Diagnosis and Treatment of Sleep Apnea

Authored By: Lesley Ranft

• Sleep Apnea Basics

Sleep apnea is difficult to diagnose and treat, partly because the medical community is still learning about sleep. We suggest involving specialists in various areas of medicine and dentistry in an integrated approach to the diagnosis of sleep apnea.

Specialists Involved in Sleep Apnea Diagnosis and Treatment

Specialists who diagnose and treat sleep apnea express varying opinions about the cause and best treatment of the breathing disorder. Ask a lot of questions of each specialist to determine the most appropriate procedure or combination of procedures for your particular case. Here are the specialists who may be involved in diagnosing your sleep apnea and the ways they might assist you:

• Your primary care physician may refer you to a sleep specialist for a sleep test.
• An ear, nose and throat doctor (ENT) may recommend surgery to clear blockages caused by a genetic abnormality in the nose or throat. The uvulopalatopharyngoplasty (UPPP) procedure eliminates tissue from the back portion of the mouth near the top of the throat. The adenoids and tonsils may be removed as well. Should your airflow blockage be life-threatening, the ENT may find it necessary to build an opening in the windpipe through a procedure called tracheotomy. Also, an operation on your nose might be necessary to improve a deviated septum or to remove polyps that are blocking your airflow.
• A pulmonologist (a doctor who deals with diseases of the respiratory system) may recommend a sleep evaluation based on an analysis of your breathing muscle capacity. Pulmonologists may also recommend the use of oxygen should blood-oxygen levels fall to dangerous levels during sleep.
• A neurologist (a doctor who deals with nervous system disorders) will evaluate brain functionality and may recommend a medication such as acetazolamide to improve the brain's ability to trigger the breathing muscles.
• A cardiologist (a doctor who deals with diseases and disorders of the heart) may recommend a sleep test as well.
• A sleep specialist may perform a sleep test that measures blood level (among other anatomical factors) during sleep. Sleep specialists may recommend the use of a continuous positive airway pressure (CPAP) machine. The machine delivers a continuous flow of oxygen through a mask that you wear over your nose during sleep. An alternative is a bi-level positive airway pressure (bi-level PAP) machine, which increases the oxygen level upon inhalation and decreases it upon exhalation. An adaptive servo-ventilation (ASV) machine is a third choice. This equipment measures your level of breathing and records the data so that oxygen delivery can be matched to your specific needs.
• Certain dentists and oral surgeons are skilled in evaluating the tongue for its ability to move freely and its tendency to block airflow during sleep. The tongue can become restricted as the mouth and gum tissue shrinks with age. In this case, a laser may be used to eliminate the tissue causing the tongue restriction. The tongue tissue may be surgically reduced, but because this surgery involves general anesthesia, stitches in the tongue, discomfort and a long recovery period, many prefer the laser approach.

Another dental approach is to position the jaw so that airflow is not blocked. If the upper and lower jaws are responsible for sleep apnea, then an oral surgeon and an orthodontist may work together to relocate them. Another alternative is a mouthpiece (the Noiselezz Anti-Snoring Mouthpiece is one type) that can be custom fitted by an oral surgeon or dentist and worn while sleeping to hold the lower jaw in an appropriate position.

Self Help for Sleep Apnea

Additionally, you can cope with or reduce the occurrence of sleep apnea by doing the following:

• Maintain proper weight: A large number of sleep apnea sufferers are obese. Excess weight in your abdomen or neck can significantly hamper the effectiveness of the breathing muscles and compress your airway. If you suffer from sleep apnea and are obese, one of the first things your dentist or doctor will recommend is weight loss. In extreme cases, weight loss surgery may be considered as a treatment option.
• Eliminate alcohol, tobacco and sedatives: Avoid anything that can depress breathing. Severely depressed breathing reflexes increase your chances of not recovering from breathing cessation in the night. The combination of sleep apnea with alcohol, tobacco and sedatives could be lethal.
• Sleep on your side with a comfortable pillow: Sleeping on your side as opposed to your back may help keep your throat open and limit the effects of sleep apnea.

Know your limits. Should you feel sleepy at various times of the day, refrain from driving or operating machinery.

Factors that may affect sleep apnea treatment costs include:

• The number of procedures or appliances used to avoid airflow blockage.
• The technology used in the procedure.
• The training of the specialist, dentist or oral surgeon.
• The number of doctors or dentists involved.
• The locale of the doctor(s).
• The type of medical or dental insurance you have.

While the high cost of procedures may discourage some people from seeking treatment, the cost of not treating sleep apnea is significant. The University of Manitoba in Winnipeg and a team led by Dr. Meir Kryger conducted a study of 181 people with the most severe form of sleep apnea. The results of the study (published in 1999) demonstrated that the average yearly cost for their physician visits dropped from approximately $500 one year prior to diagnosis to about $390 two years after diagnosis and treatment.

Because insurance plan administrators do not have consistent standards for reimbursement, it is difficult to predict out-of-pocket costs for sleep apnea diagnosis and treatment. For example, many insurance companies do not pay for the dental laser approach for reducing tissue surrounding the tongue, but they may pay for the surgical approach.

Some state Medicaid programs vary in their reimbursement policies. In the state of New York, for example, Medicaid pays for sleep disorder treatment but not for sleep disorder diagnosis.

It is wise to contact your insurance plan administrator about sleep apnea diagnosis and treatment costs. Expect to pay some out-of-pocket costs. Keep in mind, however, that if you treat your sleep apnea now, you may avoid potentially higher medical costs for more serious medical problems later. In the end, it’s hard to put a price tag on the uninterrupted, more restful sleep you may experience after treatment.

• Sleep Apnea Basics

[Updated July 2008]

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