Diagnosing and Treating Sleep Apnea

Sleep apnea is a common, growing condition in the United States, and if left untreated, can lead to serious health conditions. Self-awareness of sleep apnea can be difficult since the condition manifests itself during sleep. Yet, the consequences of the disease can be deadly. For this reason, the condition is sometimes called "the not so silent killer." The proper diagnosis of sleep apnea can only be done using a medically prescribed sleep test. 

Continue reading to learn about sleep apnea, the risk factors, other health problems associated with sleep apnea, its diagnosis, and treatment.

What is Sleep Apnea?

The Oxford definition of apnea is a temporary cessation of breathing. Sleep apnea is just that, a temporary cessation of breathing during sleep. These apneic periods can last anywhere from several seconds to over a full minute.

There are two main types of sleep apnea:

Obstructive sleep apnea (OSA): OSA happens when the airway becomes obstructed during sleep, blocking air from smoothly flowing in and out. The obstruction comes from soft tissues in and around the neck, throat, and upper airway when they relax and collapse back into the airway during sleep. The tongue can also play a role in the obstruction as it relaxes back and obstructs the airway during sleep as well.

When this obstruction occurs, the air is blocked from flowing into the airway. Any air that does pass through becomes turbulent and causes these tissues to vibrate. That is what causes the sound of snoring.

OSA is the most common type of sleep apnea and is usually the type referred to when discussing "sleep apnea."

Central sleep apnea (CSA): The cause of CSA is not an obstruction. This type of sleep apnea occurs when the brain stops signaling the body to breathe, so the body makes no effort to take the breath. It's estimated that less than 10 percent of patients that come in for a sleep study have this type of sleep apnea.1

How common is sleep apnea?

Sleep apnea is shown to affect up to 7 percent of the entire population.2 In the U.S. alone, it's estimated that 25 million adults have sleep apnea, including 26 percent of adults between the ages of 30-70.3

Even with advancements in technology and our growing knowledge of the disease, the majority of cases remain undiagnosed. This is problematic because if left undiagnosed and untreated, sleep apnea leads to further, more serious health concerns.

What happens to your body during sleep apnea?

If the airway is partially blocked, there will still be some air moving in and out, and this is when snoring is usually heard. A complete blockage will prevent any sound until you begin to breathe again.

When the airway is blocked, air is obstructed from the lungs and critically needed oxygen no longer passes into the blood. At the same time, carbon dioxide, the waste product from out cells, is not exhaled and begins to accumulate in the body.

When the oxygen levels are too low and carbon dioxide levels too high, it can be fatal. Fortunately, during sleep apnea, the body creates a wake-up signal, to wake up before low oxygen level causes death. Multiple arousals from sleep each night, some accompanied with gasps for air, can lead other, serious health issues.

Consequence of untreated sleep apnea

Waking up repeatedly from sleep apnea can cause daytime sleepiness and fatigue. This is more than just a nuisance. It can also cause:

  • a decline in cognitive function
  • a higher risk of workplace accidents
  • a higher risk of automobile accidents
  • overall poor quality of life
  • mood swings
  • poor performance at work or in school

Over time, undiagnosed and untreated sleep apneaat risk for even more serious health problems. Lower oxygen levels and elevated carbon dioxide levels put added stress on your body, especially the cardiovascular system, causing a number of problems4:

  • Hypertension (high blood pressure)
  • Heart disease
  • Heart attack
  • Diabetes
  • Stroke

Who's at risk?

Obesity is the number one risk factor for OSA and is many times behind the other health conditions mentioned above. Extra fatty tissue, particularly in and around the neck and throat can cause an obstruction during sleep. Extra chest and abdominal fat can put extra pressure on the lungs and keep them from fully expanding. Losing extra weight is the most effective treatment in this case and can most likely cure OSA completely.

It is important to note that not everyone who has OSA is obese. Those who are not obese can develop other health conditions from not treating their sleep apnea. Even diabetes, which is often associated with obesity, can occur with untreated OSA due to blood sugar levels rising during apnea.

Men are more likely to develop sleep apnea than women. However, women that have gone through menopause have an increased risk as well. This could be due to the hormone changes that take place after menopause, causing women to gain fatty tissue in places that men usually gain fat, such as around the abdomen.

