Annual medical checkups typically cover the basics: diet, exercise and mental state. Surprisingly, many primary care providers fail to ask about one of the fundamental contributors to well-being: sleep.
We are two neuroscientists who study sleep and memory. We have both experienced this omission with our own doctors, even though we represent different ages and genders.
When asked, almost everyone has complaints about their sleep, yet most people fail to prioritize sleep. But poor sleep shouldn’t be ignored.
One particularly problematic sleep disorder is sleep apnea, and it is not rare. The condition affects nearly 1 billion people worldwide, estimates suggest, and the number continues to grow. In October 2025, former basketball star Shaquille O’Neal was featured in an awareness campaign for sleep apnea. But much greater awareness is needed.
The most common type of sleep apnea, obstructive sleep apnea, is characterized by repeated blockage of breathing during sleep, often resulting in sleepiness during the day, headaches or snoring – or a combination of these – and in the long term, increased risk for cardiovascular diseases.
Patients may not fit the typical profile: The stereotype is that the ones with sleep apnea are older males trending toward obese. Others may find that their sleep-related complaints are overlooked at wellness checks. These are missed opportunities for gathering critical health information that is important for diagnosis. Sleep apnea thus remains undiagnosed far too often in women and also in other groups.
Sleep apnea is not just about sleep
Sleep apnea is more than a sleep disorder. While it manifests when you are sleeping, with repeated partial or total pauses of breathing during sleep – termed hypopneas and apneas – its effects extend far beyond the night.
Repeated apneas and hypopneas tend to occur alongside reductions in oxygen levels in the brain and body. These episodes can happen more than 100 times per hour and on average last about 20 seconds. Despite brief awakenings that can occur after a person with sleep apnea stops breathing, by the morning they usually don’t remember ever pausing their breathing.
Reduced oxygen then leads to increases in blood pressure and heart rate, which stresses the cardiovascular system. Untreated sleep apnea can lead to a host of cardiovascular diseases, such as hypertension, heart failure and stroke. Sleep apnea is also associated with increased risk of dementia, as in Alzheimer’s disease and other neurodegenerative disorders.
Beyond health effects, the disorder is linked to reduced quality of life, a higher risk for motor vehicle accidents and increased medical costs for individuals, as well as for societies and governments.
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A growing problem meets new solutions
The growing prevalence of obstructive sleep apnea reflects multiple factors. Greater awareness among medical professionals and accessible screening tools have helped.
At the same time, an increase in obesity rates and an aging global population have also contributed to the rise in cases diagnosed.
The treatment of sleep apnea has also advanced considerably over the past 20 years. The standard treatment for sleep apnea is continuous positive airway pressure, or CPAP, which prevents airway collapse with a stream of air through the mouth or nose.
However, people often report that CPAP is burdensome, and for some the therapy is intolerable. For those who dislike CPAP, implantable nerve stimulation devices can be effective. Other therapies include oral appliances to shift the jaw forward and open the airway, positional therapies to avoid back-sleeping, and myofunctional training to strengthen tongue and throat muscles.
Nevertheless, new treatment approaches are still needed. In late 2024, the U.S. Food and Drug Administration approved tirzepatide – the active ingredient in the GLP-1 drugs Mounjaro and Zepbound – for treating obstructive sleep apnea. The drug helps by lowering body weight, given that excess weight is associated with the disorder.
Both new and long-standing treatments for sleep apnea can be effective in reducing the detrimental health consequences. Yet these advances raise an important question: Who gets diagnosed and ultimately benefits from the treatments – and who doesn’t?
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Who gets diagnosed – and who gets missed
Despite the growing prevalence of sleep apnea, diagnosis and treatment do not occur equally across populations. Women with sleep apnea often experience headaches, insomnia and depression – symptoms that common screening tools for sleep apnea do not mention.
Hormonal changes throughout a woman’s life, different anatomy of the airway and differences in sensitivity to higher levels of carbon dioxide in the blood compared to men all suggest that more research and better tools are needed to improve healthcare for women with sleep apnea.
Many of the current diagnostic tools and treatment standards were developed based on studies in white populations.
Pulse oximetry on the finger detects decreases in blood oxygen, a key marker of sleep apnea screening and diagnosis. These finger oximeters are less sensitive in people with darker skin pigment, which likely leads to underestimates of severity.
At the same time, Medicaid beneficiaries in the U.S., who are disproportionately from racial minorities, are more likely to be denied long-term coverage for CPAP treatment, despite the finding that Black men have more severe sleep apnea than their white counterparts.
What you can do
Your probability of getting a referral to a specialist increases ninefold when you ask your primary care provider about sleep apnea. And there’s no need to be overly concerned about undergoing a sleep study in a hospital. Sleep studies can now be conducted at home to diagnose sleep apnea.
If you or your bed partner have any suspicions based on even a small subset of the possible symptoms of sleep apnea, bring it up with your healthcare provider. Mention any daytime symptoms, such as excessive sleepiness or headaches, and any nighttime symptoms, such as frequent urination, waking up short of breath, snoring or insomnia.
Starting the conversation may be the first step toward diagnosis and treatment – and to better health and well-being.
