There are other problems that occur besides the daytime sleepiness in sleep apnea. As noted above, high blood pressure is common. A number of studies have also shown that patients with severe sleep apnea are at a two- to seven-fold increased risk of having an automobile accident. There is also a possible risk of heart and lung damage as a result of untreated OSA. Although some doctors do not consider OSA to be significant until there are fifteen or more apneic episodes per hour of sleep, evidence suggests that even five or more episodes per hour are associated with increased risk of auto accidents and high blood pressure.
Diagnosing Sleep Apnea
Symptoms that suggest sleep apnea are snoring, being overweight, hypertension, daytime sleepiness, periods where breathing stops at night, and frequent auto accidents. If you have several of these symptoms, you should have an overnight sleep study done. During this test, several aspects of sleep are measured. An electroencephalogram (EEG) measures the brain wave patterns that tell the depth of sleep and gives a printout of how much time is spent in the various stages of sleep. It can also tell how long it takes to fall asleep, how many times you wake during the night, and how many actual hours of sleep you get. Respiratory monitors can measure air flow and tell if the blood oxygen level is dropping, which demonstrates the apnea. The test should also be able to check for leg movements to look for restless leg syndrome (more about this below) and to monitor for snoring as well.
These tests can be very expensive, costing approximately two thousand dollars. Because of the cost, insurance companies are sometimes hesitant to pay for it. It is a good idea to have the sleep laboratory get preauthorization from your insurance company before the test is done. Because of the high cost, it is common to have what is called a split-night study. When this is done, the technician spends the first half of the night looking for evidence of clinically important sleep apnea. If they find it, they put a mask on you that gently keeps up the pressure in your throat, which in turn keeps your airway from collapsing. This is like gently blowing into a balloon to keep the opening open. They will do a continuous positive airway pressure (C-pap) titration to determine the optimum mask pressure needed to keep your airway open. Because of the study’s cost, it is certainly reasonable to do a split-night study all in one night, rather than coming back for a second night to do the C-pap titration, which would double the cost.what I recommend however it is to simply videotape yourself sleeping for an hour or two. Set up the camera so it is at your feet looking towards your head. The way you can look for signs of both restless leg syndrome and sleep apnea. If you do have snoring and periods where you stop breathing, see if this occurs predominantly when you are laying on your back. If so, simply wearing a tight pajama or T-shirt at night that has a tennis ball sewn into the area by the small of your back may be enough to keep you from laying on your back while sleeping – which may be enough to eliminate the problem.
Some sleep testing machines can be used at home. These machines are often more effective (even though they monitor fewer variables) because you are more likely to be able to have a normal night’s sleep in the familiarity of your own home.
Treating Sleep Apnea
There are several treatments for sleep apnea and they fall into three main treatment categories: behavioral, pharmacologic, and mechanical. Let us consider each in turn.