What Is Obstructive Sleep Apnea?
Obstructive sleep apnea (OSA) is a sleep disorder. While you sleep, your upper airway, the space behind your tongue and soft palate, narrows or closes again and again. Each time, airflow drops or stops. The oxygen level in your blood can fall, and your sleep gets broken up.[4] Your brain wakes you just enough to start breathing again. Most people do not remember these wake-ups.
A full pause in breathing is called an apnea. A partial drop in airflow is called a hypopnea. A sleep study counts both and reports the apnea-hypopnea index (AHI). The AHI is the number of these events per hour of sleep. Sleep medicine uses AHI cutoffs of 5, 15, and 30 events per hour to sort OSA into mild, moderate, and severe.[3]
OSA is common. The American Heart Association (AHA) reports that about 34% of middle-aged men and 17% of middle-aged women meet the criteria for it. In people with high blood pressure, heart failure, atrial fibrillation, or a past stroke, rates can be as high as 40% to 80%.[4] Even so, it is often not recognized or treated.[4]
This page gives an overview of OSA and all of the main treatment paths. Each treatment section is short and links to a page with more detail. This is general education, not medical advice. Talk with your doctor about your own care.
Causes and Risk Factors
OSA happens when something blocks airflow through your upper airway during sleep. For example, your tongue may fall backward and block the airway.[1] The National Heart, Lung, and Blood Institute (NHLBI) lists these risk factors:[1]
- Excess weight. Fat deposits in the neck can block the upper airway.[1]
- Age. Risk goes up as you get older, in part because fatty tissue can build up in the neck and tongue.[1]
- Sex. OSA is more common in men. Men are also more likely to have serious OSA and to be diagnosed at a younger age.[1]
- Family history. Your genes help set the size and shape of your skull, face, and airway.[1]
- Mouth and throat anatomy. Large tonsils, a large tongue, or a large neck can narrow the airway.[1]
- Alcohol and smoking. Alcohol relaxes the muscles of the mouth and throat, which may close the airway. Smoking also raises risk.[1]
Symptoms of Sleep Apnea
Many people first hear about their symptoms from a bed partner. Signs can show up at night and during the day.[2]
Signs at Night
NHLBI lists these common signs during sleep:[2]
- Breathing that stops and starts
- Frequent loud snoring
- Gasping for air
- Waking up often during the night to urinate
Signs During the Day
Poor sleep at night shows up the next day. NHLBI lists these symptoms while awake:[2]
- Daytime sleepiness and tiredness, which can make it hard to learn, focus, and react
- Dry mouth
- Headaches
- Trouble sleeping (insomnia)
- Lower sex drive or sexual problems
Symptoms Can Differ in Women
Loud snoring is more common in men. Fatigue, headaches, and insomnia are more common in women.[2] So it helps to tell your doctor about all of your symptoms, not just snoring.
Sleep Apnea in Children
Children can have sleep apnea too. NHLBI notes that children with sleep apnea may be overactive, wet the bed, have worse asthma, or have trouble paying attention in school.[2] Some genetic conditions, such as cleft palate and Down syndrome, can lead to sleep apnea in children.[1] Children are checked and treated differently from adults. See our page on sleep apnea in children.
How a Physician Diagnoses Sleep Apnea
Obstructive sleep apnea is diagnosed by a physician through a sleep study. The study can be done in a sleep lab or at home. A dentist cannot diagnose OSA, and an online quiz cannot either.
The American Academy of Sleep Medicine (AASM) says testing should be part of a full sleep evaluation with follow-up. It recommends that questionnaires and prediction tools not be used to diagnose OSA in adults without a sleep test.[3] Your primary care doctor may order the test or refer you to a sleep physician.
Types of Sleep Studies
- In-lab sleep study (polysomnography). You spend the night at a sleep center while sensors record your breathing and sleep. The AASM calls it the standard test for diagnosing OSA in adults.[3]
- Home sleep apnea test. You wear a smaller device in your own bed. The AASM says it can be used to diagnose adults without complicating health problems who have signs of moderate to severe OSA.[3]
When an In-Lab Study Is Needed
If a home test is negative, unclear, or does not record well, the AASM recommends an in-lab study.[3] It also recommends an in-lab study instead of a home test for people with significant heart or lung disease, muscle weakness from a nerve or muscle condition, a history of stroke, long-term opioid use, or severe insomnia.[3]
What the Results Mean
Your physician reviews the study, confirms whether you have OSA, and rates how severe it is using the AHI.[3] Severity, your symptoms, and your other health conditions help guide which treatments make sense. Ask for a copy of your report. You will need it if you see a dentist or surgeon later.
