Although many people with sleep apnea don’t realize they have it, the condition increases the risk of heart failure and stroke. Getting a diagnosis is critical because it’s the first step toward treatment — and better sleep.
To determine whether you have sleep apnea, a doctor will usually order an overnight test to be done either at a lab or at home. “There are benefits of both,” says Virend Somers, who directs the Cardiovascular Facility and the Sleep Facility within Mayo Clinic’s Center for Clinical and Translational Science in Rochester, Minn.
In-lab tests are overseen by trained technicians. These monitor sleep, breathing and other biological signals using sensors that detect brain wave activity, breathing effort, oxygen levels and more. At-home tests are more rudimentary, so they’re not right for everyone. They can’t detect brain waves, but most collect data on heart rate, oxygen levels and airflow. They also allow you to take the test from the comfort of your bed, and they’re often less expensive than in-lab tests, says Grace Pien, program director of the Sleep Medicine Fellowship Program at Johns Hopkins Medicine.
Once you have results, your provider can make a diagnosis and determine a treatment plan. Refraining from drinking alcohol can reduce symptoms, as can sleeping on your side or stomach to help keep your tongue from blocking your airway. Weight loss can also help.
While lifestyle changes can make a difference, especially for moderate sleep apnea, the gold standard treatment is continuous positive airway pressure (CPAP) therapy. CPAP devices essentially work by blowing air into the back of the throat to keep the airways open. They sit by the side of the bed and are attached to a mask worn while sleeping. When used consistently, CPAP can alleviate sleep apnea symptoms.
Wearing a pressurized mask isn’t always comfortable. “Forty percent of people don’t tolerate it well at all,” Somers says. But using a CPAP consistently has real benefits.
Besides decreasing daytime sleepiness and boosting productivity and mood, some people who use the device for more than four hours a night can lower their high blood pressure.
And there are options designed to make CPAP less challenging. While some masks fully cover the nose and mouth, others simply rest under the nostrils. Another option is an autoCPAP, or APAP, which modulates the intensity of airflow in the night based on changes in your breathing.
Still, even a best-case CPAP experience takes some getting used to, Pien says, often at least a month. The first few nights are unlikely to go well, but keeping at it — plus practicing using the machine during the day — can help.
Oral appliance, electrical implant
Though CPAP is the standard treatment, apnea also can be addressed with what’s known as oral appliance therapy or with an electrical implant.
The first option, in which a customized device inside the mouth is used to move the jaw forward to create more space in the airway, is becoming a more common choice. (Ask your doctor for a referral to a dentist with training in treating sleep apnea.) The second option involves implanting a pacemaker-like device in the chest that uses electrical impulses to prevent the tongue from collapsing into the throat.
Each approach can work well for certain people but can also have limitations. Oral appliance therapy is effective only about half of the time, Pien says, and it’s better suited for those with milder sleep apnea, while a stimulation device is somewhat invasive.
And she says that both are less likely to be covered by insurance plans than a CPAP device.
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