What is a Sleep Disorder?
Sleep disorder is a medical condition in which the patient’s sleep patterns are disrupted. Sleep disorders can be very serious as disruptions in sleep pattern can significantly interfere with our normal functioning. There are many types of sleep disorders such as insomnia (inability to sleep) and sleep apnea (interrupted breathing during sleep).
Sleep Disorder Symptoms
- Obstructive Sleep Apnea (OSA)
- Frequent Awakening During Sleep
- Chronic Fatigue
- Daytime Sleepiness
Diagnosis of Sleep Disorders
Endoscopic Airway Exam
A full spectrum airway exam can be conducted to pinpoint the cause of OSA and snoring. The medical director assesses the patient’s upper airway using an endoscope.
There are two types of sleep study: take-home and in-center. Take-home sleep study is available to assess the patient’s sleep apnea. The patient comes into the clinic to pick up the study machine and is given a demonstration on how to use the machine properly before doing the test at home. The advantage of take-home machine is that it is done at the comfort of the patient’s home. The disadvantage is that take-home study machines tend to under-diagnose sleep disorders and may falsely conclude that the patient does not have sleep apnea. Thus, take-home study machines are usually recommended for moderate to severe cases of sleep apnea.
As opposed to the take-home study, in-center sleep study is done at the center under the supervision of a trained specialist. During the test, the specialist may calibrate and adjust the machine to fit the patient’s needs and conditions to generate better results. The advantage is that the patient does not have to worry about proper operation of the sleep study. One of the problem with take-home study is that the machine may disconnect during the sleep and the patient may have to re-do the entire test again. The disadvantage is that in-lab testing is often costly and restrictive in terms of time and location.
Obstructive Sleep Apnea & Snoring
Obstructive sleep apnea is the most common form of sleep apnea as over 20 million Americans suffer from it. It is caused by complete or partial obstructions of the upper airway. It is characterized by repetitive instances of breathing disruptions, which reduces the blood oxygen saturation level that can cause other complications. Individuals with OSA are often unaware of their breathing problem; it is often recognized by others like a bed partner who observed the patterns of breathing disruptions. Bed partners of individuals with OSA often suffer sleep deprivation and mood alteration as well. Symptoms associated with OSA are daytime sleepiness and fatigue. 25% of adults snore habitually and 45% of adults snore occasionally. Snoring is caused by the obstruction of upper airways.
Obstructive sleep apnea is associated with hypertension, arrhythmia, myocardial infarction, stroke, diabetes, impotence, and cataract.
Obstructive sleep apnea can be diagnosed by several methods. A thorough examination of patient’s history may reveal underlying causes for OSA. Endoscopic airway exams and take-home studies are common methods to diagnose OSA. Sleep endoscopy may also be performed.
Positive Air Pressure Device
After the diagnosis of OSA, there are several treatment options depending on the severity and history of the patient’s condition. Common form of treatment is a ventilator machine that can apply positive airway pressure to the patient. These machines are as such:
- CPAP treatment: continuous positive airway pressure
- BPAP treatment: bi-level positive airway pressure
- APAP treatment: automatic positive airway pressure
The advantage is that it is clinically proven to be effective and it is a non-permanent form of treatment. The disadvantage of ventilator devices is that they are often uncomfortable, and patients report poor tolerance and low long-term compliance rate. It must also be used for indefinite amount of time, and it is difficult to use when traveling.
Oral appliances may also be used depending on the patient’s condition. Oral appliance fits like a sport mouth-guard that is only worn during sleep. These appliances support the jaw position to maintain an open airway by advancing the soft palate and the tongue. The advantage is that it is reversible and simple. It also has higher compliance rate and significantly reduces the Respiratory Disturbance Index among mild OSA patients. The disadvantage is that the appliance has to be worn indefinitely and is not effective against moderate to severe cases of OSA. It may also incur in occlusion change and cause TMJ syndrome.
Surgical treatment options are also available. Nasal Passage Treatment, Radio Ablation Pharyngopalatoplasty (RAUP), Transoral Robotic Surgery (TORS) are some of the surgical treatments offered at the facility.
Nasal surgery is recommended when the site of obstruction is located in the nasopharynx area. Some of the more common areas include septum, adenoids, and turbinates with symptoms of polyps, rhinitis and sinusitis.
Palate surgery is recommended when the site of obstruction is located in the oropharynx area.