Maybe you’re used to being woken up in the middle of the night by your partner’s elbow because you’re snoring again. Maybe you’re the partner throwing the elbow and threatening to sleep in the guest room! Whatever the case, it’s easy to just dismiss these things as a nuisance, but they could be signs of something more serious: obstructive sleep apnea (OSA), a condition that comes with a plea for action, not comedic dismissal. When sleep feels more exhausting than refreshing, you’ve come to the right place. You’re not alone—and there are ways to get back to truly restful nights and better days.

Of the many sleep-related breathing disorders, OSA is the most common. People who have OSA can have reductions or cessation of breathing repeatedly throughout the night. Although OSA is typically described as being accompanied by loud snoring, gasping, or choking, it can occur relatively quietly as well in certain populations. Therefore, it is important to distinguish that OSA is more than snoring and has multiple factors that can cause a person to develop it, including, but not limited to: 

• A collapsible or floppy airway
• Physical obstruction due to craniofacial differences, like a small or pushed back jaw, narrow jaw, or flattened nasal bridge or cheekbones
• Oral and dental differences like a high arched palate, dental crowding, a large tongue, or a low-lying posterior pharynx
• Enlarged lymphoid tissue, like large tonsils or adenoid
• Hormonal differences like menopause (not on hormone replacement therapy) or growth hormone treatments 
• Neurologic differences with low muscle tone

The consequences of OSA extend beyond the night, and people can experience excessive daytime sleepiness (EDS), irritability, and other daytime effects, such as lower productivity and challenges with concentration and memory. 

When it comes to diagnosing OSA, there are four types of sleep testing.¹

• Type 1: A technician-attended in-laboratory polysomnography or sleep test
• Type 2: An unattended polysomnogram, meaning its level of detail (and all the wires and leads) make it more comparable to an in-laboratory study, but the test would be performed in the home, making it less commonly used
• Type 3: Portable studies that typically measure 4-7 physiologic variables, typically at minimum two breathing-related variables, (like breathing effort and airflow), a cardiac variable, and measure of oxygen in the blood. These are what most typically referred to as home sleep apnea testing (HSAT).
• Type 4: Minimal portable studies – Screening for OSA is based on rudimentary measures of one or 2 channels, typically heart rate and oxygen levels in the blood or simply airflow

Type 1 polysomnography is the gold standard – it tracks a wide range of bodily functions while you sleep, including brain waves, heart rate, and, of course, your breathing. The respiratory values that are tracked include: apneas (when breathing completely stops), hypopneas (when breathing becomes more shallow but doesn’t stop completely), and respiratory effort-related arousals (RERAs, in which shallow breathing causes the brain to wake you before your oxygen level starts to drop, thereby disturbing sleep). All of this information helps give your doctor a very accurate picture of how often your breathing is disrupted per hour of sleep, known as Apnea-Hypopnea Index (AHI). 

HSAT, on the other hand, can be done at home but typically does not measure brain waves (electroencephalography). Without measuring brain waves, the test can’t tell for sure when you are sleeping and when you are awake, and it doesn’t count RERAs or hypopneas. Instead of counting events per hour of sleep (like polysomnography), the HSAT counts events per hour of monitoring time. This difference can make the results look milder than they really are.² 

For more information about getting diagnosed, check out our sleep testing section and stay tuned for new developments in resources which can help you prep for these studies. 

OSA Diagnostic Criteria in Adults²

Criteria A and B (or A and C) and D must be met

A. The presence of one or more of the following: 

1. The patient complains of sleepiness, fatigue, insomnia, or other symptoms leading to impaired sleep-related quality of life.
2. The patient wakes with breath-holding, gasping, or choking.
3. The bed partner or other observer reports habitual snoring or breathing interruptions during the patient’s sleep.

B. Polysomnography or HSAT demonstrates

Five or more predominantly obstructive respiratory events (obstructive and mixed apneas, hypopneas, or respiratory effort-related arousals) per hour of sleep during PSG or per hour of monitoring (HSAT).

C. Polysomnography or HSAT demonstrates

Fifteen or more predominantly obstructive respiratory events (obstructive and mixed apneas, hypopneas, or respiratory effort-related arousals) per hour of sleep during PSG or per hour of monitoring (HSAT).

D. The symptoms are not better explained by another current sleep disorder, medical disorder, medication or substance use.

OSA Diagnostic Criteria in Pediatrics²

Criteria A-C must be met.

1. The presence of one or more of the following: 

1. Snoring
2. Labored, paradoxical, or obstructed breathing during the child’s sleep
3. Sleepiness, hyperactivity, behavioral problems, or learning or other cognitive problems

2. Polysomnography demonstrates one of the following:

1. One or more obstructive apneas, mixed apneas, or hypopneas per hour of sleep
2. A pattern of obstructive hypoventilation, defined as at least 25% of total sleep time with hypercapnia (PaCo₂ > 50 mm Hg) in association with one or more of the following:

1. Snoring
2. Flattening of the inspiratory nasal pressure waveform
3. Paradoxical thoracoabdominal motion

3. The symptoms are not better explained by another current sleep disorder, medical disorder, medication or substance use

The Treatment of OSA

Finding the right treatment for OSA can truly be life-changing and life-saving. If you’ve been living with sleepiness, brain fog, or restless nights, you know how much untreated sleep apnea can affect your daily life. When it comes to treatment, there’s no one-size-fits-all solution—and that’s a good thing. Whether you’ve tried continuous positive airway pressure, (CPAP) and slept soundly or struggled to use it, or you’re just starting to explore your options, there are more choices than ever before. The key is finding what works best for you—your body, your lifestyle, and your comfort. 

