Sleep apnea is a common sleep disorder characterized by repeated interruptions in breathing during sleep. It is categorized as obstructive (OSA), where the airway collapses, or central (CSA), where the brain fails to send proper signals to breathing muscles. Effective treatment requires a collaborative approach involving multiple specialized medical professionals.
Primary Care and Sleep Specialists
Management often begins with a physician who serves as the initial screener and referral point. Primary Care Physicians (PCPs), including family medicine doctors and internists, are typically the first to recognize the signs of a sleep disorder during routine check-ups. They assess for common symptoms, such as loud snoring, morning headaches, and excessive daytime sleepiness, and evaluate risk factors like obesity or a large neck circumference. If sleep apnea is suspected, the PCP facilitates a referral for diagnostic testing.
The definitive diagnosis and core medical management are overseen by a Sleep Medicine Specialist, a physician with advanced training in sleep disorders. These specialists typically come from a background in Internal Medicine, Pulmonology, Neurology, or Otolaryngology. They must complete a dedicated one-year fellowship in sleep medicine, and their expertise is formally recognized through subspecialty certification from a medical board.
The Sleep Specialist coordinates diagnostic testing, most commonly polysomnography (PSG) or an at-home sleep apnea test. Polysomnography, often called a sleep study, is an overnight test that monitors brain waves, heart rate, breathing, leg movements, and blood oxygen levels to confirm the presence and severity of the condition. Following a diagnosis, the specialist’s primary role is to prescribe and manage Continuous Positive Airway Pressure (CPAP) therapy, which is the most effective treatment for moderate to severe OSA.
CPAP works by delivering a constant stream of pressurized air through a mask to keep the airway open during sleep. The specialist determines the precise air pressure needed for the patient, often through a CPAP titration study. Ongoing management includes monitoring adherence to the therapy, interpreting data from the CPAP machine, and ordering follow-up sleep studies if symptoms return or if there is a significant change in the patient’s weight or health status.
Dental Professionals for Sleep Apnea
Specialized dental professionals offer an alternative treatment option for patients with mild to moderate obstructive sleep apnea or those who cannot tolerate CPAP therapy. These practitioners are dentists or orthodontists who have undergone specific training in dental sleep medicine. They collaborate with the Sleep Specialist, who provides the diagnosis and medical prescription for the device.
The primary intervention provided by these dental specialists is Oral Appliance Therapy (OAT), which involves the custom fabrication and fitting of devices. The most common type is the Mandibular Advancement Device (MAD), which resembles a custom-fitted sports mouthguard. The MAD works by gently holding the lower jaw and tongue slightly forward, increasing the space in the upper airway and prevent its collapse.
Creating a successful oral appliance requires a comprehensive oral evaluation to account for the patient’s dental health, jaw mechanics, and bite alignment. The specialist must ensure the device is comfortable and effective, often making iterative adjustments to balance therapeutic advancement with patient tolerance. Continued monitoring is important to manage any potential side effects, such as jaw soreness or minor changes in the bite.
Surgical Treatment Teams
When CPAP and oral appliances are ineffective or cannot be tolerated, surgery becomes an option, requiring a specialized surgical team. These procedures aim to physically remove or reposition tissue and bone that obstruct the upper airway. The surgical team involves Otolaryngologists, commonly known as Ear, Nose, and Throat (ENT) surgeons, and sometimes Maxillofacial Surgeons.
Otolaryngologists focus on procedures involving the soft tissues of the throat and nose. A common procedure is Uvulopalatopharyngoplasty (UPPP), which involves removing excess tissue from the soft palate and uvula to widen the airway. They also perform nasal surgeries, such as septoplasty or turbinate reduction, which can improve airflow and enhance the effectiveness of other treatments like CPAP.
For obstructions lower in the throat, ENTs may also perform procedures like genioglossus advancement, which moves the tongue attachment point forward to reduce tongue base collapse. For more complex structural issues, Maxillofacial Surgeons may be involved to perform Maxillomandibular Advancement (MMA). This major surgery repositions both the upper and lower jaws forward, significantly expanding the entire airway from the nose to the throat. MMA is reserved for severe cases or those with significant jaw deficiency.