality of life.

That said, CPAP isn't the only option, and it isn't right for everyone — mask discomfort and adjustment difficulties are common reasons some people struggle to stick with it. Alternatives include:

• Oral appliances, custom-fitted mouthpieces that reposition the jaw or tongue to keep the airway open, typically used for mild to moderate cases.

• Positional therapy, since some people's apnea is significantly worse when sleeping on their back.

• Implantable devices — the FDA has approved two electronic implants, Inspire and Genio, which stimulate airway muscles during sleep to prevent collapse, offering a mask-free option for appropriate candidates.

• Weight management, since excess weight is a major contributing factor to airway narrowing in many people with OSA.

• Surgery, including procedures on the nose, jaw, or throat, generally considered when other approaches haven't worked or anatomy is directly contributing to the blockage.

A newer option: medication for sleep apnea

Treatment options have expanded beyond devices and surgery in the past two years. Tirzepatide (marketed as Zepbound for weight management) has been FDA-approved specifically for obstructive sleep apnea in adults with obesity — the first medication ever approved for that indication, rather than being used off-label. This reflects the strong link between excess weight and airway narrowing in OSA, and it gives clinicians a pharmaceutical option to use alongside, or sometimes instead of, other therapies for appropriate patients.

Researchers are also studying other medications aimed at improving airway muscle tone during sleep, though most of these remain investigational and are not yet standard first-line treatment. Any medication for sleep apnea should be discussed with a sleep specialist rather than pursued independently, since these drugs come with their own risks and aren't appropriate for every case.

FAQ

What's the difference between obstructive and central sleep apnea? Obstructive sleep apnea happens when throat muscles relax and physically block the airway, and is the more common, snoring-associated type. Central sleep apnea occurs when the brain fails to properly signal the breathing muscles, and is often linked to underlying conditions like heart failure.

How is sleep apnea diagnosed? Diagnosis requires a sleep study, either in a lab or through an approved home sleep apnea test, which measures breathing interruptions per hour using the apnea-hypopnea index (AHI) to classify severity as normal, mild, moderate, or severe.

Is CPAP the only treatment for sleep apnea? No. While CPAP remains the standard for moderate to severe cases, alternatives include oral appliances, positional therapy, FDA-approved implantable devices like Inspire and Genio, weight management, and in some cases surgery.

Can losing weight cure sleep apnea? Weight loss can significantly improve or, in some milder cases, resolve obstructive sleep apnea, since excess weight is a major contributing factor to airway narrowing. It's not guaranteed to eliminate the condition entirely, and a sleep specialist can help determine whether it's likely to be sufficient on its own.

Is there a medication for sleep apnea now? Yes. Tirzepatide (Zepbound) is FDA-approved specifically for obstructive sleep apnea in adults with obesity, making it the first medication approved for this condition rather than being used off-label for weight loss alone.

Takeaway

If a partner has flagged your snoring or breathing pauses, or you're waking up tired no matter how early you go to bed, a sleep study is the only way to know for sure what's happening — and today's treatment options go well beyond the CPAP machine most people picture when they hear "sleep apnea."

5. Sources

• Mayo Clinic — "Obstructive sleep apnea: Symptoms and causes" and "Sleep apnea: Diagnosis and treatment"

• Mayo Clinic Health System — "Sleep apnea: Symptoms and treatment"

• Mayo Clinic Press — "Sleep apnea treatment: Which option is right for you?"

• Cleveland Clinic — "Sleep Apnea: What It Is, Causes, Symptoms & Treatment"

• American Academy of Sleep Medicine (AASM) — 2025 guideline on treatment of central sleep apnea in adults