Sleep Bytes & Blog

Is It Sleep Apnea—or Menopause? This week’s Sleep Byte is inspired by a question from Ellen: “How does one differentiate the CPAP/sleep apnea need vs post-menopausal syndrome? Similar symptoms. Different treatments.” Good question, Ellen. When your sleep falls apart in midlife, it’s easy to wonder: Is this sleep apnea, menopausal changes, or both? The symptoms can look similar—insomnia, daytime fatigue, brain fog, mood changes, and waking unrefreshed. But the causes and the treatments are different, so getting it right matters – although it’s not always easy. Here’s the simplest way to think about it. With menopause, your body’s thermostat misfires—hot flashes, night sweats, and temperature swings can pull you out of sleep, often resulting in early morning awakenings. With sleep apnea, your airway is like a tunnel that keeps narrowing; breathing gets blocked, oxygen levels dip, and your brain briefly wakes you to reopen the passage—again and again. Both can leave you exhausted, but the triggers are different: heat surges versus airway blockages. Clues that point toward sleep apnea include snoring – although this isn’t always prominent in women - choking arousals, waking with a dry mouth or sore throat, morning headaches, unexplained bathroom trips during the night, and sleep that feels “light” or restless despite plenty of hours in bed. Other clues, like high blood pressure, obesity, or type 2 diabetes, increase the odds that sleep apnea is playing a role. Clues that point toward menopause-driven sleep disruption include night sweats or hot flashes that wake you up, new temperature sensitivity - during the day or night, irregular or absent periods, joint aches, and a “tired but wired” pattern with difficulty returning to sleep after a hot flash awakening. You can absolutely have both—menopause raises the risk of sleep apnea—so the question is which problem is primary and what to test first. Here’s a quick, practical path. If you or a bed partner notices snoring—or you wake with headaches or dry mouth—screen for sleep apnea and consider a home sleep apnea test or in-lab study. If your main night problem is sudden heat, sweats, and kicking off covers, talk with your clinician about treating vasomotor symptoms; that might include non-hormonal options or, if appropriate for your health history, hormone therapy. If you try menopause-targeted treatment and you’re still unrefreshed, circle back to sleep apnea testing. In the clinic, I recently met a 52-year-old woman who was certain she had “menopause insomnia.” She had night sweats and felt exhausted. But her partner also noticed snoring and a few nights where she seemed to stop breathing. Her sleep study showed moderate obstructive sleep apnea. Once we started therapy, her morning headaches and brain fog improved within weeks. She still had some hot flashes, but sleep became restorative again. One more important note: fatigue and brain fog are often labeled “just menopause,” especially in short primary-care visits. If you’re peri- or post-menopausal and still waking tired, ask directly, “Could this be sleep apnea?” Bring a brief symptom log and, if possible, your bed partner’s observations. The right diagnosis leads to the right treatment: CPAP or other airway-focused strategies for sleep apnea or evidence-based menopause care for vasomotor symptoms. Of course, cognitive behavioral therapy for insomnia is also important if a learned insomnia pattern is also present. Bottom line: similar symptoms, different fixes. If you’re not waking restored, check for sleep apnea, address menopause symptoms, and treat what you find. Better sleep—and better days—are absolutely possible.

