The most common sleep-related breathing disorder is obstructive sleep apnea, which is estimated to affect 10% of men and 4% of women between the ages of 35 and 65. Obstructive sleep apnea is defined by periods of not breathing during sleep, which are typically followed by loud gasping for air. Sleep apnea may cause daytime sleepiness, contribute to high blood pressure, and increase the risk of stroke or heart attack. The NorthShore Sleep Center is one of the area's leaders in sleep apnea diagnosis, as well as sleep apnea treatment.
Obstructive sleep apnea results from collapse of the upper airway. This may be due to large tonsils, a big uvula, or fatty deposits inside the throat resulting in a small airway. During sleep, the muscles that keep the airway open relax. Sleeping supine (on your back) usually increases the chance of having sleep apnea.
Signs and Symptoms
The most common sign of sleep apnea is loud snoring. As many as 20% of loud snorers have sleep apnea. The snoring is irregular, with frequent snorts, gasping and choking sounds. Apnea disrupts sleep, and patients often report episodes of drifting off to sleep during the day or difficulty concentrating. Other symptoms of sleep apnea include:
- Morning headaches
- Dry mouth on awakening
- Memory loss
- High blood pressure
Awareness of risk factors can help expedite sleep apnea diagnosis. Some of these factors include:
- Large neck circumference (over 18" for men, 14" for women)
- Large tonsils, large tongue, large uvula
- Lung disease (especially COPD)
- Heart disease (especially heart failure)
- Alcohol use and smoking
Sleep apnea is most common in middle-aged men.
Sleep Apnea Diagnosis
Sleep apnea diagnosis is usually made by an overnight sleep study (polysomnogram) that measures the number of times breathing stops, changes in oxygen level in the blood, and effects on heart rate. Limited studies may indicate the presence of sleep apnea if they are positive, but do not eliminate the diagnosis if they fail to detect apnea.
Sleep Apnea Treatment
Nasal Continuous Positive Airway Pressure (CPAP) is the sleep apnea treatment of choice. This device pressurizes air and delivers it to the nose via a tube and a mask. The mask rests on or in the nose and makes a tight seal. The pressurized air keeps the airway open during sleep, eliminating the apnea and snoring. Most patients with sleep apnea respond to CPAP therapy immediately; some patients respond after a period of adjustment; a few patients are not able to use CPAP.
Alternatives to CPAP therapy include:
- Weight loss
- Upper airway surgery to reduce redundant tissue
- Oral appliances that move the jaw forward
The NorthShore University HealthSystem Sleep Disorders Program includes the Evanston Hospital Sleep Disorders Center, which is accredited by the American Academy of Sleep Medicine, and the Glenbrook Hospital Sleep Disorders Center. Physicians in the Department of Neurology serve as medical directors of the centers. Staff physicians include additional neurologists and a pulmonologist. All are experienced in the diagnosis and treatment of a broad variety of sleep disorders, especially sleep apnea diagnosis and treatment.
After a clinical evaluation including a detailed history and physical examination, most patients undergo a polysomnogram. Large, private bedrooms are available in both hospital laboratories for the test. State of the art monitoring equipment is used in both centers. Diplomates of the American Board of Sleep Medicine evaluate the polysomnograms. The results are discussed with the patient as well as their referring physician.