Guest writer Leah Kaylor, PhD, MSCP, is the author of If Sleep Were a Drug and an expert in sleep science, helping readers optimize their brain and body through better rest.
Obstructive sleep apnea (OSA) is one of the most underdiagnosed health conditions among first responders, despite its profound implications for safety, cognition, and long-term health.
Characterized by repeated airway obstruction during sleep, OSA leads to fragmented rest, intermittent hypoxia, and excessive daytime fatigue.
For those serving in high-risk, high-vigilance professions such as law enforcement, firefighting, and emergency medical services, the consequences of untreated OSA extend far beyond poor sleep—they can compromise operational performance and public safety.
Studies indicate that OSA affects a substantial portion of first responders, often at rates higher than the general population. In a landmark study of over 4,900 police officers, approximately 40% screened positive for at least one sleep disorder, with OSA being the most common (Rajaratnam et al., 2011). Unfortunately, stigma, lack of awareness, and limited access to sleep medicine services often prevent diagnosis and treatment.
OSA disrupts the restorative architecture of sleep—particularly deep and REM stages—resulting in persistent fatigue and cognitive deficits.
When breathing repeatedly stops and starts during sleep, the brain doesn’t get enough oxygen, which can result in next day consequences of slowed thinking, clouded judgment, and poor memory.
For first responders, whose roles demand rapid judgment and precise coordination, these deficits can increase the likelihood of operational errors, motor vehicle crashes, and delayed reaction times.
"One study found that commercial drivers with untreated OSA were nearly five times more likely to be involved in preventable crashes compared to those without the disorder (Tregear et al., 2009). While data specific to first responders are still emerging, the parallels are clear: untreated OSA poses a direct threat to situational awareness and public safety."
Sleep fragmentation from OSA alters emotional regulation and stress tolerance—factors essential to first-responder resilience.
Not getting enough sleep makes the emotional part of the brain overreact and weakens the part that helps with self-control, leading to more irritability and impulsive decisions.
This dysregulation can impair judgment in crisis situations and exacerbate interpersonal conflict within teams. Moreover, OSA is strongly associated with mood disorders, including depression and anxiety, both of which are already prevalent in high-stress professions.
"Untreated sleep apnea has been shown to worsen post-traumatic stress symptoms, likely because poor-quality sleep interferes with the brain’s ability to regulate fear and process emotional memories. For responders routinely exposed to trauma, addressing sleep-disordered breathing may be an essential—yet often overlooked—component of trauma recovery."
The physiological strain of untreated OSA extends beyond fatigue. When oxygen levels drop over and over during sleep, the body stays stuck in stress mode, which can lead to inflammation, high blood pressure, and strain on blood vessels.
Over time, this cascade elevates the risk of cardiovascular disease, stroke, insulin resistance, and obesity—all conditions disproportionately affecting first responders.
Researchers found that individuals with untreated, severe sleep apnea had a more than threefold higher risk of death from any cause compared to those without sleep apnea (Marin et al., 2005). For professionals already exposed to occupational hazards, this silent disorder compounds cumulative health risk and shortens career longevity.
The good news is that OSA is highly treatable. Continuous positive airway pressure (CPAP) therapy remains the gold standard, normalizing oxygen levels and restoring healthy sleep architecture.
When people use their CPAP every night, they tend to feel sharper, have fewer accidents, and see big improvements in heart and overall health. Agencies can promote screening through annual physicals, integrating simple questionnaires such as the STOP-BANG into wellness programs.
Early identification, combined with access to sleep medicine specialists, can prevent the downstream effects of untreated OSA. On an individual level, maintaining a healthy weight, limiting alcohol use, and prioritizing sleep consistency during off-duty hours can reduce risk.
For first responders, untreated OSA is not merely a medical issue—it is an operational threat. Fatigue, impaired cognition, and emotional instability undermine performance in moments where clarity and precision are critical. By recognizing sleep apnea as both a health and safety concern, public safety agencies can protect not only the wellbeing of their personnel but also the communities they serve.
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Leah Kaylor, PhD, MSCP
Enjoyed this piece? You’ll love my book If Sleep Were a Drug, where I dive even deeper into the science of sleep and how to use it to optimize your brain and body. Link to the book: https://a.co/d/cP7b2GO
References
Marin, J. M., Carrizo, S. J., Vicente, E., & Agusti, A. G. (2005). Long-term cardiovascular outcomes in men with obstructive sleep apnoea–hypopnoea with or without treatment with continuous positive airway pressure: An observational study. The Lancet, 365(9464), 1046–1053.
Rajaratnam, S. M. W., Barger, L. K., Lockley, S. W., Shea, S. A., Wang, W., Landrigan, C. P., & Czeisler, C. A. (2011). Sleep disorders, health, and safety in police officers. JAMA, 306(23), 2567–2578.
Tregear, S., Reston, J., Schoelles, K., & Phillips, B. (2009). Obstructive sleep apnea and risk of motor vehicle crash: Systematic review and meta-analysis.
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