You likely need a CPAP machine if you regularly stop breathing during sleep, snore loudly enough to wake yourself or a partner, or wake up gasping or choking at night. These are hallmark signs of obstructive sleep apnea, a condition where your airway repeatedly collapses while you sleep. A CPAP machine holds that airway open with gentle air pressure. But you can’t just buy one and start using it: you need a sleep study first, and the results determine whether CPAP is the right treatment for you.
Signs That Point Toward Sleep Apnea
The nighttime symptoms are often the most telling, though you may not notice them yourself. Loud snoring, pauses in breathing that a bed partner observes, and waking up gasping or choking are the classic trio. Many people also experience a dry mouth or sore throat each morning from breathing through an open mouth all night, along with headaches that fade within an hour or two of waking.
The daytime symptoms can be harder to connect to a sleep problem. Excessive sleepiness despite what felt like a full night of rest is the most common. You might find yourself fighting to stay awake during meetings, while reading, or while driving. Poor concentration, irritability, mood changes, and brain fog that doesn’t improve with caffeine are also typical. If you’re sleeping seven or eight hours and still dragging through every day, disrupted breathing at night is a strong possibility.
A Quick Self-Screening You Can Do Now
Doctors use a tool called the STOP-BANG questionnaire to quickly gauge your risk. It asks eight yes-or-no questions covering snoring, tiredness, observed breathing pauses, high blood pressure, BMI, age, neck circumference, and male sex. Each “yes” scores one point. A score of 0 to 2 puts you at low risk for moderate to severe sleep apnea. A score of 5 to 8 puts you at high risk. If you land in the middle (3 or 4), additional factors like a BMI over 35 push you into the high-risk category.
Another common screening tool, the Epworth Sleepiness Scale, measures how likely you are to doze off in eight everyday situations like sitting and reading, watching TV, or riding as a passenger in a car. You rate each scenario from 0 (would never doze off) to 3 (high chance of dozing off), giving a total between 0 and 24. A score of 10 or below is considered normal daytime sleepiness. Anything above that suggests something is interfering with your sleep quality and warrants a conversation with your doctor.
Physical Risk Factors That Raise Your Odds
Certain body measurements increase the likelihood of obstructive sleep apnea. A neck circumference greater than 17 inches for men or greater than 16 inches for women is a well-established risk factor, because extra tissue around the neck can compress the airway when throat muscles relax during sleep. Excess weight in general is one of the strongest predictors, particularly fat deposits around the upper airway.
Other risk factors include being over 50, having a naturally narrow airway or recessed jaw, a family history of sleep apnea, nasal congestion, smoking, and alcohol use (which relaxes throat muscles further). Men are diagnosed more frequently, though women’s risk rises significantly after menopause.
How Sleep Apnea Gets Diagnosed
No one gets prescribed a CPAP based on symptoms alone. You need a sleep study that measures how many times per hour your breathing stops or becomes dangerously shallow. This number is called the apnea-hypopnea index, or AHI. An event counts when airflow stops for at least 10 seconds or drops by 30% or more with a corresponding dip in blood oxygen.
The AHI scale breaks down like this:
- Mild: 5 to 15 events per hour
- Moderate: 15 to 30 events per hour
- Severe: more than 30 events per hour
There are two ways to get this measurement. A home sleep apnea test is a small device you wear for one or two nights in your own bed. It monitors your breathing, airflow, and oxygen levels but doesn’t track brain waves or sleep stages. For people suspected of having moderate to severe obstructive sleep apnea without other complicating conditions, home tests accurately identify the condition about 90% of the time.
A lab-based sleep study, or polysomnography, is more comprehensive. You spend a night in a sleep clinic wired with sensors that track brain activity, eye movements, heart rhythm, and leg movements in addition to breathing. This is the gold standard test, and it’s recommended if you have cardiovascular disease, use opioids, have severe insomnia, or have a neuromuscular condition. It’s also the next step if a home test comes back negative or inconclusive despite strong symptoms. Many insurance plans will only cover a lab study after a home test has been tried first.
When CPAP Is Recommended vs. Other Options
CPAP is recommended for all patients with an AHI of 30 or higher, regardless of whether they feel symptomatic. At that severity, the risk of developing high blood pressure is significant enough on its own to justify treatment. For milder cases, with an AHI between 5 and 30, CPAP is recommended when you also have excessive daytime sleepiness, cognitive problems, mood disorders, insomnia, high blood pressure, heart disease, or a history of stroke.
If your AHI falls in the mild range and you don’t have those accompanying symptoms, your doctor may suggest lifestyle changes first. Weight loss is one of the most effective non-CPAP interventions for obstructive sleep apnea, because reducing tissue around the airway can dramatically lower the number of breathing events. Positional therapy (training yourself to sleep on your side), oral appliances that hold your jaw forward, and reducing alcohol intake are other options for mild cases.
What Untreated Sleep Apnea Does Over Time
The reason doctors push for treatment isn’t just to stop snoring or improve energy. Untreated sleep apnea carries serious cardiovascular consequences. People with the condition are two to three times more likely to need blood pressure medication. Men with untreated sleep apnea are six times more likely to develop congestive heart failure compared to people without it. The overall risk of dying from cardiovascular causes is roughly five times higher in people with untreated moderate to severe sleep apnea.
There’s a flip side to these numbers that’s worth knowing. When sleep apnea is diagnosed and treated before surgery, for example, the risk of cardiac and neurological complications drops by about 50%, bringing it close to the risk level of someone without the condition at all. Treatment works, and it works measurably.
How to Get Started
Your primary care doctor can order a home sleep test or refer you to a sleep specialist. If your doctor suspects sleep apnea based on your symptoms and risk factors, you may be referred directly to a sleep center for evaluation. Depending on your results, you might also see an ear, nose, and throat doctor to check for physical blockages, or a cardiologist if there’s concern about your heart.
For insurance coverage of a CPAP machine, Medicare and most private insurers require an AHI of 15 or higher, or an AHI of 5 to 14 with documented symptoms like excessive daytime sleepiness, cognitive impairment, or cardiovascular disease. Medicare typically covers an initial 12-week trial period. If you’re using the machine consistently during that window, coverage continues. The sleep study results and your doctor’s documentation of symptoms are what make or break the insurance approval, so be thorough and specific when describing your symptoms at your appointment.