Recognizing and Treating Sleep Apnea

Until recently, most family doctors would rarely diagnose apnea or were unfamiliar with how to treat it. Sleep apnea was only officially defined in 1965.

"If you tell a doctor that you're fatigued, tired, and sleepy during the day, he'll laugh because he's sleep-deprived himself," Dr. Millman says. "It's not going to send off bells and whistles like chest pain."

If you think you or your partner may have apnea, talk to your doctor. He or she should refer you to a pulmonary specialist or ear, nose, and throat doctor. Make sure the person specializes in sleep disorders and sleep apnea. During the exam, your nose, throat, and jaw will be examined. You and your mate will be asked about snoring history, gasping or snorting, sleep habits, daytime tiredness, or falling asleep in front of the TV. Yosef Krespi, M.D., director of ear, nose, and throat service at New York City's St. Luke's-Roosevelt Hospital, gives his patients and their bed partners an eight-page questionnaire.

The only sure way to make a diagnosis, however, and determine severity is to spend a night or two in a sleep lab for a polysomnography exam. Technicians monitor blood oxygen levels, heart rate, temperature, brain waves, and the number of times breathing stops.

Polysomnography in a lab is expensive (about $2,000), but it's often covered by insurance. There also are home monitoring devices at half the cost, but insurance carriers don't always pay. "Portable unattended tests aren't as sensitive," says Dr. Pelayo. "They pick up obvious apnea but not the milder varieties."

Simple lifestyle changes may help you muffle loud snoring. Avoid alcohol after dinner and stay away from tranquilizers, which relax throat muscle tone, depress breathing, and make apnea more likely. Dr. Millman suggests people with stuffy noses use a decongestant or nasal strips, such as Breathe Right, to open the nasal passage. Some apneics improve by sleeping on their sides and stomachs, rather than their backs. That's because the tongue falls back when a person lies on his back. A classic technique is to stuff a tennis ball into a sock and slip it to the back of your nightshirt so you don't roll onto your back.

If you smoke, quit. Smoking can swell throat tissues, increase mucus formation, and worsen the low oxygen levels that accompany apnea. Losing weight can make apnea disappear in some people. Even a 10 percent weight loss could reduce the frequency of episodes. At this time, there are no pills that can treat sleep apnea.

Continuous positive air pressure (CPAP, pronounced see-pap), according to Dr. Pack, is "the gold standard" for treating sleep apnea. "It can abolish apneic events in anyone, no matter how severe," he says.

Patients wear a mask over their nose that delivers air under pressure to their lungs. The forced air keeps the airway open. As a result, the heart doesn't have to work as hard, and blood pressure may drop to normal.

The first time Jim used his CPAP, he says, he got the first good night's sleep in a long time. "Now, I don't know when I last took a nap," he says. Once Marlene started using a CPAP, she stopped falling asleep at her computer or when visiting friends.

CPAP has to be worn every night for the rest of your life. The mask can be uncomfortable for some patients, and some get eye, nose, or mouth irritations. Others complain it's difficult to breathe out against the high air pressure.

Another alternative: A dentist can fit you with an oral device that repositions your tongue and jaw to hold them forward. It works because when you pull the jaw forward, the tongue moves forward as well.

"These devices are no worse than a retainer and results are similar to CPAP," Dr. Scharf says. The problem is that there are 37 different types which look and operate differently, they can be costly, and your insurance company may not cover the expense.

Surgery -- the final option. Surgery to widen the airway is usually not done unless all other options have failed. Called the uvulopalatopharyngoplasty or UPPP (UP3), it reduces the size of the uvula, soft palate, or both. Only 50 percent of apneics have some success with this technique. It's expensive, there's a painful recovery, and, like all surgery, it carries risks.

"You know you've done something with surgery if patients say they're having wild dreams. With severe apnea, patients don't dream," says Derek Lipman, M.D., an ear, nose, and throat specialist in Portland, Oregon.

The newest surgical procedure involves zapping away excess tissue with a laser, called a laser-assisted uvulopalatoplasty or LAUP. Originally designed to eliminate snoring, LAUP is an office procedure using only local anesthesia. Compared with UP3, it's less costly and less painful with a quicker recovery. On the downside, it may require several treatments. And it is controversial.

"The concern is turning the person into a silent apneic," says Dr. Pack. In other words, the jackhammer sound effects are gone, but the apnea isn't. Success depends on how carefully patients are selected. "In better studies where they are meticulous in selection, the success rate is 80 percent," says Dr. Lipman.

Dr. Krespi, who has treated over 1,200 patients with this procedure, has found that it works for mild apnea if the obstruction is in the palate (and uvula). "People who have moderate or severe apnea, are overweight and can't lose weight, or have uncontrolled high blood pressure aren't good candidates for laser surgery," he says.

One thing experts agree on is that, if you have surgery, you should have a postsurgery sleep study to see how your apnea was affected.

• The American Sleep Apnea Association, 1424 K Street NW, Suite 302 Washington, DC 20005, 202-293-3650.
• The American Academy of Sleep Medicine, 6301 Bandel Road NW, Suite 101, Rochester, MN 55901, 507-287-6006.
• The National Heart, Lung and Blood Institute, Information Center, P.O. Box 30105, Bethesda, MD 20824-0105, 301-251-1222. Ask for "Facts about Sleep Apnea."