Exercise guide
In obstructive sleep apnoea (sleep apnea in the US), your airway narrows or closes while you sleep, so your breathing stops and starts. Regular exercise helps: in trials, a few months of walking, cycling and strength training cut breathing pauses by about 6 to 7 an hour and eased daytime sleepiness, even without much weight loss. It doesn't cure sleep apnoea, and it doesn't replace continuous positive airway pressure (CPAP), a machine that keeps your airway open through a mask, or the other treatments your sleep service offers.
Daily mouth and throat exercises may help a little more, though the evidence is mixed. If you're overweight, losing weight is the strongest change you can make yourself.
This guide covers how much exercise helps, the tongue, soft palate and cheek exercises from the trials as step-by-step instructions, what weight loss adds, why CPAP still matters, the driving rules, and when to see a general practitioner (GP).
Across 12 trials with 526 people, exercise training cut breathing pauses by about 7 an hour and lowered sleepiness by about 2 points on the Epworth Sleepiness Scale, which runs from 0 to 24. In the main trial, 12 weeks of walking or cycling plus strength work took people from about 32 to 25 pauses an hour, though their weight barely changed.
CPAP lowers breathing pauses the most, by about 25 an hour. The National Institute for Health and Care Excellence (NICE) recommends lifestyle advice for everyone with sleep apnoea, and CPAP as well for moderate or severe sleep apnoea. Never stop CPAP because you've started exercising: your sleep service decides.
The UK guidelines (150 minutes a week of moderate activity, plus strength exercises on 2 days) match the main trial. In trials, breathing pauses fell with about 70 to 150 minutes a week, kept up for at least 12 weeks.
In a large study, a 10% weight loss went with about 26% fewer breathing pauses. In men already using CPAP, an 8-week programme of diet, exercise and sleep habits halved them.
Daily tongue, soft palate and cheek exercises eased sleepiness in small trials. Their effect on breathing pauses is mixed: a Cochrane review found about 13 fewer an hour (low certainty), later reviews 7.5 to 9.5 fewer, and a 2025 trial found no benefit.
You must not drive while you're excessively sleepy, and you must tell the Driver and Vehicle Licensing Agency (DVLA) if you have moderate or severe sleep apnoea with excessive sleepiness. See a GP if your breathing stops and starts in your sleep, or you always feel very tired during the day.
The National Health Service (NHS) says sleep apnoea is when your breathing stops and starts while you sleep, and that the most common type is obstructive sleep apnoea. NICE explains that the upper airway narrows or closes when your muscles relax in sleep, so you breathe too shallowly or stop breathing, and you wake or your sleep lightens to end each episode.
At night: breathing that stops and starts, gasping, snorting or choking noises, waking a lot and loud snoring. By day: feeling very tired, finding it hard to concentrate, mood swings and a headache when you wake up. NICE adds unrefreshing sleep, needing to pee at night, insomnia and memory problems. Not everyone who snores has sleep apnoea: the American Academy of Sleep Medicine says to notice snoring broken by silent pauses and gasps.
A GP can refer you to a sleep clinic, and the test is usually done at home overnight. Severity is measured by the apnoea-hypopnoea index (AHI), the number of times an hour your breathing stops or becomes very shallow: 5 to 14 is mild, 15 to 30 moderate and over 30 severe (NHS). NICE says not everyone with sleep apnoea feels sleepy, so a sleepiness questionnaire isn't used on its own.
It's common: a modelling study, funded by a maker of breathing machines, estimated that 936 million adults aged 30 to 69 have it worldwide, and the DVLA says at least 4 in every 100 men. It's linked with obesity, a large neck, older age, family history, alcohol, smoking, large tonsils, sleeping on your back and chronic obstructive pulmonary disease. NICE lists conditions where it's more common, including type 2 diabetes, high blood pressure that's hard to treat, atrial fibrillation, heart failure, stroke, polycystic ovary syndrome, Down's syndrome and overweight in pregnancy. The American Diabetes Association estimates that 55% of people with type 2 diabetes have it.
