Breaking the Silence: Confronting the Myths and Stigma Surrounding Sleep Apnea

by Denise Love

Sleep Apnea!

The image that instantly pops into your brain is an overly obtrusive face mask strapped to some middle-aged overweight man's head, attached to a big tube, attached to a big machine. You might envision a scene of a wife who has to nudge, or more appropriately, "jab" her husband in the ribs to get him to roll over and stop snoring.  I've heard it.  But this is not always the case.

The other day I listened to a comedian poking fun at the thought of "Sleep Apnea" and the mental image conjured up in his head.  While this comedic skit certainly got a laugh, the action of laughing at people can contribute to an ongoing cycle of cultural bias and negative stereotypes.   

Experts estimate that 30 million people likely have sleep apnea, but only 6 million have received a formal diagnosis.  Those people not being treated, unknowingly or unwillingly, create an additional burden on the healthcare industry.  Scientific evidence is clear about the relationship between sleep apnea and poor physical, mental, and emotional health.    Misconceptions, myths, and stigma have a significant impact on underdiagnosis and contribute to poor compliance and delayment in care in the treatment of this condition. 

The Dangers of Untreated Sleep Apnea

Sleep apnea is when a person stops breathing repeatedly during the night due to relaxed muscles in the throat, causing the airway to become blocked, robbing the body of precious oxygen essential to ALL bodily functions, including the brain and heart.   This condition can lead to many different types of diseases, such as high blood pressure, diabetes, heart attack or stroke, obesity, mental health problems, and substance use disorders, to name a few.   This condition can be so bad it can create a fast-track path to such issues.

Types of Sleep Apnea

The most common type of sleep apnea is obstructive (OSA).  OSA occurs when the muscles of your upper airway in the throat relax and collapse into the throat, causing a blockage and, hence, stopping breathing.  Being overweight does place you at a high risk of having OSA. Other risks, such as substance use and other medical conditions, can be a cause of sleep apnea, including pregnancy, are less commonly known.    

The second type of sleep apnea is central (CSA), which occurs when the brain doesn't connect the signals to the muscles to breathe correctly, causing a closure in the upper airway. This type is commonly associated with spinal cord injury, kidney failure, and opioid use. It is not typically associated with snoring. 

The third type of sleep apnea is complex or mixed sleep apnea. This type of sleep apnea occurs when a person has both OSA and CSA at the same time. Apply named "Complex," this is the least common form of sleep apnea, but it is more dangerous and usually results in a combination of treatment options from both the OSA and  CSA treatment plans. 

Myths and Misconceptions

Incorrect or misleading thoughts and ideas can lead people to believe that it can't happen to them or that it's not real.  Countless times have I heard people tell me that they don't snore and they are not fat, so they can't have sleep apnea. In the same conversation, some of those same people talk about not sleeping well or being tired all day. If you are not getting good restorative sleep at night and have difficulty concentrating the next day, or your partner reports you are snoring, you should talk to your doctor about this.   

Phrases such as "Well, I haven't died yet" or "It is just another way to get more money from you" are phrases I have heard a few times, implying that noncompliance with the prescribed CPAP machine was no big deal and that no actual harm was occurring, or that the diagnosis of sleep apnea or needed equipment was a scam.  These are just a few more misconceptions surrounding this diagnosis.  

Some studies on sleep disorders indicate people from socially disadvantaged or marginalized groups are more affected than others. People from racial or ethnic minority groups are more likely to have persistent, severe, and undiagnosed sleep disorders, including sleep apnea, compared to non-Hispanic white people. One scientific study identified stigma as a form of discrimination and found a high overlap between these two concepts. 

The Stigma Surrounding Sleep Apnea

Stigma is a concept often used to disgrace another based on some attribute that negatively impacts a community of people who do or do not know they have sleep apnea.  Additionally, how people experience stigma

can vary, depending on their circumstances and experiences. 

Some people internalize stigma, developing feelings on their own about the diagnosis of sleep apnea.  Feelings of "being weak or broken" or "less than others" can be shared.  

Others perceive stigma in ways such as fear and anxiety.  Uncertainty of what the future can hold for them or the ability to adjust their lives around the newly prescribed nightly routine successfully is common.

Others may anticipate stigma by expecting some negative bias from others.     Fear of being judged or labeled can turn people away from treatment.  Social isolation or rejection from family or friends are valid concerns for many.   Anticipation of stigma often leads individuals to be more cautious, guarded, or even avoid discussing their condition with others to protect themselves from potential judgment or discrimination.

