Prevalence of Sleep Apnea in Special Operations Forces
Obstructive sleep apnea (OSA) is a highly prevalent and underrecognized condition among retired and active Special Operations Forces (SOF) personnel, with unique challenges and treatment needs shaped by their service history and lifestyle.
This post explores the prevalence of OSA in SOF, the limitations of continuous positive airway pressure (CPAP) therapy, and the growing role of oral appliance therapy (OAT)—especially mandibular advancement devices (MADs)—as an alternative treatment.
Prevalence of Sleep Apnea in Special Operations Forces
OSA is common in the general population, affecting up to 38% of U.S. adults, with higher rates in men and those with increased body mass index.1 In military and veteran populations, the prevalence is even greater. Studies show that OSA is highly prevalent among active-duty personnel and veterans, especially those with comorbid conditions like PTSD. For example, more than 75% of veterans with PTSD have OSA, and over half of active-duty personnel with PTSD are diagnosed with OSA.2 The demanding nature of SOF service—irregular sleep schedules, high physical and psychological stress, and frequent deployments—further increases risk. As sleep disorders become more common with age, retired SOF personnel are particularly vulnerable.2
Why CPAP Isn’t Always the Best Fit for SOF Veterans
CPAP is the gold standard for OSA treatment, delivering air pressure via a mask to keep the airway open during sleep.2-3 However, many patients struggle with CPAP adherence due to discomfort, mask issues, dryness, and the inconvenience of equipment maintenance. For SOF veterans, these challenges are compounded by frequent travel, remote living, and a desire for high-speed, low-drag solutions. Studies in military populations show that those with OSA and PTSD are significantly less adherent to CPAP therapy than those with OSA alone.2 Even among the general population, CPAP adherence rates hover around 26 – 75% for the minimum recommended use, with fewer patients using it for all sleep.3
Oral Appliance Therapy: A Practical Alternative
Oral appliance therapy (OAT), particularly mandibular advancement devices (MADs), is a proven alternative for mild to moderate OSA and for those who cannot tolerate CPAP. MADs work by gently moving the lower jaw forward, increasing the airway space and reducing obstruction during sleep.2,6 These devices are custom-fitted by dental sleep specialists and are worn like a mouthguard.
Effectiveness and Patient Preference
While CPAP is more effective at reducing the apnea-hypopnea index (AHI), studies show that MADs provide similar improvements in daytime sleepiness, cognitive function, blood pressure, and quality of life.1,4-6 Importantly, adherence to MADs is often higher, especially in military and veteran populations. In a randomized crossover trial, veterans with OSA and PTSD were significantly more adherent to and preferred MAD therapy over CPAP, with equivalent health outcomes.2,4 At Fort Hood, Texas, 85.5% of patients achieved successful OSA control with OAT, and only a small fraction switched back to CPAP due to intolerance.8
Advantages of Oral Appliance Therapy for SOF Veterans
– Portability and Convenience: MADs are small, easy to transport, and require no electricity or water—ideal for travel and austere environments.2,8
– Discreet and Comfortable: No mask or machine noise, making them less disruptive to bed partners and easier to use nightly.6,9
– High Adherence: Greater patient preference and comfort lead to better long-term use, which is critical for managing a chronic condition like OSA.2,4,8
– Cost Savings: Implementing OAT programs in military settings has shown significant cost savings compared to CPAP, with potential for broader adoption across Defense Health Agency facilities.8
Limitations and Considerations
OAT is most effective for mild to moderate OSA. Severe cases can often be managed by OAT but may still require CPAP or other interventions. Some patients may experience jaw discomfort or dental changes, so regular follow-up with a qualified dentist is essential.5,6,9 A follow-up sleep study is recommended to ensure the device is working optimally.5
Other Alternatives and Emerging Therapies
For patients who cannot tolerate CPAP or OAT, other options include surgical interventions (e.g., maxillomandibular advancement, hypoglossal nerve stimulation) and lifestyle modifications such as weight loss and positional therapy.1,3,7 These are typically reserved for select cases and require specialist evaluation.
Shared Decision-Making and Access
The Department of Veterans Affairs and Department of Defense guidelines emphasize a shared decision-making approach, considering patient preferences, comorbidities, and lifestyle when choosing OSA therapy.2 Expanding access to MADs for military and veteran populations is a priority, given the unique needs and barriers faced by SOF personnel.2,8
Conclusion
For SOF personnel, oral appliance therapy offers a practical, effective, and patient-centered alternative to CPAP for managing sleep apnea.
With high prevalence rates and unique challenges in this population, increasing awareness and access to OAT can improve health, safety, and quality of life. If you suspect you have sleep apnea or struggle with CPAP, consult a sleep specialist or dental sleep medicine provider to explore your options.
About the Author
By. Alex Vaughan, DDS, Captain, U.S. Army (Ret.) Dr. Vaughan is a board certified Orofacial Pain specialist and co-founder of Virginia Total Sleep in Richmond Virginia. Learn more about Dr. Vaughan here.
References
- Obstructive Sleep Apnea and Chronic Insomnia Disorder: Updated Guidelines from the VA/DoD. American Academy of Family Physicians (2021).
- The Management of Chronic Insomnia Disorder and Obstructive Sleep Apnea (Insomnia/OSA) (2025). Amir Sharafkhaneh MD PhD, Aaron Thomas MD, Christi Ulmer PhD DBSM, et al. Department of Veterans Affairs.
- Obstructive Sleep Apnea in Adults. Veasey SC, Rosen IM. The New England Journal of Medicine. 2019;380(15):1442-1449. doi:10.1056/NEJMcp1816152.
- The Management of Chronic Insomnia Disorder and Obstructive Sleep Apnea: Synopsis of the 2019 U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guidelines. Mysliwiec V, Martin JL, Ulmer CS, et al. Annals of Internal Medicine. 2020;172(5):325-336. doi:10.7326/M19-3575.