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How To Diagnose Sleep Apnea

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Who Reviews Sleep Apnea Test Results

How to diagnose sleep apnea?

While an in-lab sleep test takes much longer to analyze because of all the extra data they must interpret, home sleep tests have a much faster turnaround time. Once you wear the device during a successful night of sleep, you will mail it back for the data to then be interpreted by a board-certified sleep physician.

Sure Signs Of Sleep Apnea

Medically speaking, signs are objective results of medical conditions that are observable by others, while symptoms are the subjective experiences of the person suffering from the condition. The most obvious sign of sleep apnea is what is literally called an apnea, or temporary cessation of breathing, that occurs during sleep. This is often followed by a slight stirring in the person that has stopped breathing, and breathing resumes after a moment. This may be observed by a sleep partner, or may be diagnosed during a sleep observation study.

What To Know About An At

    Do you find yourself waking up tired, or maybe with a headache or drymouth?Obstructive sleep apneacould be to blame. This happens when your breathing is interrupted duringsleep, often for more than ten seconds.

    When you sleep, your muscles relax, including the throat and chest muscles that help you breathe. If you have sleep apnea, relaxation of throat muscles combine with a narrowed airway to interrupt breathing.

    At-home sleep apnea testing is an easy, cost-effective way to figure out whether youre having trouble breathing, says Susheel P. Patil, MD, PhD, clinical director of the Johns Hopkins Sleep Medicine Program. A home sleep apnea test is a very simplified breathing monitor that tracks your breathing, oxygen levels, and breathing effort while worn. It does not fully capture what is monitored with an overnight sleep study. Overnight sleep studies give a more thorough assessment of sleep issues. They are attended by a sleep technologist and capture many more signals, including brainwaves for sleep, muscle tone, and leg movements. For individuals with certain heart, breathing, or neuromuscular problems, an overnight sleep study at a sleep center may be better.

    If you are being told that you snore, snort and gasp, if you have disrupted sleep or are sleepy during the day, and you are overweight or obese, an at-home sleep apnea test may be very appropriate. Talk with your clinical provider about your options., Patil says.

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    How Can I Monitor Sleep Apnea At Home

  • How Can I Monitor Sleep Apnea at Home? Center
  • It is a potentially serious condition that can cause several complications including heart diseases and high blood pressure. Sleep apnea may be of different types. A common type of sleep apnea is called obstructive sleep apnea . OSA is usually seen in overweight or obese individuals. The affected person has repeated episodes of apnea that lasts for a few seconds throughout the night. The estimated prevalence of OSA associated with daytime sleepiness is 4% in adult men and 2% in adult women. If you suffer from sleepiness, daytime fatigue, morning headaches, and snoring, you should get screened for OSA.

    What Causes Sleep Apnea

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    Obstructive sleep apnea is caused by a blockage of the airway, usually when the soft tissue in the rear of the throat collapses during sleep. Central sleep apnea is usually observed in patients with central nervous system dysfunction, such as following a stroke or in patients with neuromuscular diseases like amyotrophic lateral sclerosis . It is also common in patients with heart failure and other forms of heart, kidney or lung disease.

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    What To Think About

    If you are thinking about having surgery to treat sleep apnea, talk with your doctor about having a sleep study done first.

    Experts typically suggest that you try continuous positive airway pressure before considering surgery.

    Laser-assisted uvulopalatoplasty uses a laser to perform surgery. It is sometimes used to treat mild to moderate sleep apnea, although not all people benefit. This surgery is not recommended by the American Academy of Sleep Medicine to treat sleep apnea.footnote 15

    Sleep Apnea Causes And Risk Factors

    While anyone can have sleep apnea, certain factors increase the risk:

    • Sex Men are much more likely to have sleep apnea than women, although after menopause, frequency in women increases.
    • Older age While sleep apnea can occur at any age, it is more common as you get older. According to the Wisconsin Sleep Cohort study, its prevalence peaks when people are in their 50s and 60s and then plateaus.
    • Weight The risk of sleep apnea is much higher in those who are overweight, and higher still in those who are obese.
    • Anatomical differences Physical attributes that can contribute to sleep apnea include a small upper airway, a small or receding jaw, a long soft palate, a high tongue position, a deviated septum, and enlarged tonsils and adenoids.
    • Smoking According to a study conducted by Center for Tobacco Research and Intervention, University of Wisconsin, Madison, smokers are three times more likely to have sleep apnea than those who have never smoked.
    • Neck circumference greater than 17 inches in men or 16 inches in women.

