Sleep apnea is a common sleep disorder where a person’s breathing repeatedly stops and starts during sleep. This condition prevents the body from getting enough oxygen and leads to fragmented rest. The two main forms are Obstructive Sleep Apnea (OSA) and Central Sleep Apnea (CSA). OSA, the more prevalent type, occurs when soft tissues in the throat temporarily collapse and block the airway. CSA is less common and involves the brain failing to send correct signals to the breathing muscles. Because sleep apnea is linked to increased risks of conditions like high blood pressure and heart disease, professional medical attention is necessary for diagnosis and management.
Identifying the Sleep Medicine Specialist
The medical doctor who specializes in treating sleep apnea is known as a Sleep Medicine Specialist. These physicians typically complete a residency in a field like internal medicine, neurology, pediatrics, or otolaryngology, followed by a fellowship specifically in sleep medicine. The multidisciplinary nature of this field means specialists draw upon knowledge from various areas, including pulmonary medicine, psychiatry, and dentistry.
Following their fellowship, specialists seek board certification in sleep medicine from a member board of the American Board of Medical Specialties (ABMS). This certification signifies a high standard of expertise in the diagnosis and treatment of all sleep disorders. For example, a physician might be certified by the American Board of Internal Medicine with a subspecialty in sleep medicine.
The Path to Diagnosis
The diagnosis of sleep apnea often begins with a Primary Care Physician (PCP). The PCP performs an initial screening based on symptoms reported by the patient or a bed partner, such as loud snoring, choking, or excessive daytime sleepiness. To gauge the probability and severity of the condition, the doctor utilizes standardized questionnaires.
Two common screening tools are the STOP-BANG questionnaire and the Epworth Sleepiness Scale (ESS). The STOP-BANG tool assesses risk factors like snoring, tiredness, observed apneas, and high blood pressure, along with demographic factors. The ESS measures the patient’s subjective level of daytime sleepiness. A high-risk score on these tools suggests a significant possibility of sleep apnea and warrants a referral to a sleep medicine specialist for definitive testing.
Diagnostic Procedures
Once a sleep specialist is involved, the next step is performing a diagnostic sleep study. The gold standard test is an overnight Polysomnography (PSG), conducted in a specialized sleep center. During a PSG, a technician monitors numerous biological signals, including brain activity, eye movements, heart rate, muscle activity, airflow, and blood oxygen levels.
An increasingly common alternative is a Home Sleep Apnea Test (HSAT), a simplified version patients perform themselves. HSATs typically measure airflow, breathing effort, and oxygen saturation, and are appropriate for patients with a high probability of uncomplicated OSA. The results of both tests are measured using the Apnea-Hypopnea Index (AHI), which is the average number of apnea and hypopnea events per hour of sleep. An AHI of 5 to 15 events per hour indicates mild sleep apnea, 15 to 30 is moderate, and 30 or more events per hour is classified as severe.
Comprehensive Treatment Management
The sleep specialist determines the most effective treatment plan based on the AHI severity and the specific type of apnea diagnosed. For most patients with Obstructive Sleep Apnea, the first-line treatment is Continuous Positive Airway Pressure (CPAP) therapy. A CPAP machine delivers a steady stream of pressurized air through a mask to keep the upper airway from collapsing during sleep.
If a patient cannot tolerate the single continuous pressure of CPAP, the specialist may prescribe an Auto-PAP (APAP) device, which automatically adjusts the pressure throughout the night. Another option is a Bi-level Positive Airway Pressure (BiPAP) machine. BiPAP delivers two different pressure settings: a higher pressure for inhalation and a lower pressure for exhalation, which many individuals find more comfortable. For those with mild to moderate OSA, Oral Appliance Therapy (OAT) is an alternative, involving a custom-fitted dental device that repositions the lower jaw and tongue to maintain an open airway.
Surgical options are generally reserved for patients who cannot tolerate or do not respond to positive airway pressure therapy. One traditional procedure is Uvulopalatopharyngoplasty (UPPP), which involves removing excess tissue from the back of the throat and palate to widen the airway. A newer, less invasive option is Hypoglossal Nerve Stimulation, where an implanted device senses the patient’s breathing and stimulates the nerve controlling tongue movement, pushing the tongue forward to prevent obstruction. The specialist also advises on lifestyle changes, such as weight loss and positional therapy, to help manage the condition.