Sleep Apnea – Diagnosis and Treatment

Sleep Apnea - Diagnosis and Treatment

What is Sleep apnea?

Sleep apnea is a serious sleep disorder that happens when a person’s breathing is interrupted during sleep. People with untreated sleep apnea stop breathing repeatedly during their sleep, sometimes hundreds of times during the night.

If it’s not treated, sleep apnea can cause a number of health problems, including hypertension (high blood pressure), stroke, cardiomyopathy (enlargement of the muscle tissue of the heart), heart failure, diabetes, and heart attacks. Untreated sleep apnea can also be responsible for job impairment, work-related accidents, motor vehicle crashes, as well as underachievement in school in children and adolescents.

There are two types of sleep apnea, obstructive and central:

  • Obstructive sleep apnea is the more common of the two. Obstructive sleep apnea occurs as repetitive episodes of complete or partial upper airway blockage during sleep. During an apneic episode, the diaphragm and chest muscles work harder as the pressure increases to open the airway. Breathing usually resumes with a loud gasp or body jerk. These episodes can interfere with sound sleep, reduce the flow of oxygen to vital organs, and cause heart rhythm irregularities.
  • In central sleep apnea, the airway is not blocked but the brain fails to signal the muscles to breathe due to instability in the respiratory control center. Central apnea is related to the function of the central nervous system.

Who gets sleep apnea?

Sleep apnea occurs in about 25% of men and nearly 10% of women. Sleep apnea can affect people of all ages, including babies and children and particularly people over the age of 50 and those who are overweight.

Certain physical traits and clinical features are common in patients with obstructive sleep apnea. These include excessive weight, large neck, and structural abnormalities reducing the diameter of the upper airway, such as nasal obstruction, a low-hanging soft palate, enlarged tonsils, or a small jaw with an overbite.

Symptoms of Sleep Apnea

Often the first signs of OSA are recognized not by the patient, but by the bed partner. Many of those affected have no sleep complaints. The most common signs and symptoms of OSA include:

  • Snoring.
  • Daytime sleepiness or fatigue.
  • Restlessness during sleep, frequent nighttime awakenings.
  • Sudden awakenings with a sensation of gasping or choking.
  • Dry mouth or sore throat upon awakening.
  • Cognitive impairment, such as trouble concentrating, forgetfulness, or irritability.
  • Mood disturbances (depression or anxiety).
  • Night sweats.
  • Frequent nighttime urination.
  • Headaches.

How is sleep apnea diagnosed?

If your doctor determines that you have symptoms suggestive of sleep apnea, you may be asked to have a sleep evaluation with a sleep specialist or may order an overnight sleep study to objectively evaluate for sleep apnea.

  • Testing includes an overnight sleep study called a polysomnogram (PSG). A PSG is performed in a sleep laboratory under the direct supervision of a trained technologist. During the test, a variety of body functions, such as the electrical activity of the brain, eye movements, muscle activity, heart rate, breathing patterns, air flow, and blood oxygen levels are recorded at night during sleep. After the study is completed, the number of times breathing is impaired during sleep is tallied and the severity of the sleep apnea is graded.
  • For adults, a Home Sleep Test (HST) can sometimes be performed instead. This is a modified type of sleep study that can be done in the comfort of the home. It records fewer body functions than PSG, including airflow, breathing effort, blood oxygen levels, and snoring to confirm a diagnosis of moderate to severe obstructive sleep apnea.

Device-based Therapeutic Treatment

There are several methods and treatments available for sleep apnea disorder. Among non-invasive treatments, PAP therapy treatments are most commonly used.

Positive Airway Pressure (PAP) therapy

This is the preferred initial treatment for most people with obstructive sleep apnea. With PAP therapy, patients wear a mask over their nose and/or mouth. An air blower gently forces air through the nose and/or mouth. The air pressure is adjusted so that it is just enough to prevent the upper airway tissues from collapsing during sleep. PAP therapy prevents airway closure while in use, but apnea episodes return when PAP is stopped or if it is used improperly. There are several styles, and types of positive airway pressure devices depending on the specific needs of patients. Styles and types include:

  • CPAP (Continuous Positive Airway Pressure) is the most widely used PAP device. The machine is set at one single pressure. As you sleep, the airstream from the CPAP machine pushes against any blockages, opening your airways so your lungs receive plenty of oxygen.

    Without anything obstructing this flow of oxygen, your breathing doesn’t pause. As a result, you don’t repeatedly wake up in order to resume breathing.

  • APAP (automatic positive airflow pressure) machine. This kind checks your breathing throughout the night. It automatically adjusts the air pressure to compensate for changes in your sleep position or medications that may have changed your breathing.
  • Bi-Level PAP uses one pressure during inhalation (breathing in), and a lower pressure during exhalation (breathing out). Auto CPAP or Auto Bi-Level PAP uses a range of pressures that self-regulate during use depending on pressure requirements detected by the machine.

CPAP Devices are also available in portable versions that are easy to carry and are battery-operated devices. However portable CPAP machines do need charging if they must be used for long periods of time.

Portable sleep apnea machines are best suited for people who travel a lot and need to pack light. Traveling with portable CPAP devices is easy because they are lightweight and small.

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