Obstructive sleep apnea (OSA) is a breathing disorder, not just poor sleep. The evidence linking OSA to fertility is limited and mixed — in men it is tangled up with weight and testosterone, and in women with conditions like PCOS. The evidence is stronger once pregnant: sleep-disordered breathing has been associated with higher rates of preeclampsia and gestational diabetes. If either partner has loud snoring, gasping, or heavy daytime sleepiness, getting evaluated before trying is a reasonable step, and anyone already using CPAP should keep using it.
Who should think about a sleep evaluation?
Sleep apnea is not the same as poor sleep
General sleep advice — consistent bedtimes, less screen time, a dark room — matters for everyone, and shift work raises its own issues (see night shift and fertility). Obstructive sleep apnea is a different thing. The American Academy of Sleep Medicine describes it as a common and serious disorder in which the airway repeatedly becomes blocked during sleep, limiting airflow. Better sleep habits do not fix a blocked airway.
The AASM lists these symptoms:
- Loud or frequent snoring, often with pauses in breathing, choking, or gasping.
- Daytime sleepiness, fatigue, unrefreshing sleep, or insomnia.
- Morning headaches, waking at night to urinate, trouble concentrating, memory problems, irritability.
- Reduced sex drive and erectile difficulties.
Risk factors include excess weight, a larger neck size, middle age, male sex (with risk rising for women after menopause), high blood pressure, alcohol or sedating medicines, nasal or airway problems, and family history. Many people with OSA do not know they have it. Very often, the bed partner is the first to notice.
What the evidence says about fertility — honestly
You will find confident claims online that sleep apnea “causes infertility.” The research does not support that level of certainty yet.
For the partner producing sperm
A 2023 review in Biomedical Reports found that several studies link OSA severity to lower testosterone, but that the effect has not shown up in every study, and obesity is a major confounder. Importantly, the review says CPAP has not been shown to reliably normalize the hormonal axis in men, with mixed results across studies. The authors describe the human data on OSA and infertility as “relatively limited,” with proposed mechanisms (oxidative stress, inflammation, hormone disruption) supported largely by animal studies.
What is clearer is the effect on sex itself. The AASM lists reduced sex drive and erectile difficulties as OSA symptoms, and treating the sleep disorder is a reasonable part of addressing them. For conception, the practical problem is often simple: exhaustion and low desire mean less sex during the fertile window.
For the partner hoping to carry
The same review notes a higher OSA risk in people with PCOS, but evidence that treating OSA improves PCOS-related hormones or fertility is not established. In short: OSA is worth diagnosing and treating for its own sake, and any fertility benefit is a possible bonus rather than a proven one.
Why it matters more once pregnant
Pregnancy itself changes breathing during sleep. The nuMoM2b sleep-disordered breathing study, which enrolled 3,705 people in their first pregnancy and measured breathing during sleep, found sleep-disordered breathing in 3.6% in early pregnancy and 8.3% by mid-pregnancy, as summarized by researcher Francesca Facco in CHEST Physician.
In that study, sleep-disordered breathing was associated with roughly double the odds of preeclampsia and two to three times the odds of gestational diabetes, after adjusting for other factors. The CDC also lists sleep apnea among risk factors for preeclampsia.
| Outcome (nuMoM2b) | Adjusted odds with sleep-disordered breathing (early / mid-pregnancy) |
|---|---|
| Preeclampsia | 1.94 / 1.95 |
| Hypertensive disorders of pregnancy | 1.46 (not statistically significant) / 1.73 |
| Gestational diabetes | 3.47 / 2.79 |
These are associations, not proof that sleep apnea causes these conditions, and the same summary notes that universal screening and treatment in pregnancy is not yet supported by evidence. But it gives a clear reason to take symptoms seriously before pregnancy, and it explains the guidance that anyone already using CPAP should keep using it during pregnancy. If high blood pressure or diabetes is already part of your history, see chronic high blood pressure before pregnancy and type 2 diabetes and prediabetes before pregnancy.
Getting diagnosed
OSA is diagnosed with a sleep study ordered by a clinician. The AASM describes two main types:
- Home sleep apnea test: a simpler monitor you wear at home. It suits people with several risk factors and no other significant medical conditions.
- In-lab sleep study: an overnight stay with sensors recording brain waves, breathing, heart rate, and movement; recommended for more complex cases.
