Sleep Equity Project
Sleep Apnea Awareness
You will learn the following in this section:
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Symptoms and Signs
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Nontraditional Symptoms and Signs
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Gender Differences in Sleep Apnea Symptoms and Signs
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Racial Inequity In Recognizing Sleep Apnea
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Screening and Diagnosis Pathways
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Treatment Options
Just the Basics
Learn more here about what are traditional signs and symptoms for sleep apnea. No single sign or symptom appears in everyone with a sleep-related breathing disorder. Each person may experience different indicators, making these conditions complex and difficult to recognize. This variability can also make it hard for individuals to understand what their bed partner or loved one observes during sleep.
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Becoming aware of the condition, receiving a diagnosis, and adjusting to treatment is rarely a quick or straightforward process.
Signs
Something a bed partner or relative notices
Symptoms
Something a Person May Experience
In Adults:​
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Gasping or choking while asleep
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Pause in breathing during sleep (Apnea)
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Loud snoring
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Tossing and turning at night
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Mental foginess
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Drowsy Driving
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Behavioral changes
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In Children:
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Bedwetting
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Hyperactive/Inattentive (can look like ADHD)
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Poor school performance
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Frequent movement while asleep
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Sleeping in an unusual position with neck extended
In Adults:​
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Consistent sleepiness despite many hours sleep
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Poor concentration
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Morning headache
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Dry mouth
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Poor memory
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Irritability
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Difficulty staying asleep
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Reflux or heartburn
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Issues with mood such as depression or anxiety
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In Children:
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Can be same as above
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BUT children may not be able to describe these symptoms
Nontraditional Signs and Symptoms
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Frequent trips to the bathroom at night (nocturia)
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Teeth grinding during sleep (bruxism)
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Clumsiness or poor coordination
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Slower processing of information or reaction time
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Can't remember dreams
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Difficulty connecting the dots between all these symptoms
Gender Differences in How Women Describe Sleep Apnea
Why Women Are Underdiagnosed With Sleep Apnea
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Women with OSA report of symptoms such as insomnia, restless legs, depression, nightmares, palpitations, and hallucinations; men are more likely to report snoring and apneic episodes (1).​​
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This contributes to women being grossly underdiagnosed with sleep apnea
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The myth of being an overweight man as the only type of person who could have sleep apnea impacts women being underdiagnosed
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Multiple factors combine to lower the total number of events (how many times the airway closes for 10 seconds in an hour) counted by sleep studies with regard to women
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The stages of sleep are made up of Rapid Eye Movement (REM) and Non-REM. 20% is REM and 80% is NONREM.
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Women have been found to have more events during REM. This results in less events being counted during the sleep study which lowers the total events (3) ​
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Women tend to have Hypopneas (partial Airway Closure) which may not get counted as events during a sleep study which then lowers their total events (4)
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The lack of recognition by primary care physicians due to the differing ways women report symptoms of sleep apnea translate to less women being referred to sleep medicine physicians
Racial Inequity in Recognizing Sleep Apnea
Various factors lead to less minorities being diagnosed with sleep apnea
Recognized need by Primary Care of Signs and Symptoms
Signs and symptoms often go unnoticed by individuals. This same issue is widespread among society and various medical professionals. This leads to a lack of referral by primary care physicians to sleep medicine.
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Some medical specialties are doing better at recognizing when someone may have sleep apnea. Cardiologists have added sleep as their 8th lifestyle habit for a healthy heart (5). Some cardiologists are even board certified in sleep medicine and treat both conditions.
Minority Representation in Primary Care and Sleep Medicine Workforce
Race of Physician Impacts Mortality and Health Outcomes
Lack of Access to Health Care
A large body of research has shown that compared to the White population, racial/ ethnic minority groups experience disparities in access to care and healthcare quality, including effectiveness of treatment, timeliness, patient safety, and preventive screening (6).
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Minority Americans, particularly Hispanic and African American populations, are more likely to be uninsured and face greater barriers to accessing healthcare. A lack of health insurance is associated with reduced access to medical services and more negative healthcare experiences across the board. These disparities contribute to delayed diagnoses, untreated conditions, and overall poorer health outcomes (7).
