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Sleep Apnea

Table of Contents

What is sleep apnea?

Sleep apnea is a sleep disorder where breathing repeatedly stops and starts throughout the night. The most common form, obstructive sleep apnea (OSA), occurs when throat muscles relax excessively and collapse the airway. Central sleep apnea, less common, happens when the brain fails to send proper signals to breathing muscles. Some people have mixed sleep apnea, combining features of both types.

OSA affects roughly 12 percent of adults, with up to 30 percent of men and 17 percent of women meeting diagnostic criteria. An estimated 80 percent of cases remain undiagnosed [1]. This means millions face serious health risks every night without knowing it.

How sleep apnea damages your cardiovascular system

Each apnea episode triggers a cascade of stress responses. Oxygen levels drop, blood pressure spikes, and the sympathetic nervous system activates. Over time, this nightly strain substantially increases risks of hypertension, atrial fibrillation, coronary artery disease, heart failure, and stroke [2].

A 2025 Lancet meta-analysis of over one million OSA patients found that CPAP therapy reduced all-cause mortality by 37 percent and cardiovascular death by 55 percent [3]. Beyond heart health, sleep apnea disrupts metabolism, promotes insulin resistance and type 2 diabetes, impairs cognitive function, increases depression risk, and raises motor vehicle accident rates due to daytime sleepiness.

Sleep apnea and accelerated aging

Research shows OSA accelerates biological aging at the cellular level. Mendelian randomization studies link OSA to increased DNA methylation age. Chronic intermittent hypoxia creates oxidative stress and systemic inflammation, both drivers of cellular senescence [4].

Addressing sleep apnea through CPAP therapy, weight management, or other interventions may slow this accelerated aging process. Early diagnosis and consistent treatment are essential for preserving long-term health and extending healthspan.

References

  1. 1. Home Sleep Apnea Testing for Obstructive Sleep Apnea (Hussein et al., Missouri Medicine, 2024)
  2. 2. Obstructive sleep apnea as a risk factor for stroke and death (Yaggi et al., New England Journal of Medicine, 2005)
  3. 3. CPAP therapy reduces all-cause mortality and cardiovascular death in OSA patients (Lancet Respiratory Medicine, 2025)
  4. 4. Obstructive sleep apnea and accelerated biological aging (Huang et al., Frontiers in Medicine, 2024)
  5. 5. Alcohol and the risk of sleep apnoea: a systematic review and meta-analysis (Simou et al., Sleep Medicine, 2018)
1.

Maintain a consistent sleep schedule

Going to bed and waking up at the same time every day helps regulate your circadian rhythm and can improve sleep quality. Poor sleep hygiene and irregular schedules can worsen sleep apnea symptoms and reduce treatment effectiveness.
2.

Sleep on your side to reduce apnea events

Positional therapy is one of the simplest interventions for obstructive sleep apnea. Sleeping on your side rather than your back can reduce the apnea-hypopnea index by up to 50 percent, as gravity no longer pulls the tongue and soft tissues backward into the airway.
www.sleepfoundation.org
3.

Lose weight to significantly reduce OSA severity

A 10 percent reduction in body weight can decrease the apnea-hypopnea index by 26 percent or more. Excess fat deposits around the upper airway narrow the breathing passage, so weight loss through diet, exercise, or medical intervention directly addresses one of the primary structural causes of OSA.
pmc.ncbi.nlm.nih.gov
4.

Avoid alcohol and sedatives before bedtime

Alcohol relaxes the upper airway muscles and can increase the duration and frequency of apnea episodes by up to 25 percent. Avoid alcohol for at least three hours before sleep, and discuss sedative medications with your doctor, as benzodiazepines and opioids can worsen sleep-disordered breathing.
pmc.ncbi.nlm.nih.gov
5.

Get tested with a home sleep apnea test

If you suspect sleep apnea, a home sleep apnea test (HSAT) offers a convenient diagnostic option. These portable devices measure airflow, blood oxygen levels, and breathing effort overnight. While polysomnography in a sleep lab remains the gold standard, HSAT is appropriate for most uncomplicated cases and has dramatically improved access to diagnosis.
pmc.ncbi.nlm.nih.gov
6.

Use CPAP consistently for at least four hours per night

Research shows a clear dose-response relationship between CPAP usage and health outcomes. Using CPAP for at least four hours per night is the minimum threshold for meaningful cardiovascular protection, but greater adherence yields greater benefits. Try different mask styles and use the ramp feature to gradually increase pressure for better comfort.
www.thelancet.com
1.

What is the 4-hour rule for CPAP?

The 4-hour rule refers to the minimum CPAP usage threshold for insurance coverage and therapeutic benefit. Medicare and most insurers require CPAP use for at least 4 hours per night on 70 percent of nights to continue coverage. Clinically, this threshold represents the minimum for meaningful cardiovascular protection, though research shows greater benefits with longer use. Many doctors recommend aiming for 6-8 hours of nightly CPAP use for optimal health outcomes.
2.

Can sleep apnea kill you?

Sleep apnea itself does not directly cause sudden death during sleep, but untreated severe OSA significantly increases the risk of fatal cardiovascular events including heart attack, stroke, and sudden cardiac death. A 2025 Lancet meta-analysis found that CPAP use reduced all-cause mortality by 37 percent, underscoring that treatment meaningfully extends lifespan. The cumulative effect of years of untreated sleep apnea on blood pressure, heart rhythm, and metabolic health can be life-threatening.
3.

What is the downside of using a CPAP machine?

Common CPAP challenges include mask discomfort, nasal dryness or congestion, skin irritation, claustrophobia, and noise. Some users experience aerophagia (swallowing air), which causes bloating. However, modern CPAP machines are significantly quieter and more comfortable than earlier models. Using a heated humidifier, trying different mask types, and adjusting pressure settings can resolve most issues. The health benefits of consistent CPAP use far outweigh these manageable side effects.
4.

How do I know if I have sleep apnea?

Key warning signs include loud and persistent snoring, observed breathing pauses during sleep (often reported by a bed partner), waking up gasping or choking, excessive daytime sleepiness despite adequate sleep time, morning headaches, and difficulty concentrating. Screening questionnaires like the STOP-BANG can help assess your risk. If you score high, a home sleep apnea test or in-lab polysomnography can confirm the diagnosis. Many smartwatches now also offer basic blood oxygen monitoring that may flag potential issues.
5.

What are the types of sleep apnea?

There are three main types. Obstructive sleep apnea (OSA) is the most common, accounting for about 84 percent of cases, and is caused by physical airway collapse during sleep. Central sleep apnea (CSA) occurs when the brain fails to properly signal breathing muscles and is often associated with heart failure or opioid use. Complex (treatment-emergent) sleep apnea is initially diagnosed as OSA but displays central apnea events when treated with CPAP. Each type requires a different treatment approach.
6.

Can sleep apnea be cured without CPAP?

For some patients, yes. Significant weight loss (particularly losing 10 percent or more of body weight) can substantially reduce or even eliminate mild to moderate OSA. Oral appliances that advance the lower jaw are effective alternatives for mild to moderate cases. Surgical options include hypoglossal nerve stimulation (Inspire implant), uvulopalatopharyngoplasty (UPPP), and maxillomandibular advancement for anatomically suitable candidates. However, CPAP remains the most consistently effective treatment for moderate to severe OSA, and lifestyle changes should complement rather than replace medical therapy.
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This content was created and reviewed by the New Zapiens Editorial Team in accordance with our editorial guidelines.
Last updated: February 26, 2026
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