Sleep Apnea: Should I Have a Sleep Study?

You have sleep apnea when your breathing is often blocked or partly blocked while you sleep. It can be mild, moderate, or severe, depending on the number of times an hour that you have less airflow to your lungs. Apnea may occur from 5 times an hour to more than 30 times an hour.

The most common form of sleep apnea is obstructive sleep apnea. Although doctors use sleep studies to diagnose both obstructive sleep apnea and central sleep apnea, this Decision Point focuses on obstructive sleep apnea.

Obstructive sleep apnea happens when the airways in your nose, mouth, or throat are blocked or become narrow. Everyone's throat muscles and tongue relax during sleep. But in some people, certain things can cause this normal process to partly or completely block the airway.

This can happen because:

• You have bones that aren't a normal shape or you have tissues in your nose, mouth, or throat that are too big. For example, you may have large tonsils. During the day when you are awake and standing up, this may not cause problems. But when you lie down at night, the tonsils can press down on your airway, narrowing it and causing sleep apnea.
• You are very overweight.
• You take certain medicines or drink alcohol before bed.
• You sleep on your back.

Symptoms of sleep apnea can include:

• Being so sleepy during the day that it gets in the way of the normal things you do, such as work or school.
• Feeling tired in the morning.
• Having trouble concentrating.
• Waking up with a headache.

Your bed partner may notice that while you sleep:

• You stop breathing.
• You often snore loudly.
• You gasp or choke.
• You toss and turn.

Snoring and lack of sleep from apnea can make it hard to get through the day. You may feel grouchy a lot and have trouble focusing on work and activities. If you snore, your bed partner also might not get enough sleep. This can make your relationship suffer.

A sleep study is the only sure way to know if you have sleep apnea. The main type is an all-night sleep study done in a qualified sleep lab. It is called polysomnography (say "pawl-ee-sawm-NAW-gruh-fee"). Sleep studies also can be done with portable equipment that you use at home.

You might want a sleep study, because if you have sleep apnea and it's not found and treated, it can interfere with your quality of life. It can make you too sleepy when you should be awake.

It also is linked to problems such as:

• High blood pressure.
• High blood pressure in the lungs (pulmonary hypertension).
• Depression.
• Irregular heart rhythms.
• Heart failure.
• Coronary artery disease.
• Stroke.

Early treatment of sleep apnea can reduce your risk of these problems. It also can reduce your symptoms, such as headaches, snoring, having to urinate at night, daytime sleepiness, and trouble concentrating.

If you snore but don't have other symptoms, you may not need a sleep study. Lifestyle changes-such as losing weight (if needed), sleeping on your side, and going to bed at the same time every night-may reduce your snoring.

Treatment for sleep apnea can include:

• Lifestyle changes, such as losing weight (if needed), sleeping on your side, going to bed at the same time every night, avoiding alcohol and sedating medicines before bedtime, and not smoking.
• Continuous positive airway pressure (CPAP). This uses a machine to keep your airway open while you sleep.
• Oral breathing devices or other types of devices that you wear while you sleep to help keep your airway open.
• Medicines to help you stay awake during the day.
• Surgery. There are several types of surgery, including:
  • Surgery to remove extra tissue in the throat (uvulopalatopharyngoplasty).
  • A procedure that moves the upper and lower jaw forward to enlarge the airway (maxillo-mandibular advancement, or MMA).
  • A procedure that shrinks the size of the tongue and other tissues in the mouth that can interfere with breathing while sleeping (radiofrequency ablation, or RFA).
  • Surgery to implant small plastic rods in the soft palate (palatal implants). The implants make the soft palate stiffer to keep the tissue from blocking the airway.
  • Laser-assisted surgery to reshape the tissue of the palate so it does not block the airway (laser-assisted uvulopalatoplasty, or LAUP).
  • Surgery to implant a nerve stimulator in the upper chest. It senses the breathing pattern and mildly stimulates the airway muscles to keep the airway open.
  • Surgery that makes a hole through the neck and the windpipe (tracheostomy).

Your doctor probably will have you try lifestyle changes and CPAP first. But surgery might be your first choice if your sleep apnea is caused by a blockage that can be fixed easily.

Research shows that treating sleep apnea can reduce daytime sleepiness.^{footnote 1, footnote 2}

It may also improve blood pressure.^{footnote 3, footnote 4} For people who have sleep apnea and coronary artery disease, treatment of sleep apnea can lower the risk of some problems such as heart failure.^{footnote 5} People who have sleep apnea and diabetes may find that treating the sleep apnea makes it easier to control blood glucose levels. But if you have mild sleep apnea, treatment may not work as well as it can for people with more severe apnea.

Your doctor might recommend a sleep study if:

• You have symptoms of sleep apnea, such as heavy snoring and being sleepy during the day.
• You have a risk of other health problems from sleep apnea.
• Lack of sleep is hurting your quality of life or raising safety issues.