Multiple studies have shown that racial and ethnic concordance between patients and physicians leads to better health outcomes (8). When minority patients are cared for by providers who share their racial or ethnic background, they are more likely to experience improved communication, higher trust, and increased satisfaction with care (9). This alignment has been linked to outcomes such as longer life expectancy and reduced mortality rates.​
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Diagnosis and Screening Pathways
Identifying and diagnosing sleep apnea can be a complex and time-consuming process. Many individuals are unaware of the signs and symptoms or may not realize that their daily fatigue, memory issues, or frequent nighttime awakenings are related to a sleep disorder.
To help screen for sleep apnea and excessive daytime sleepiness, healthcare providers often use tools like the Epworth Sleepiness Scale, which asks patients to rate their likelihood of dozing off in various situations. A higher score may indicate problematic sleepiness that warrants further evaluation.
Another widely used screening tool is the STOP-Bang questionnaire, which assesses key risk factors such as Snoring, Tiredness, Observed apnea, high blood Pressure, Body mass index (BMI), Age, Neck circumference, and Gender. A high STOP-Bang score suggests an increased risk of obstructive sleep apnea.
If screening tools suggest a sleep disorder, a diagnostic sleep study (polysomnography) is typically recommended. This can be performed in a sleep center, where various physiological signals—such as brain activity, breathing patterns, oxygen levels, and muscle movements—are monitored overnight by trained specialists.
Alternatively, for certain individuals, an at-home sleep apnea test (HSAT) may be appropriate. These portable tests are more convenient and measure key indicators like airflow, oxygen saturation, and respiratory effort, though they do not provide the full range of data captured in a sleep lab. While at-home tests are useful for diagnosing moderate to severe obstructive sleep apnea, they may miss more complex or subtle sleep disorders. Regardless of the method, proper diagnosis is critical for developing an effective treatment plan and improving long-term health outcomes.
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Click the links below to learn more
Screening Tools
Sleep Studies
Finding a Solution
If you’ve been diagnosed with sleep apnea, you’re not alone—and the good news is, there are several treatment options available. In this section, we’ll walk you through the most common approaches, how effective they are, what challenges patients often face, and the average cost of each option.
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In this section, we will give you basic information about:
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What options are available
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How effective each option is
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What are some barriers to adopting the treatment
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Average cost of treatment option
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Treatment Options
Continout Positive Airway Pressure (CPAP)
What it is:
CPAP is the most common and effective treatment for obstructive sleep apnea. It involves wearing a mask that delivers a steady stream of air to keep your airway open during sleep.
Effectiveness:
Very high—CPAP is considered the gold standard for treating moderate to severe OSA. When used consistently, it greatly reduces apnea episodes and improves oxygen levels, sleep quality, and daytime alertness.
Barriers to Use:
• Discomfort wearing the mask
• Noise from the machine
• Skin irritation or dryness
• Travel inconvenience
• Adjustment period for consistent nightly use
Average Cost:
• Machine: $500–$1,200
• Supplies (mask, tubing, filters): $20–$100/month
• Covered by most insurance, often with co-pays
Improving Sleep Hygeine
What it is:
Sleep hygiene refers to creating healthy habits and an environment that support quality sleep. While not a treatment for sleep apnea on its own, good sleep hygiene can enhance the effectiveness of other therapies and improve overall sleep quality.
Effectiveness:
Moderate—helps reduce sleep disruptions, supports other treatments like CPAP or oral devices, and can make it easier to fall and stay asleep. While it won’t cure OSA, it can lessen fatigue and improve well-being.
Key Sleep Hygiene Practices:
• Stick to a consistent sleep schedule—even on weekends
• Create a dark, cool, and quiet bedroom environment
• Avoid screens (phones, TVs, tablets) at least 30–60 minutes before bed
• Limit caffeine and alcohol intake, especially in the evening
• Develop a calming bedtime routine (e.g., reading, stretching, or mindfulness)
Barriers to Use:
• Lifestyle demands (e.g., shift work, family obligations)
• Difficulty breaking old habits
• Environmental challenges like noise, light, or shared spaces
Average Cost:
• Often free to implement
• May involve small purchases (e.g., blackout curtains, white noise machines, or sleep-friendly lighting—typically under $100)
Weight Loss and Lifestyle Changes
What it is:
Improving sleep apnea symptoms through weight loss, exercise, reducing alcohol intake, quitting smoking, and sleeping on your side instead of your back.
Effectiveness:
Can be highly beneficial for individuals with obesity-related OSA. Lifestyle changes may reduce the severity of symptoms and improve overall health but may not fully eliminate the need for additional treatment.
