Sleep apnea is largely preventable, and even people already at risk can take meaningful steps to reduce the likelihood of developing it. The condition, where breathing repeatedly stops during sleep, currently affects about one in three American adults to some degree. Projections estimate that number will climb to 76.6 million cases in the U.S. by 2050, with prevalence among women nearly doubling. The good news: the most powerful risk factors are ones you can change.
Weight Is the Single Biggest Factor
Excess body weight, particularly around the neck and throat, narrows the airway and makes it more likely to collapse during sleep. A neck circumference greater than 17 inches for men or 16 inches for women is one of the strongest physical markers of elevated risk. You can measure this yourself with a flexible tape measure just below your Adam’s apple.
The relationship between weight loss and breathing improvement is well documented and dose-dependent. Every 1% of body weight you lose produces a measurable improvement in nighttime breathing disruptions. A 20% reduction in BMI is associated with a 57% decrease in the frequency of breathing interruptions during sleep, though returns diminish somewhat beyond that point. For someone weighing 220 pounds, that 20% BMI reduction translates to losing roughly 40 to 45 pounds. Even modest losses of 10 to 15 pounds can make a noticeable difference in snoring and sleep quality if you’re carrying extra weight around your midsection and neck.
Exercise Helps Even Without Weight Loss
Regular physical activity reduces sleep apnea severity through mechanisms that have nothing to do with the number on the scale. A randomized controlled trial of older adults found that a 12-week exercise program reduced the severity of sleep apnea independent of changes in body composition, though it did shrink neck circumference. Exercise appears to reduce fluid retention in the neck and upper airway, improve muscle tone in the throat, and decrease the kind of systemic inflammation that causes airway tissue to swell.
Aerobic exercise is the most studied form: brisk walking, cycling, swimming, or anything that keeps your heart rate elevated for 30 minutes or more. Aim for at least 150 minutes per week. Resistance training also helps by improving overall muscle tone, including the muscles that keep your airway open at night.
How You Sleep Matters
Sleeping on your back is the worst position for airway health. Gravity pulls your tongue and the soft tissue at the back of your throat backward, partially blocking the airway. Side sleeping keeps the airway clear and can significantly reduce both snoring and breathing interruptions.
If you naturally roll onto your back during the night, a few strategies can help. A body pillow or bolster placed along your back makes it harder to roll over. Some people sew a tennis ball into the back of a sleep shirt. Elevating your head and upper body with a wedge pillow or adjustable bed also helps by preventing tissue from collapsing into the airway. For added comfort and to reduce lower back strain, try placing a pillow between your knees when sleeping on your side.
Keep Your Nasal Passages Clear
When your nose is blocked, you breathe through your mouth during sleep, and mouth breathing dramatically increases the chance of airway collapse. In one controlled study, treating nasal obstruction reduced the proportion of mouth breathing during sleep from 39% to just 8%, and it lowered the frequency of breathing disruptions by an average of 12 events per hour.
Chronic nasal congestion from allergies, sinus problems, or a deviated septum deserves attention. Treating allergies with appropriate medications, using saline rinses before bed, and keeping your bedroom free of dust and pet dander all help. External nasal strips can modestly improve airflow if your congestion is mild. If you consistently feel blocked on one side, that could indicate a structural issue worth discussing with a doctor.
Limit Alcohol and Sedatives
Alcohol is both a central nervous system depressant and a peripheral muscle relaxant. It specifically reduces the activity of the genioglossus, the main muscle responsible for keeping your tongue from falling backward into your throat. Even moderate drinking in the evening can turn mild snoring into significant airway obstruction.
The closer to bedtime you drink, the stronger the effect. Finishing your last drink at least three to four hours before sleep gives your body time to metabolize the alcohol and restore normal muscle tone. Sedative medications, including some prescription sleep aids and antihistamines, produce similar muscle-relaxing effects and carry the same risk. If you take any of these regularly and snore, the medication itself could be contributing.
Maintain Adequate Vitamin D Levels
Vitamin D receptors are widely distributed throughout the muscles of the respiratory system, including the muscles that hold the upper airway open. Deficiency appears to impair the function of these airway dilator muscles while simultaneously increasing systemic inflammation, which can cause the soft tissues of the throat to swell and become more collapsible during sleep. Getting your vitamin D levels checked through a simple blood test is worthwhile, particularly if you live in a northern climate, spend little time outdoors, or have darker skin. Correcting a deficiency through sunlight, diet, or supplementation won’t cure sleep apnea on its own, but it supports the muscle and immune function that keeps your airway stable at night.
Know Your Risk Profile
Some risk factors for sleep apnea are beyond your control. Men develop it at roughly twice the rate of women, though that gap is narrowing. Prevalence among women is projected to increase by 65% over the next 25 years, partly driven by rising obesity rates and the hormonal changes of menopause. Age is another fixed factor: the muscles of the throat naturally lose tone over time, and the prevalence of sleep apnea rises steadily after age 40.
Family history matters too. If your parents or siblings have sleep apnea, you’re more likely to have an airway shape that predisposes you to obstruction. The same goes for people with naturally recessed jaws or large tonsils. You can’t change your anatomy, but knowing you’re at higher risk makes the modifiable factors, like weight, sleep position, and alcohol intake, that much more important to address proactively.
Smoking is another avoidable risk factor. It irritates and inflames the tissues of the upper airway, causing swelling that narrows the breathing passage. People who smoke are significantly more likely to develop sleep apnea than nonsmokers, and quitting reduces that inflammation over time.