Anyone of any age can struggle with obstructive sleep apnea (OSA), the most common type of sleep apnea. In fact, OSA is one of the most common reasons patients seek out The Insomnia and Sleep Institute of Arizona. 

We are staffed by sleep specialists concentrating in sleep medicine, and are home to the “Top Doc” in the area, as voted by peers. Setting the standard for sleep medicine in the Phoenix area, our outcome-driven clinic ensures that you meet with a sleep specialist during your consultation so a quick and correct diagnosis can pave the way for testing and treatment. When it comes to OSA, it’s critical to work with leading sleep experts for the best outcome.

You may be surprised to learn that even athletes at the peak of physical fitness have dealt with this condition. Texas Rangers MLB All-Star Prince Fielder left spring training camp in 2016 to undergo a sleep study after struggling to feel rested. His results were alarming.

He stopped breathing 39 times per hour. In a press conference reported by ESPN, Fielder said, “I felt like I was sleeping long, but I wasn’t feeling rested.” (1). He was back in the lineup within days, using a CPAP mask, proof that getting diagnosed quickly and acting on it matters. His story is a powerful reminder that OSA has nothing to do with fitness level or discipline. It is a physiological condition, and it can quietly drain even the most elite performers. 

Why CPAP Is the Gold Standard for Sleep Apnea Treatment

CPAP therapy remains the gold standard in OSA management and treatment, and CPAP is required before any patient can be approved for more aggressive therapies like the Inspire implant. 

There are many causes of OSA. Carrying extra weight is one of the most common factors that increases risk. However, a recent study found that physiological traits also increase the likelihood of OSA.

What’s Behind OSA?

The study published in the American Journal of Respiratory and Critical Care Medicine found that a lower arousal threshold, as well as high or low pharyngeal muscle compensation, are linked to OSA and a lower adherence to CPAP therapy. The research trial included individuals with objective CPAP adherence tracked over a two-year period. Polysomnography was used to monitor arousal threshold, pharyngeal muscle compensation, loop gain, and pharyngeal collapsibility (2). 

It turns out that those with a lower arousal threshold, meaning they wake more easily, also had lower CPAP usage rates.  Additionally, abnormal pharyngeal muscle compensation, whether low or high, was linked to reduced CPAP use.

Why Physiological Traits Matter in CPAP Compliance

Researchers stress that being aware of these physiological characteristics can help identify patients at risk for poor CPAP adherence and allow for earlier intervention.  According to the authors, “Our findings suggest that a prior knowledge of an individual’s OSA pathophysiology may aid in identifying patients  at risk of poor CPAP adherence and may improve OSA therapy in a more precise way.” (2)

What this Means for OSA Patients

Does this mean someone with these physiological traits is not a good candidate for OSA therapy?? Not at all. While CPAP is the standard treatment for OSA (3), some patients may need additional or alternative therapies depending on their clinical picture. If a patient has both OSA and insomnia, CBT-I may be used alongside CPAP to improve insomnia symptoms and support treatment success (4)(5). In adults with obesity and moderate to severe OSA, tirzepatide (Zepbound) is now FDA-approved as a medical treatment option when used with diet and physical activity (6). 

For selected adults with moderate to severe OSA who cannot use or tolerate PAP, the Inspire implant may also be considered (7).   Understanding a sleep disorder is a comprehensive and holistic process. That’s why it’s so important to work with sleep experts who can help patients find a solution that works for them.

Even the most driven and high-profile individuals have had to accept that CPAP therapy requires adjustment. Grammy Award-winning music legend Quincy Jones, producer of some of the most iconic records in history and a man who kept one of the most relentless work schedules in the music industry, has also dealt with sleep apnea. In a PBS American Masters interview in 2001, Jones candidly revealed: “I have apnea. I didn’t find out till six years ago. And I was a kid. I could really only sleep when I was on my stomach.” (8). His story is a reminder that the condition does not announce itself. It requires professional evaluation to identify. 

Going Beyond CPAP for OSA

Many patients who struggle with CPAP therapy are interested in implant options. Patients must first demonstrate CPAP intolerance before becoming eligible for surgical intervention. For those who qualify, an implant can be an effective method for managing OSA. The device stimulates throat muscles that collapse during sleep to keep the airway open. 

The Link Between Weight, Sleep Apnea, and Daily Function

Treating OSA can be a catch-22 and a vicious cycle. For those whose OSA appears or worsens with excess weight, unmanaged OSA can make them too tired to exercise regularly. 

Routine exercise, along with a healthy diet and good sleep, is a critical component of maintaining a healthy weight. Getting OSA under control is essential, and sleep experts can help. A full understanding of what causes and worsens OSA is important to correctly treat each unique patient.

Randy Jackson, longtime American Idol judge and music producer, experienced this firsthand.  He was diagnosed with both sleep apnea and Type 2 diabetes at the same time, a dual diagnosis that is more common than many realize due to the metabolic effects of disrupted sleep. After treatment and lifestyle changes, Jackson reported sleeping better and feeling significantly more energetic. His journey illustrates why treating OSA must be part of the bigger picture of overall health (9). 

What Is Arousal Threshold in Sleep Apnea?

Arousal threshold is the amount of breathing effort required to wake someone from sleep (10). In OSA, a low arousal threshold means the person wakes too easily during breathing disturbances. This can fragment sleep and interfere with the respiratory stimuli that help activate airway muscles (11). 

It may also affect treatment success, since a lower arousal threshold has been linked to worse CPAP adherence over time (12)(13). Understanding this trait helps sleep specialists identify patients who may need a more individualized therapy approach (14). 

Can Sleep Apnea Be Treated Without CPAP?

Yes, depending on severity and physiology. CPAP remains the first-line treatment because it directly keeps the airway open. However, alternatives include:

  • Oral appliances reposition the jaw to prevent airway collapse
  • Positional therapy helps patients avoid sleeping on their backs
  • Weight management reduces airway obstruction in some patients
  • CBT-I or behavioral strategies improve sleep quality and adherence
  • Upper airway stimulation (Inspire implant) activates airway muscles during sleep

These options are often used when CPAP is not tolerated or not effective. The best approach is individualized based on anatomy, sleep study results, and symptom severity.

Why Early Diagnosis and Treatment of OSA Is Critical

If you or your child has OSA, or if it is suspected, the sooner you get help, the better. Unmanaged OSA is linked to conditions ranging from diabetes to stroke and heart disease. 

Schedule your consultation with a sleep expert today and get on the path to better sleep. Call The Insomnia and Sleep Institute today to schedule your consultation or, for the fastest response, simply complete the online form.

Dr. Ruchir P. Patel Shares His Own Personal CPAP Journey

In this short teaser from the Dr. Ruchir P. Patel: The Real Sleep Doc podcast, Dr. Patel opens up about his own experience with CPAP therapy. Listen to the rest of the episode here.

Stay tuned for more insights in upcoming episodes!

Disclaimer: The information provided in this blog post is for educational and informational purposes only and is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always consult with a licensed healthcare provider for recommendations specific to your individual health needs.