5 Easy Non-CPAP Ways to Improve Sleep Apnea  Not ready for CPAP? Or maybe you’re looking for ways to improve your sleep apnea beyond CPAP? You’re not alone. In this video, I’ll share five proven, non-CPAP strategies that can help you breathe easier and sleep better. These solutions are easy to understand and can be game-changers for your sleep health. Sleep apnea happens when your airway becomes partially or fully blocked during sleep, and while CPAP is the gold standard treatment, these tips can help reduce your symptoms and improve your quality of life, with or without CPAP. The first strategy is weight loss. Even modest weight loss can significantly improve sleep apnea by reducing the tissue around your airway that contributes to blockages. Start with small, sustainable changes in your diet and activity levels. You’ll not only improve your sleep but your overall health, too. Next, let’s talk about positional therapy. Many people experience worse sleep apnea when lying on their back. By sleeping on your side, you can keep your airway more open. Positional therapy devices like the SlumberBUMP or Sleep Noodle are designed to help you stay off your back comfortably throughout the night. Another effective approach is keeping your mouth closed. An open mouth can narrow your airway and worsen sleep apnea. Mouth-sealing products like the SomnoSeal or mouth tape help encourage nasal breathing and maintain an open airway. It’s a simple fix with big results. Strengthening your airway muscles is another powerful tool. Products like the REMplenish water bottle are designed specifically for this purpose, and you can also find throat exercises online or even learn how to play the didgeridoo! These activities strengthen the muscles around your airway, making it less likely to collapse during sleep. Finally, avoid alcohol and sedatives, especially in the evening. These substances relax your muscles, including those in your airway, making it more likely to collapse and worsen sleep apnea. By cutting back, you can make a big difference in your sleep quality. Improving sleep apnea doesn’t have to start and end with CPAP. These five strategies can make a real impact. For more tips or to join a supportive sleep health community. Better sleep is just a step away! Sleep Well!

New Drug for OSA? Today, I’m talking about a groundbreaking new development in the treatment of obstructive sleep apnea (OSA). For years, the standard treatment for OSA has been CPAP therapy, which helps keep your airway open during sleep. (as an astute sleep warrior, you already know that!)  But what if there was a medication that could significantly reduce your sleep apnea symptoms—maybe even reduce the need for CPAP? Enter tirzepatide, also known as Zepbound and currently available under the trade name Mounjaro. This medication works very differently from AD109, a drug I discussed in a prior Sleep Byte that directly affects the muscles in the back of the throat. Mounjaro, on the other hand, is one of the new weight loss drugs, similar to the popular Ozempic.  Originally designed to manage type 2 diabetes and obesity, Mounjaro has shown remarkable results in a recent study, published in June 2024, in the New England Journal of Medicine, a very well-respected medical journal. This research involved over 450 participants and demonstrated that Mounjaro could reduce sleep apnea severity by up to two-thirds! The study's findings highlight a significant decrease in the apnea-hypopnea index (AHI), offering new hope for those with both OSA and obesity. Now, it's important to remember that not all cases of sleep apnea are related to excess weight. There are many factors that contribute to OSA, and each patient’s situation is unique. However, as a sleep medicine provider, I am excited about the potential of a new therapy that could benefit a significant portion of my patients. The idea of prescribing a medication like Mounjaro to help manage sleep apnea is intriguing, and I wonder if this will be part of my treatment arsenal in the near future. Imagine fewer sleep interruptions, lower cardiovascular risks, and potentially less reliance on CPAP therapy—all from a weekly injection. While more research is needed to fully understand the long-term risks and benefits, Mounjaro offers hope for a new approach to treating OSA, especially for those who have struggled with traditional therapies. Thanks for being here, I’ll see you next week!

First 'Ask the Expert' Q&A Thank you for all the amazing questions you’ve submitted. To kick off the program, I’m excited to share answers to the following questions you’ve asked: Can I take melatonin if I use CPAP? Is an oral mandibular device a substitute for CPAP? How well does it work, and how do I know if it's working? Can it be used in combination with CPAP? Can I use mouth tape if I have asthma? Can I occasionally reuse the water in my humidifier chamber if I poured too much and didn't use it all? I've received so many great questions that I’ll be compiling them into more extended Sleep Bytes soon.  If you have one, then please submit your CPAP or Sleep Apnea Questions here.