A number of therapies are now available to treat OSA, including positive airway pressure (PAP), oral appliances (OA), surgical procedures, neuromodulation devices, and even medication, with the best choice being based on what works for your body and your preferences. Weight loss and exercise have also been shown to improve symptoms of OSA.³ 

It is not uncommon for clinicians to quote that the preferred treatment for OSA is with a device that delivers PAP through a full-face or nasal mask or pillows to keep the airway open during sleep. The pressure can be CPAP, auto-adjusting (APAP), or bilevel (BPAP), which is based on the 2019 American Academy of Sleep Medicine guidelines.³ With this stated, one of Dr. Morse’s favorite quotes to summarize is from her close friend, esteemed colleague, and OSA expert Dr. Atul Malhotra, “The preferred treatment for OSA is the one the patient prefers (and will use).” Therefore, we should not dismiss or diminish any of the approaches that can improve the severity of sleep-disordered breathing and always work toward the best personalized approach to optimize outcomes.  

OAs, preferably custom devices, are an effective alternative to PAP for people with OSA who prefer an OA or who do not tolerate PAP.⁴ There are multiple OA manufacturers, and the appliance should be customized to your mouth and the severity of your sleep-disordered breathing. In general, a dentist who is specialized in sleep would be the best person to customize your device.

Multiple surgical options are available for the treatment of OSA and are always personalized to the specific airway obstructions that may be present. In pediatrics, surgical revision of tonsil or adenoid enlargement is typically considered first-line therapy but may not be as commonly encountered in adults. Ear, nose, and throat surgeons (otolaryngologists), oral maxillofacial surgeons, and plastic or reconstructive surgeons may be involved. Surgical approaches may include sinus surgery to improve nasal breathing, reconstructive airway surgery, and jaw (mandibular) advancement, among other procedures.⁵ In addition, neuromodulation devices can be implanted and programmed to stimulate the nerves of the base of the tongue to help move the tongue forward.⁶

Nonsurgical options, including myofunctional therapy and neuromuscular electrical stimulation (NMES), can help improve tone and responsiveness of the upper airway muscles and tongue to prevent them from collapsing in the airway. 

In 2024, the US Food and Drug Administration (FDA) approved the first and only drug treatment, tirzepatide, a glucagon-like peptide-1 and gastric inhibitory polypeptide (dual GLP-1 and GIP) receptor agonist, for the treatment of moderate to severe OSA in adults with obesity.⁷ The pivotal trials that led to the approval of this drug studied adults with moderate to severe OSA and obesity who consistently used PAP therapy as well as those on no PAP therapy; in both groups, the AHI markedly improved, as did time spent in low oxygen states and cardiometabolic parameters, such as cholesterol levels and blood pressure.

Many people who use these standard treatments to successfully reduce their AHI continue to experience daytime consequences of OSA, including EDS and others. EDS associated with OSA does have options for treatment beyond what has been described above, including the wake-promoting agents armodafinil, modafinil, and solriamfetol that have been approved by the US Food and Drug Administration and pitolisant and solriamfetol that have been approved by the European Medicines Agency.⁸ The utilization of these medications as well as other off-label medications should always be personalized to the individual risk-benefit profile.

No matter where you are in your journey with OSA, you have options—and the right one can help you unleash your best self. The key is to work with your healthcare team to find a treatment that fits your needs, your lifestyle, and your comfort. You don’t have to settle for feeling tired, foggy, or frustrated. It might take a little trial and error, but with the right support and the right tools, restful nights and energized days are possible.

References

1. Kapur VK, Auckley DH, Chowdhuri S, et al. Clinical practice guideline for diagnostic testing for adult obstructive sleep apnea: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. 2017;13(3):479-504.
2. American Academy of Sleep Medicine. International Classification of Sleep Disorders, 3rd ed, Text Revision. American Academy of Sleep Medicine; 2023.
3. Patil SP, Ayappa IA, Caples SM, Kimoff RJ, Patel SR, Harrod CG. Treatment of adult obstructive sleep apnea with positive airway pressure: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. 2019;15(2):335-343.
4. Ramar K, Dort LC, Katz SG, et al. Clinical practice guideline for the treatment of obstructive sleep apnea and snoring with oral appliance therapy: an update for 2015. J Clin Sleep Med. 2015;11(7):773-827.
5. Huyett P, Soose RJ. Rationale and indications for surgical treatment. In: Friedman M, Jacobowitz O, eds. Sleep Apnea and Snoring. Elsevier; 2020:66-69.
6. Mashaqi S, Patel SI, Combs D, et al. The hypoglossal nerve stimulation as a novel therapy for treating obstructive sleep apnea–a literature review. Int J Environ Res Public Health. 2021;18(4).
7. Eli Lilly and Company. Zepbound (tirzepatide). Published 2025. Accessed May 14, 2025.
8. Wang Y, Zhang W, Ye H, Xiao Y. Excessive daytime sleepiness in obstructive sleep apnea: Indirect treatment comparison of wake-promoting agents in patients adherent/nonadherent to primary OSA therapy. Sleep Med Rev. 2024;78:101997.