Barriers to Use:
• Requires long-term commitment
• May not be effective as a standalone treatment
• Not all individuals with OSA are overweight
Average Cost:
• Varies widely depending on program; weight loss counseling or fitness plans may be covered by insurance
Positional Therapy
What it is:
Training yourself to sleep in non-supine (side-sleeping) positions using devices like specialty pillows, vests, or belts that prevent back-sleeping.
Effectiveness:
Helpful for people whose apnea occurs mostly when sleeping on their back (positional OSA). May be used alone for mild cases or with other treatments.
Barriers to Use:
• Discomfort or difficulty staying in one position
• May not be effective for non-positional OSA
Average Cost:
• $50–$200 (typically not covered by insurance)
Oral/ Dental Appliances
What it is:
Custom-fitted devices worn in the mouth during sleep to keep the airway open by repositioning the lower jaw and tongue.
Effectiveness:
Moderate—best for mild to moderate OSA or for those who can’t tolerate CPAP. May reduce snoring and apnea episodes but is not as effective as CPAP for severe cases.
Barriers to Use:
• May cause jaw pain, dry mouth, or dental discomfort
• Requires custom fitting by a sleep-trained dentist
• May not be suitable for patients with significant dental issues
Average Cost:
• $1,500–$3,000 (often partially covered by insurance)
Surgery
What it is:
Surgical procedures to remove or reposition tissue, correct nasal obstructions, or implant devices (like Inspire therapy) that stimulate airway muscles. Consult your physician for specific options.
Effectiveness:
Varies widely depending on the procedure and patient anatomy. Some surgeries provide long-term relief, while others have mixed results.
Barriers to Use:
• Invasive, with possible complications
• Recovery time
• Not guaranteed to eliminate OSA
Average Cost:
• $5,000–$15,000+ (may be partially covered by insurance)
Frequently Asked Questions
Q: Are sleep doctors just trying to sell CPAP machines?
A: Absolutely not. Sleep physicians are highly trained to diagnose complex sleep breathing disorders that cannot be self-detected. Since we’re asleep during these events, we can’t observe our own heart rate, respiration, body position, leg movements, or sleep stages—data that is crucial and collected during both in-lab and at-home sleep studies. Sleep doctors interpret this data to help you find the safest and most effective treatment.
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Q: How do I clean my CPAP machine?
A: Cleaning your CPAP regularly is important to prevent buildup and bacteria. Recommended methods include:
1. White vinegar rinse – Gently disinfects; be sure to rinse thoroughly.
2. Mild soap and warm water – Simple and effective; avoid harsh chemicals.
Always allow your equipment to air dry completely before use.
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Q: What’s the difference between a CPAP and a BiPAP?
A: A CPAP (Continuous Positive Airway Pressure) machine delivers one steady level of air pressure. Most modern CPAPs are auto-adjusting (Auto-CPAP). A BiPAP (Bilevel Positive Airway Pressure) machine delivers two pressures: one for inhalation and a lower one for exhalation, which may be more comfortable for some users.
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Q: Can I make changes to my CPAP machine to improve comfort?
A: Yes, but only adjust comfort settings like humidity level or ramp time. Do not change your pressure settings—those are prescribed by your sleep physician based on clinical data. Always consult your doctor before making pressure changes.
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Q: Do I really need to use distilled water in my CPAP every day?
A: Yes. Tap water can leave behind minerals and sediment, which can damage your humidifier chamber and increase the risk of respiratory irritation.
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Q: If I’m not overweight, can I still have sleep apnea?
A: Yes. Sleep apnea affects people of all body types. We’ve seen thin individuals—both men and women—diagnosed with severe sleep apnea, so body weight is just one of many factors.
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Q: What’s the Inspire device I keep seeing in commercials?
A: Inspire is an FDA-approved, implantable device that treats moderate to severe obstructive sleep apnea. It works by stimulating the airway muscles during sleep to keep the airway open and is typically considered when CPAP therapy isn’t tolerated.
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Q: Why do I have sleep apnea?
A: There are typically three main causes:
• Excess weight that narrows the airway
• Anatomical features such as a recessed jaw
• Enlarged tissues in the back of the throat or nasal passages
Often, it’s a combination of these factors.
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Q: Why is sleep apnea only the second most diagnosed sleep disorder?
