What Is Obstructive Sleep Apnea?
Obstructive sleep apnea (OSA) is a chronic condition that affects as many as 22 million Americans*. Many people are unaware that they may suffer from OSA, which is responsible for most cases of sleep apnea. Eighty percent of the cases of moderate or severe OSA remain undiagnosed.
One of the reasons that OSA is under-diagnosed is that it only happens when you are asleep and therefore, you don’t know it is happening. OSA causes breathing pauses (apneas) or very shallow breathing during sleep. The apneas occur when the upper airway tissues block, or obstruct, the airway. When sleeping, the tissues in the back of the throat or the tongue relax too much, and obstruct the airway, making it difficult for air to reach your lungs. When air tries to move past the obstruction, the tissues vibrate, causing a snoring sound. These apneas can last 10 seconds or longer and can occur many times every hour. During apneas, your oxygen levels can fall to dangerously low levels, potentially leading to serious health conditions.
Males and females of any age can be diagnosed with OSA. Men over 40 or with a large neck circumference, post-menopausal women, and those who are overweight are at higher risk. OSA affects your sleep quality even after sleeping a full night. You may still feel sleepy in the morning, making it difficult to feel alert, concentrate, and perform daily tasks. Poor sleep quality, combined with unhealthy oxygen levels, can negatively affect your body.
Taking the time to learn about OSA, your risk factors, and how it can affect you are the first steps towards better health.
If you think you may have OSA, you should make an appointment with your doctor. For more information, call Breathe Pennsylvania at 724-772-1750.
STOP-BANG Questionnaire
STOP
No / Yes
S (snore)
Do you snore loudly (louder than talking or loud enough to be heard through closed doors)?
T (tired)
Do you often feel tired, fatigued, or sleepy during daytime?
O (observed)
Has anyone observed you stop breathing during sleep?
P (blood pressure)
Do you have or are you being treated for high blood pressure?
BANG
No / Yes
B (Body Mass Index (BMI))
BMI > 35 kg/m2?
A (age)
Age > 50 years?
N (neck)
Neck circumference > 40 cm?
G (gender)
Gender male?
Yes to ≥ 3 questions = high risk of obstructive sleep apnea
Yes to < 3 questions = low risk of obstructive sleep apnea
*Adapted from Chung et al. The STOP-BANG questionnaire is commonly used by healthcare providers as a screening tool for obstructive sleep apnea. It is included here as only a tool to help you begin a conversation with your doctor about your risk of OSA.
Obstructive sleep apnea (OSA), a sleep disorder that is very common and treatable, is a chronic condition that affects as many as 22 million Americans.* This workbook will provide additional information and questions to help you identify if you may have OSA, as well as Sleep Journals to be filled in by you and shared with your doctor.
Nasal Pillow
Designed to apply CPAP pressure directly into your nostrils. This style uses pillows (nasal cushions) that sit directly inside your nose and create a seal. If you breathe through your mouth a chin strap may be needed.
Sizing:
Sizing usually depends on the size of the user ’s nostrils, and typically you can get a fit pack that comes with various nasal pi l low sizes.
Nasal Mask
Designed to apply CPAP pressure indirectly through a mask that covers your nose. The top of a nasal mask f i ts over the bridge of your nose and the bot tom lies above your upper lip.
Sizing:
Measure your actual nose size f rom top to bot tom and side to side.
General Sizing:
Petite: 1 .5″ tall, 1 .5″ wide
Small: 1 .75″ tall, 1 .5″ wide
Medium: 2″ tall, 1 .75″ wide
Large: 2.25″ tall, 2″ wide
Standard: 1 .75″ to 2″ tall, 1.75″ wide
Please note: Manufacturer’s usually have a sizing guide you can print to get a fit for the exact mask you want to use. Try googling the masks name and “sizing guide.”
Full Face Mask
Designed to let you breathe through your nose and mouth during sleep. Generally, the top of this mask fits on the bridge of your nose and the bottom fits below your lower lip.
Sizing:
Measure st raight down f rom beneath your eye to just below the lower l ip. Measure the width of your mouth in a natural posi t ion. ( i .e. not smi l ing)
General Sizing:
Small : 3.25″ tall, 2.75″ wide
Medium: 3.5″ tall, 3.25″ wide
Large: 4.25″ tall, 3.25″ wide
Please note: Manufacturer ‘s usual ly have a sizing guide you can print to get a fit for the exact mask you want to use. Try googling the masks name and “sizing guide.”
Once you have chosen your mask and style you will need to make adjustments to your headgear for a proper fit. Try sitting on the side of your bed, turn your CPAP machine on and place the mask on your face with the straps loose, slowly and gently pull the straps to the point that feels comfortable and no leaks are present. Test out your fit by positioning yourself in bed with your head on the pillow and make adjustments as necessary. Be patient it may take a few at tempts but you will get it! Your mask should come with a user ’s guide to help you. When you have a comfortable mask in the correct size it will provide you with restful sleep and energy for your day to come.