    Allergies or other medical conditions that cause nasal congestion and blockage can also contribute to sleep apnea.

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    Surgery For Sleep Apnea

    There is still some skepticism surrounding the effectiveness of surgery to alleviate sleep apnea, but there have been some promising studies in recent years. Currently, the most common procedure to treat sleep apnea is uvulopalatopharyngoplasty, which surgically removes throat tissues that can obstruct the airways in deep sleep. But statistics show that this procedure only helps patients roughly 60% of the time.

    Though less invasive than uvulopalatopharyngoplasty, upper airway stimulation therapy is a newer treatment that implants a series of sensors beneath the skin of the throat and chest areas. During sleep, should the sensors detect obstructions, the implants send some mild stimulation to help clear the obstruction and reinstate normal breathing.

    Additional Treatments For Sleep Apnea

    Easy At-Home Test To Diagnose Sleep Apnea

    Therapy for sleep apnea is specifically designed for each patient. These treatments may be used in conjunction with lifestyle changes and devices to address sleep apnea symptoms.

    • Implant placement, including an implant that stimulates airway muscles and a nerve stimulator implant. An implant may help manage central sleep apnea.
    • Orofacial therapy, exercises to improve tongue position and strengthen oral muscles
    • Surgery including placement of implants andtonsillectomy and other operations to enlarge the airway for obstructive sleep apnea

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    Continuous Positive Airway Pressure

    Symptomatic patients with OSA should undergo a trial of treatment with continuous positive airway pressure.4,9 Continuous positive airway pressure reduces AHI and sleepiness.4 Although previous meta-analyses have not been definitive, the findings of some recent well-designed RCTs support that the use of continuous positive airway pressure improves quality of life.46 There is ongoing research to establish the benefits of OSA treatment on associated morbidity. Randomized controlled trials have shown reductions in blood pressure .4

    Other health benefits of treatment using continuous positive airway pressure for OSA are less clear. For example, there is conflicting evidence on the effects of continuous positive airway pressure on glycemic control in patients with diabetes.4,58 It is currently unclear if treatment can prevent some of the fetal and maternal complications associated with OSA.5961 A systematic review and meta-analysis showed that therapy using continuous positive airway pressure reduced the risk of motor vehicle crashes in patients with moderate to severe OSA.62

    Sleep Apnea Detection And Correction

    If you suspect sleep apnea to be behind your fatigue, make sure to have your physician rule it out. After evaluating your medical and family histories and performing a physical exam, sleep apnea is ultimately diagnosed from a sleep study performed by a sleep specialist.

    Upon a sleep apnea diagnosis, there are a variety of treatment solutions. They include:

    • Lifestyle Changes These include avoiding alcohol, stopping smoking, losing weight if overweight or obese, sleeping on your side to keep the throat open and keeping nasal passages open at night with nose sprays, allergy medications or a specially designed spring-loaded bandage.
    • Mouthpiece A mouthpiece is a custom-fitted device made by a dentist or orthodontist that adjusts the lower jaw and tongue to help keep the airway open during sleep.
    • Breathing Devices Continuous positive airway pressure is the most common treatment for moderate to severe sleep apnea in adults. A CPAP machine uses a mask that fits over the mouth and nose, or just over the nose. The machine gently blows air into the throat to stop the airways from becoming narrowed or blocked during sleep.
    • Surgery Some people who have sleep apnea require surgery to widen breathing passages. The procedure typically involves removing, shrinking or stiffening excess tissue in the mouth and throat or resetting the lower jaw.

