Obstructive sleep apnea

Diagnosis

Based on your symptoms, medical history, and a thorough examination, your doctor will evaluate the severity of your condition. They may recommend further testing by a sleep specialist. During the physical examination, your doctor will assess the back of your throat, mouth, and nose for any signs of excess tissue or abnormalities. They may also measure your blood pressure and evaluate the size of your waist and neck.

To accurately diagnose and assess your disorder, a sleep specialist may conduct additional tests. These tests could involve an overnight stay at a sleep center, where your breathing and other vital functions will be monitored during sleep. These comprehensive evaluations will help determine the nature and severity of your condition and aid in devising an appropriate treatment plan.

Tests

The following tests can identify obstructive sleep apnea:

• 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 during this sleep study.

In a split-night sleep study, you might be observed the entire night or just a portion of it.

In a split-night sleep study, the first part of the night will be monitored. Staff members may wake you up and administer continuous positive airway pressure for the remainder of the night if you have been diagnosed with obstructive sleep apnea.

Other sleep disorders, such as narcolepsy or periodic limb movements (which induce jerky bouts of sleep during the day), that can cause excessive daytime sleepiness but call for different therapies, can also be found with the aid of this sleep study.

• Home sleep apnea testing. Your doctor may occasionally recommend an at-home polysomnography test for the detection of obstructive sleep apnea. Airflow, breathing patterns, blood oxygen levels, and potentially limb movements and snoring intensity are all typically measured during this examination.

Treatment

Lifestyle changes

Your doctor may suggest lifestyle modifications for obstructive sleep apnea in milder cases:

• Have a routine exercise
• Shedding off excess weight
• Stop smoking.
• Take antihistamines or nasal decongestants.
• Avoid sleeping lying on your back
• Steer clear of sedative pharmaceuticals like sleeping pills or anti-anxiety medications.
• If you do drink alcohol, do it in moderation. Avoid drinking in the hours before going to bed.

Your doctor may suggest further therapies if these steps don’t help you sleep better or if your apnea is moderate to severe. A few tools can aid in clearing a clogged airway. Other times, surgery can be required.

Therapies

• Positive airway pressure. Positive airway pressure may help people with obstructive sleep apnea. In this procedure, a machine applies air pressure to your nose or to the area around your mouth and nose while you sleep.

Positive airway pressure enhances your quality of life by lowering the frequency of respiratory episodes that take place while you sleep, cutting down on daytime tiredness, and more.

Continuous positive airway pressure, or CPAP, (SEE-pap), is the most popular kind. When receiving this treatment, your upper airway airways are kept open by the continuous, steady, and slightly elevated pressure of the air you are breathing. Snoring and obstructive sleep apnea are prevented by this air pressure.

Even though CPAP is the most effective and widely used treatment for obstructive sleep apnea, some people find the mask to be bulky, uncomfortable, or noisy. Although there are several mask designs for personal comfort, contemporary machines are smaller and less noisy than older ones.

Additionally, most people can adjust the mask to get a snug and comfortable fit with a little effort. To locate a mask that fits, you might need to try a few different kinds. There are several choices, including face masks, nasal pillows, and nasal masks.

Some machines feature additional adaptable pressure functions to increase comfort if you have trouble with pressure in particular. In addition to your CPAP machine, employing a humidifier may be beneficial.

Both continuous (fixed) and variable (autotitrating) pressures (APAP) can be used when administering CPAP. The pressure with fixed CPAP remains constant. If the machine detects increased airway resistance when autotitrating CPAP is being used, the pressure levels are changed.

Another form of positive airway pressure is called bilevel positive airway pressure (BPAP), which applies a fixed amount of pressure when you breathe in and a varied amount when you breathe out.

Because it has been well researched for obstructive sleep apnea and has been proven to be an effective treatment, CPAP is increasingly frequently utilized. However, BPAP or APAP might be worth a try for those who have trouble tolerating fixed CPAP.

If you experience problems, keep using your positive airway pressure device. To find out what modifications you can make to increase its comfort, consult your doctor.

Additionally, get in touch with your physician if you continue to snore despite therapy, if you start snoring again, or if your weight changes by 10% or more.

• Mouthpiece. Oral device offer an alternative for some persons with mild or moderate obstructive sleep apnea, even though positive airway pressure is frequently an effective treatment. It is also utilized by those who are unable to use CPAP due to severe sleep apnea. These tools could lessen your tiredness and raise your standard of living.

These tools are made to maintain an open throat. Some gadgets prevent snoring and obstructive sleep apnea by moving your lower jaw forward to keep your airway open. Your tongue is held in a different position by other devices.

If you and your doctor decide to investigate this possibility, you’ll need to have the fitting and ongoing treatment done by a dentist skilled in dental sleep medicine appliances. There are numerous gadgets available. To guarantee a successful outcome and that using the device doesn’t affect your teeth, close monitoring is required.

Surgery or other procedures

Surgery is often only undertaken if all other treatments have failed or are not an appropriate option for you. Surgical options could consist of:

• Surgical removal of tissue. During an uvulopalatopharyngoplasty (UPPP), your doctor will cut away tissue from the top of your throat and the back of your mouth. You might also have your tonsils and adenoids taken out. A general anesthesia is required for UPPP, which is frequently conducted in a hospital.
• Upper airway stimulation. People with moderate to severe obstructive sleep apnea who cannot tolerate CPAP or BPAP are approved to use this new gadget.

In the upper chest, a tiny, thin impulse generator called a hypoglossal nerve stimulator is implanted. The apparatus tracks your breathing patterns and, if necessary, activates the nerve that regulates tongue movement.

According to studies, upper airway stimulation significantly reduces the symptoms of obstructive sleep apnea and enhances quality of life.

• Maxillomandibular advancement. Your jaw’s upper and lower parts are separated from the rest of your facial bones during this treatment. This increases the area behind the tongue and soft palate, decreasing the likelihood of obstruction.
• Tracheostomy. If existing therapies haven’t worked for your severe, life-threatening obstructive sleep apnea, you might need this kind of surgery.

Your surgeon creates a hole in your neck during a tracheostomy and inserts a metal or plastic tube through which you breathe. Your lungs receive and expend air without having to go through the congested airway in your throat.

By widening or clearing airways, other surgical procedures, such as:

• Nasal surgery to remove polyps or align your deviated septum, which is the divider between your nostrils,
• Tonsil or adenoid surgical removal