Sleep apnea is a serious breathing disorder where breathing repeatedly stops and starts during sleep. The most common form, obstructive sleep apnea (OSA), involves the upper airway collapsing, which reduces oxygen levels and fragments sleep. This condition increases the risk of serious health complications, including high blood pressure, heart disease, and stroke. Addressing this disorder requires a coordinated approach involving a multidisciplinary team of specialized medical professionals.
Where the Journey Begins
Addressing potential sleep apnea typically starts with a Primary Care Physician (PCP) or General Practitioner. The PCP performs the initial screening to determine if a specialist referral is needed. This screening involves reviewing symptoms like loud snoring, witnessed breathing pauses, and excessive daytime sleepiness.
The PCP also assesses risk factors, such as obesity, neck circumference, and high blood pressure. Standardized questionnaires, like the Epworth Sleepiness Scale (ESS), quantify the severity of daytime sleepiness. A high score on the ESS, combined with physical indicators, suggests a high probability of sleep apnea, prompting a referral.
The PCP gathers preliminary data to determine the likelihood of a sleep-related breathing disorder. They do not diagnose the condition definitively but facilitate objective diagnostic testing by a specialist.
The Specialist for Diagnosis and Primary Care
The specialist who leads diagnosis and initial treatment is the Sleep Medicine Physician, often called a “sleep doctor.” These physicians are board-certified in Sleep Medicine, completing fellowship training after residency in fields like internal medicine, pulmonology, neurology, or psychiatry. This background provides an understanding of the disorder’s systemic effects.
The sleep doctor orders and interprets the Polysomnography (PSG), the standard diagnostic test for sleep disorders. This overnight study, conducted in a lab or at home, monitors brain activity, heart rate, breathing patterns, and blood oxygen saturation levels. The results confirm the diagnosis and determine severity using the Apnea-Hypopnea Index (AHI).
The sleep specialist prescribes and manages Continuous Positive Airway Pressure (CPAP) therapy, the most common non-surgical treatment for moderate to severe sleep apnea. CPAP delivers pressurized air through a mask to keep the airway open during sleep. The physician determines air pressure settings, often through a titration study, and manages long-term adherence and follow-up care.
Specialists for Advanced Treatment Options
When CPAP therapy is not tolerated, contraindicated, or proves ineffective, a patient is referred to other specialists for non-CPAP interventions. The choice of specialist depends on the anatomical cause of the obstruction.
For interventions involving the soft tissues of the throat, the Otolaryngologist, or Ear, Nose, and Throat (ENT) doctor, becomes involved. The ENT evaluates the upper airway for structural issues like enlarged tonsils, a long soft palate, or nasal obstructions. They perform procedures such as Uvulopalatopharyngoplasty (UPPP), which removes excess tissue to widen the airway. These surgical options aim to reduce the physical collapse that occurs during sleep.
When the skeletal structure of the jaw contributes to the airway problem, an Oral and Maxillofacial Surgeon or a trained ENT specialist may be consulted. They perform Maxillomandibular Advancement (MMA), a procedure that moves both the upper and lower jaws forward to increase the space behind the tongue and soft palate. This skeletal expansion is a surgical treatment often reserved for patients with severe conditions or specific facial anatomy.
A dentist specializing in Dental Sleep Medicine treats mild to moderate sleep apnea. These dentists create custom-fitted oral appliances, such as Mandibular Advancement Devices (MADs), worn during sleep. The MAD holds the lower jaw and tongue slightly forward, preventing the collapse of the upper airway. This therapy requires specific training to ensure the device is properly adjusted and monitored.