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    What Are The Principles Of Ongoing Management And Follow

    The Canadian Thoracic Society guideline for the diagnosis and treatment of sleep disordered breathing in adults recommended that patients with sleep disordered breathing should be counselled to avoid excessive alcohol and sedative use.9 A meta-analysis of the effects of exercise training on sleep apnea80 and a longitudinal prospective cohort study81 reported, respectively, that exercise of moderate intensity and weight loss of 10% of baseline weight in patients who are overweight or obese resulted in modest reductions in AHI. For patients with supine-predominant OSA, a systematic review and meta-analysis found that positional therapy may reduce AHI by up to 10 events per hour but may be limited by poor adherence in addition, there was no clear evidence of improvements in sleepiness, total sleep time or functional outcomes of sleep.82 When appropriate, patients who are obese may be referred for bariatric surgery after sustained weight loss, repeat testing may be indicated to determine if OSA persists.83

    What Are The Dangers Of Prolonged Sleep Apnea

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    In the individuals suffering from sleep apnea, due to fat deposition between the muscle fibers, the tongue and the throat muscles have poor tone. These muscles go flaccid as the person sleeps, causing the airways to collapse. Such a person has a period of no breathing for a short time that awakens him for a second and he drifts off to sleep again. The prolonged cycle of awakening and sleeping throughout the night limits the amount of time spent in deeper sleep stages. Untreated OSA is a risk factor for hypertension, stroke, heart failure, poor work performance, and accidents.

    Hence, it is important to diagnose sleep apnea in time and treat it.

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    What Are The Treatments For Sleep Apnea

    Conservative treatments: In mild cases of obstructive sleep apnea, conservative therapy may be all that is needed.

    • Overweight persons can benefit from losing weight. Even a 10% weight loss can reduce the number of apneic events for most patients. However, losing weight can be difficult to do with untreated obstructive sleep apnea due to increased appetite and metabolism changes that can happen with obstructive sleep apnea.
    • Individuals with obstructive sleep apnea should avoid the use of alcohol and certain sleeping pills, which make the airway more likely to collapse during sleep and prolong the apneic periods.
    • In some patients with mild obstructive sleep apnea, breathing pauses occur only when they sleep on their backs. In such cases, using a wedge pillow or other devices that help them sleep in a side position may help.
    • People with sinus problems or nasal congestion should use nasal sprays or breathing strips to reduce snoring and improve airflow for more comfortable nighttime breathing. Avoiding sleep deprivation is important for all patients with sleep disorders.

    Hypoglossal nerve stimulator: A stimulator is implanted under the skin on the right side of the chest with electrodes tunneled under the skin to the hypoglossal nerve in the neck and to intercostal muscles in the chest. The device is turned on at bedtime with a remote control. With each breath, the hypoglossal nerve is stimulated, the tongue moves forward out of the airway and the airway is opened.

    Therapies For Sleep Apnea

    While many experience anxiety or stress around the decision to treat their sleep apnea with continuous positive airway pressure or automatic positive airway pressure machines, these devices remain the most effective treatment for those suffering from all levels of sleep apnea.

    CPAP and AutoPAP Treatment

    For those curious about the differences between these two machines, the CPAP provides a continuous stream of light air pressure that prevents obstructions to the throat and chest during sleep, preventing apnea events.

    The AutoPAP is a newer, more innovative option that senses obstructions or disturbances in your breathing and provides an increasing amount of airway pressure until the obstruction is eliminated. This is an extremely effective treatment for those experiencing severe snoring, apneas, and hypopneas during sleep. Some newer AutoPAP machines include built-in humidifiers to combat dryness that can result from the increased airway pressure.