Looking for Science-Backed Information about Sleep Apnea? Hi there and welcome. I'm Kimberly MD, and I'm here to help you get a great night's sleep in today's session. I'm gonna help you understand some of the fundamentals of sleep apnea. I recently learned how to play pickleball. It's a fun and social sport, and I was anxious to get started and I wanted to win, but I wasn't really winning until I slowed down and really started paying attention to the fundamentals. The forehand, the backhand, and the game strategy. Once I spent time on these fundamentals and practiced, I really improved. Now I'm killing it. Like pickleball, learning the basics of sleep apnea and CPAP treatment will greatly improve your chances of success. I'm here to help you learn the fundamentals of sleep apnea. And I hope that you will take the time to understand them so that you can be more successful on your journey to better sleep. What you'll learn in today's lesson is one, what is sleep apnea? Two, what are the health consequences of untreated sleep apnea? And three, what the heck is an AHI? And why is it important? Let's get started. What is sleep AP apnea? Well, apnea means stopping breathing. So, sleep apnea just means stopping breathing during sleep. And the most common form of sleep apnea is obstructive sleep apnea, which is when the back of the throat blocks your breathing while sleeping. If you think of your airway, like a balloon, the skinny part that you blow into, it's very collapsible and can close off. And so when you relax at night to sleep and your body relaxes the back of your throat also relaxes, and it can close down, then you don't get any air in that causes your oxygen levels to drop. Then that message gets back to your brain and it causes you to do one of these and wake up... sound familiar? This arousal to wake up and breathe can happen. Hundreds of times, each night, really fragmenting your sleep so that you're not able to get into and stay in some of the deeper stages of sleep that we know are needed in order to feel and function our best during the day. Also, each time this happens, our body goes through a stress response. We tend to panic because we're not breathing. Our blood pressure goes up. Our heart rate goes up, and it puts our body under stress. So cumulatively over time, this can cause a lot of problems. Stay tuned to later in this recording, where I'll give you a peek behind the curtain to see what this sleep apnea really looks like in your sleep test. And let me tell you it ain't pretty. You're probably already aware that sleep apnea makes you feel bad, but did you know that untreated sleep apnea is associated with a number of short and long-term health consequences? Let's use your teeth as an example. If you decide that brushing your teeth is a waste of time, you may develop bad breath and some yellowing of your teeth in the short term, but over the long term, not brushing your teeth will lead to cavities, tooth pain, and probably having to have your teeth pulled. So it seems like a good idea to go ahead and brush your teeth. Well, sleep apnea is similar. It can negatively affect you now and make you feel bad. But the cumulative effect of untreated sleep apnea over time can lead to many more serious medical issues. Let's start with the short-term effects of untreated sleep apnea. These can be broken down into daytime and nighttime symptoms. One of the most common symptoms of sleep apnea is snoring. And your bed partner may notice pauses in your breathing. These are the apnea. Your sleep may be very restless, or you may feel that you wake up a lot during the night. Apnea can even cause you to wake up to go to the bathroom. During the day, you may feel groggy and notice morning headaches. You may feel excessively sleepy and may even doze off during routine activities, such as in a meeting, or maybe during this video, you can also feel more irritable and have trouble concentrating. When we don't sleep well, we just don't function well in the long term. Untreated sleep apnea has been associated with a number of serious medical problems, and we are learning more every year. Most notably, sleep apnea increases blood pressure. Every time you have an apnea at night, your body responds by increasing your heart rate and your blood pressure. When this happens many times an hour, night after night, year after year, it takes a toll on your body, which further leads to more heart attacks, strokes, and even problems with sexual function. There are also studies showing an increased risk for weight gain, diabetes, and dementia with