This article outlines what sleep apnea is and the process by which diagnosis and treatment occur.Eighteen million Americans are estimated to suffer from sleep apnea, according to the National Sleep Foundation.
Sleep apnea is a common disorder, with a person having one or more pauses in breathing or experiencing shallow breaths while sleeping. The pauses can last a few seconds to several minutes. Thirty or more such pauses are possible in a single hour.
The result is a poor quality of sleep and daytime fatigue. The condition is usually noted by a family member, not the person with the disorder.
Dr. Anne Magauran at the Center for Sleep Disorders at Exeter Hospital said sleep apnea is treatable and she enjoys helping patients get a better night's sleep. She said anyone who is constantly tired during the day should discuss the problem with their primary care physician because a sleep disorder can be the cause and sometimes people are not aware they have sleep apnea issues.
"Sleep apnea is possible at any age," Magauran said. "When a person is referred to us, we have a list of questions called the Stop Bang questionnaire. If they answer yes to three or more of the questions, we suspect a sleep disorder and may do a sleep study."
Among the questions are whether the person snores, feels tired during the day, has high blood pressure or is overweight. Also, patients are asked whether anyone has ever observed them stop breathing while they are asleep.
"Sleep apnea is more common in people over the age of 50 and it is more common in men than in women," Magauran said. "We get referrals from primary care doctors or from specialists like pulmonary or cardiology because this increases the risk of heart attacks or strokes."
Once a referral is made, Magauran will conduct a detailed interview with the patient for a complete medical history, which includes lifestyle, medications, intake of caffeine and alcohol, exercise, weight and neck size — all factors in sleep disorders. Her questions also include the length of time a person has had sleep problems. She said people who say they are suffering from insomnia are often surprised to learn sleep apnea can be a cause.
Once diagnosed, sleep apnea requires long-term management and possibly surgery to correct airway issues. The best way to diagnose sleep apnea is for medical experts to conduct a sleep study. During the overnight study, doctors observe a patient and measure brain waves, eye and chin movements, heart rate and rhythms, respiration, levels of oxygen and carbon dioxide in the blood, and leg movements.
A sleep study can be done in a medical setting or at home. Magauran said a home study has less monitoring but does use an apparatus that the patient wears to bed. The device records the way the person sleeps and it is returned to the sleep center to be analyzed. Then a treatment plan is developed if necessary.
"Sleep apnea has defined criteria," Magauran said. "We look at how many times per hour the airway narrows or closes for 10 seconds or more, associated with a drop in oxygen and patient arousal."
Untreated sleep apnea can increase the risk of high blood pressure, heart attacks and stroke. It can worsen arrhythmias and diabetes. People suffering from poor sleep are more likely to be involved in car crashes and to have job performance issues.
There are three types of sleep apnea. Obstructive apnea comes from a blockage of the airway, usually the result of soft tissue that collapses and closes the rear of the throat during sleep. In central apnea, the airway is not blocked but the brain fails to signal the muscles to breathe. Mixed apnea is a combination of the first two conditions.
In mild cases, treatment may involve the use of decongestants and positional therapy. Some people snore when lying on their back and teaching them to sleep in a different position can help.
"There are devices, like an anti-snore belt that helps patients stay off of their back, if they can tolerate them," Magauran said. "It's not for everyone."
Oral devices such as a continuous positive airway pressure (CPAP) device can be used successfully in some patients.
Surgical methods can be used in adults to open a compromised airway. In children, tonsils and adenoids may be the culprit and surgery can resolve apnea completely.
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