The most common sleep-related breathing disorder is obstructive sleep apnea, which is estimated to affect more than 25 percent of adults between the ages of 30 and 70 years. 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 & Symptoms
The most common sign of sleep apnea is loud snoring. As many as 20 percent 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
The sleep apnea diagnosis can be made by an overnight sleep study (polysomnogram) or a portable home sleep apnea test. These tests measure the number of times breathing stops, changes in oxygen level in the blood, and effects on heart rate. Home sleep apnea 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, especially with severe sleep apnea. 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.
Customized oral appliances are alternative treatments to CPAP when the sleep apnea is mild or moderate in degree. A breakthrough implantable system known as Inspire® therapy may help those patients who cannot tolerate oral appliances or CPAP.
Other alternatives to CPAP therapy include:
- Weight loss
- Upper airway surgery (to reduce redundant tissue)
- Tracheotomy (rarely performed except in cases when all other therapies fail)
- Positional therapy (to avoid back sleeping)
The NorthShore University HealthSystem Sleep Disorders Program features multiple clinic sites and two sleep labs, both accredited by the American Academy of Sleep Medicine. Staff physicians include neurologists and pulmonologists. All are experienced in the diagnosis and treatment of a broad variety of sleep disorders.
After a clinical evaluation including a detailed history and physical examination, most patients undergo a polysomnogram. Large, private bedrooms are available in both 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.