untreated sleep apnea, pretty scary, huh? A lot can go wrong. When our bodies are put through the stress of untreated obstructive sleep apnea, which leads me to our third and final topic of the session, the AHI or the apnea OFIA index. The AHI is a number that tells you how severe your sleep apnea is with higher numbers indicating more severe sleep apnea. Your apnea severity is directly correlated to your health risks associated with untreated sleep apnea, as well as what treatments are available to you. Let's go back to our teeth brushing example. If you skip brushing your teeth, occasionally, say one to two times per week, it's gonna take a lot longer for your teeth to rot and fall out than it will. If you skip brushing, say five times a week, or if you decide to never brush your teeth again. Well, if you have mild sleep apnea, which is stopping breathing just a few times per hour, it will take a lot longer for you to develop heart disease or dementia. For example, then it will, if you stop breathing 30 or 60 times per hour, which suggests more severe sleep apnea, and that's why AHI, or the measure of severity of your sleep apnea, is important. Take a look at this sleep study data. This is from a home apnea test and shows what normal breathing looks like. This person is having stable breathing. Their oxygenation is also remaining stable and is in the normal range in the mid-nineties. Now, look at this sleep study data. These flat lines are apneas or periods when breathing stops and are marked by the red areas, then breathing starts again for several breaths, then stops again. This person is having severe sleep apnea, with one apnea after another, it's during this time when breathing restarts that the blood pressure and heart rate go up as their body goes through a stress response. When we calculate your AHI or apnea hypopnea index, we're counting how many of these apnea or red-shaded areas you have over the entire night and divide it by the amount of time that you are asleep. This gives us an average, which is your AHI. Your AHI is reported on your sleep study and it's used by your healthcare team to make treatment decisions. In reality, there are times when sleep apnea is better or worse during a single night, for example, it tends to be worse when you're sleeping on your back or when you're in dream or REM sleep. If you dig deeper into your sleep study report, you can often find what's called a supine AHI or a REM AHI, which will give you the specific AHI for those particular sleep conditions. However, for the sake of this session, and for a general understanding the overall AHI is an average over the entire night. This gives us a uniform guide that everyone can understand. There are other important measures in your sleep study, such as your lowest oxygen level or the time that you spent with an oxygen level below normal, which is typically 90%, but for simplicity in today's session, I am simply focusing on the AHI. Do you know what your AHI is? If your AHI is less than five, that is generally considered within normal limits for an adult, and you would not be diagnosed with sleep apnea, at least not based on that night, an AHI between five and 15 is considered mild sleep apnea. And between 15 and 30 moderate sleep apnea, an AHI above 30 is considered severe apnea. And the numbers only go up from there. I have had patients over the years within AHI over a hundred, which basically means they aren't having any normal breathing during their sleep at night. Having untreated severe sleep apnea is like having a mouthful of cavities and still refusing to brush your teeth. Wow. You all have learned a lot. Thanks for sticking with me. In summary, today, we talked about three topics. Number one, what sleep apnea is, which is periods of stopping breathing during sleep, most often due to blockage at the back of your throat. Number two, what some of the health consequences are of untreated apnea, such as feeling groggy, irritable, and having trouble concentrating in the short term and high blood pressure, strokes, and even dementia in the long term, just to name a few. And lastly, number three, we talked about the apnea hypoapnea index or the AHI and how that number is the average number of breathing events you had per hour during your sleep study, and how this number gives you an idea of how severe your sleep apnea truly is with higher numbers, equaling more severe sleep apnea. Thanks for joining me. And I hope to see you again, as I continue on my journey for making a bigger difference in the lives of patients with sleep disorders.

