CPAP Machines Aren't Sexy, but Neither Is Chronic Exhaustion

Like most people, Jaime Fratilla thought loud, excessive snoring was the hallmark of sleep apnea. Because Fratilla doesn't snore, she was surprised when her partner, Jordan (who didn't want to use his last name), suggested she get a sleep study.

"I was always a big fan of my two hour naps," she says. "But Jordan thought they were a sign I wasn't getting enough sleep at night."

Although initially somewhat resistant, Fratilla remembered how her dad snored when she was growing up, and the rift it caused in her family when he refused to address it.

"We always wanted my dad to take the sleep study, and he never did," she says. "I didn't want to be that person."

After an in-home test proved inconclusive, Jaime went for an overnight study that confirmed she has obstructive sleep apnea (OSA) — a chronic sleep disorder characterized by repeated episodes of upper airway obstruction, sleep fragmentation and hypoxia.

She's not alone. Approximately 39 million adults in the United States have sleep apnea, including 10% to 15% of women and 15% to 30% of men, according to an August 2024 report.

Gone untreated, sleep apnea can lead to more serious health issues, such as hypertension, coronary artery disease, heart failure, stroke and diabetes, as well as cognitive decline as a result of the brain's lack of oxygen. One recent study concluded that sleep apnea contributes to a risk of dementia in older adults, especially women.

Yet "women are woefully under-diagnosed with sleep apnea, in part because women present differently," says Wendy Troxel, a senior behavioral scientist at the RAND Corporation and author of the book "Sharing the Covers: Every Couple's Guide to Better Sleep." "It's not always the loud snoring and gasping for air."

Instead, women's symptoms can include anxiety, depression, headaches, insomnia and excessive daytime sleepiness.

The most common and reliable method of treating sleep apnea is with a CPAP (continuous positive airway pressure) machine that generates a steady stream of air through a flexible tube and into a face mask sealed around the nose or mouth.

While CPAP is nearly 100% effective when used properly, many people prescribed CPAP use it rarely if at all, with one study showing a much higher rate of compliance among men than women.

In a society that puts a high value on beauty, it's not surprising that many women would avoid an invasive treatment with head straps that might tousle hair, leave marks on the face and irritate skin. Some even feel embarrassed using a CPAP machine.

"It's not pretty," Troxel admits. "We've heard this message loud and clear from women."

But feeling unattractive is just one of several reasons some women avoid treatment.

Most CPAP machines require patients to have a constant supply of distilled water available. They also need regular cleaning, which involves disassembling several removable parts, washing, rinsing and air drying. For some women, adding one more thing to an already lengthy to-do list may feel like a bridge too far.

Wearing a CPAP machine can also disrupt important bedtime rituals between partners, from cuddling to chatting about your day to spontaneous, last-minute intimacy.

Troxel adds that American culture has historically undermined the importance of sleep, while emphasizing the need to keep going no matter what, so someone who's constantly tired is often seen as just lazy.

"It feels like there's something wrong with you," she says. "This is particularly salient for women."

There's also a lot of shame and stigma around sleep apnea.

"Snoring is the butt of so many jokes," she says. "We have this image of the snorer, and it's often not a woman but an overweight, middle-aged man."

Fratilla thought she was unique in being diagnosed by her partner, but Troxel says it's actually quite common, which is why she often addresses sleep apnea as a couples-based disorder in contrast to the traditional, individual approach.

"Partners are involved in every stage of the sleep apnea experience, from diagnosis to treatment and treatment outcomes," she says. "Both partners are affected, and both partners stand to benefit from successful treatment."

Fratilla agrees that her partner's support has been pivotal. If it weren't for Jordan's observation, "I never would have known," she says.

He also encouraged her to keep at it when she initially struggled with the CPAP machine.

"I hated it," she says. "I was anxious and afraid, and so sure I wouldn't get used to it."

Fratilla's experience isn't uncommon. Although CPAP is a very effective treatment, adherence tends to be poor with up to 50% of patients using it less than four hours per night — which is the minimum needed to get the health benefits and for the machine to be covered by most insurance companies.

"A supportive partner can really benefit CPAP treatment outcomes," Troxel says. And vice versa according to one study she co-authored which showed that, "adherence to CPAP treatment and better sleep efficiency is associated with higher relationship satisfaction."

That's definitely true with Fratilla and Jordan. She says she felt better almost immediately after starting CPAP therapy.

"I have a lot more mental and physical energy, and I've changed my life in a lot of ways. I don't take two hour naps anymore, and he's very happy that I don't pass out right after work every day," Fratilla says.

She says it also helped that she trusted her partner's concerns even before she recognized there was a problem.

"I think it makes him more confident in our relationship that I took the steps he asked me to take, and it worked."

While traditional treatment for sleep apnea focuses on the individual, Troxel and her team are developing WePAP, a new couples-based approach they hope will motivate better CPAP adherence.

She says she's heard from many patients who thought wearing the mask would immediately kill their sex life, only to find the opposite was true.

"It's not sexy," she admits, "but neither is being chronically sleep deprived. With treatment, you suddenly have the energy to be interested in sex. We know that a well-slept woman has greater sexual desire and greater sexual frequency."

She suggests developing new nighttime rituals together as a couple, preserving those moments of intimacy and togetherness, and making CPAP the final step in the bedtime routine.

Amber Campbell is a journalist and digital communications consultant writing about travel, health, culture and parenting. She built the Rainier Valley Post, voted Best Local Website in Seattle by the Seattle Weekly, and more of her work can be found at theambercampbell.com. Read More