Treating Not-So-Silent Sleep Disorders         

In “Macbeth,” Shakespeare called it, “the raveled sleeve of care,” as primary medicine extols the importance of restoring the mind and body after the wear of daily life.

Dr. Scott Leibowitz has earned the label, “Dr. Sleep.” Here he comments on snoring, obstructive sleep apnea (OSA), and maybe saving some noisy marriages.

Studies estimate that 82 percent of men and 93 percent of women with moderate-to-severe sleep apnea have not been diagnosed. More recent estimates have suggested that roughly 80 percent of cases remain undiagnosed. OSA is not limited to obesity.

“While weight gain and/or obesity can exacerbate OSA, this isn’t exclusively a disease of obesity. Approximately 2/3 of adults with OSA are not obese,” Leibowitz said, underscoring that obesity is an important risk factor, but not a requirement.

A 2025 U.S. prevalence analysis estimated that approximately 83.7 million American adults age 20 and older have OSA, approximately 32 percent of the adult population. The estimate was 39.1 percent among men and 26 percent among women. For those diagnosed with OSA, about half have mild disease, while approximately 30 percent have moderate, and 18 percent severe disease. Snoring is often the first clue.

“Snoring is at the beginning of the spectrum of sleep-related breathing disorders. While snoring is extremely common, it’s not normal breathing.”

He described throat muscles relaxing during sleep, the airway becoming restricted.

“Eventually, that leads to repeated pauses in breathing. One can snore without having sleep apnea. But it’s extremely uncommon to have sleep apnea and not snore.”

Leibowitz divides the reasons for treatment into categories: snoring itself, particularly when a bed partner cannot sleep, sleep and wake dysfunction, frequent nighttime awakenings, non-restorative sleep and daytime sleepiness, and lastly, cardiovascular and metabolic risk.  Other warnings include waking up tired, frequent nighttime urination, morning headaches, dry mouth, and cognitive difficulties.

Leibowitz explained, “The reason patients can feel exhausted despite spending hours in bed is fundamental … OSA repeatedly disrupts sleep as the brain responds to episodes of impaired breathing. It’s essentially a survival mechanism, but one that can leave patients with poor-quality sleep.”

If OSA is suspected, Leibowitz recommends starting with a primary care physician to initiate evaluation. For many, the test no longer requires an overnight sleep lab.

Family history counts, “Having a first-degree relative with OSA increases an individual’s risk by about 70 percent,” Leibowitz said.

The continuous positive airway pressure (CPAP) is a major treatment for OSA, but it isn’t right for everyone. National CPAP compliance averages a little above 50 percent. At Leibowitz’s base at Northside Hospital, compliance rates are closer to 70 percent.

He related, “The benefits depend on why a patient is being treated. For some, eliminating snoring is the goal. For others, the objective is restoring restful sleep and reducing daytime symptoms … or aimed at reducing cardiovascular risk.”

Custom dental devices move the lower jaw forward, helping prevent the tongue from falling backward and obstructing the airway. They can cause jaw pain, bite changes, and dental problems and generally are more appropriate for milder OSA.

Inspire is an implant using electrical stimulation of the nerve, controlling the tongue to help keep the airway open. Leibowitz describes Inspire as “an effective option for some patients, but in my view, a last resort.” It requires an implanted chest battery with extending electrodes. A newer hypoglossal nerve stimulation system uses an external battery as opposed to an implanted one.

Leibowitz’s interest in sleep medicine began early. The native Atlantan attended Brandeis University, the Medical College of Georgia, the University of Colorado Health Sciences Center for internal medicine residency, and then Stanford University for a clinical and research fellowship in sleep medicine. As a sleepy child, his mother took countless photographs of him asleep, including at his own birthday party. Later, while working in pulmonary critical care in Denver and taking night shifts, he realized just how strongly his body resisted nighttime work.

A colleague introduced him to the specialty, setting him on his career path.
Scott and his wife have been married for 22 years and have two children, plus two Australian shepherds. Outside medicine, he plays guitar and is a member of the band, Elephant Nellie. He enjoys art, creating things, and being outdoors. Exercise is his therapy.