A Pill for Sleep Apnea? Hey, sleep warrior!  When you think about treating sleep apnea, the idea of using a drug, or a pill, might raise some eyebrows. After all, sleep apnea is primarily a mechanical problem—how can a pill help keep our airways open at night? Despite my initial skepticism, I'm genuinely excited to dive into the emerging data on AD109, a new medication that's currently under investigation. Let’s dive in. As many of you know, CPAP therapy, while effective, is not universally tolerated. And let's be honest, even among those who do tolerate it, it’s not always liked. With a significant number of people still going untreated each year, we need to do better. That's why exploring new treatment options is crucial for our field. AD109 represents a novel approach. It's an oral medication designed to stimulate the nerves that control the muscles keeping our airway open while we sleep. By activating these nerves, AD109 aims to maintain a clear airway throughout the night, potentially reducing the severity of sleep apnea. AD109 combines two medications in a nasal spray format—a decongestant and a muscle relaxant targeting the muscles that collapse the upper airway. It's designed to decrease the physical obstructions that cause sleep apnea by minimizing nasal congestion and relaxing the muscles that can block the airway during sleep. The Mariposa research study assessed the efficacy and safety of AD109 in adults with moderate to severe obstructive sleep apnea. The results were quite promising: AD109 significantly reduced the number of apnea events per hour of sleep compared to a placebo, by about 45%.  Participants also reported improved sleep quality, reduced daytime sleepiness, and an enhanced overall quality of life.  These benefits could be life-changing for those who struggle with CPAP machines. Though some did experience mild nasal discomfort and an unpleasant taste, these side effects were generally mild. For those intrigued by this new treatment and wondering about participation in ongoing research, more information is available on Apnimed's website where you can learn more about the study and how you might get involved. So, while the initial results from the Mariposa study are promising, it's important to remember that the path from research to reality can be lengthy. Clinical trials are thorough and meticulous by design, ensuring that new treatments are both effective and safe for widespread use. If AD109 continues to show promise in its subsequent trials, we are still looking at a timeline that would extend to 2026 or later before it becomes available to the public. So don’t put your CPAP away just yet. Patience is key in the development of new medical treatments, as rigorous testing is essential to bring truly beneficial therapies to our community. Thanks for being here. I’ll see you next week!

Central vs. Obstructive Sleep Apnea The other day, my patient was anxious to talk to me, “Doc, the AHI on my CPAP machine jumped from 4 to 12, mostly due to 'clear airway' events. What should I do?” Calmly, I encouraged him to relax and invited him to join me in unraveling the secrets between central and obstructive sleep apnea and when to be concerned. Now, you probably know that sleep apnea is a common sleep disorder that affects millions of people worldwide. And you may be aware that there are two primary types of sleep apnea - the very common obstructive sleep apnea (OSA) and the less common central sleep apnea (CSA). But did you know that many, if not most, people have some degree of both? Let’s explore this a bit deeper… First, let’s understand what central sleep apnea is. Central sleep apnea occurs when the brain fails to send proper signals to the body to breathe during sleep. Unlike obstructive sleep apnea, CSA is not caused by physical airway obstructions in the back of the throat. Instead, it stems from underlying medical conditions, such as heart failure, stroke, or brainstem injury. It can also occur in people taking certain medications, such as opioids for pain. Think of CSA as an issue with the breathing “switch” in your brain - the switch could be faulty itself from something like a stroke or brain injury, or it could be simply acting erratically due to receiving mixed messages from the body, such as what happens in heart failure or with certain medications. Similarly to OSA, people with CSA experience repeated interruptions in their sleep as well as oxygen desaturation. So, it’s not surprising that people with CSA may not feel rested in the mornings or experience daytime symptoms, such as sleepiness and fatigue. The good news is that most of us have some degree of central sleep apnea, and it isn’t always problematic. In fact, it can be a normal response after a deep breath.  However, if you are using CPAP and you notice an increase in the “clear airway”, aka “central” apnea events, here are some of the circumstances when you would want to bring this to the attention of your healthcare provider: If you have more central apneas than obstructive apneas. This may suggest that the pressures on your machine may need to be adjusted If you are having a return of sleep apnea symptoms You’ve developed a new medical condition, such as heart problems You’ve started new medications So, in conclusion, the primary difference between CSA and OSA lies in their underlying causes. CSA is driven by a lack of proper brain signals for breathing, while OSA is a result of physical airway obstructions. So, what happened with my patient? Well, after our discussion, he said he had recently strained his back and had been taking one narcotic pain pill before bed each night to help him sleep. Aha! The new medication was the likely culprit, and I asked him to switch to extra-strength Tylenol. Sure enough, he noticed right away that his machine’s AHI number returned to normal. Thanks for being here. I’ll see you next week! Disclaimer: This information is for educational purposes only and not intended to be direct medical advice.