Health Risks of Untreated Sleep Apnea
OSA is more than a snoring problem. Repeated drops in oxygen and broken sleep put stress on the heart and blood vessels.[4] NHLBI lists these possible complications of untreated sleep apnea:[5]
- Heart and blood vessel diseases, such as atrial fibrillation, hardened arteries (atherosclerosis), hard-to-control high blood pressure, heart attack, heart failure, high blood pressure in the lungs (pulmonary hypertension), and stroke[5]
- Type 2 diabetes and metabolic syndrome[5]
- Kidney disease, eye problems, and problems during pregnancy[5]
- Dementia in older adults[5]
Treatment Options
There are several ways to treat OSA. The right choice depends on how severe it is, the shape of your airway, your weight, your other health conditions, and what you can stick with. The AHA says everyone with OSA should be considered for treatment, including behavior changes and weight loss when needed.[4] Below is a short look at each main path, with links to our detailed pages.
CPAP and Other Breathing Machines
Continuous positive airway pressure (CPAP) is the most common treatment for sleep apnea.[7] A small bedside machine sends air through a mask to hold your airway open while you sleep. A physician prescribes it. The AASM recommends CPAP or auto-adjusting PAP (APAP) for ongoing treatment of adult OSA.[6] The AHA says CPAP should be offered to people with severe OSA.[4]
CPAP works when you use it, but it can take time to get used to. Side effects can include congestion, dry eyes or mouth, nosebleeds, and a runny nose.[7] The AASM recommends education when you start CPAP and suggests extra support and troubleshooting early on.[6] Many mask and comfort problems can be fixed. If CPAP is not working for you, see our guide to CPAP alternatives and our comparison of oral appliances and CPAP.
Oral Appliance Therapy From a Dentist
An oral appliance is a custom mouthpiece you wear while you sleep. The most common type, a mandibular repositioning (advancement) device, holds your lower jaw slightly forward to help keep the airway open.[7] A dentist or orthodontist custom fits the device and teaches you how to use it.[7]
A joint guideline from the AASM and the American Academy of Dental Sleep Medicine recommends that sleep physicians consider prescribing an oral appliance for adults with OSA who cannot tolerate CPAP or who prefer another treatment. It suggests a custom, adjustable device over a non-custom one. It also suggests dental follow-up to watch for bite changes, and a follow-up sleep test to confirm the device works.[8] The AHA says oral appliances can be considered for mild to moderate OSA or for people who cannot tolerate CPAP.[4]
Learn more on our pages about oral appliance therapy, the sleep apnea mouth guard, and whether mouth guards work for sleep apnea.
Side Sleeping and Lifestyle Changes
For some people, sleep apnea is worse when they sleep on their back. Your provider may suggest sleeping on your side, which can help keep your airway open.[7]
NHLBI also lists healthy habits that can help: regular physical activity, good sleep habits, a healthy weight, limiting alcohol and caffeine, and quitting smoking.[7] Ask your physician whether these steps are enough for you, or whether you should pair them with another treatment.
Weight Loss and Medication
Extra fat in the neck can block the upper airway, so weight loss can help when obesity is part of the cause.[1][4]
There is now a medicine approved for OSA. On December 20, 2024, the U.S. Food and Drug Administration (FDA) approved tirzepatide (brand name Zepbound) for moderate to severe OSA in adults with obesity. It is used along with a reduced-calorie diet and more physical activity.[9] It is a shot given under the skin.[7] In two 52-week studies of 469 adults without type 2 diabetes, people taking it had a larger drop in AHI than people on a placebo, along with meaningful weight loss.[9] Common side effects include nausea, diarrhea, vomiting, constipation, and stomach discomfort.[9] It is a prescription medicine managed by your physician. It is not a dental treatment.
Weight-loss (bariatric) surgery is another option for some people. The AASM recommends that clinicians discuss a referral to a bariatric surgeon with adults who have OSA and a body mass index (BMI) of 35 or higher who cannot use or do not accept PAP.[10]
Surgery
Surgery changes the structure of the airway. The AASM recommends that clinicians discuss a referral to a sleep surgeon with adults who have OSA and a BMI under 40 who cannot use or do not accept PAP.[10] Different surgeons do different procedures:
- Maxillomandibular advancement (MMA). An oral and maxillofacial surgeon moves the upper and lower jaws forward. This makes the airway larger and keeps the tongue and soft tissues from blocking it during sleep.[11] It is a major operation for selected adults. See our page on maxillomandibular advancement.
