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Diagnosis & Treatment

Diagnosis & Treatment

How is Sleep Apnea Diagnosed? | How is Sleep Apnea Treated?

How is Sleep Apnea Diagnosed?

If you suspect you might have sleep apnea, it is highly recommended that you contact your primary doctor as soon as possible. As you read in Understanding Sleep Apnea, it is a disorder that can have dramatic or fatal effects. Be sure to share the data you acquired by reviewing the OSA Identification List and taking the Epworth Sleepiness Scale test.

Your doctor will most likely have you see either a pulmonologist, neurologist, or other doctor's with a background in sleeping disorders in order to obtain a definitive diagnosis. Many sleep specialists are neurologists as a link between neurological and sleeping disorders exists. The specialist uses your sleep history to evaluate symptoms such as difficulty falling asleep, difficulty staying asleep, daytime sleepiness, daytime fatigue, breathing problems in sleep, and other troublesome behaviors. Sleep apnea is not easy to diagnose since different reasons exist for disturbed sleep.

The following lists the most common and trusted tests used in diagnosing Sleep Apnea:

  • Test ElectrodesPolysomnography (PSG): The diagnosis of sleep apnea requires an overnight stay at a sleep center. A PSG is an overnight test that measures your sleep patterns. Sensors (Figure 3, click to enlarge) are applied to the surface of your skin using paste and tape. These sensors measure your brain waves, eye movements, muscle tone, breathing patterns and blood oxygen levels. The technologist is specially trained to operate the sleep diagnostic equipment and remains all night in an adjacent control room.
  • CPAP Titration Study: CPAP stands for Continuous Positive Airway Pressure and at the start of a CPAP study, sensors will be applied to your skin and the technologist will monitor your brain waves, eye movements, muscle tone, breathing patterns, and blood oxygen levels using special diagnostic sleep equipment. Before you fall asleep the technologist will fit you with the CPAP device. If you had a previous PSG and have been diagnosed with sleep apnea (OSA), your physician may have you return to the Sleep Disorders Center for a sleep study with CPAP.
  • 1/2 PSG & 1/2 CPAP: In some cases, both diagnosis and treatment of a breathing problem can be accomplished in a single night. As during the PSG, sensors that measure brain waves, eye movements, muscle tone, breathing patterns and blood oxygen levels are applied to your skin using paste and tape. Once you are asleep, the technologist carefully monitors the sleep diagnostic equipment for any sign of disrupted breathing during sleep. If apneas are seen, the technologist will apply CPAP during the second half of the test.
  • Multiple Sleep Latency Test (MSLT): This test consists of five scheduled “nap” recordings during which you will be allowed to sleep for a brief period. The MSLT is conducted on the day following an overnight PSG. During the PSG, sensors are applied to your skin with paste and tape to measure brain waves, eye movements, muscle tone, breathing patterns, and blood oxygen levels. On the morning after your PSG some of these sensors will be removed. The naps are scheduled 2 hours apart, with the first one occurring approximately 2 hours after you get up. During the naps, the technologist will monitor your sleep/wake patterns.

All of these diagnostic tests and studies are normally preformed at a sleep center, or at your local hospital. In most cases, the sleep rooms are private with a comfortable double bed in a hotel-like atmosphere. The outcome of these tests will be sent to your primary doctor and/or your sleep specialist. The results will determine the type of treatment you will receive. To help demystify sleep studies, you are able to view a sleep study online at the Stanford University Sleep Disorders Clinic.

It is important to note that snoring alone does not always mean you have OSA. Some important differences exist between OSA and what is termed "simple snoring", or snoring without apneic episodes:

  • You normally wake up feeling refreshed
  • There are no signs of insomnia
  • You do not experience excessive daytime sleepiness

Other symptoms will be present in addition to snoring in order to be classified as OSA. This is mentioned only to dispel the misconception that because you snore, you have sleep apnea.

How is Sleep Apnea Treated?

Sleep apnea treatment is normally tailored to your medical history, physical examination and the diagnostic results from your sleep study. Medications may be tried, but are generally not effective for treating OSA. Treating OSA with oxygen administration may help raise blood oxygen levels, but will not eliminate the apneic episodes or improve daytime sleepiness. The most effective treatment for OSA is the use of Continuous Positive Airway Pressure (CPAP). Depending on your sleep study test results, your sleep apnea will be classified into one of three categories: mild, moderate or severe.

If you are classified as mild, this means you have sleep apnea but with no apneic episodes. Behavioral changes such as weight loss and sleeping on your side are normal and effective options at this level, Avoiding the use of alcohol, tobacco and sleeping pills are also normal treatment options. In some cases, the use of dental appliances will be used to reposition the jaw and tongue and is usually installed by a dentist or orthodontist. Obstructive sleep apnea does not occur in these classifications.

CPAP MaskThe most effective treatment for moderate to serious cases of sleep apnea (OSA) is the use of CPAP. In this classification, you experience multiple apneic episodes per hour and take several seconds to start breathing again. As shown in Figure 4 (click to enlarge), you wear a mask over your nose while you sleep, and continuous airflow is delivered through the nasal passages to the airway preventing an apneic episode. A mask which covers both the nose and mouth is also available for people who have difficulties breathing through their nose. The treatments provided in the mild description may also be used in conjunction with CPAP.

Surgical procedures are available to increase the size of the airway but none are completely successful or without risk. In most cases, more than one procedure is required before any benefits are realized. Following is a summary of the more common surgical procedures:

  • Uvulopalatopharyngoplasty (UPPP): a procedure that removes soft palate tissue from the back of the throat. The success rate ranges from 30-50%. It may decrease or eliminate snoring but not the apneic events.
  • Laser-Assisted Uvulopalatoplasty (LAUP): involves the use of a laser to remove soft palate tissue from the back of the throat. Like UPPP, it has been effective in treating snoring, but not sleep apnea as a whole.
  • Tracheostomy: is an extreme measure and is only used when severe and life-threatening cases of sleep apnea exist. A small hole is made in the windpipe and a tube is inserted into the opening. During the day, or waking hours, the tube remains closed and allows normal breathing and speech. At night, or while sleeping, the tube is opened so that air passes directly into the lungs bypassing any upper airway obstructions.

Surgical procedures are used to treat obesity are sometimes recommended for overly obese people as are surgical reconstruction procedures for deformities of the lower jaw. In both cases, the person already has been diagnosed with sleep apnea and these procedures are necessary if they are the cause of the upper airway obstruction.

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