An unmade bed with two pillows

O bstructive sleep apnea (OSA), marked by numerous pauses in breathing during sleep, can cause daytime drowsiness and boost heart failure, stroke, and dementia risks.

The condition appears to be common: A new study published online in The Lancet Respiratory Medicine estimates that 936 million people between age 30 and 69 worldwide have OSA—and 425 million of the cases are thought to be moderate to severe. (The study was funded by ResMed, a manufacturer of devices to treat sleep apnea.) 

In terms of sheer numbers of people with OSA, the study found that the U.S., with an estimated 54 million cases—24 million of them moderate to severe—is second only to China. About 24 percent of men and nine percent of women in the U.S. show the breathing symptoms of sleep apnea, according to the American Academy of Sleep Medicine (AASM).

And some people with OSA don’t know they have it: A 2018 study of older adults from the University of Michigan found that 56 percent of participants were at high risk for OSA, yet only 8 percent were tested for it.

Risks and Symptoms

Older adults may be uniquely vulnerable to OSA.

“As we get older, we lose muscle tone in the structures at the back of the throat, which may play a role in OSA,” says Raj Dasgupta, M.D., a pulmonary and sleep medicine specialist at Keck Medicine of USC in Los Angeles.

You may also be more likely to have OSA if you’re overweight, have a large neck circumference, are male, or smoke. But many older adults with OSA don’t fit this picture.

More on Sleep

For instance, two to three times as many men as women have OSA, but that gap narrows after women reach menopause. And postmenopausal women’s OSA symptoms, such as insomnia and mood changes, may be different from men’s.

Recognizing OSA can also be challenging because you experience it while asleep. One possible sign: dozing off at inopportune times of day—while having a conversation or driving—says Douglas Kirsch, M.D., immediate past president of the AASM.

When to Talk to Your Doctor

If your partner complains that you snore loudly or have long breathing pauses followed by choking or gasping noises, make an appoint­ment. And “tell your primary care doctor if you don’t feel like you’re sleeping well at night or you don’t feel well-rested when you wake,” says Tiffany Braley, M.D., a sleep-disorder researcher at the University of Michigan. Do the same if you notice fuzzy thinking, which can be related to poor sleep.

If the doctor suspects OSA, you should be referred to a sleep specialist who may recommend an in-lab sleep study or home testing.

During an in-lab study, you’ll spend the night in a sleep center while technicians monitor the number of times you stop breathing. In a home test, which is less sensitive, you’ll wear a small device that tracks changes in breathing patterns while you sleep. Check with your health insurer before deciding.

Getting Treated for Sleep Apnea

Lifestyle modifications—particularly weight loss if you are obese, or changing your sleep position—can help. Your doctor is also likely to recommend continuous positive airway pressure (CPAP), a type of therapy that uses a mask connected to a pump that pushes air into your airway, helping to keep it open while you sleep.

CPAP can cut the number of apnea episodes, lower blood pressure, improve sleep quality, and reduce daytime sleepiness—if you stick with it. But a 2016 review of studies found that roughly one-third of people don’t. Some find the mask uncomfortable or hard to use. If you do, start by wearing it for a half-hour during the day, increasing the time slowly over weeks until you’re comfortable putting it on at night.

If you still have trouble after this, tell your sleep specialist. You might need help adjusting settings, or the mask simply might not be a good fit. “It may take a few trials to find what works,” Dasgupta says.

Those who can’t tolerate CPAP have other options. Mandibular advancement devices (mouth guards) to help keep the airway open may benefit some people with mild to moderate OSA but may be less effective than CPAP. For moderate to severe apnea, some people may find relief with a surgically implanted device that delivers electrical impulses to the nerve that controls the upper airway muscles. ­

Research published last year in the Journal of Clinical Sleep Medicine suggested that dronabinol, a synthetic cannabis compound, relieved OSA symptoms in a small subset of people. The AASM has called for more research on the safety and efficacy of medical cannabis and any synthetic extracts for OSA, and is not recommending such therapy at this time.

Editor’s Note: A version of this article also appeared in the September 2018 issue of Consumer Reports On Health. The article was updated on July 10, 2019, to include new information on the prevalence of obstructive sleep apnea.