If you snore loudly, someone has seen you stop breathing in sleep, or you are so sleepy by day you want to sleep while driving, get a sleep study for sleep apnea; for moderate to severe cases, wear a CPAP machine at night

Sleep apnea means breathing stops or gets shallow in waves during sleep; you wake gasping and are sleepy by day. After CPAP, daytime sleepiness drops clearly, and driving crashes fall by about seven tenths. Trials have not shown it prevents heart disease or lowers death; you wear it to stay awake by day.

Cost

First go to a hospital sleep clinic, pulmonology, or ENT. Diagnosis needs one night of sleep monitoring, in hospital or with a device borrowed for home. If you need a CPAP machine, you generally buy it yourself; that is a substantial cost. The hard part is sticking with it: wearing a mask every night, awkward for the first few weeks, and many people take it off after a few hours.

Benefit

The American Academy of Sleep Medicine 2017 diagnostic guideline lists who is more likely to have moderate to severe disease. Most days very sleepy by day, plus at least two of the next three: one, frequent loud snoring; two, someone has seen you stop breathing, gasp, or choke awake in sleep; three, already diagnosed hypertension. The guideline requires sleep monitoring for diagnosis; questionnaires alone are not enough. Five or more breathing pauses or shallow spells per hour plus symptoms count as the disease. Fifteen or more count whether or not there are symptoms. The American Academy of Sleep Medicine 2019 systematic review pooled 38 randomized controlled trials. Versus no treatment, people on CPAP cut self-rated sleepiness by 2.4 points (95% CI 1.9–2.8). That score is the Epworth Sleepiness Scale, max 24, higher means sleepier. Counting only people who were not sleepy to begin with, 5 trials cut 1.0 point; the authors saw no clinical meaning. The same review pooled 10 before-after treatment studies. After CPAP, crash rate was 0.3 times the pre-treatment rate (RR 0.3, 0.2–0.4), about seven tenths less. A 2010 analysis pooled 9 similar studies, result RR 0.278 (0.22–0.35). It also said daytime sleepiness dropped clearly after one night of use, and simulated driving improved within 2 to 7 days. A 2009 analysis by the same group said untreated patients’ crash risk was roughly 1.21 to 4.89 times others’. Then heart and lifespan. The SAVE trial enrolled 2717 people aged 45 to 75 with moderate to severe disease and coronary disease or prior stroke. After randomization they were followed 3.7 years on average. Cardiovascular events: 17.0% on CPAP, 15.4% without. No difference between groups (HR 1.10, 0.91–1.32). Users averaged only 3.3 hours a night. Their snoring, daytime sleepiness, quality of life, and mood all improved. A 2017 analysis pooled 10 randomized trials and 7266 people. Overall mortality also did not differ (RR 1.13, 0.99–1.29). A 2019 estimate said about 176000000 (1.76亿) people aged 30 to 69 in China have the disease, 23.6%. Of them about 65520000 (6552万) have moderate to severe disease, 8.8%, the largest count worldwide.

Notes

Contested. Whether CPAP prevents heart disease or extends life has not shown up in randomized trials. People in SAVE were mostly not very sleepy and wore it little. But the 2017 analysis split by hours of use and still saw no difference. Crash figures come from before-after comparisons, not randomization; people after treatment may simply have been more careful. China’s case count is extrapolated from one 2005 study of 3648 people; that estimate was funded by a CPAP maker. The US Preventive Services Task Force said in 2022 that screening people without symptoms has unclear benefit and harm. So people who do not snore and are not sleepy by day need not seek testing. Benefit set to medium is a judgment: sleepiness score fell 2.4 points; hours more awake per day were not measured. Which department is author experience (grade C); hospitals differ. If sleepy while driving, stop first; see Section 1, Item 9 (stop and rest when sleepy). For long daytime sleeps, see Section 2, Item 37 (naps over one hour warrant checking why). Long-term insomnia is item 26 of this section (long-term insomnia). The main beneficiary is you; people in the same car and on the road benefit too.

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