Fit but Fatigued: Why Lifters Shouldn’t Ignore Sleep Apnea
Dr. Martin Hopp MD, ENT
When you think of someone at risk for obstructive sleep apnea (OSA), the image that probably comes to mind is an older, sedentary individual with obesity. But what if we told you that people who are incredibly fit, especially weightlifters and strength athletes, can also be at risk—despite having low body fat and peak physical conditioning?
That’s the paradox many fitness-focused people face: they’re crushing it in the gym, prioritizing recovery, tracking macros—and still waking up feeling foggy, fatigued, or unrefreshed. The culprit may not be overtraining or under-recovery. It could be sleep apnea.
The Link Between Weightlifting and OSA
OSA is a condition where the upper airway collapses during sleep, temporarily stopping breathing and causing fragmented, poor-quality rest. While excess body fat—especially around the neck and abdomen—is a well-known risk factor, anatomy plays a significant role too.
This is where weightlifters, bodybuilders, and other muscular individuals may unknowingly fall into the at-risk category. Heavy strength training often leads to increased neck circumference due to hypertrophy in the neck, upper chest, and shoulder muscles. While a thick, muscular neck may look impressive, it can also reduce airway space and increase the likelihood of upper airway obstruction during sleep—especially when lying on the back.
It’s also important to note that many women, especially during perimenopause and menopause, are turning to weightlifting to combat slowed metabolism, muscle loss, and declining bone density. While they may not have the same thick necks as male lifters, women are not immune to sleep apnea—hormonal shifts and changes in upper airway muscle tone can increase their risk, even if they appear lean and healthy.
Other Factors That May Increase Risk for Lifters
In addition to neck circumference, several other factors may make sleep apnea more common in those who are intensely active in the gym:
- Jaw and facial structure: Some people have anatomies (like a recessed jaw or narrow airway) that make them more susceptible to OSA regardless of body weight. These structural issues can be masked in people who appear outwardly “fit.”
- Use of performance-enhancing drugs (PEDs): Steroid use, particularly anabolic steroids, can lead to fluid retention or thickened soft tissues in the airway, both of which can increase OSA risk.
- Overtraining and poor sleep quality: If you're relying on caffeine or pre-workouts to push through the day, that fatigue could be more than just under-recovery—it could be the result of disrupted, non-restorative sleep caused by untreated sleep apnea.
- High-altitude or resistance mask training: While popular for building lung capacity, these types of training can affect nighttime breathing patterns or complicate existing breathing disorders.
Symptoms You Shouldn’t Ignore
Many lifters overlook or dismiss the signs of OSA because they assume fatigue, brain fog, or poor recovery are just part of the training grind. But common red flags include:
- Loud or chronic snoring
- Waking up gasping or choking
- Feeling unrefreshed despite 7–9 hours of sleep
- Daytime sleepiness or difficulty concentrating
- Grinding teeth at night (bruxism)
- Headaches upon waking
Proactive, Not Panicked: What to Do If You're at Risk
Being at risk for OSA doesn’t mean you should stop lifting. Far from it. Resistance training has countless benefits, including for metabolic and cardiovascular health. The key is being aware and proactive.
If you’re experiencing symptoms—or even if you’re just curious—it’s worth getting tested. Today, convenient at-home sleep tests are available and can provide an accurate diagnosis without needing to visit a lab.
If you’re diagnosed with sleep apnea, treatment doesn’t have to mean a bulky CPAP machine (although for some, that’s the best option). Many active individuals prefer custom-made oral devices—discreet, comfortable appliances that gently reposition the jaw during sleep to keep the airway open. They’re a great alternative for people with OSA, especially those who can’t tolerate CPAP.
The Bottom Line
Being fit doesn’t make you immune to sleep apnea—and for some lifters, the very things that build strength and size can also subtly increase your risk. But awareness is power. If you’re waking up exhausted, hitting a wall mid-day, or struggling with brain fog, don’t just write it off as overtraining or stress.
You’ve built a body that performs. Make sure you’re giving it the rest it deserves. Get screened, get treated if necessary, and get back to doing what you love—stronger and more rested than ever.