Original Ultra owners miss out on sleep apnea and hypertension alerts and watchOS 27. Here is what the $799 Ultra 4 gives back, and who should wait.
The first Apple Watch Ultra can't get sleep apnea alerts or watchOS 27. The Ultra 4, on sale since September 18 for $799 in the US and £749 in the UK, has both, plus alerts for possible high blood pressure.
Sleep apnea detection uses the watch's motion sensor to check 30 days of sleep for breathing problems. It needs at least 10 nights of wear and is meant as a prompt to see a doctor, not a diagnosis.
If you wear the first Apple Watch Ultra, your watch can’t tell you that you might have sleep apnea. That feature, along with high blood pressure alerts and the new watchOS 27, skips the first-generation model entirely. The Apple Watch Ultra 4, on sale since September 18 for $799, has all of it.
That gap is the real reason to think about an Apple Watch Ultra upgrade this year. Sleep apnea often goes unnoticed for years, and untreated it is linked to problems like high blood pressure. A watch you already wear to bed can nudge you to see a doctor. The question is whether that, plus three days of battery, is worth $799 when your old Ultra still tracks workouts and shows notifications just fine.
The Ultra 4 uses its accelerometer, the motion sensor inside the watch, to spot small breathing disturbances while you sleep. It looks at that data over 30 days and sends a notification if it sees steady signs of moderate to severe sleep apnea.
To get it working, you need to turn on sleep tracking and wear the watch to bed on at least 10 nights in each 30-day window. Apple designed the alerts for adults who have not already been diagnosed. You can view the breathing data in the Health app on your iPhone and export a PDF report to share with your doctor.
The alert is not a diagnosis. It is a prompt to get checked. One recent example: a 38-year-old Air Force veteran ignored his Apple Watch alert at first, then thought about his snoring and headaches and sent his doctor a screenshot. He was diagnosed with sleep apnea and prescribed a CPAP machine, which keeps the airway open at night.
The feature works on the Apple Watch SE 3, Series 9 or later and Ultra 2 or later. That is why the first Ultra misses out. It also launched in mainland China in mid-October after approval from regulators there.
The Ultra 4 can also warn you about possible hypertension, the medical term for high blood pressure. It does not measure your blood pressure numbers the way a cuff does. Instead, it studies how your blood vessels respond to each heartbeat over 30 days and looks for patterns linked to high blood pressure.
If it flags something, Apple suggests taking readings with a blood pressure cuff for seven days, if you have one, before talking to a doctor. The check repeats every 30 days, so it keeps watching in the background without you doing anything.
The outside looks familiar. Both watches share the 49mm titanium case and the orange Action button. Each has an emergency siren and dual-frequency GPS, and both are rated for recreational dives as deep as 40 meters. The inside is where four years of updates add up.
There is more on the way. Siri Recap, which turns conversations into short AI summaries, and Live Rewind, which shows a transcript of the last 15 seconds of speech, are due in beta later this year. They need an Ultra 4 or Series 12 and a newer iPhone that supports Apple Intelligence.
Your original Ultra still works. It handles notifications, activity tracking, navigation and dive features as before. What it loses is new software: watchOS 27 runs on the Series 9, Ultra 2 and newer, so the first Ultra won’t get the new Siri or later health features.
Upgrade now if any of these sound like you:
Waiting another year is fair if your battery still covers your normal days and you don’t care about the new health alerts. Reviewers also note the Ultra 4 is only a small step up from the Ultra 3, so if a discounted Ultra 3 turns up, it covers most of the same features, including satellite messaging.
The Ultra 4 starts at $799 in the US, £749 in the UK and €899 in Europe, the same US price as the Ultra 3. It comes in two colors with a range of bands. It went on sale on September 18, and Apple stopped selling the original Ultra back in 2023.
If price matters more than ruggedness, the Apple Watch Series 12 starts at £369 in the UK and the Watch SE 3 at £219. The SE 3 also supports sleep apnea notifications, which makes it the cheapest way to get them.
Yes. It uses the accelerometer to check 30 days of sleep for breathing disturbances and alerts you if it sees signs of moderate to severe sleep apnea.
No. Sleep apnea notifications need an Ultra 2 or later, a Series 9 or later, or an SE 3.
Not directly. It looks for signs of hypertension in 30 days of heart data and suggests checking with a cuff and a doctor if it finds them.
You're reading the quick version.
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