What to Expect During a Sleep Test (Polysomnography)
How you will know what to expect
Prior to your appointment date, you should receive confirmation from the sleep lab along with some general preparation instructions. Many general instructions are listed below:
- Try to conform to your regular daily activities as much as possible on the day of your study.
- Bring any regular bedtime medications with you. If you take a sleep aid, you should also bring it and let the technologist know that you have it. Also, be sure to bring a list of all of your current, daily medications.
- Pack a two-piece pajamas set or shorts and T-shirt for sleep. A two-piece outfit makes it easier for doctors to hook you up to monitors.
- Do not drink alcohol on the day/evening of your exam, as alcohol can worsen a sleep problem.
- Limit caffeine after noon on the day of your study, as caffeine may change your sleep habits.
- Your hair and skin should be free of oil, creams and lotions when you come to the sleep lab. The electrodes used during your study will adhere much better when your skin and scalp are clean.
- Be sure to bring any other items that you routinely use for your evening and morning routine (toothbrush, make-up remover, etc.) and clean clothes for the morning.
- You should follow your normal night time routine. If you normally read or listen to music before bed, you are encouraged to bring a book or headphones with you.
Where you will sleep
You will be sleeping in a private room that is set up similar to a hotel rather than a hospital room. The room will be dark and quiet, and it have a video camera so that your sleep can be monitored from outside the room. There will also be an audio system so that you can communicate with your sleep technologist during the night.
How your sleep will be monitored
A sleep test gathers a large variety of information that can diagnose many different sleep disorders. To do this, the sleep technologist will place many sensors in various locations on your body using a mild adhesive. Below is a summary of what information is collected, the reason for it, and how it is done:
- Stages of sleep: Your sleep stages will be monitored by recording your brain activity and eye movements. Recording this information is necessary to evaluate your sleep behavior. In order to do gather this information, small sensors will be attached to various locations on your scalp and forehead.
- Muscle movement: The muscles in your body react differently during the changing stages of sleep. Excessive or unusual muscle movement is associated with different sleep disorders. To monitor muscle movement, you will have two small sensors placed in your chin area, and a sensor placed on the shin area of each leg.
- Air movement: With sleep apnea, there are periods of no air flow from your nose/mouth (apnea). A sensor will be placed in this area to monitor your airflow.
- Breathing effort: There are different kinds of apneas. Sometimes, your brain doesn’t send the signal to your respiratory muscles in your chest to breathe (central apnea). In other instances, your brain may send the signal, but your tongue or tissue in the back of your throat block the air as it tries to get to your lungs (obstructive sleep apnea). In order to know if either of these situations are happening, a thin soft belt will be clipped around your chest area to monitor your breathing effort.
- Heart rate and rhythm: Some sleep disorders cause the heart to act differently than normal. During your test, two or three sensors will be placed over your chest area to record your heart’s activity (electrocardiogram).
- Oxygen levels in your blood: If you stop breathing during your sleep, your oxygen levels may drop below normal. A small probe will be connected to your finger to watch for changes in your oxygen level as you sleep (pulse oximetry).
Getting up in the middle of the night
Even though you will have wires attached to each of the sensors, the wires are long enough that you will be able to move around freely during sleep, and they all connect into one small unit. If you need to get out of bed, the technologist can easily disconnect the wires from the small base unit for you.
Wearing CPAP during your study
Depending on your insurance and your general health, you will either be ordered a one- or two-night study. If you are ordered a one night study, the first half of the night will be spent monitoring your sleep. If your study shows that you have sleep apnea, the sleep technologist may need to wake you and place you on CPAP for the second half of the night.
Once you are on asleep on CPAP, your CPAP level will be adjusted (titrated) to eliminate your apneas. In order to prepare you for this possibility, your technologist will help you try out CPAP and various mask styles until you find one that you think you can wear. This process will occur before you go to sleep and will help you know what to expect if you need to be placed on CPAP for titration during the night.
Your sleep quality in the lab
Many people do not want to have a sleep study because they are afraid that being in a strange environment attached to cords and wires will make it difficult for them to sleep. Although you may not fall asleep as easily as you would at home or sleep as well, sleep results are not typically affected.
After the sleep study
The sleep technologist will probably wake you between 5 and 6 a.m. to remove the wires so that you can start your day. You will not be given any results at this time. The sleep study will be interpreted by a doctor who specializes in sleep medicine and the results will be sent to the physician who recommended that you have the study. You should ask the sleep technologist if you will need to contact your physician and how long you should wait.
Obstructive Sleep Apnea Information
For more information about the Obstructive Sleep Apnea program, contact:
Phone: (724) 772-1750