Untreated, it's linked with high blood pressure, stroke, type 2 diabetes, heart disease, depression and accidents caused by tiredness. The DVLA says it significantly increases the risk of traffic accidents.
NICE recommends advice on weight, smoking, alcohol and sleep habits for everyone, and says advice on sleep habits may include exercising regularly. For mild sleep apnoea that doesn't affect your day, lifestyle changes can stop it getting worse. CPAP is offered for moderate or severe sleep apnoea, and for mild sleep apnoea that affects daily life; a mouth splint is an option if you can't get on with CPAP, and a device that keeps you off your back suits some people. The NHS also lists exercises for your mouth and facial muscles among other treatments; NICE didn't review them and makes no recommendation on them.
Three reviews agree: exercise training cut breathing pauses by about 6.3 an hour (5 studies, 129 people), 7.1 an hour (12 trials, 526 people) and 5.2 an hour with aerobic exercise alone (7 studies). Most trials were small and short, in middle-aged adults with overweight.
In 43 adults who weren't active, with overweight and at least moderate sleep apnoea, 12 weeks of 150 minutes a week of moderate aerobic exercise, plus strength training twice a week, took the AHI from about 32 to 25 an hour, while it rose in a group doing stretching. Their weight didn't change significantly, and no one had a harmful reaction.
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Across three reviews, exercise lowered sleepiness by about 2.4 to 3.3 points on the 0 to 24 Epworth scale.
In people already using CPAP well, exercise improved fitness but didn't lower breathing pauses or sleepiness any further.
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Across 11 trials, breathing pauses fell most with about 100 minutes of aerobic exercise a week, or about 70 minutes in programmes lasting 12 weeks or more, and sleepiness kept improving with more minutes.
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Adding strength training to aerobic exercise showed a trend towards a bigger drop in breathing pauses, but strength training on its own didn't clearly lower them.
Across 80 trials, CPAP lowered breathing pauses by about 25 an hour, more than exercise, mouth splints or diet. NICE recommends it for moderate or severe sleep apnoea, and the American Academy of Sleep Medicine strongly recommends it for adults with excessive sleepiness.
Build up to 150 minutes a week of brisk walking, cycling, swimming or similar, over 3 to 5 days, and give it at least 12 weeks. The main trial built up over 4 weeks to 150 minutes a week in 4 sessions, at a moderate effort where you can talk but not sing.
Twice a week. The trial used 2 sets of 10 to 12 on 8 machine exercises (shoulder press, lat pulldown, leg extension or leg curl, chest press, upright row, leg press, biceps or triceps, and crunches), adding weight when 12 reps on the second set felt easy.
The DVLA says all drivers who fall asleep at the wheel have a degree of warning. Our suggestion: exercise at times of day when you're alert, and don't cycle on roads or swim alone while you're very sleepy.
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No trial in sleep apnoea has compared times of day, so our suggestion is to choose what suits you. Our sleep guide covers exercising in the evening.
The NHS says CPAP works best if you use it every night, so keep using it. Exercise still improves your fitness.
Build over about 4 weeks to 150 minutes a week at a moderate effort, as in the main trial, where people with shin pain switched from the treadmill to a recumbent bike. The recumbent bike and elliptical trainer pages' dose is 10 to 20 minutes at a moderate effort to start, building towards 30, and the indoor rowing page's is 3 rounds of 4 to 5 minutes at a pace you could hold a conversation at. Don't swim alone if you're sleepy (our suggestion).
3D demoTreadmill walkingBeginner · Cardio machine
3D demoRecumbent exercise bikeBeginner · Cardio machine
3D demoStationary cyclingBeginner · Cardio machine
3D demoElliptical trainerBeginner · Cardio machine
3D demoIndoor rowing (rowing machine)Beginner · Cardio machine
Front crawl (freestyle swimming)Intermediate · Other / check instructionsTwice a week. The trial's circuit was 2 sets of 10 to 12 on 8 machine exercises, adding weight when 12 felt easy on the second set; the home moves at the end of the list work the same muscles. With high blood pressure or a heart condition, our suggestion is to breathe out on each effort and not hold your breath.
