Diagnosing obstructive sleep apnea

Obstructive sleep apnea is a condition where breathing stops while a person sleeps. "Apnea" is a medical term that means "without breathing." The most common reason people develop this condition is due to excess soft tissue in the back of the throat that relaxes during sleep. This tissue can block the airway—basically like putting a lid on the windpipe—so we can't breathe. The blockage is usually temporary, lasting only a few seconds. Our bodies react by waking us up just enough to start breathing again.

Symptoms include loud snoring, other people noticing that your breathing stops during sleep, and daytime sleepiness. That sleepiness is often what prompts a doctor to suspect sleep apnea. It happens because the sleep is non-restorative—your body keeps waking up throughout the night, even if you don’t remember it. Unfortunately, untreated sleep apnea can lead to problems like car accidents, high blood pressure, and heart disease.

The most common reason people develop excess soft tissue in the throat is being overweight. People with large neck circumferences—greater than 17 inches—are at especially high risk. Men are more likely to develop sleep apnea than women. About 25 to 30 percent of men are suspected of having sleep apnea, and most of them haven’t been diagnosed. Around 9 to 17 percent of women are suspected of having it.

Sleep apnea is diagnosed using a sleep study. Most sleep studies are done at home. A home sleep study company will ship the supplies to you and may or may not do a telehealth visit to help you set up the test. Supplies vary, but may include a finger sensor, a nosepiece to monitor breathing, and one or more elastic belts around the chest or abdomen to hold a small monitor in place. After the sleep study, the company sends a report to the healthcare provider who ordered the test. The most important number on the report is called the AHI, which stands for apnea-hypopnea index. This tells us how often your breathing stops or slows per hour of sleep. An AHI of 5 to 14 is considered mild sleep apnea, 15 to 29 is moderate, and 30 or more is severe. An AHI below 5 is considered normal. The more severe the sleep apnea, the more likely someone is to benefit from treatment.

Sleep apnea is usually treated with a CPAP device. CPAP stands for continuous positive airway pressure. These are small machines connected to a mask worn on the face. Some masks go over the mouth and nose, while others just go in the nose (called nasal pillows). The CPAP machine provides a gentle stream of air to keep the airway open while you sleep. Most doctors now prescribe autoCPAP (also called APAP), which adjusts the pressure throughout the night based on your needs. It may take some trial and error to find the right mask, but most people eventually find one that works for them. Weight loss is also recommended. Losing just 10 percent of your body weight can improve or even reverse sleep apnea.

If someone can’t tolerate CPAP, there are other options. One is the Inspire device, which looks like a pacemaker and is implanted under the skin near the collarbone. A wire is placed near the tongue, and the device uses electrical stimulation to move the tongue out of the way while you sleep. Inspire is used for people with moderate to severe sleep apnea who can’t tolerate CPAP. Another option is an oral appliance, usually provided by a dentist. These are typically used for mild to moderate sleep apnea.

If you think you might have sleep apnea, talk to a healthcare professional about getting tested. If you don’t already have a provider, consider BrightMed Clinic in Lansing, KS. We’re a primary care and weight management practice, and we’d be happy to support you on your journey to better health. We accept Medicare, Tricare, and commercial insurance. We offer in-person and telehealth appointments. Visit us at www.brightmedclinic.com to learn more.