    Oral Appliances May Be An Option

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    Reevaluate Your Treatment Plan

    If youre actively treating sleep apnea and continuing to battle fatigue, youre not alone. In CPAP users, this can happen in 5 to 55 percent of patients, according to a study published in September 2016 in the journal Sleep Medicine Clinics. The researchers suggest sticking to CPAP therapy, if youre using it improving your sleep habits, which are worth another look asking your doctor if any of your medications are interfering with your sleep and figuring out if you have another underlying condition thats contributing to your fatigue, such as diabetes or hypothyroidism. You should also consider being evaluated for other sleep disorders, such as narcolepsy or restless legs syndrome.

    Together, youll get to the bottom of it and feel energized in the future.

    What To Tell Your Primary Care Doctor If You Suspect You Have Sleep Apnea

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    If you suspect sleep apnea, start by telling your primary care doctor about your symptoms. Your doctor will likely do three things: obtain a full medical history, conduct a physical exam, and possibly order a sleep test. She or he may also do further tests to rule out other medical conditions that may be causing your symptoms, such as an echocardiogram to evaluate the structure and function of the heart and problems such as heart failure an electrocardiogram to detect irregular heart rhythms thyroid function tests or arterial blood gases .

    Other questions to expect from your primary care physician that may be helpful to make a sleep apnea diagnosis include the following:

    Based upon her findings, your doctor may suggest an at-home sleep test or a sleep study performed in a sleep lab.

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    What You Can Expect

    Lifestyle changes and treatments like continuous positive airway pressure , oral appliance therapy, positional therapy, and weight loss may make big improvements in your quality of life.

    Here are some changes you can expect when you start treating your sleep apnea:

    Better sleep. âTreatment can restore your regular sleep pattern and increase your total sleep time by eliminating breathing pauses in your sleep,â Ramar says. âThis will help you wake up feeling more refreshed and boost your energy throughout the day.â

    More productivity. âUsing CPAP may improve your ability to think, concentrate, and make decisions,â Ramar says. He points out that this can also improve your productivity and lessen the chances of making a costly mistake at work.

    Improved quality of life. With better sleep comes more wellness. Ramar says treatment may improve your mood, lower your risk of depression, and improve your overall quality of life.

    Adjust Your Cpap Mask

    One of the most common reasons for discomfort when using a CPAP machine is because of an improperly fitted face mask. Troubleshoot what the problem with your mask may be. Is it falling out or sliding around while you move in your sleep? Is it leaving red marks or indentations on your face when you take it off in the morning?

    Determine what types of adjustments need to be made to improve the comfort levels and make the tweaks while lying down in a sleeping position so you can see how it will fit while you sleep. If you make a few adjustments and still feel that the face mask isnt fitting correctly, your sleep physician can help ensure your mask is fitting right.

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    After Your Sleep Study Expenses To Expect

    Youll likely have some additional costs after being diagnosed with a sleep disorder. For example, your doctor may need you to participate in a second study, which is expected if youve only done an at-home test. In addition, those who need CPAP therapy will need to determine the appropriate pressure settings for the CPAP machine, which may also require further study and the purchase or rental of a CPAP machine.

    CPAP machines typically run anywhere from $300 to $800 or more. However, they can be rented, costing anywhere from $29 per month to $80 per month, or higher. Renting a machine may be a good option if the individual plans to lose weight to combat the issue.

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    Future Perspectives And Unanswered Questions

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    There is emerging interest in personalized approaches to the diagnosis and management of OSA. Individualized treatment approaches acknowledge the complex biological mechanisms underlying OSA and aim to tailor treatments to the patients physiology. Pathophysiologic mechanisms of OSA under investigation include an anatomic predisposition to upper airway collapse increased ventilatory control instability reduced arousal threshold ineffective upper airway dilator muscles or hypoglossal nerve function decreased lung tethering and nocturnal rostral fluid shift. Furthermore, research is underway to identify biomarkers and genetic factors that might predict adverse outcomes associated with OSA.92,93

    In parallel with the development of targeted therapies for OSA, it is important that attention be paid to the wide variations in the diagnosis and treatment of OSA within Canada.94 Research into the models of service delivery for OSA, including strategies to improve timely access to care, funding for OSA treatment and patient preference, will be important to improve the care of Canadians with sleep disordered breathing.

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