3D demoLeg pressBeginner · Strength machine
3D demoChest press machineBeginner · Strength machine
3D demoLat pulldownBeginner · A cable machine
3D demoMachine shoulder pressBeginner · Strength machine
3D demoLeg extensionBeginner · Strength machine
3D demoMachine leg curlBeginner · Strength machine
3D demoDumbbell biceps curlBeginner · A dumbbell
3D demoTriceps pushdownBeginner · A cable machine
3D demoDumbbell goblet squatIntermediate · A dumbbell
3D demoSit to stand from a chairBeginner · A bench or box
3D demoIncline push-upBeginner · A bench or box
3D demoWall push-upBeginner · A wall
3D demoBand rowBeginner · A band + An anchor point
3D demoShoulder press with a bandBeginner · A bandAcross 9 trials with 347 people, lasting 2 to 4 months, mouth and throat exercises compared with sham exercises probably lowered daytime sleepiness, by about 4.5 points on the Epworth scale (moderate certainty), and probably made snoring a little quieter. They may have lowered breathing pauses by about 13 an hour, but that rests on 2 trials with 82 people (low certainty). Compared with CPAP, breathing pauses were about 10 an hour higher with the exercises alone. None of the trials reported on harms.
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Later reviews found about 7.5 to 9.5 fewer breathing pauses an hour, though most of the studies had a high risk of bias. An earlier review of before-and-after studies found the AHI roughly halved. But in a 2025 trial of 32 people with mild to moderate sleep apnoea, 20 weeks of mouth, throat and neck exercises made no difference to breathing pauses or sleepiness, and the authors suggested that programmes done less often may not work.
In 31 adults with moderate sleep apnoea, about 30 minutes of exercises a day for 3 months, taught by a speech therapist, took the AHI from 22 to 14 an hour and sleepiness from 14 to 8, with no change after sham exercises. In 39 adults with snoring or mild to moderate sleep apnoea, a shorter home programme of about 8 minutes, 3 times a day for 3 months, roughly halved how much they snored.
Our suggestion: try them as an add-on, especially with snoring or mild sleep apnoea, or alongside CPAP or a mouth splint, and keep using your treatment. The NHS lists exercises for your mouth and facial muscles among the treatments sometimes used. A speech and language therapist can teach the fuller programme.
NICE recommends a mandibular advancement splint, which holds your lower jaw forward, if you can't get on with CPAP. That's different from the splints used for jaw pain. If your jaw clicks, locks or hurts during the exercises, see our jaw pain guide or a dentist.
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Our wording of the home programme in a trial for snoring (Ieto 2015), as the Cochrane review describes it: about 8 minutes, 3 times a day, every day for at least 3 months. Stop if your jaw clicks, locks or hurts.
The same routine as a move, with its dose and cautions. There's no 3D demo, because the figure can't show the tongue and soft palate.
In a trial of 25 adults with moderate sleep apnoea and snoring, learning and practising the didgeridoo for about 25 minutes, 6 days a week for 4 months, lowered sleepiness by 3 points and the AHI by about 6 an hour, and partners slept better. It's one small trial.
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A review of 6 studies found singers snored less and players of some wind instruments had less sleep apnoea, but the overall effect was zero to small, on low-certainty evidence. Most of the studies compared groups at one point in time rather than testing training.
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Training the breathing muscles with a handheld device eased sleepiness by about 3 points and lowered systolic blood pressure by about 6.6 mmHg across 10 trials, but it didn't lower the AHI. Relaxation breathing, such as slow breathing before bed, is a different thing: it may help you wind down, but it isn't a treatment for sleep apnoea (our reading of the evidence).
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In a year-long trial of 37 people, adding yoga to diet and exercise advice didn't lower the average AHI more than the advice alone. In another trial of 44 people, online yoga 3 times a week improved sleepiness and fitness. It's a reasonable way to be active, but not a treatment on its own.
