Sleep Apnea

“The most common symptom that we see in patients with sleep apnea is being very, very sleepy," says Meir Kryger, MD, professor of Pulmonary, Critical Care & Sleep Medicine at Yale Medicine. "Many patients in whom the sleepiness has come on gradually, over months or years, may not even appreciate that they're sleepy, and in fact, it's their family member that will bring them in for medical attention.”

Sleep apnea is usually characterized by a history of very loud snoring and extreme daytime sleepiness. In some cases, sleep apnea sufferers experience headaches or fatigue and wake with a dry mouth or throat.

People with sleep apnea may also make choking or gasping sounds during sleep, which can be frightening for parents, caregivers or bed partners.

Sleep apnea is found in all age groups, from children to the elderly, though the causes of the disorder may differ, depending on the person affected and the type.

For example, children may have an obstructive sleep apnea caused by big tonsils that can block the airway during sleep. For adults, obstructive sleep apnea is most often caused simply by being overweight.

Smoking also increases the risk of sleep apnea as it causes inflammation close to the airway. Though obstructive sleep apnea affects men and women, men are at a much higher risk than women.

The risk of developing central sleep apnea is related to fewer factors:

• Age
• Use of narcotics
• Heart disease and history of stroke.

In older patients, those who use narcotics, have been diagnosed with congestive heart failure and who’ve previously had a stroke tend to be more susceptible.

Proper diagnosis of sleep apnea requires a visit to a doctor if someone is exhibiting symptoms of the condition. An evaluation, typically performed overnight during regular sleeping hours, can be conducted either in the sleep clinic or at home.

The latter option, which provides patients with equipment that measures heart rate, blood oxygen level, airflow and breathing patterns, is becoming more common.

“We're evaluating more and more patients in their own homes, and they find this much more comfortable," says Meir Kryger, MD, professor of Pulmonary, Critical Care & Sleep Medicine at Yale Medicine.

Based on the findings of the sleep study, a doctor will determine the best treatment.

“The most common treatment for sleep apnea is to try to deal with the cause, which in many cases, is obesity. But as everybody knows, obesity is actually very hard to treat," says Meir Kryger, MD, professor of Pulmonary, Critical Care & Sleep Medicine at Yale Medicine.

In addition to addressing needs for weight loss, sleep apnea patients are frequently prescribed a device called a CPAP machine, which stands for continuous positive airway pressure. A CPAP is a mask that fits over the nose (and sometimes mouth) that attaches to a blower. It keeps the airway open, thereby preventing the interruption of breathing. It can also help reduce snoring. Yale Medicine has a positive airways pressure (PAP) management program that trains patients on how to use their CPAP machine (this is a device to improve airflow during sleep). Because of our program, 80% of our patients who are prescribed CPAP actually use the machine; this is double the national average of 40%.

Another device-based treatment involves a dental appliance that people wear while they sleep that brings the lower jaw up and forward, helping to keep the airway open.

Less often, doctors will recommend surgery. “The most revolutionary surgery that we can offer patients is basically to stimulate the nerve that goes to their tongue, which pushes it forward, which, in many cases, can actually get rid of the sleep apnea," says Dr. Kryger.

Technological advances are adding monitoring capability to the devices used to treat sleep apnea. Sensors can be embedded into equipment and used to gather data while patients are asleep at home. That information can be uploaded automatically and transmitted directly to a doctor, giving her a clear picture of exactly how the patient is doing.

For very select patients, there’s surgery that stimulates the nerve that connects to the tongue. If successful, the procedure can eliminate the sleep apnea.

The future of sleep disorder treatments has been helped by a significant increase in public awareness about sleep disorders in general.

“The most exciting part of sleep medicine right now is that the public is starting to get it. It used to be that if someone had a sleep problem, people would ignore it," says Meir Kryger, MD, professor of Pulmonary, Critical Care & Sleep Medicine at Yale Medicine. "We now know that sleep disorders can be deadly and they can be treated.”

One of the most important benefits of seeking sleep apnea treatment at Yale Medicine is the breadth of knowledge among the team that treats the condition.

“We have experts in women's sleep disorders,” says Meir Kryger, MD, professor of Pulmonary, Critical Care & Sleep Medicine at Yale Medicine. “We have experts in people with movement disorders. We have experts who have studied stroke in patients with sleep apnea. We have world-class clinicians who have written books and are the thought leaders in the treatment of sleep apnea.

"If a patient comes to us for the treatment of their sleep disorders, they're guaranteed to be in a world-class laboratory. The message is: If you have a sleep problem, Yale Medicine can help.”