You wake up tired after logging a full eight hours in bed. Why? If you’ve invested in a high-end wearable like a newish Apple or Samsung Galaxy watch, you may see episodes of sleep apnea. This is when you stop breathing for 10 to 30 seconds, and your blood oxygen levels plummet.

It’s usually not enough to rouse you completely, and you may have no recollection of the incident. However, according to the Public Health Agency of Canada (PHAC), “Sleep disturbances and repeated reductions in blood oxygen levels result in excessive daytime sleepiness, reduced quality of life, and impaired cognitive function such as memory loss and poor concentration.” Sleep apnea is also believed to be a factor in motor vehicle accidents where people just fall asleep at the wheel.

In addition to the loss of restorative sleep, sleep apnea has been linked to serious medical conditions including high blood pressure, stroke, heart attacks and diabetes. There’s even a vicious circle, since sleep disruptions can alter hunger-related hormones like ghrelin and leptin, leading to increased appetite and cravings. Obesity is one of the factors that predisposes people to sleep apnea.

PHAC’s website also notes psychological aspects of sleep apnea, since people with it are “2.2 times more likely to report a mood disorder such as depression, bipolar disorder, mania or dysthymia (persistent sadness).”

Snoring and sleep apnea have a lot in common. Both are caused by a blocked upper airway during sleep. In snoring, the blockage is partial, and the noise relates to air turbulence. Snoring can be horrible for your sleeping partner but doesn’t carry the medical risks of sleep apnea.

Canadian males are more than twice as likely to be diagnosed with sleep apnea (8.8%) as females (4.0%), according to Statistics Canada. That’s only the start of the story. Most sleep apnea goes undiagnosed.

A landmark Canadian study, published in 2024, looked at Canadians considered at high risk for obstructive sleep apnea (OSA), the most common type, in which the tongue collapses backward toward the back of the throat, preventing normal airflow.

The research, led by Dorrie Rizzo of Montreal’s Jewish General Hospital, studied a large sample of Canadian adults aged 45 to 85 years old who participated in the Canadian Longitudinal Study on Aging. They concluded that “The great majority (92.9%) of the participants at high risk of OSA were unrecognized and had no clinical diagnosis of OSA.”

Conventional treatments for sleep apnea range from surgeries like tonsillectomies to CPAP (positive pressure) machines and custom-fitted mouthguards. You may have seen TV ads for hypoglossal nerve stimulation, commonly sold under the brand name Inspire Therapy. It’s an implant, kind of like a pacemaker, that’s placed in the chest. Controlled by a remote and a smartphone app, it delivers pulses to the airway muscles to keep the airway open.

Since some CPAP users detest their machines, this solution is appealing. However, it’s not as widely available in Canada as in the U.S., which is the target market for those TV ads. You need a specialized referral from an ear, nose, and throat doctor, and provincial health plans generally will not pay for it. The cost is estimated at $30,000 to $50,000 CAD for the device and the associated procedures.

Lifestyle changes can help with sleep apnea. In many cases, losing some weight and cutting down on alcohol and the use of sedatives will help. Specialized pillows are available for both CPAP users and non-users. They can help by elevating the upper throat area. Sleeping on your side rather than your back also helps minimize OSA.

Researchers, including Rizzo, did an interesting study of 101 women and 75 men aged over 45 at Montreal family medicine clinics. They offered them screening for sleep apnea, including polysomnography, an overnight sleep lab study considered the gold standard. They found that “93 per cent of participants received a diagnosis of OSA.” Those who went on treatment (mostly CPAP) showed “improvements in co-morbid insomnia and daytime functioning.”

However, the bad news is that at the three-year mark, almost half of the participants who were started on CPAP had discontinued it. Those placed on non-PAP therapies (oral appliances, positional strategies, or weight loss) were still adhering to the treatment.

This study seems to confirm the widely held belief that people just don’t like CPAP machines. Hopefully, other treatments like hypoglossal nerve stimulation will come down in price and someday be covered for Canadians who need it. In the meantime, check your watch and see if it’s time to make some lifestyle changes.

Tom Keenan is an award-winning journalist, public speaker, professor in the School of Architecture, Planning, and Landscape at the University of Calgary, and author of the best-selling book Technocreep: The Surrender of Privacy and the Capitalization of Intimacy.