In 690 adults followed for 4 years, a 10% weight loss went with about 26% fewer breathing pauses, and a 10% weight gain with about 32% more and 6 times the odds of moderate to severe sleep apnoea.
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In 72 adults with mild sleep apnoea, a very low calorie diet with lifestyle counselling made sleep apnoea much less likely a year later. In 63 men with moderate or severe sleep apnoea, a very low energy diet took off about 20 kg and lowered the AHI by about 23 an hour in 9 weeks. In 89 Spanish men using CPAP, an 8-week programme of weekly group sessions on eating, exercise, sleep, alcohol and smoking halved the AHI, and the effect held at 6 months.
In that 8-week programme, 29% were free of sleep apnoea at 6 months, and the clinical team judged that 62% no longer needed CPAP because their sleep apnoea had become mild with no sleepiness. It was one trial, in men only, and only your sleep service can make that decision.
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The American Thoracic Society strongly recommends a full lifestyle programme, with a lower-calorie diet, more activity and support to change habits, for people with sleep apnoea and overweight. NICE recommends lifestyle advice, including on weight, for everyone with sleep apnoea.
In two trials funded by its maker, tirzepatide, a weight loss injection, lowered the AHI by 20 to 24 an hour more than a dummy injection over a year, in people with obesity and moderate to severe sleep apnoea. Your doctor decides whether a medicine like this is right for you.
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Exercise on its own takes off only a few kilos, yet it lowered breathing pauses in trials even when weight barely changed. Pairing it with changes to eating does the most. Our weight loss guide explains how.
CPAP lowers breathing pauses more than anything else, and NICE recommends it for moderate or severe sleep apnoea and for mild sleep apnoea that affects your daily life. The NHS says it may feel strange at first, but try to keep using it: it works best if you use it every night, and you should tell your doctor if it's uncomfortable or hard to use.
CPAP doesn't make you lose weight. Across 39 trials with 6,954 people, BMI (body mass index) rose very slightly on CPAP, by 0.15 on average, mainly in people who used it for less than 5 hours a night.
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A mouth splint that holds your jaw forward if you can't get on with CPAP, devices that keep you off your back, surgery for some people, and an implant that stimulates the nerve to your tongue (hypoglossal nerve stimulation) at some sleep centres.
The NHS suggests sleeping on your side, not smoking, not drinking too much alcohol, especially before bed, and not taking sleeping pills unless a doctor recommends them. Asthma + Lung UK says more than half of people with sleep apnoea have worse symptoms on their back.
If exercise or weight loss helps, your sleep service decides whether you still need CPAP. NICE asks services to give people on CPAP access to advice and support between appointments.
GOV.UK says you must tell the DVLA if you have:
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"You must not drive until you're free from excessive sleepiness or until your symptoms are under control and you're strictly following any necessary treatment." You can be fined up to £1,000 if you don't tell the DVLA about a condition that affects your driving.
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The DVLA's guide for doctors says that with excessive sleepiness from mild or suspected sleep apnoea, you must not drive until your symptoms are under control, and the DVLA must be told if that can't be achieved within 3 months.
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With excessive sleepiness, you must not drive and must tell the DVLA. To drive again, you need control of the condition, improved sleepiness and to be sticking to treatment, confirmed by a doctor, with a review at least every 3 years for a car or motorcycle licence, or every year for a bus or lorry licence.
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The DVLA's leaflet says there is no excuse for falling asleep at the wheel, and that all drivers who fall asleep at the wheel have a degree of warning.
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Our suggestion: the same applies to cycling on roads, and in the US, where the rules vary by state, ask your doctor.
The full-body machine workout is closest to the trial's circuit; its sets (2 to 3 of 12 to 15, close to failure) are harder than the trial's 2 sets of 10 to 12, so start with 2 sets and stop with a few reps to spare (our suggestion). The easy cardio workout and bike ride match the trial's moderate walking and cycling. At home, the 20-minute strength, beginner and band workouts cover strength twice a week. Ignore the glucose checks in the weights then cardio workout unless you take insulin.
A 45-minute full-body gym workout on machines: leg press, chest press, machine row, leg curl, shoulder press and arms, with sets, reps and rest.
