Twenty percent of the population has some form of sleep apnea or closely related conditions (SDB). The proportion of people with chronic pain who have SDB is much higher. The low oxygen levels and sleep disturbance of any form of SDB damages tissue contributing to chronic pain. SDB has many other negative health effects. The ongoing tissue damage works against what we are trying to accomplish with SI. The clinical presentation of SDB is highly variable. Learning to recognize the signs of SDB and referring clients for testing and treatment leads to greater client health and comfort and greater success toward the goals of SI.