Lifestyle factors can also play a role in sleep apnea. Alcohol, for example, can cause tissues and the tongue to relax back in the airway during sleep, causing an obstruction. Alcohol on occasion is not known to cause sleep apnea but can worsen sleep apnea for someone who already has it. Regular alcohol use may put you at greater risk for developing sleep apnea.

Smoking is another lifestyle factor to consider. Smoking cigarettes causes inflammation of the airway and lungs, worsening sleep apnea symptoms.

Craniofacial abnormalities are another cause of OSA. These abnormalities include an elongated soft palate, enlarged uvula, small jaw, cleft palate, enlarged tongue, among others.5

Do you have sleep apnea?

Because there are so many cases of OSA that go undiagnosed, it's important to know the signs to look for.

Most of the time it's the partner that notices severe snoring or pauses in breathing. Your partner may notice you gasping for air throughout the night.

Other signs to look for are:

  • Feeling excessively sleepy or fatigued during the day
  • Waking up still feeling like you need more sleep
  • Waking up with dry mouth
  • Waking up with a headache (most likely due to a decrease in oxygen during sleep)
  • You have trouble concentrating during the day
  • Frequently waking up at night with the feeling of choking or gasping for air

Anyone experiencing some or all of these symptoms should consider having a sleep test.

Sleep testing for sleep apnea

Polysomnography is a sleep study traditionally done overnight in a sleep lab. During a sleep test, sensors are attached to the body that record certain signals, which are used by a sleep physician to interpret and diagnose any sleep disorder, like sleep apnea.

These signals include respirations (air moving in and out as your chest rises), blood oxygen levels (oxygen saturation), body position during sleep, brain waves (electroencephalogram, or EEG), muscle activity, eye movement, and heart rate. These factors can determine the sleep cycle and the time spent in each stage of sleep.

Having a test at a sleep lab will require preparation and planning. Before going to sleep, electrodes are attached that will record both wake and sleep data, which will determine how long it takes you to fall asleep. 

The sleep technician will monitor sleep, recording data, including how many times breating stops and for how long.

Currently, with the COVID-19 pandemic, testing at a sleep lab may not be the best decision. With social-distancing and key respiratory technicians pulled to the front lines, some of these testing facilities remain closed.

If you think you have sleep apnea, it is crucial to get a sleep study, but should you go into a sleep lab for testing? Your decision needs to protect yourself and the staff at the clinic.

In any case, sleep testing should not be put on hold, due to the toll it can take on your health. Many doctors are using telemedicine instead of seeing patients in the clinic.

Fortunately, home sleep tests are available for diagnosing OSA without having to leave your home.

Home Sleep Testing for Sleep Apnea

Home sleep tests are effective in diagnosing sleep apnea. Because testing for sleep apnea only requires subset of the sensors used to diagnose other sleep conditions, fewer electrodes are needed,

Though it is possible to pick up sleep test equipment from your doctor, advances in telemedicine now make it possible to have a sleep test delivered directly to your home.

Some home sleep tests are multiple use, When using a multiple use test, the results can take a few days since the results are contained within the mini-computer machine that is returned. A technician will download the sleep recording and the results will be interpreted by a sleep physician to determine a diagnosis. (note: be sure that you treat the equipment with care. You can be responsible for any damage to this expensive equipment)

These units are then cleaned and shipped to the next patient.

Some may have concerns about reusing equipment previously used by someone else. Devices are cleaned and sanitized thoroughly following the CDC's standards. But improper cleaning can leave viruses on a surface for up to three days.6

One-Time Use Home Sleep Test

There is a home sleep apnea test that does not require return and clean, because it is a single use test. Rather than send an expensive mini computer to record your sleep activity, the results are uploaded to the cloud through a special app developed just for this purpose. The electrodes used in this test are one time use and can be discarded once the test is complete.

This one-time unit monitors your:

  • PAT signal, which stands for peripheral arterial It's recorded with a finger monitor and plays a part in diagnosing sleep-related breathing disorders.
  • Oxygen saturation (amount of oxygen in the blood)
  • Rest and activity cycles
  • Heart rate
  • Chest movement
  • Body position
  • Snoring

Your results are immediately sent to a sleep physician, and there is no expensive recording device that needs to be returned.

So You Have Sleep Apnea...Now What?

