Obstructive Sleep Apnea (OSA)
What is sleep apnea?
How do you diagnose sleep apnea?
One of the most common sleep disorders treated in sleep clinics across the country is obstructive sleep apnea also called sleep apnea commonly.
What is obstructive sleep apnea?
Obstructive sleep apnea (OSA) involves repetitive episodes of shallow or paused breathing during sleep leading to lack of oxygen being exchanged in the lungs. Obstructive sleep apnea is different from the other type of sleep apnea called central sleep apnea in that there is no effort to breath in central apnea whereas in obstructive sleep apnea, the patient actually makes effort to breath but there is no significant airflow due to obstruction in the airway. The episodes of decreased breathing, called “apneas” (literally, “without breath”), typically last 20 to 40 seconds.
Individuals with OSA are rarely aware of difficulty breathing, even upon awakening. It is often recognized as a problem by others who observe the individual during episodes or is suspected because of its effects on the body.
OSA is commonly accompanied with snoring, excessive tiredness or sleepiness during the day, not being refreshed upon awakening, need to wake up to urinate at night, frequent arousals during sleep, history of being overweight or obese (although up to 30% of those with sleep apnea can be thin but still have it due to their anatomy), smoking.
Can someone get used to the symptoms that they do not realize they may have it?
Yes. Symptoms may be present for years or even decades without identification, during which time the individual may become conditioned to the daytime sleepiness and fatigue associated with significant levels of sleep disturbance. Individuals who generally sleep alone are often unaware of the condition, without a regular bed-partner to notice and make them aware of their symptoms.
How does the airway close on itself during sleep?
As the muscle tone of the body ordinarily relaxes during sleep, and the airway at the throat is composed of walls of soft tissue, which can collapse, it is not surprising that breathing can be obstructed during sleep. Although a minor degree of OSA is considered to be within the bounds of normal sleep, and many individuals experience episodes of OSA at some point in life, a small percentage of people have chronic, severe OSA.
Diagnosis of OSA is often based on a combination of patient history and sleep studies which can be lab or home-based sleep studies.
At most W8MD Weight Loss, Sleep and MedSpa centers, we offer both in lab and home based sleep studies based on your insurance and patient preference.
How is sleep apnea severity categorized?
Based on the AHI, a personal can have any of the following:
AHI of <5 Normal
AHI of 5-15 Mild Sleep Apnea
AHI of 15-30 Moderate
AHI of >30 Severe
What is the difference between central and obstructive sleep apnea?
Polysomnography in diagnosing OSA characterizes the pauses in breathing. As in central apnea, pauses are followed by a relative decrease in blood oxygen and an increase in the blood carbon dioxide. Whereas in central sleep apnea the body’s motions of breathing stop, in OSA the chest not only continues to make the movements of inhalation, but the movements typically become even more pronounced. Monitors for airflow at the nose and mouth demonstrate that efforts to breathe are not only present but that they are often exaggerated. The chest muscles and diaphragm contract and the entire body may thrash and struggle.
An “event” can be either an apnea, characterized by complete cessation of airflow for at least 10 seconds, or a hypopnea in which airflow decreases by 50 percent for 10 seconds or decreases by 30 percent if there is an associated decrease in the oxygen saturation or an arousal from sleep.
To grade the severity of sleep apnea, the number of events per hour is reported as the apnea-hypopnea index (AHI). An AHI of less than 5 is considered normal. An AHI of 5-15 is mild; 15-30 is moderate and more than 30 events per hour characterizes severe sleep apnea.
Home sleep study
In patients who are at high likelihood of having OSA, a randomized controlled trial found that home oximetry (a non-invasive method of monitoring blood oxygenation) may be adequate and easier to obtain than formal polysomnography.
High probability patients were identified by an Epworth Sleepiness Scale (ESS) score of 10 or greater and a Sleep Apnea Clinical Score (SACS) of 15 or greater. Home oximetry, however, does not measure apneic events or respiratory event-related arousals and thus does not produce a true AHI value.
What are the treatment options for sleep apnea?
Numerous treatment options are used in obstructive sleep apnea. Avoiding alcohol and smoking is recommended, as is avoiding medications that relax the central nervous system (for example, sedatives and muscle relaxants). Weight loss is recommended in those who are overweight. Continuous positive airway pressure (CPAP) and mandibular advancement devices are often used and found to be equally effective. Physical training, even without weight loss, improves sleep apnea. There is insufficient evidence to support widespread use of medications or surgery.
What is Apnea Hypopnea Index?
