HOW IS OBSTUCTIVE SLEEP APNEA DIAGNOSED?

The following tests may be ordered by your family physician, Respirologist or Sleep Specialist to help evaluate you for obstructive sleep apnea:

Overnight oximetry testing is the most common form of testing for sleep apnea. This includes a probe worn on your finger while you sleep that measures your blood oxygen levels and heart rate.  Repeat overnight oximetry tests may be required to ensure adequate treatment with the CPAP machine.  Overnight oximetry testing is provided free of charge through Coastal Sleep Homecare.

Sleep Surveys including the common Epworth Sleepiness Scale or Berlin Score are common assessment tools to help medical professionals gauge your daytime sleepiness and treatment improvement.  Sleep surveys are performed during the sleep disorder program.  

Polysomnography is a test done at a sleep lab that records a variety of body functions during sleep, such as the electrical activity of the brain, eye movement, muscle activity, heart rate, respiratory effort, air flow and blood oxygen levels. This test is considered the “Gold Standard” to diagnose sleep apnea and to determine its severity.  (Some extended health care companies require a polysomnography test for medical coverage.)

TREATMENT:  

Sleep apnea, like many other disorders comes in varying degrees of severity and occurs for various reasons.  To effectively treat all patients with sleep apnea there are many different therapeutic options. These include: 

• Lifestyle changes
• Body positioning
• Dental appliances
• Surgery
• Continuous Positive Airway Pressure (CPAP)

LIFESTYLE CHANGE:

Many of the lifestyle changes that improve OSA will also improve one's overall health. Lifestyle changes are often the hardest things to accomplish, but perseverance can make a dramatic improvement in people with OSA. Regardless of the final treatment or treatments chosen, the items described below are worthwhile goals.

  OBESITY:

Obstructive sleep apnea is often associated with obesity. Overweight individuals often have respiratory problems due to thick chest walls and increased compression on the diaphragm from abdominal contents. The thick neck often seen in obesity also increases airway resistance. Weight loss, even in small amounts, can therefore have a profound effect on improving sleep apnea.

  ALCOHOL:

Alcohol when consumed in excess can exacerbate snoring and OSA. The muscles of the upper airway have been shown to loose muscle tone after consumption of even a small amount of alcohol. Individuals with sleep apnea should avoid alcohol 4-6 hours before bedtime.

  SMOKING:

Smoking is another important factor affecting regular sleep because of its stimulant properties. People that smoke are three times more likely to have sleep apnea. There are a number of medical aids to help quit smoking such as the nicotine patch or Ziban.  If you are interested in quitting smoking, talk to your family physician or one of our respiratory therapists.

  MEDICATIONS:

As with alcohol, certain medications like narcotic pain relievers and barbituates often worsen OSA.  Talk to your physician to decide if you currently take any medications that should be avoided.

  SLEEP HYGIENE:

The following is a brief list of general tips to promoting a better nights sleep:

• Establish a regular routine that includes going to bed and getting up at the same time every day, even on weekends.   Regular sleep is key to better health overall.
• Do not nap during the day as this results in poor sleep at night.
• Go to bed when you are sleepy. If you have difficulty falling asleep or wake up shortly after going to sleep, leave the bedroom and read quietly or do some other relaxing activity. Avoid overly bright lights as this can cue your wake cycle.
• Develop sleep rituals before going to bed. Do the same things in the same order before going to bed to cue your body to slow down and relax.
• Avoid stress and worries at bedtime. Address tomorrow's activities, concerns, or distractions earlier in the day. Certain activities, such as listening to soft music, reading, or taking a warm bath, can help you wind down.
• Use your bed for sleeping only. Often, doing other activities in bed like watching TV, paying bills, or working only serve to initiate worries and concerns. Let your mind associate the bed with sleeping and relaxing.
• Avoid heavy meals late in the evening; similarly, avoid going to bed hungry. A light snack, especially dairy foods, can help you sleep.
• Reduce your intake of caffeine and nicotine 4-6 hours before going to sleep. Stimulants interfere with your ability to fall asleep and progress into deep sleep.
• Exercise regularly. Regular exercise, even for 20 minutes, 3 times a week, promotes deep sleep. Avoid exercise in the evening within 3 hours of bedtime.
• Don't nap for more than 30 minutes or after 3 p.m. Avoiding naps all together will ensure that you are tired at night. Longer naps disrupt the body's ability to stay asleep.
• Maintain a dark, quiet, and cool room for sleep.

BODY POSITIONING:

Snoring and OSA are usually worse when you sleep on your back. This is because gravity promotes collapse of the soft palate and the tongue, especially during deep sleep when the muscles are most relaxed. 

There are several body positioning strategies that can help you if you have mild apnea only when lying on your back. Some patients sew a tennis ball or marble into the back of their pajamas to train themselves to sleep on their sides.   Another technique is to use positional pillows to assist you in sleeping on your side.

For some patients who are very overweight, sleeping with their torso elevated 30 degrees relieves the pressure on the diaphragm (from the abdomen) and improves patency of the upper airway.

Positional techniques have their limits, but many have been tried with success.

DENTAL APPLIANCES:

A dental appliance is a special mouthpiece fashioned by a dentist to fit your teeth and jaw. Dental appliances work by pulling the jaw and tongue forward in order to open the air passage while you sleep. There are various different kinds of dental appliances, which claim to be effective.  Consult with your physician or a dentist experienced in the use of these devices before trying one. People do have issues with sore jaw muscles and ineffective treatment depending on the patient’s severity.

SURGERY:

Surgical intervention is generally regarded as a fairly extreme form of treatment. If you have been diagnosed with OSA and are considering surgery, talk to a sleep specialist and/or experienced surgeon about the different procedures. Discuss with him/her the chances that surgery will be effective for you with your anatomy and the risks involved with the surgery. Success rates with surgical procedures to treat OSA vary depending on the individual and the type of surgery. 

CPAP THERAPY:

CPAP, which stands for Continuous Positive Airway Pressure is a specific pressure-generating machine that provides air pressure to a mask worn on your nose or mouth. The pressure generated within this mask is applied to your airways and lungs.  This applied pressure acts like a splint, keeping the airway patent and free of snoring and obstruction.  CPAP is 99% effective when used appropriately and is considered the GOLD STANDARD.