Older adults are no strangers to sleep troubles. Up to 70 percent of them have chronic sleep issues.* And yet sleep apnea — the second-most common sleep disorder in the U.S. — often goes undiagnosed in people over age 65. 

In fact, one study shows that more than half of people 65 and older were at high risk for obstructive sleep apnea. Yet only 8 percent of them had been tested. And of those who were, a whopping 94 percent got a diagnosis of apnea.* Why are there so many missed diagnoses? 

“Older people frequently have other health issues that may make sleep apnea harder to diagnose,” says Meir Kryger, MD. He’s a professor at the Yale School of Medicine in New Haven, Connecticut. “If you’re an overweight 54-year-old male who snores, it’s a piece of cake to diagnose. You can do that with a home sleep test,” Dr. Kryger says. “But it can be harder to tease out in people over the age of 65 who may have other medical problems. If a patient complains to their doctor that they’re very sleepy, their provider often mistakenly assumes it’s a sign of depression, without taking the time to figure out what else is causing that person’s sleepiness.”

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It’s important that people with sleep apnea be diagnosed and get treatment. Untreated sleep apnea is linked to serious health concerns. They include:*

• High blood pressure
   
• Type 2 diabetes
   
• Stroke
   
• Heart attack

People living with sleep apnea were also more than twice as likely to experience sudden death as those without sleep apnea in one study.* So if you suspect you have sleep apnea, it’s critical that you understand it and take steps to treat it. Here’s what you need to know. 

What exactly is sleep apnea? 

Sleep apnea is a condition in which breathing during sleep repeatedly stops and starts. There are two main types:

1. Obstructive sleep apnea (OSA). This is the most common type. It happens when throat muscles relax, which causes your throat to narrow. As a result, you have trouble breathing and you wake up. (Though you usually don’t awaken completely.) Risk factors include:

• Being overweight
   
• Being male
   
• Having a family history of OSA
   
• Using alcohol or sedatives
   
• Smoking

2. Central sleep apnea. In this form of apnea, your brain doesn’t send the right signals to the muscles that control your breathing. You may stop breathing while you sleep, wake up suddenly short of breath or experience insomnia. It can result from other health conditions, such as heart failure or stroke. Or it may be due to taking medicines that can affect breathing, such as opioids.

The subtle signs of sleep apnea

The major symptoms of sleep apnea are: 

• Snoring
   
• Fatigue 
   
• Feeling sleepy during the day

But you can still have sleep apnea without these symptoms. More subtle signs to look for include:

• Uncontrolled high blood pressure. Up to half of all people with hypertension also have sleep apnea.* “A red flag is what we call resistant hypertension. Which means that you can’t get your blood pressure under control despite being on at least two high blood pressure medications,” says Dr. Kryger. The good news: Blood pressure usually improves once these patients get their sleep apnea diagnosed and treated.
   
• Morning headache. About 30 percent of people with sleep apnea notice a headache when they wake up in the morning.* It generally goes away on its own within a few hours of waking up.
   
• Impotence. As many as half of all men with sleep apnea also have erectile dysfunction (ED).* “Men with sleep apnea may have lower testosterone levels, which may be associated with a loss of interest in sex. Or they may have other medical conditions like high blood pressure,” says Dr. Kryger. Both can cause ED.
   
• Sleep problems. If you have sleep apnea, you may notice that you wake often throughout the night. This may lead you to think you have insomnia when you really don’t, says Dr. Kryger. In fact, if your doctor prescribes sleeping pills to treat it, that can make the apnea worse, he says. 
   
• Dry mouth. Apnea forces you to breathe through your mouth, which dries it out, says Dr. Kryger. 

How to overcome sleep apnea

Have you noticed any of the above signs? If so, ask your doctor for a referral to a sleep specialist. They can screen you for the condition and recommend treatments. 

The gold standard treatment for sleep apnea is a CPAP machine. It increases air pressure in your throat. As a result, your airway doesn’t collapse when you breathe in. You can choose from multiple types of machines and masks to help you find a comfortable option. 

The following lifestyle changes may also help:

• Switch up your sleep position. If possible, try to stay away from sleeping on your back. 
   
• Lose weight if you’re overweight or have obesity.
   
• Avoid alcohol and sleeping pills. It’s important to drink very little alcohol. That’s true even during the daytime.

Finally, remember that taking the first step — identifying the problem — is key. It can help improve your sleep and quality of life for years to come.

If you qualify for both Medicare and Medicaid, you may be eligible for an Aetna Dual Eligible Special Needs Plan (D-SNP).

If you're 65 or older and have diabetes or an eligible heart disease, you may qualify for an Aetna Chronic Condition Special Needs Plan (C-SNP). C-SNPs are currently available in select counties in IL and PA.  

You may be eligible for an Institutional Special Needs Plan (I-SNP) if you’ve lived (or plan to live) in a participating facility for 90+ days or you have Medicare Part A (hospital insurance) and Part B (medical insurance).

*FOR HOW MANY ADULTS HAVE SLEEP ISSUES: The Sleep Foundation. Aging and sleep. May 25, 2023. Accessed December 7, 2023.

*FOR SLEEP APNEA MISDIAGNOSES: Braley TJ, Dunietz GL, Chervin RD, et al. Recognition and diagnosis of obstructive sleep apnea in older Americans. Journal of the American Geriatrics Society. May 9, 2018; 66(7): 1296-1302. 

*FOR HEALTH CONCERNS LINKED WITH SLEEP APNEA: Johns Hopkins Medicine. The dangers of uncontrolled sleep apnea. Accessed December 7, 2023.

*FOR SLEEP APNEA AND SUDDEN DEATH LINK: Heilbrunn ES, Ssentongo P, Chinchilli VM, et al. Sudden death in individuals with obstructive sleep apnoea: a systematic review and meta-analysis. BMJ Open Respiratory Research. June 9, 2021; 8(1): e000656. 

*FOR SLEEP APNEA AND HIGH BLOOD PRESSURE LINK: Chaudhary SC, Gupta P, Sawlani KK et al. Obstructive sleep apnea in hypertension. Cureus. April 2023, 15(4): e38229. 

*FOR SLEEP APNEA AND HEADACHE LINK: Spalka J, Kedzia. K, Kuczynski W, et al. Morning headache as an obstructive sleep apnea-related symptom among sleep clinic patients — a cross-section analysis. Brain Sciences. January 2020; 10(1): 57. 

*FOR SLEEP APNEA AND PREVALENCE OF ED: Pascual M, de Batlle J, Barbe F, et al. Erectile dysfunction in obstructive sleep apnea patients: a randomized trial on the effects of continuous positive airway pressure (CPAP). PLoS One. August 2018; 13(8): e0201930.

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