Sleep apnea (SA) is a chronic disorder where breathing repeatedly stops or becomes shallow during sleep, causing fragmented rest and reduced oxygen in the blood. This condition involves the respiratory system, neurological control, and upper airway anatomy, often requiring a coordinated team of medical professionals for effective management. Because the underlying causes and severity of SA vary greatly, treatment is highly individualized and involves a diverse group of specialists.
The Path to Diagnosis: Primary Care and Sleep Specialists
The initial step in addressing poor sleep and related symptoms often begins with a Primary Care Provider (PCP), such as a family physician or internist. PCPs are typically the first to recognize signs of a sleep disorder when a patient reports excessive daytime sleepiness, unrefreshing sleep, or a bed partner reports chronic snoring or witnessed pauses in breathing. The PCP screens for common risk factors like obesity, hypertension, and neck circumference, then initiates the referral process for specialized testing.
The definitive diagnosis is confirmed by a Sleep Specialist, a physician with advanced training in sleep medicine. These specialists often come from disciplines like Pulmonology, Neurology, or Otolaryngology. The Sleep Specialist orders and interprets the results of a sleep study, known as polysomnography (PSG), or a home sleep apnea test.
This diagnostic test monitors physiological parameters overnight, including brain waves, heart rate, blood oxygen levels, and breathing patterns. The specialist uses this data to calculate the Apnea-Hypopnea Index (AHI), which measures breathing interruptions per hour of sleep, establishing the diagnosis and severity. Once confirmed, the Sleep Specialist coordinates the personalized treatment plan.
Managing CPAP and Ongoing Therapy
For most patients, the primary treatment involves Continuous Positive Airway Pressure (CPAP) therapy, managed by the Sleep Physician. This device delivers pressurized air through a mask to keep the airway open during sleep, preventing collapse. The Sleep Physician determines the specific pressure settings, often through an in-lab CPAP titration study, and monitors the patient’s progress.
Ongoing management requires collaboration with allied health professionals, notably Respiratory Therapists (RTs) and sleep technologists. These experts provide hands-on support, including fitting the patient with the correct mask size and style to ensure comfort and minimize air leaks. They are instrumental in patient education, teaching proper machine usage, maintenance, and troubleshooting common issues.
Adherence to CPAP is a major factor in treatment success. The Sleep Physician and RTs regularly review data downloaded from the CPAP machine to track usage hours and residual events. If the patient struggles, the physician may adjust the pressure, switch the machine to a bilevel positive airway pressure (BiPAP) mode, or explore alternative options.
Specialized Treatment: Surgical and Dental Options
When CPAP therapy is not tolerated or cannot fully resolve sleep apnea, treatment may shift to options focused on anatomical correction, involving surgical specialists. Otolaryngologists (ENT doctors) evaluate structural issues in the nose and throat that contribute to airway obstruction. They may perform procedures like tonsillectomy and adenoidectomy, or Uvulopalatopharyngoplasty (UPPP), which involves remodeling tissue at the back of the throat to widen the airway.
For complex or skeletal obstructions, Oral and Maxillofacial Surgeons may become involved. These specialists perform Maxillomandibular Advancement (MMA), a procedure that moves the upper and lower jaws forward, physically enlarging the space behind the tongue and soft palate. This surgery is considered a highly effective option for addressing severe anatomical causes of sleep apnea.
A less invasive alternative to CPAP or surgery is the use of an oral appliance, managed by specially trained Sleep Dentists. These dentists fabricate custom Mandibular Advancement Devices (MADs) that resemble a mouthguard. The device works by gently holding the jaw and tongue forward, preventing soft tissues from collapsing into the airway during sleep. This treatment is recommended for patients with mild to moderate sleep apnea or those who cannot tolerate CPAP.