What sleep apnea is
In obstructive sleep apnea (OSA), the muscles of the throat relax during sleep and the airway repeatedly narrows or closes. Breathing drops or stops for ten seconds or more, oxygen levels fall, and the brain briefly jolts you toward waking to reopen the airway. This can happen dozens of times an hour, usually without you ever remembering it.
Severity is measured by the apnea-hypopnea index (AHI): the average number of breathing pauses or significant drops per hour of sleep.
| AHI (events per hour) | Severity |
|---|---|
| Under 5 | Normal |
| 5–15 | Mild |
| 15–30 | Moderate |
| 30+ | Severe |
A less common form, central sleep apnea, happens when the brain doesn't send the signal to breathe. It's treated differently, and this guide focuses on the obstructive kind.
Why it's so common in men
Worldwide, researchers estimate close to a billion people have some degree of sleep apnea, and men are affected roughly two to three times as often as women before menopause. Most people with moderate or severe OSA don't know they have it. The main risk factors:
Men tend to store more fat around the neck and upper airway, and hormonal differences affect airway muscle tone. But thin, fit men get sleep apnea too. Jaw structure and airway anatomy matter as much as weight.
Signs & symptoms
At night
- Loud, frequent snoring
- Pauses in breathing, gasping, or choking (often noticed by a partner)
- Restless sleep and frequent waking
- Waking up to urinate several times
- Night sweats
During the day
- Waking unrefreshed, even after a full night
- Morning headaches or a dry mouth
- Daytime sleepiness, nodding off when sitting still
- Poor concentration and memory
- Irritability or low mood
- Low libido or erectile dysfunction
Not everyone who snores has sleep apnea, and not everyone with sleep apnea snores loudly. The only way to know is a sleep test.
STOP-BANG screener
STOP-BANG is a validated eight-question tool doctors use to estimate sleep apnea risk. Check each one that applies to you.
A screening tool, not a diagnosis. STOP-BANG is designed to catch as many cases as possible, so it flags some people who turn out not to have sleep apnea. And a low score doesn't rule it out if you have symptoms. Your answers stay in your browser.
Why it matters
Every breathing pause drops your oxygen and spikes your stress hormones and blood pressure. Night after night, that adds up. Untreated moderate-to-severe OSA is linked to:
- ✕High blood pressure, including hard-to-control hypertension that doesn't respond well to medication. Blood pressure guide →
- ✕Heart disease, including atrial fibrillation, heart failure, and stroke.
- ✕Type 2 diabetes and insulin resistance.
- ✕Car crashes. Drowsy drivers with untreated OSA have a substantially higher crash risk.
- ✕Depression, memory, and concentration problems.
- ✕Low testosterone and erectile dysfunction.
Sleep apnea, low T & TRT
Sleep apnea and low testosterone often show up together, and the relationship runs in both directions:
- OSA lowers testosterone. Fragmented sleep and repeated oxygen drops suppress testosterone production. Excess weight, a shared risk factor, lowers it further.
- TRT can worsen OSA. Testosterone therapy, particularly at higher doses, can aggravate existing sleep apnea. The Endocrine Society's guidelines recommend against starting TRT in men with untreated severe sleep apnea.
What this means in practice:
- If you're being evaluated for low T and have symptoms of OSA, ask to be screened for sleep apnea. Treating it may improve your energy, and sometimes your testosterone, on its own.
- If you're already on TRT, watch for new or louder snoring, or growing daytime tiredness, and raise it with your prescriber.
- A good TRT provider asks about sleep. If a clinic never mentions it, that's a signal about how thorough its screening is. Compare providers in our directory →
Getting tested
There are two main ways to diagnose sleep apnea. A primary care doctor, sleep medicine specialist, or ENT can order either one.
| Test | How it works |
|---|---|
| Home sleep apnea test | A small device worn for a night or two at home that tracks breathing, oxygen, and heart rate. Convenient and much cheaper. A good fit for otherwise healthy adults with a high suspicion of moderate-to-severe OSA. |
| In-lab sleep study (polysomnography) | An overnight stay in a sleep lab with brain, heart, breathing, and muscle monitoring. The most complete test. Used when a home test is inconclusive, or if you have heart or lung disease or a suspected different sleep disorder. |
A negative home test doesn't always rule out sleep apnea, since it can underestimate mild cases. If symptoms persist, ask about an in-lab study.
Treatment options
CPAP (continuous positive airway pressure)
The standard first-line treatment for moderate and severe OSA. A bedside machine gently blows air through a mask, keeping the airway open. When used consistently, it works for nearly everyone, and it reliably reduces snoring and daytime sleepiness and modestly lowers blood pressure. Whether CPAP prevents heart attacks and strokes is still debated, partly because many trial participants used it for only a few hours a night. Auto-adjusting machines (APAP) that tune the pressure through the night are now common.
Oral appliances
A custom mouthguard-like device, fitted by a dentist trained in sleep medicine, that holds the lower jaw slightly forward to keep the airway open. A good option for mild to moderate OSA, or for people who can't tolerate CPAP. It's less effective than CPAP on paper, but many people wear it more consistently.
Weight loss & medication
Losing weight can substantially reduce the severity of sleep apnea, and occasionally resolve it. In late 2024, the FDA approved tirzepatide (Zepbound) as the first medication specifically for moderate-to-severe OSA in adults with obesity. Weight-loss medications are usually used alongside CPAP or other treatment, not as an instant replacement, and apnea should be retested after significant weight change.
Hypoglossal nerve stimulation
An implanted device (the best-known is Inspire) that stimulates the nerve controlling the tongue, moving it forward with each breath. Typically for people with moderate-to-severe OSA who can't tolerate CPAP and who meet specific weight and airway anatomy criteria.
Surgery
Options range from removing large tonsils to procedures on the soft palate or jaw advancement surgery. Results vary widely depending on anatomy, so it's usually considered after other treatments, with a sleep surgeon who evaluates your specific airway.
Positional therapy
Some people only have significant apnea when sleeping on their back. Wearable devices or simple tricks that keep you on your side can help in those cases. A sleep study will show whether your apnea is positional.
Making CPAP work
CPAP only helps when you wear it, and many people give up in the first few weeks. Most of the problems are fixable:
- Mask fit is everything. Nasal pillows, nasal masks, and full-face masks all feel very different. Ask your supplier to swap if yours leaks or is uncomfortable. It's common to try two or three.
- Dry mouth or nose: turn on or adjust the heated humidifier, or try a chin strap if you breathe through your mouth.
- The pressure feels like too much: most machines have a "ramp" feature that starts gently and builds as you fall asleep.
- Build up gradually. Wear it while reading or watching TV to get used to it, then all night.
- Give it a few weeks. Many people notice they feel dramatically better within days to weeks, and that's the best motivation to stick with it.
What helps on your own
These don't replace treatment for moderate or severe OSA, but they help, and they can be enough for some mild cases:
- ✓Lose excess weight. Even a 10% reduction in body weight can meaningfully lower apnea severity.
- ✓Avoid alcohol and sedatives in the evening. They relax the airway muscles and make apnea worse.
- ✓Sleep on your side if your apnea is worse on your back.
- ✓Treat nasal congestion from allergies or a deviated septum.
- ✓Quit smoking, which inflames the upper airway.
- ✓Exercise regularly. It improves apnea severity somewhat even without weight loss.