Overcoming Stigma 

Combating myths, misconceptions, and stigma associated with sleep apnea starts with understanding and recognizing it as an actual medical condition, and treatment is essential in preventing long-term health consequences.  

Improving patient and healthcare provider communication can improve compliance and health outcomes.  Educating patients on their condition and the associated health risks is fundamental to the foundation of care.  Creating safe environments for patients to discuss their concerns and offering encouragement and support are paramount. 

Individuals and families are encouraged to educate themselves and others about sleep apnea.  Knowing and understanding how necessary treatment is to their long-term health is crucial in overcoming stigma and compliance.  Advocating for oneself in healthcare settings is vitally important in today's world.  Speak out if you have this condition and are having trouble with the equipment or experience some negative feedback from family or friends.  Your healthcare provider won't know you are struggling if you don't communicate with them.  

A positive in the face of poor compliance is peer support groups, which can be an effective tool for people diagnosed with sleep apnea.   A study from the University of Arizona Health Sciences found that people who struggle with CPAP machines had better compliance when connected with a peer who has the diagnosis themselves and who has mastered the working fundamentals of the CPAP equipment—this type of program results in improved compliance, satisfaction, and consistent use of the machine.  Patients with sleep apnea can experience peer support through in-person visits or phone calls over a set time frame. Peer support reduces the burden on the healthcare industry and is generally more acceptable to the patient in the long run.  

The Role of Public Awareness Campaigns

Improving public awareness is another crucial step in improving health outcomes for people diagnosed with sleep apnea.   The "Count on Sleep" public awareness project is a multiorganizational project led by the American Academy of Sleep Medicine. It focuses on identifying and encouraging individuals with undiagnosed obstructive sleep apnea to speak to their healthcare provider. The organization focuses on populations of known health disparities, such as African Americans, Hispanics, and Indian populations.  Gathered data suggest a need for culturally competent public health interventions.  

The "Sleep Well-Be Well" national priority campaign highlights sleep as one of the three most important aspects of maintaining a healthy lifestyle.  This website has a lot of sleep-help information on general sleep topics and sleep apnea.  The article discusses the importance of good sleep and the damaging health effects of undiagnosed sleep apnea.  

Conclusion

In conclusion, the topic of sleep apnea brings with it many misunderstandings and stereotypes that can create a stigma that reduces or interferes with diagnosis and treatment compliance.   Adhering to prescribed treatment plans, including CPAP machines, is crucial to long-term health and reducing healthcare burden.  Education to eliminate myths and misconceptions, as well as peer support and public awareness, are ways to reduce stigma and increase diagnosis and compliance to improve health and reduce the healthcare burden. 

References

American Academy of Sleep Medicine (2025, January 1). Sleep Well, Be Well: A national health priority. AASM | Sleep Education. Retrieved March 7, 2025, from https://sleepeducation.org/get-involved/campaigns/sleep-well-be-well-a-national-health-priority/

Gillette, H., & Johnson, T. (2024, November 6). Types of Sleep Apnea. Retrieved March 7, 2025, from https://www.healthline.com/health/types-of-sleep-apnea

Martin, J., Rowley, J., Goel, N., Heller, C., Gurubhagavatula, I., DelRosso, L. M., Rodriguez, A., Clark, M., & Rice-Conboy, L. (2024). "Count on Sleep": An OSA awareness project update. Journal of Clinic Sleep Medicine, 20(2), 303-307. https://doi.org/https://jcsm.aasm.org/doi/10.5664/jcsm.10864

Nwanaji-Enwerem,, U., Condon, E. M., Conley, S., Wang, K., Iheanacho, T., & Redeker, N. S. (2022, June 8). Adapting the Health Stigma & Discrimination Framework to Understand the Association between Stigma and Sleep Deficiency: A Systematic Review. HHS Public Access. Retrieved March 7, 2025, from https://pmc.ncbi.nlm.nih.gov/articles/PMC9233012/pdf/nihms-1788701.pdf

Villarreal, P. (2024, December 3). Peer support could help millions with sleep apnea slumber easier, study says. The University of Arizona Health Sciences. Retrieved March 7, 2025, from https://healthsciences.arizona.edu/news/releases/peer-support-could-help-millions-sleep-apnea-slumber-easier-study-says

Zhang, B., Hu, Y., Zhao, F., Wen, F., Gurubhagavatula, I., Dang, J., & Zawisza, M. (2023). Editorial: The psychological process of stereotyping: Content, forming, internalizing, mechanisms, effects, and interventions. Frontiers in Psychology, 13. https://doi.org/10.3389/fpsyg.2022.1117901

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