A: It’s estimated that over 1 billion people worldwide have sleep apnea, but up to 80% remain undiagnosed (9). Studies show rising obesity rates contribute significantly, but other causes—like facial structure and throat anatomy—are less recognized, especially among healthcare providers (10).
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Q: Does Medicare or Medicaid cover sleep studies and CPAP therapy?
A: Yes. Both Medicare and Medicaid typically cover sleep studies and CPAP treatment when medically necessary, although prior authorization and documentation may be required.
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Q: Can I bring my CPAP machine on a plane?
A: Yes. A CPAP is a medical device and does not count toward your carry-on limit. It’s best to bring it with you in your carry-on luggage to prevent loss or damage.
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Q: Where can I get a sleep study?
A: Sleep studies can be conducted at a sleep clinic or in your home, depending on your doctor’s recommendation. Both options gather important data to help your provider diagnose sleep disorders.
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Q: You can really do a sleep study at home?
A: Yes! At-home sleep studies use small, easy-to-use devices to collect data like breathing patterns, oxygen levels, and heart rate. While not as detailed as an in-lab study, they’re a convenient and effective option for many patients.
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Q: What if I don’t want a CPAP or want to return it?
A: That’s understandable—CPAP adjustment can take time. Some people feel better in a few weeks, while for others, it may take months to notice improvements. If you’re struggling, don’t give up—support is available, including our peer-led groups. If you decide not to continue, talk to your provider about alternative treatments.
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Q: My bed partner won’t wear their CPAP and I can’t sleep. What should I do?
A: This is a common challenge. Offer patience and understanding—many people struggle to accept their diagnosis, especially when they don’t feel sick. Our culture often glorifies overwork and exhaustion, but sleep is essential, not optional. Encourage your partner to seek support and stay involved in their care.
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Q: What is the Sleep Equity Project?
A: We are a patient-led nonprofit founded in January 2023 to address disparities in sleep health—particularly among minority populations, who are often underdiagnosed, underserved, and disproportionately impacted by chronic conditions related to untreated sleep disorders. We provide support, education, advocacy, and empowerment to help people take control of their sleep health.
References:
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American Lung Association. Obstructive sleep apnea (OSA) symptoms, causes & risk factors. https://www.lung.org/lung-health-diseases/lung-disease-lookup/sleep-apnea/symptoms-diagnosis
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​Wimms A, Woehrle H, Ketheeswaran S, Ramanan D, Armitstead J. Obstructive Sleep Apnea in Women: Specific Issues and Interventions. Biomed Res Int. 2016;2016:1764837.
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Forbes Magazine-Sleep Apnea in Women: Risk Factors and More https://shorturl.at/anOS9
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Lin CM, Davidson TM, Ancoli-Israel S. Gender differences in obstructive sleep apnea and treatment implications. Sleep Med Rev. 2008;12(6):481-496. doi:10.1016/j.smrv.2007.11.003
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What is Heart-Healthy Living? | NHLBI, NIH. NHLBI, NIH. Published April 23, 2024. https://www.nhlbi.nih.gov/health/heart-healthy-living
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Minority American Lag Behind Whites on Nearly Every Measure of Healthcare Quality, Many have Communication and Financial Barriers to Care, and Lack Trust in Doctors: A Press Release by The Commonwealth Fund March 2002 accessed January 10, 2024
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Snyder JE, Upton RD, Hassett TC, Lee H, Nouri Z, Dill M. Black Representation in the Primary Care Physician Workforce and Its Association With Population Life Expectancy and Mortality Rates in the US. JAMA Netw Open. 2023;6(4):e236687. doi:10.1001/jamanetworkopen.2023.6687
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National Research Council (US) Panel on Race, Ethnicity, and Health in Later Life; Bulatao RA, Anderson NB, editors. Understanding Racial and Ethnic Differences in Health in Late Life: A Research Agenda. Washington (DC): National Academies Press (US); 2004. 10, Health Care. Available from: https://www.ncbi.nlm.nih.gov/books/NBK24693/
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Romero-Corral A, Caples SM, Lopez-Jimenez F, Somers VK. Interactions between obesity and obstructive sleep apnea: implications for treatment. Chest. 2010;137(3):711-719. doi:10.1378/chest.09-0360
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Motamedi KK, McClary AC, Amedee RG. Obstructive sleep apnea: a growing problem. Ochsner J. 2009;9(3):149-153.