45 minBeginner14 movesCardio machine, A bandA steady 30 to 45 minute cardio session at talk-but-not-sing pace: walk, cycle, row or cross-train, counting toward weekly activity guidelines.
40 minBeginner3 movesCardio machine, A wallA steady bike ride for a first triathlon or fitness: 5 to 10 minutes easy, a ride you can talk through, optional short faster bursts and an easy cool-down.
45 minBeginner4 movesCardio machine, A wallA 25-minute standing cardio circuit with no jumping: marching, step jacks, sit-to-stands, punches, step-ups and wall push-ups, with a seated option for most moves.
25 minBeginner9 movesA bench or box, A stepA 40-minute walk alternating 3 minutes fast and 3 minutes easy, five times over: the interval walking tested in Japanese trials, built up from three rounds.
40 minBeginner3 movesCardio machine, A wallA 30 to 45-minute beginner pool swim: a shoulder warm-up on the side, easy lengths, a main set of repeats with rests, and an easy swim down, any stroke.
35 minBeginner5 movesOther / check instructionsA 20-minute full-body dumbbell workout: two supersets of squats, rows, Romanian deadlifts and push-ups. Twice a week covers the minimum dose.
20 minBeginner8 movesA dumbbell, A bench or boxA gentle 20-minute beginner home workout with a chair, a wall and a band: sit-to-stands, wall push-ups, band rows, step-ups and dead bugs.
20 minBeginner11 movesA bench or box, A wallA full-body resistance band workout: squats, rows, push-ups, presses, pull-aparts, band walks, good mornings and flyes.
30 minBeginner9 movesA band, An anchor pointStrength moves first, then 20 to 30 minutes of steady cardio, with glucose checks built in. In one small type 1 diabetes trial, weights first kept glucose steadier.
45 minBeginner11 movesA dumbbell, A bench or boxWeight loss plus activity is the strongest combination you can manage yourself: the weight loss plan pairs both, and the walking plan builds to 150 minutes a week.
A free 8-week walking plan for beginners: build to 150 minutes of brisk walking a week, with intervals, hills and two short strength sessions.
6 training days40 minBeginner5 days a weekA 12-week workout plan for weight loss: three strength days, two cardio days and daily steps, building to 200 minutes a week, with honest results.
3 training days45 minBeginner2 days a weekYour first four weeks: two, then three short strength sessions a week at home plus walks, building gently to a full routine.
2 training days20 minBeginnerThis is general information, not a diagnosis. In the US, call 911 where this page says 999.
The NHS says see a GP if:
If someone else has seen you have the symptoms, the NHS says it can help to bring them with you. Not feeling sleepy doesn't rule sleep apnoea out, NICE says.
Call 999 (911 in the US) for chest pain, severe difficulty breathing or someone who collapses during or after exercise. Our heart disease guide lists the signs.
Palpitations that don't go away, or come with chest pain, breathlessness or feeling faint, need urgent help: our atrial fibrillation guide gives the NHS advice. NICE lists atrial fibrillation among the conditions where sleep apnoea is more common.
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Tell your doctor or sleep service if CPAP is uncomfortable or hard to use: NICE says you should be able to get advice, support and equipment between appointments.
NICE asks sleep services to see people quickly if they drive for a living or have a job where safety depends on staying alert, so tell your GP.
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Children who snore with pauses in their breathing should see a GP; in children, large tonsils or adenoids are the main cause, Asthma + Lung UK says. This page is for adults.
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Sleep apnoea can bring depression or mood changes. Our suggestion: see a GP if low mood lasts; our depression guide says where to get urgent help.
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It lowers breathing pauses by about 6 to 7 an hour on average. In the main trial the average went from about 32 to 25, which is still moderate sleep apnoea. CPAP lowers them most.
Compared with CPAP, breathing pauses were about 10 an hour higher with mouth exercises alone, on low-certainty evidence. They're an add-on, not a replacement.
In trials, breathing pauses fell with exercise, and rose in the group doing stretching, with no harmful reactions. Alcohol, sleeping pills and weight gain make it worse.
