DEAR DR. ROACH: I have been diagnosed with mild sleep apnea. (No surprise there as symptoms were omnipresent.) CPAP machines seem incredibly uncomfortable. Are they the preferred gold standard even for mild sleep apnea? (I’m not even sure if “mild” is accurate since all sleep issues are serious to me.)

Also, I believe my deviated septum is the bane of my sleep existence since I can’t breathe through my nose. I understand they have to break my nose to straighten the bone, which does not sound like fun. On the other hand, the stakes are high by not getting it fixed. Thoughts? — E.M.

ANSWER: Obstructive sleep apnea is when a person stops breathing during sleep due to obstruction of their airway. Some people have an anatomy in the back of their throat that predisposes them to their throat closing when their muscles are relaxed during sleep.

Eventually, the oxygen level in the blood decreases, the carbon dioxide increases, and a person wakes up — usually just long enough to get a few breaths in. This is enough to get gas levels back to normal, and the person can fall asleep again. (It’s called an “apnea event” if no air gets in and a “hypopnea event” if some but not enough air gets in, but both of them are bad for you.)

This can happen many times per night, preventing the person from getting high-quality sleep, although they may be totally unaware of the problem during the night. (Their bed partners, however, are usually very well aware of the problem.) Symptoms include falling asleep easily during the day and morning headaches.

The terms mild, moderate and severe refer to how many apnea and hypopnea events per hour a person has. OSA is diagnosed with more than five events per hour, mild is less than 15, and greater than 15 is moderate or severe. (I’m simplifying things a little bit.)

All people diagnosed with OSA should avoid alcohol and sedatives before bed. Many people with OSA benefit from weight loss, and OSA is a specific indication for the new GLP-1 drug tirzepatide (Zepbound) in people with obesity.

The first-line treatment for symptomatic OSA with 5-14 events per hour is positive airway pressure (PAP), which can be continuous (CPAP) or at two levels (BiPAP). There are many different types of devices now, and most of my patients have been able to find a device that is comfortable for them with time and patience.

Sleep position, face size, the degree of claustrophobia, and other characteristics are important in choosing a mask. Having a professional makes finding a good fit more likely, but it still may take several trials. I recommend a PAP device for nearly all of my patients to start. Despite how uncomfortable they look, most people will eventually do really well on a PAP device once they get used to it.

There are some people who cannot tolerate masks despite doing everything right. Surgical treatment can be considered for some, but fixing a deviated septum alone is unlikely to solve sleep apnea. A more extensive surgery on the soft palate is usually required and only recommended for those whose anatomy is favorable for a procedure. An evaluation for this procedure is done by a head and neck surgeon.

If surgery is deemed unlikely to correct the sleep apnea, there are other options including oral devices and nerve stimulators.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu. (c) 2025 North America Syndicate Inc. All Rights Reserved