Can I Trust My At-Home Sleep Study Results? Hey sleep warriors,  In this part 2 of my 2-part series on at-home sleep tests, I’m going to cover who is best suited for having their study done at home vs in the lab, Then I’ll touch on how the differences in the two studies can impact the diagnosis and treatment of your sleep disorder.  People who are well-suited for doing their studies at home include: People at high risk for sleep apnea - meaning you have several risk factors, such as loud snoring, being overweight, non-refreshing sleep, daytime sleepiness, or fatigue.  People who don’t want to spend the night away from home People who are comfortable hooking up the testing equipment at home (which is ‘moderately’ simple) People with insurance plans that require a home apnea test first. After all, the cost of doing the at-home study averages about $500, but costs over $3,000 in the lab.   People who are being evaluated only for sleep apnea. If you have unusual behaviors during sleep or are concerned about leg jerks, you will need to head to the lab.    Next, you may remember last week when I mentioned that an in-lab study is a more sensitive test for sleep apnea (because of that whole EEG and arousal thing). The AHI (which is the measure of the severity of your apnea) is often HIGHER in an in-lab test than in an at-home study. I had a patient last week whose AHI was less than 10 in her at-home study and was over 30 in the lab. That’s the difference between mild and severe sleep apnea in the same patient!  And because the severity of your sleep apnea can influence what treatment options are recommended, you will want to remember that whatever your AHI number is on an at-home study, it is likely an underestimate of the true severity of your disease.  To be clear, this doesn’t mean that everyone with an at-home sleep study should follow it up with an in-lab study. I just want you, my educated sleep warriors, to understand these differences.  That’s it for today, I’ll see you next week!

Do At-Home Sleep Studies Work?  Hey sleep warriors, If you have a diagnosis of sleep apnea, I bet many of you had a home apnea test, or HAT, for short, to get the diagnosis. Well, you aren’t alone!  Home apnea tests are cheaper, easier, and more comfortable than in-lab polysomnograms (or PSGs), which require spending the night away from home hooked up to a bunch of wires.  With a large number of people out there that need sleep studies and long wait times to get into a lab, home apnea tests are quickly becoming the most common diagnostic sleep test for obstructive sleep apnea.  But are they accurate? Well... it depends.  I’ll help simplify this issue in part one of this two-part series on at-home sleep testing. I’m going to discuss 3 primary differences between at-home and in-lab sleep testing (besides the obvious difference of one being at home in your own bed and the other being more at a sleep center!). In the lab, brain waves are measured, which is called EEG. And EEG measures whether you are asleep or awake as well as your sleep stages - like REM, or dreaming sleep. EEG also determines if sleep apnea is disrupting your sleep, or causing “arousals”. In at-home sleep studies, breathing events are scored only if there is an associated oxygen desaturation with them. While in the lab, a breathing event can be scored if it causes an oxygen desaturation OR if it disrupts your sleep by causing an EEG arousal. Because of this, in-lab sleep studies are generally felt to be more sensitive at picking up sleep apnea and a more accurate measure of the severity.   In the lab, technologists are present throughout the night to be sure the signals are accurate. If the oximeter slips from your finger - no problem, the techs put it right back on. They can also help be sure you spend time in all different sleep positions, such as on your side and on your back, which can have different levels of apnea severity. CPAP treatment for sleep apnea can be started. If your sleep apnea is significant, most in-lab sleep centers will wake you up and start you on CPAP therapy. This hands-on treatment during your first night with therapy can really be helpful.  The question then becomes, who should have which study and when do the additional measurements of being in the lab actually make a difference in the diagnosis and treatment of your sleep disorder?   Stay tuned for next week when I will address this question in more detail, but the short answer is that if your home apnea test is negative for sleep apnea, but you have symptoms of sleep apnea (like sleepiness, loud snoring, or non-refreshing sleep), then I recommend you have an in-lab study. Because a home test can “miss” sleep apnea up to 25% of the time! Thanks for being here. I’ll see you next week!