When we do the sleep studies, we get the number of episodes of either reduced air flow called hyponea or complete obstruction called apnea categorized as apnea hypopnea index which tells us how severe a person’s sleep apnea is.
Did you know that sleep disorders such as sleep apnea can make you gain weight and weight gain in turn can put you at increased risk of sleep problems such as sleep apnea?
Realizing the bidirectional relationship between sleep disorders and weight gain, most W8MD medical weight loss centers of America’s weight loss centers also offer a comprehensive sleep medicine program to help deal with both sleep disorders and metabolic disorders including obesity.
What are Sleep Studies?
Sleep studies help doctors diagnose sleep disorders such as sleep apnea, periodic limb movement disorder, narcolepsy, restless legs syndrome, insomnia, and nighttime behaviors like sleepwalking and REM sleep behavior disorder. A sleepstudy is done in a room that is made to be comfortable and dark for sleeping.
Sleep Disorders Treated at W8MD medical weight loss and sleep centers
- Obstructive Sleep Apnea
- Central Sleep Apnea
- Restless Legs Syndrome
- Circadian Rhythm Disorders
- Sleep Walking
- REM Sleep Behavior Disorder
- Periodic Limb Movements of Sleep
- Pediatric Sleep Disorders
Assessments & Treatments of sleep disorders
- Polysomnography with Full EEG
- Home Sleep Testing
- Multiple Sleep Latency Testing
- Maintenance of Wakefulness Testing
- CPAP and BPAP
- Adaptive Servo-Ventilation
- Average Volume Assured Pressure Support
- Bright Light Therapy
- Durable Medical Equipment (CPAP, Auto-PAP, BPAP)
List of the common sleep problems
- Obstructive Sleep Apnea: This us due to upper airway obstruction while sleeping, which limits deep sleep; snoring usually accompanies it.
- Insomnia: This can be difficulty falling asleep or staying asleep and can be acute or chronic.
- Hypersomnia: This literally means a person is very sleepy despite getting enough sleep opportunity and it can be a sign of an underlying sleep problem such as sleep apnea, narcolepsy or idiopathic hypersomnia.
- Noctural Enuresis or Children Bed Wetting: usually seen in children
- Delayed Sleep Phase Syndrome (DSPS): usually affects teenagers but can affect anybody.
- Advanced Sleep Phase Syndrome (ASPS): A circadian rhythms disorder where person goes to sleep early and rises early
- Non-24-Hour Sleep-Wake Syndrome: is a circadian rhythm disorder where the body does not function with the 24 hour biological clock
- Narcolepsy: Caused by a deficiency of wakefulness promoting chemicals in the brain for unknown reasons, Narcolepsy is a condition where a person has excessive daytime sleepiness, sleep paralysis, hypnogogic and hypnopompic hallucinations, sometimes cataplexy(see below).
- Nocturia: A reccuring need to go to the bathroom and urinate at night
- Cataplexy: Abrupt weakness with one’s motor muscles
- Shift Work Sleep Disorder: a person does shift work and feels sleepy or tired during their wakeful time, and has difficulty falling asleep at times.
- Night Terror: Not nightmares but rather a sudden awakening with gasping, moaning, or crying out that tends to happen in children but adults can also have it.
- Restless Leg Syndrome (RLS): Associated with Periodic Limb Movement with an irresistible need to move the legs
- Periodic Limb Movement Disorder (PLMD) / Nocturnal Mycolonus: The involuntary movement of legs and/or arms while sleeping
- Rapid Eye Movement Behavior Disorder (RBD): Movements in REM sleep from twitches to acting out dreams
Other less common sleep problems include:
- Sleep Paralysis: A temporal paralysis of the body right before or after sleep. Often associated with auditory, visual, or tactile hallucinations and it can be sign of narcolepsy.
- Sleep walking, sleep talking, sudden infant death syndrome, night eating disorder etc.
Philadelphia Insurance Weight Loss Sleep & MedSpa: 1718, Welsh Rd, Philadelphia, PA, 19115 Ph: 1-215-676-2334
W8MD coming to Cherry Hill NJ. Grand Opening in Jan 2019
W8MD Weight Loss, Sleep & MedSpa
140 E. Evesham Road, Cherry Hill, NJ 08003.
Our sleep doctors
Our founder, Dr. Prab R. Tumpati, has been a practicing board certified internal medicine, sleep and obesity medicine physician. As a practicing sleep medicine physician, Dr. Tumpati sees a lot of obese patients that are struggling to lose weight.