- Genioglossus advancement. This procedure pulls the muscles under the tongue forward so the tongue does not fall back into the airway.[11]
- Throat and soft palate surgery. Uvulopalatopharyngoplasty (UPPP) removes tissue from the mouth and throat to make the airway larger. Removing the tonsils is another option for some people.[7] These procedures are done by ear, nose, and throat (ENT) surgeons, also called otolaryngologists, and by some oral and maxillofacial surgeons.[11]
- Hypoglossal nerve stimulation. A small device is implanted under the skin of the chest and connected to the nerve under the tongue, to help keep the airway open.[7] ENT surgeons and some oral and maxillofacial surgeons place it.[11] Inspire is one brand. See our guide to Inspire vs. an oral appliance.
How Surgeons Work Together
Oral and maxillofacial surgeons often work with sleep medicine physicians, ENT surgeons, lung doctors (pulmonologists), and general dentists to plan care.[11] For more on the dental side, read our guide to oral surgery for sleep apnea.
Choosing a Treatment and Following Up
You do not always have to pick just one option. Some people use more than one, such as an oral appliance plus side sleeping, or weight loss plus CPAP. Your sleep physician can help you decide what fits.
Follow-up matters with every treatment. The AHA says follow-up sleep testing should be done to check that treatment is working.[4] For oral appliances, the AASM and AADSM guideline suggests a follow-up sleep test and regular visits with both the dentist and the sleep physician.[8] NHLBI notes that people with an oral device may need to see their dentist after 6 months and then every year.[5]
Do not stop a treatment on your own. If something is not working, ask your physician about another plan. Untreated sleep apnea can make you sleepy and make it hard to pay attention while driving, and NHLBI advises not driving if you feel tired or sleepy.[5]
How Dentists Fit Into Sleep Apnea Care
Dentists play a real but specific part in OSA care. They do not diagnose it. Here is what a dentist can do:
- Screen. A dentist may ask about snoring, tiredness, or teeth grinding, or notice signs during an exam. A screening question or exam cannot confirm OSA. Only a sleep test can.[3]
- Refer. If OSA seems possible, your dentist can send you to your primary care doctor or a sleep physician for a sleep study.
- Fit an oral appliance on prescription. After a physician diagnoses OSA and prescribes an oral appliance, a qualified dentist makes a custom, adjustable device, adjusts it over time, and watches for bite changes.[8]
- Work with your physician. The physician orders a follow-up sleep test to confirm the device is working.[8]
Training and Dental Specialties
Dental sleep medicine is not a dental specialty recognized by the American Dental Association. Many general dentists offer oral appliance therapy. Oral and maxillofacial surgery, orthodontics, prosthodontics, orofacial pain, and pediatric dentistry are recognized dental specialties, and dentists in these fields may be part of OSA care in different ways. Ask any dentist about their training, how they work with your physician, and how they handle follow-up.
If you also have jaw pain or grind your teeth, see our pages on TMJ and sleep apnea and bruxism and sleep apnea. For questions about jaw growth and braces, see orthodontic treatment for sleep apnea and airway orthodontics.
Insurance Basics
Because OSA is a medical condition, treatment is usually billed to medical insurance, even when a dentist provides the oral appliance. Medicare, for example, covers a custom oral appliance (code E0486) when four conditions are met: you have an in-person visit with your treating practitioner before the sleep test, the sleep test results meet set levels, the practitioner orders the device after reviewing the test, and a licensed dentist provides and bills for it. Medicare does not cover premade, non-custom appliances under this policy.[12]
Private plans set their own rules, and costs depend on your plan, where you live, and the treatment you need. Ask your plan what it covers before you start. Our oral appliance cost and insurance guide explains more.
Find a Provider for Sleep Apnea Care
Start with a diagnosis. If you have symptoms, ask your primary care doctor about a sleep study. Obstructive sleep apnea is diagnosed by a physician through an in-lab or home sleep study, not by a dentist.[3]
If your physician prescribes an oral appliance, browse our list of dentists who provide oral appliance therapy, grouped by state. The dentist screens, refers, and fits the appliance on your physician's prescription, then works with your physician on follow-up testing.[8]
If your physician refers you to discuss jaw surgery, search for oral and maxillofacial surgeons near you, or browse the full provider directory. When you call an office, ask how it works with your sleep physician and how follow-up testing is handled.
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