The diagnosis and treatment of sleep apnea
How can I tell if I have sleep apnea and how can I treat it?
The typical patient with sleep apnea is an overweight middle-aged male with a neck size of more than 17 inches. However, the condition is also common in women and not all sufferers are overweight. Almost everybody who has sleep apnea is a snorer, often a very heavy snorer. Pauses in breathing during sleep are commonly noticed by a bed partner but this history is often lacking and up to five “events” per hour are considered normal.
One of the more consistent symptoms is “nonrestorative sleep” meaning that the patient wakes in the morning feeling unrefreshed no matter how much he slept during the night. Excessive daytime sleepiness is common in sleep apnea of any severity but some patients complain of fatigue rather than sleepiness. However, many patients with severe sleep apnea have no complaint of sleepiness or fatigue.
The most accurate diagnostic tool, polysomnography, can confirm the diagnosis and assist the doctor in identifying the type of sleep apnea present. In the past, this test was only done in hospitals and in specialized sleep laboratories. There are now portable sleep recording systems that can perform unattended polysomnography in the patient’s home, but in-laboratory testing with a technician present remains the standard and is required by many insurers including Medicare before they will pay for treatment of sleep apnea.
With advances in portable electronics, patients can now use a small device called a pulse oximeter, which is attached to a fingertip to measure the oxygen saturation of the blood (percent of the total hemoglobin that is combined with oxygen). This non-intrusive monitor measures the difference in the color of the oxygenated and of the deoxygenated hemoglobins. Recordings of blood oxygen saturation during sleep may give an estimate of the severity of the problem although it’s not been the most reliable screening tool.
There are a variety of treatments for sleep apnea, depending on an individual’s medical history and the severity of the disorder. Most treatment regimens begin with lifestyle changes, such as avoiding alcohol and medications that relax the central nervous system (for example, sedatives and muscle relaxants), losing weight, and quitting smoking.
Some people are helped by special pillows or devices that keep them from sleeping on their backs. Some cases are treated with oral appliances to keep the airway open during sleep.
If these conservative methods are inadequate, doctors often recommend continuous positive airway pressure (CPAP). A face mask is attached to a tube and a machine that blows pressurized air into the mask and through the airway to keep it open. There are also surgical procedures that can be used to remove tissue and widen the airway. Some individuals may need a combination of therapies to successfully treat their sleep apnea.
In conclusion, sleep apnea left untreated can be life threatening. Excessive daytime sleepiness can cause people to fall asleep at inappropriate times, such as while driving. Sleep apnea also appears to put individuals at risk for stroke and transient ischemic attacks (TIAs, also known as “mini- strokes”), and is associated with coronary heart disease, heart failure, irregular heartbeat, heart attack, gout and high blood pressure.
Although there is no cure for sleep apnea, recent studies show that successful treatment can reduce the risk of heart and blood pressure problems.