How Sleep Apnea is Diagnosed

The most difficult part of diagnosing sleep apnea is realizing that it is present in the first place. Since sleep apnea occurs during the different sleep cycles it is often difficult to realize the problem exists and is often assumed to be insomnia by the person who has sleep apnea.  However, once a spouse or family member recognizes that something is not quite normal during your sleep pattern then there are many different methods that are used to diagnose and eventually treat sleep apnea. 

The following information will help to provide you with an overview of the different methods that are used to diagnose sleep apnea.

Physical Exam and Health History

Like other medical diagnosis that is used to identify health issues, determining sleep apnea begins with a review of health history and complete physical exam. Your healthcare provider may also request a survey of your sleep habits and daytime drowsiness.  A particular focus of the physical exam involves examination of your neck and throat which is a common contributor to the development of sleep apnea.

ABG

An ABG or arterial blood gas analysis is a test that is performed to measure the amount of oxygen and carbon dioxide that is present in your blood.  The blood is drawn from your artery as opposed to a vein before it is immediately sent to the laboratory to ensure an accurate reading on oxygen and carbon dioxide levels.  The purpose of the test is to check for respiratory diseases and other health issues that affect the lungs.

ECG

An ECG or electrocardiogram is used to determine electrical activity in your heart.  The test is performed by connecting electrodes to your chest, arms, and legs.  The electrodes are connected to a machine which provides a reading of electrical signals coming from your heart.  This type of test is performed to determine your heart rate and to determine the position of the chambers in your heart.

Thyroid

Tests on your thyroid are performed to determine how well your thyroid gland is functioning.  The test is performed on your blood to help diagnose a thyroid that is underactive or overactive and to help determine the activity of your thyroid gland.

TTE

A TTE or transthoracic echocardiogram is an ultrasound that is performed on the heart to create a moving image of the heart.  The advantage of the ultrasound is it provides a more accurate image of the heart as opposed to an x-ray.  The test is performed to enable medical professionals to see your heart activity, the manner in which it is beating, blood circulation around the heart, and a clear image of the overall function of your heart.

Polysomnogram

A polysomnogram is also referred to as a sleep study and requires you to remain overnight in a sleep center to have your sleep habits and patterns monitored.  This test helps to determine the type of sleep apnea you have so the appropriate treatment can be recommended.

The sleep study monitors your activity during two states of sleep which include the REM stage which is also known as the rapid eye movement stage and the NREM stage also known as the non-rapid eye movement stage.  The activities include but are not limited to brain waves, heart rate, muscle activity, breathing, blood oxygen, and body position.  Your body position may be monitored via the use of a video camera where other tests are performed using electrodes.

The purpose of a sleep study is to determine if there are any breathing obstructions present during the sleep process in which case you would be diagnosed as having obstructive sleep apnea. The sleep study will also help to identify any other complications such as dreams that are being acted out physically or excessive movement disorders that occur during the sleep cycle.  Patients arrive at the sleep center a few hours before it is time to go to bed and then the test is conducted throughout the night so professionals can study your sleep patterns.

All of the above named tests may be performed or just a few depending upon what your health care provider thinks is necessary to recommend treatment.  The sleep study is almost always a necessary part of diagnosis and then the other tests are recommended on a basis of factors which include your health history, current health status, and health issues from the physical exam that may raise concerns.

If normal values result from the test this means that the test results showed normal muscle activity and brain wave during the course of the test.  If the results are abnormal this is a sign that a sleep disorder such as sleep apnea is present and further treatment will be recommended.

History of Sleep Apnea

Sleep apnea exists in different forms which include central sleep apnea, obstructive sleep apnea, and mixed sleep apnea.  As a common condition of the different types of sleep apnea, the disorder is defined as a brief obstruction of air flow to the lungs which occur as multiple episodes through the course of the night.

Sleep Apnea First Documented in 1837

Sleep apnea is not a new phenomenon however if it is a new concept to you, it may help you to know the condition is recorded as far back as 1837 when Charles Dickens first made reference to the disorder when he authored “The Posthumous Papers of the Pickwick Club.”  In this writing Dickens mentioned that sleep is something everyone is familiar with however there are very few that understand it. 

Dickens’ references led to the invention of EEG which monitors the electrical activity of the brain during sleep.  At this point the different stages of sleep were recognized such as the REM stage which involves rapid eye movement and the NREM stage which means non-rapid eye movement.

Studies on Individuals in 1965-1985

Sleep apnea was first mentioned in 1837 with studies that continued well into the 1960s to mid 1980s in an effort to understand the phenomenon.  In 1965 sleep apnea was studied in great depth by Dr.Gestalt, a French doctor who went to great lengths to study sleep apnea in a variety of individuals.  Although this led to a better understanding of what happens during an apnea episode there still was no cure to relieve the symptoms of sleep apnea.

By 1978, a better understanding of sleep apnea was discovered by a Harvard healthcare professional who concluded that blocked air passages are directly related to snoring and gasping during sleep.  It was determined that the multiple episodes of blocked breathing were detrimental to a person’s health and it was during this time the disorder was named ‘obstructive sleep apnea.’  This represented a significant step toward finally finding a cure to relieve the symptoms of sleep apnea.

Three years later in 1981 an Australian doctor came up with a solution for keeping air passages from collapsing during sleep.  Dr. Collin Sullivan along with a few other research specialists came up with a device to relieve the symptoms of sleep apnea which is now widely known as Continuous Positive Airway Pressure therapy or CPAP in short.  The therapy involves a mask that the sleep apnea patient wears during sleep which pumps air into the windpipe during the REM phase of sleep in an effort to keep the walls of the air passages from collapsing.

The very first CPAP therapy devices were large and made a lot of noise which prevented the sleep apnea patient from actually getting a full night of restful sleep.  As the concept caught on further research was conducted to devise a way to make a smaller and quieter device that was more convenient and comfortable to wear during sleep.  As the technology advanced medical companies were able to design specialized pillows that prevent sleep apnea patients from inadvertently sleeping on their back as well as dental devices to assist with jaw problems that contribute to apnea episodes.

Current Sleep Apnea Treatment

Today, the CPAP therapy mask is one of the most common treatments for obstructive sleep apnea and is now offered in many different models and types to provide the greatest comfort for a patient who suffers from sleep apnea.  Without this discovery, patients often had to resort to different surgeries that often perpetrated more complications. 

A prime example of this is patients who were required to undergo surgery which involved placing an air opening in the neck to serve as an air passage during sleep.  A small tube was inserted into the passage which allowed the patient to breathe in the event a blockage occurred in the mouth and throat area.  The surgery was known as a tracheotomy and caused much discomfort to the sleep apnea patient and often disrupted their lifestyle during the daytime hours.  This type of surgery is no longer necessary despite the fact that other types of corrective surgery are used to improve the symptoms of sleep apnea.

The sleep study has also been perfected over the years and modern technology has allowed for accurate results through the use of electrodes that monitor and record the patterns that occur during the patient’s sleep. Medical professionals can now identify the exact type of sleep apnea as well as some of the health issues that are associated with the disorder.  By being able to achieve an accurate diagnosis, focused treatments are now possible and lifestyle changes are recommended to help sleep apnea patients to cope more effectively with the disorder and live a happier and more energetic lifestyle.