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About Sleep Apnea

What Causes Sleep Apnea?

Syptoms of Obstructive Sleep Apnea

Sleep Apnea Risk Factors

Sleep Apnea and Heart Disease

Sleep Apnea Test, Diagnosis and Treatmentsd 

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Sleep Apnea Test, Diagnosis and Treatments

The greatest technology advances in sleep have been made in the diagnostic technology for the home solution, focusing on size, comfort, ease to use and accuracy of sleep test results.

Sleep facilities' technology for conducting diagnostic testing procedures has been relatively stagnant for several years. Therapeutic device technology (i.e. CPAP) has been improved over time to facilitate ease of use and patient comfort. The greatest technology advances in sleep have been made in the diagnostic technology for the home solution. Home solutions technology focused on size, comfort and ease of use.

There are two major sleep study tests that are widely accepted:

  • Home Sleep Test

sleep apnea home sleep test

This test is conducted at the home of the patient. This test is specifically designed to assist in the diagnosis of sleep disordered breathing, specifically Sleep Apnea. The test is convenient for the patient and many experts agree that testing the patients sleep in their normal home environment offers many advantages to the laboratory setting that is admittedly uncomfortable for the patient.

The process for this test is to have your dentist screen patients for sleep abnormalities during their routine visits. When abnormalities are found, the physician will dispense a take home device that they have available in their office. The patient will take the device home, wear it that evening while they sleep, and return it to the physician's office the next day. Results will be available usually within 24 hours. Based on the results, the physician can
a)rule out OSA b)diagnose OSA and prescribe therapy or c)prescribe further testing or titration to be performed in a sleep laboratory using PSG. Prior to the home sleep test, only option 3 was available to primary care physicians at the expense and inconvenience of millions of patients.

 

An overnight PSG (Polysomnogram)

sleep apnea overnight

This test is conducted in a sleep lab or hospital setting. It requires the patient to stay in the sleep lab of hospital overnight which can be inconvenient. It is an expensive process (hospital setting, sleep technician, often manual scoring) and many sleep centers are operating at full capacity so there is often a 3-4 week wait. We have found a 40% drop off rate from patients that are referred to a sleep lab to those who actually show up and complete the test. In addition, the patient is traditionally burdened with extra deductibles and charges ($700-$2500) since this is occurring outside of the primary care setting. It is widely agreed that PSG is a thorough and reliable test when the patient completes the process.

 

Sleep Apnea Treatments

 

There are several treatment options for mild to moderate OSA, especially if the OSA occurs primarily in the supine position (i.e., when sleeping on the back). For severe sleep apnea and pregnancy-related OSA, continuous positive airway pressure (CPAP) is the primary treatment of choice. CPAP treatment is also recommended for drivers of commercial vehicles with severe OSA. A brief description of treatment options and issues are presented below.

Treatments for Obstructive Sleep Apnea may include:

 

Weight Loss-The most common cause of OSA is obesity, so losing weight is important for those who are overweight regardless of OSA severity. For mild sleep apnea, this might be enough.

  • Continuous Positive Airway Pressure (CPAP)

sleep apnea CPAP

Nasal Continuous Positive Airway Pressure, or CPAP treatment, requires the patient to wear a mask over the nose during sleep. The mask is connected by a hose to a small air pressure generator. When the mask is worn, the air pressure inside the throat is increased. The air pressure is adjusted so that it is just enough to prevent the throat from collapsing during sleep. The CPAP eliminates a person's snoring, gasping, and choking during the night. The CPAP prevents airway closure while it is worn, but apnea episodes will return when CPAP is stopped or if it is used improperly. CPAP technology has improved considerably in the past five years. The devices are much quieter and there are numerous mask options that improve the fit and comfort.

 

Treatment with CPAP requires adjustment (or titration) of the amount of pressure needed to keep the airway open. Patients who have an ARES study no longer need to have a CPAP pressure setting determined in the laboratory. Multiple studies have shown that auto-adjusting CPAPs, which automatically deliver the correct pressure, are as effective as in-laboratory determined pressure. Alternatively, the CPAP pressure can be predicted using a formula and the pressure adjusted until the snoring subsides. CPAP units are obtained from Durable Medical Equipment providers with a prescription provided by your physician.

 

 

 

Oral Appliances

sleep apnea oral appliance

An oral device is fitted by a dentist and worn much like a retainer or sport mouth-guard. They are designed to keep the mandible (jaw) and/or tongue in a forward position that allows the airway to remain open. Generally, oral devices work best for patients with mild to moderate OSA, patients who experience OSA mostly in the supine position (when sleeping on their backs), and for those who are not obese and do not have a large neck. In Advanced Brain Monitoring (ABM) clinical study, the ARES showed a 96% efficacy rate across all patients, even in patients who suffered from severe OSA but had failed CPAP therapy.

  • Surgery

A variety of surgical techniques have been used to reconfigure the upper airway so that it remains open during sleep, but these procedures may not be helpful in every patient, and their long term effectiveness is unproven. The most common surgery to treat OSA, uvulopalatopharyngoplasty (UPPP), has a short-term success rate of about 50% in unselected cases. Removing the tonsils and/or adenoids may be effective in some patients.

  • Sleep Position Restriction

Gravity promotes sleep apnea when a person sleeps on his or her back (supine). The ARES measures OSA by position, so if it is shows difficulty only or mostly on the back, then simply avoiding sleeping on the back may be successful. Patients who have OSA primarily while on their back are also more likely to be helped by an oral appliance.

  • Treatment Follow-up

For all treatment options other than CPAP, it is recommended that a follow-up ARES study be performed approximately 1 to 3 months after initiation to ensure that the selected procedure was effective. After any significant weight loss or weight gain, your treatment may need to be reevaluated.

 

This information has been provided by Watermark Medical.    http://www.watermarkmedical.com/index.php