If you have sleep apnea, more than likely you are going to be prescribed a CPAP machine. A CPAP (continuous positive airway pressure) machine is made up of a machine and a mask that are connected by a hose.

You will need to wear your CPAP mask while you sleep, as the machine delivers a prescribed pressure. This pressure will hold your airway open as you breathe, not allowing for the collapse of tissues that would otherwise obstruct it.

Many people claim they feel more rested after just the first night using their CPAP machines.

Finding CPAP Equipment That's Right For You.

When deciding on a CPAP mask, you have a few different types to choose from:

  • A full-face mask is probably the most effective type of mask, as it covers the nose and mouth completely. It's suitable for higher
  • A nasal mask fits snugly over your nose only. It covers the bridge of the nose down to the upper These are typically less bulky and more comfortable than full-face masks.
  • Nasal pillows are held in place by headgear at the base of the These may be an option for those that feel claustrophobic with a mask on. With nasal pillows, there is less contact with the face than the other types of masks.

When deciding on a CPAP mask, first decide if you breathe through your nose or your mouth to decide which type you need. If you're a mouth-breather, you'll probably do best with a full-face mask. If you breathe primarily through your nose, you should do fine with a nasal mask. If you're worried about having a mask on your face all night and are a nose breather, nasal pillows may be right for you.

If you are doing a home sleep test, you might also find convenience in buying your CPAP equipment online. Masks can be bought from most durable medical equipment (DME) shops online, and also directly through most manufacturer websites.

Before ordering, make sure you measure your face properly. CPAP masks are not a one-size-fits-all thing. They come in all different sizes and you will need to get one that fits just right.

Each mask has a specific fitting guide for that particular mask. If shopping around, do not just fit for one mask and assume you will need another mask in the same size. If you have questions about sizing, it's a good idea to contact the equipment supplier directly. It's also a good idea to check the return policy ahead of time in case your particular mask isn't the fit you need.

When you receive your mask, check its fit while lying down in whichever position you sleep in, since your facial muscles change when you change positions. Make sure you have a good seal. You should keep your mask as loose as you can to obtain a good seal. If you have to tighten your mask so much that it starts to hurt just to get a seal, it's the wrong size.

Once you have your mask and are ready to wear it, just be aware that the mask and constant pressure can take some time to get used to. Some people need to start slowly, wearing it only for an hour or two at a time, building up to being able to wear it all night. If you're having trouble, you may want to start by just wearing it during daytime naps.

Some CPAP machines also offer a "ramp" option. This means that instead of starting at your set pressure right away, the machine starts with a low pressure and slowly ramps up until it reaches your set pressure. This can also help ease you into wearing your CPAP mask every night.

At some point, you may need to be refitted for your mask. This might be the case if you lose or gain weight, have changes to your facial hair, or have any facial injuries, surgeries, or structural changes.

Other Treatments for Sleep Apnea

CPAP is the most common treatment for sleep apnea and is highly effective in most cases. However, it does not cure sleep apnea. In some cases, sleep apnea can be completely reversed. This may be the case if your OSA is caused by being overweight since weight loss can remove the extra tissue blocking the airway and you may not need to wear your CPAP machine anymore.

In rare cases, surgery for sleep apnea may also correct the problem if anatomy is the cause of the obstruction.

For people that snore and do not have sleep apnea, or have mild sleep apnea and cannot tolerate a CPAP mask, there are mouthguards on the market that lift the lower jaw and stabilize the tongue to help keep the airway open.

In conclusion, sleep apnea is a health condition that must not go untreated. If you don't seek treatment for your OSA, you're likely to deal with more serious health complications down the road.

If you think you may have sleep apnea, do not delay getting a sleep test. With all of the options available for testing and treatment of OSA, you can now get a diagnosis and treatment without leaving your home.

References:

1 https:://www.acc.org/latest-in-cardiology/articles/2014/07/22/08/25/basics-of-central-sleep-apnea

2 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2645248/

3 https://aasm.org/rising-prevalence-of-sleep-apnea-in-u-s-threatens-public-health/

4 https://www.hopkinsmedicine.org/health/wellness-and-prevention/the-dangers-of-uncontrolled-sleep-apnea 

5 https://www.aafp.org/afp/1999/1115/p2279.html

6 https:://www.nih.gov/news-events/news-releases/new-coronavirus-stable-hours-surfaces