The AASM notes that consumer sleep apps and trackers may be unreliable for diagnosis. A partner’s description of snoring and pauses, or a short phone recording, is often more useful to bring to the appointment.
Treatment options and how they fit with trying
| Treatment | Notes for the TTC window |
|---|---|
| CPAP | The AASM’s frontline treatment for most people. Fine to use while trying and, per the nuMoM2b summary, people already on CPAP are encouraged to continue in pregnancy. |
| Oral appliance | A dentist-fitted device for mild to moderate OSA or for people who cannot tolerate CPAP. |
| Surgery or upper airway stimulation | Options for selected people; if surgery is being considered, ask how recovery timing fits your conception plans. |
| Weight management, position, alcohol | Weight loss may improve OSA, though not guaranteed. Limiting alcohol and quitting smoking also help. |
| Tirzepatide (Zepbound) | FDA-approved in December 2024 for moderate to severe OSA in adults with obesity. See the note below if you could become pregnant. |
A plan for both partners
- If either of you snores loudly or wakes unrefreshed, mention it at a primary care or preconception visit.
- Bring a partner’s description or a recording of the snoring and pauses.
- If you are diagnosed, give CPAP a fair trial, and ask your sleep team about mask fit and comfort settings if it is hard to tolerate.
- Review medications that affect breathing during sleep, including sedatives, with your clinician.
- If low libido or erectile difficulties are part of the picture, say so — they are listed OSA symptoms and treatable.
- For the sperm-providing partner, general sperm-health basics are covered in how to improve sperm health.
The human side: masks, snoring, and the shared bed
Sleep apnea lives in the bedroom, which is also where trying to conceive happens. That overlap is awkward in ways people rarely say aloud. Snoring partners often feel embarrassed; the person lying awake often feels resentful, then guilty for feeling resentful. Separate rooms can feel like a sign of trouble when they are really a sign of exhaustion.
A few things couples find helpful: treat diagnosis as something you are doing for both of you, not a complaint about one person; agree that a CPAP mask goes on after intimacy, not instead of it; and notice the payoff — better sleep often means more energy and more interest in sex. If you have been trying for a while without success, the usual timelines for getting help apply; see when to see a fertility specialist.
Frequently asked questions
Can sleep apnea cause infertility?
The evidence is limited and mixed. Reviews link OSA to lower testosterone in some men and note higher OSA risk with PCOS, but obesity is a major confounder and treating OSA has not been proven to improve fertility. OSA can reduce sex drive and cause erectile difficulties, which can affect conception.
Does CPAP raise testosterone or improve sperm?
Not reliably. A 2023 review found that studies on CPAP and testosterone in men show mixed results, with meta-analyses finding no significant change. CPAP is still worth using for its other benefits.
Is sleep apnea dangerous during pregnancy?
Sleep-disordered breathing in pregnancy has been associated with higher rates of preeclampsia and gestational diabetes in the nuMoM2b study, and the CDC lists sleep apnea as a preeclampsia risk factor. People already using CPAP are encouraged to continue during pregnancy.
Can I use CPAP while trying to conceive and during pregnancy?
Yes. CPAP is the frontline treatment for most people with OSA, and pregnancy guidance encourages people already on CPAP to keep using it.
Should I stop Zepbound before trying to get pregnant?
If you could become pregnant, plan it with your prescriber. The American Diabetes Association says GLP-1 and GIP/GLP-1 medicines should be stopped before pregnancy, with contraception used while taking them.
Sources & guidance
- American Academy of Sleep Medicine (SleepEducation.org): Obstructive Sleep Apnea
- CHEST Physician (Facco F.): Sleep-disordered breathing and pregnancy complications — emerging data and future directions (nuMoM2b)
- CDC: High Blood Pressure During Pregnancy (preeclampsia risk factors)
- Cojocaru C, et al. Sleep apnea syndrome associated with gonadal hormone imbalance (Review). Biomedical Reports 2023;19(6):101
- WebMD News: FDA approves Zepbound for obstructive sleep apnea (December 2024)
- ADA Standards of Care in Diabetes—2026, Section 15: Management of Diabetes in Pregnancy (GLP-1 discontinuation)
- Lilly Medical: Can tirzepatide be used with oral contraceptives?