Sleep apnea

Diagnosis

Your doctor may perform an assessment based on your symptoms and a sleep history, which you can provide with assistance from a bed partner or household member, if possible.

Most likely, a sleep problem clinic will be recommended to you. There, a sleep expert can assist you in deciding whether you need additional testing.

During sleep testing at a sleep center, your breathing and other bodily systems are frequently monitored overnight as part of an evaluation. There may also be a choice for at–home sleep testing. Testing for sleep apnea may involve:

• Nocturnal polysomnography. Your heart, lungs, and brain activity, breathing patterns, arm and leg movements, and blood oxygen levels are all tracked by equipment as you sleep throughout this test.

Home sleep tests. Your doctor may give you streamlined tests that you may perform at home to identify sleep apnea. During these examinations, your blood oxygen level, airflow, and breathing patterns are typically measured. If central sleep apnea is suspected, your doctor is more likely to advise polysomnography at a sleep lab rather than a home sleep test.

If the results are abnormal, your doctor might be able to recommend a therapy without conducting any additional tests. Sometimes portable monitoring tools fail to detect sleep apnea. So even if your initial results are within the normal range, your doctor can still advise polysomnography.

Your doctor may suggest that you see an ear, nose, and throat specialist if you have obstructive sleep apnea in order to rule out a blockage in your throat or nose. To determine the reasons of central sleep apnea, a patient may need to be evaluated by a cardiologist (a physician who specializes in the heart) or a neurologist (a physician who specializes in the neurological system).

Treatment

For mild cases of sleep apnea, your doctor may recommend lifestyle changes such as smoking cessation or weight loss. Adjusting your sleeping position may also be suggested. If nasal allergies are a contributing factor, allergy medication might be recommended.

In cases where the above measures are ineffective or if you have mild to severe sleep apnea, there are several alternative therapies available. Certain tools can assist in clearing a blocked airway, while in other situations, surgical intervention may be necessary.

Therapies for OSA

• Continuous Positive Airway Pressure (CPAP). Use of a device that produces air pressure through a mask while you sleep may be beneficial if you have moderate to severe obstructive sleep apnea. The air pressure provided by CPAP is just enough to keep the upper airway passages open and avoid apnea and snoring. It is slightly higher than the air pressure in the room.

CPAP is the most widely used and effective treatment for sleep apnea, but some people find it inconvenient or uncomfortable. To find a comfortable mask, test out a few different kinds and speak with your health care practitioner.

• Other airway pressure devices. You might be able to utilize an alternative airway pressure device if using a CPAP machine continues to be a problem for you. This device automatically changes the pressure while you’re sleeping (auto–CPAP). There are also devices that deliver bilevel positive airway pressure (BPAP). With these, your pressure increases during inhalation and decreases during exhalation.
• Oral appliances. Another option is to wear an oral appliance designed to keep your airway open during sleep. While oral appliances can be more user–friendly, continuous positive airway pressure (CPAP) therapy is generally more consistently effective. Some oral appliances are specifically designed to bring your jaw forward and help open your throat, which can provide relief for mild obstructive sleep apnea and snoring.

Your dentist may have a range of devices available, and it may be necessary to try out different options before finding the most suitable one for you. Once you have found the right fit, it is important to regularly follow up with your dentist to ensure the appliance still fits properly and to evaluate the effectiveness of symptom management, especially beyond the initial year.

Surgery for OSA

In cases where alternative treatments have failed, surgery may be a possibility for those with OSA. Prior to considering surgery, it is usually advised to try out other treatments for at least three months. But for a tiny percentage of patients with certain jaw structural issues, surgery is a good initial step.

Possible surgical options include:

• Tissue removal. A surgeon will remove tissue from the top of your throat and the back of your mouth during this treatment (uvulopalatopharyngoplasty). In most cases, your tonsils and adenoids are also removed.

This kind of surgery may be effective in preventing throat tissues from vibrating and snoring. It isn’t regarded as a trustworthy treatment for obstructive sleep apnea and is less effective than CPAP.

For those who cannot tolerate CPAP or oral appliances, radiofrequency ablation (removal of tissues with radiofrequency energy) may be an alternative.

• Tissue shrinkage. Another choice is to use radiofrequency ablation to reduce the tissue in the back of the mouth and the throat. If you have mild to moderate sleep apnea, this technique might be done. According to one study, these results are comparable to those of tissue removal but come with lower surgical risks.
• Jaw repositioning. The jaw is advanced relative to the other face bones during this treatment. This increases the area behind the tongue and soft palate, decreasing the likelihood of obstruction. The term “maxillomandibular advancement” refers to this surgery.
• Implants. Following local anesthesia, soft rods, typically composed of polyester or plastic, are surgically placed into the soft palate. To find out how effectively implants function, more study is required.
• Nerve stimulation. Surgery is required to place a tongue–movement–controlling stimulator into the hypoglossal nerve. Increased stimulation aids in keeping the tongue in a posture that maintains an open airway. More study is required.
• Creating a new air passageway, known as tracheostomy. If alternative therapies haven’t worked for your severe, life–threatening sleep apnea, you might need this kind of surgery. Your surgeon creates a hole in your neck and installs a metal or plastic tube, which you breathe through.

Throughout the day, you cover the opening. However, you leave it open at night so that air can enter and exit your lungs without having to go via the closed airway in your throat.

By opening up or widening airways, several surgical procedures could help treat sleep apnea and lessen snoring which includes tonsil or adenoid surgical removal and bariatric surgery (surgery performed for weight loss).

Therapies for CSA

• Treatment for associated medical problems. Treating cardiac or neuromuscular issues, which are potential causes of central sleep apnea, may be helpful. Additionally, supplementary oxygen, CPAP, BPAP, and adaptive servo–ventilation (ASV) may be utilized as treatments for CSA.
• Medicine changes. You might be given acetazolamide or another medication to assist control your breathing. Your healthcare physician may adjust your medications if drugs like opioids are making your CSA worse.
• Supplemental oxygen. If you have central sleep apnea, using more oxygen while you sleep may be beneficial. Devices that supply oxygen to your lungs come in a variety of types.
• Adaptive Servo–Ventilation (ASV). This more contemporary airflow device that has been approved learns your regular breathing pattern and keeps the data in an integrated computer. The device employs pressure to control your breathing pattern after you nod off and avoid breathing pauses.

Some persons with treatment–emergent central sleep apnea may be able to benefit from ASV. For those with severe heart failure with predominate central sleep apnea are not advised to use ASV.