In 10 small studies with 213 people, 2 found some improvement and the rest found none, and the reviewers warned of a potentially serious risk of harm, including suffocation if your nose is blocked.
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The DVLA says it's most common, but not only, in people who are overweight. Women more often report tiredness, insomnia or morning headaches than classic snoring and pauses, the Cochrane review notes, and the American Academy of Sleep Medicine says the risk in women rises with the menopause.
NICE says not all people with obstructive sleep apnoea have excessive sleepiness.
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The American Academy of Sleep Medicine says there's no guarantee that losing weight will get rid of sleep apnoea, though it may help. After large weight loss in trials, 17% to 29% were free of it.
On average, BMI rose very slightly on CPAP. Weight loss needs changes to eating and activity.
A trial of mouth and throat exercises with neck exercises found no benefit, and we found no trial of neck exercises on their own. They're fine for a stiff neck.
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Yes, alongside treatment. In trials, exercise training cut breathing pauses by about 6 to 7 an hour and eased daytime sleepiness, even without much weight loss. It doesn't cure it: CPAP lowers breathing pauses the most.
Brisk walking, cycling, swimming or similar for 150 minutes a week, plus strength training twice a week, as in the main trial. Aerobic exercise is the best studied, and adding strength work may help a little more. Mouth and throat exercises are a separate, daily add-on.
They may help a little. In small trials lasting about 3 months, daily tongue, soft palate and cheek exercises eased sleepiness and made snoring quieter, but their effect on breathing pauses is mixed: one review found a large drop on low-certainty evidence, and a 2025 trial found no benefit. They don't replace CPAP.
The home programme in the trials took about 8 minutes, 3 times a day: tongue slides, tongue sucks, pressing the back of the tongue down, short "ah" sounds to lift the soft palate, and pressing each cheek out against a finger. The steps are on this page. Trials measured results after about 3 months.
Not on your own. Exercise and weight loss can lower breathing pauses, and in one trial the sleep team told some men they no longer needed CPAP after a lifestyle programme, but only your sleep service can decide that. Keep using CPAP every night until they say otherwise.
It can help a lot and sometimes clears it: a 10% weight loss went with about a quarter fewer breathing pauses, and after large weight loss in trials, about 1 in 6 to 3 in 10 people no longer had sleep apnoea. But there's no guarantee, and many people still need treatment.
Build up to 150 minutes a week of moderate activity, such as 30 minutes on 5 days, plus strength exercises on 2 days. In trials, breathing pauses fell with 70 to 150 minutes a week kept up for at least 12 weeks.
No trial found that: breathing pauses fell with exercise, and no harmful reactions were reported. Alcohol, sleeping pills, smoking and putting on weight do make it worse. If you have high blood pressure or a heart condition, our suggestion is to build up gradually and breathe out on each effort.
Training the breathing muscles with a device eased sleepiness and blood pressure in trials but didn't lower breathing pauses. Playing the didgeridoo for 4 months lowered sleepiness and breathing pauses in one small trial, and singers snore less, but the evidence is thin.
It hasn't been shown to lower breathing pauses: in a year-long trial of 37 people, adding yoga to diet and exercise advice made no difference to the average. Online yoga improved sleepiness and fitness in another small trial, so it's a reasonable way to be active.
You must not drive while you're excessively sleepy, and you must tell the DVLA if you have confirmed moderate or severe sleep apnoea with excessive sleepiness. You can drive again once your symptoms are under control and you're sticking to your treatment; if you had to tell the DVLA, it will need a doctor to confirm this. In the US, rules vary by state, so ask your doctor.
There's little good evidence that it helps, and a review warned of a potentially serious risk of harm, including if your nose is blocked. Don't use it instead of your treatment.
Exercise education, not a diagnosis or treatment plan, and clinical review of these guides is pending. Stop and get advice for chest pain, unusual breathlessness, dizziness or fainting, or new pain, and check with your doctor or midwife first if they have told you to limit activity. Health disclaimer.
