How can I be evaluated for a sleep disorder?
Consult with your physician regarding a referral to the Snore and Sleep Center or call (210) 692-0934, ext. 201. Office Hours: Monday - Friday, 8:00am - 4:30pm
What happens next?
You will be scheduled for
a consultation with one of our experienced sleep physicians. During your visit,
the physician will determine wether a sleep study is warranted, and an appointment
will be scheduled.
Will my insurance cover my visit to the sleep center?
Most insurance companies cover sleep disorders. Our referral/authorization coordinator will verify any limitations.
What nights are open for service?
For your convenience our sleep center is open seven days a week, with flexible times available for those who sleep irregular hours.
When will I receive my sleep study results?
We strive to provide you with timely sleep study results. Test results will be ready within seven business days.
What do I need to
prepare for the study?
- Take your medications
as usual, unless advised otherwise by the physician.
- Avoid taking a nap.
- Refrain from caffeine
use after 12 p.m.
- Do not drink alcohol.
- Shower, wash and dry
hair; do not use any lotions, hair sprays or gels.
- You may bring your own
pillow, blanket and reading material.
- Arrive at the lab at
your scheduled time.
Where should I park?
You should park at the
Medical Center Tower II parking garage, preferably on the C level for easy access.
After 7p.m. entry into the building will only be through the C level.
Where do I go when I enter the building?
From the C level, second floor, proceed through the double glass doors. On your right, next to the building directory, suite 240, is our administrative office/clinic. To enter the sleep center, proceed straight ahead past the administrative office/clinic elevators and the security desk. The lab is in suite 220 on the left.
Will I be able to enter the lab if I arrive early?
The sleep center door will be opened at 7:45 p.m. for entry. You may have a seat on the bench in the hallway until then.
Will I have my own room?
Yes, we have nine private bedrooms with home-like furnishings.
What time do I need to go to bed?
Lights out will be at 11 p.m., but you may go to sleep earlier.
What time will the study end?
Wake-up time is between
5:30 a.m. and 6 a.m.
Will I need to have another sleep study?
Another study may be necessary in order to fully diagnose or assess effectiveness of treatment.
What are the symptoms
of sleep apnea?
People with sleep apnea usually
do not remember waking up during the night. Indications of the problem may be vague symptoms such as:
- Excessive daytime sleepiness
- Morning headache
- Irritability and impaired
mental or emotional functioning
- Snoring
- Very loud and interrupted
snoring reported by bed partners
- Heartburn (Acid back-up
that causes heartburn may be responsible for some cases of sleep apnea.)
What causes sleep
apnea?
Structural Abnormalities
Any abnormality in the
throat, mouth or nose that causes some obstruction in the upper airways can produce sleep apnea syndrome. Among the most likely
structural causes of sleep apnea are abnormalities in the soft palate and surrounding areas that cause the pharynx to collapse more easily during inspiration.
Snoring
Chronic snoring may actually
be a cause of some cases of sleep apnea. Over time the vibration and the increased
pressure against the upper airways as a snoring person inhales may cause the
soft palate to lengthen. This stretched palate is more prone to collapse and
obstruction.
Snoring is very common.
It does not always reflect apnea nor is it always a sign of respiratory disorder.
While snoring is also associated with daytime sleepiness regardless of whether
apneas are present, snoring alone does not appear to pose any major health risks.
Obesity
Obesity is strongly associated
with sleep apnea, and there is some evidence it may be a cause of it. Imaging
scans have shown fatty cells infiltrating the throat tissue, which suggests that
they could narrow the airways. One study showed that the more obese a person
with sleep apnea was, the
greater the obstruction of the airway. Obstructive sleep apnea may contribute
to obesity, due to the fatigue and inactivity. A sleep person tends to be sedentary.
Gastroesophageal Reflux
Disease (GERD)
GERD (the cause of heartburn)
may cause sleep apnea. In patients with GERD, stomach acid enters the esophagus.
This can produce spasms of the vocal cords (larynx), thereby blocking
the flow of air to the lungs.
Who has sleep apnea?
Some researchers estimate that 18 to 25 million people have sleep apnea. Less than a 10 percent are aware of it. More men than women appear to have sleep apnea. Sleep apnea may be under-diagnosed in women. In general, older women have the same incidence as men their own age. A range of studies reports that apnea or hypopnea are present in nine to 24 percent of men and four to 15 percent of women.
Sleep apnea affects people of all ages. Although it is most common in older adults, it has been reported in some 1.6 to 3.4 percent of children. Some experts believe that sleep disorder breathing may occur in as much as 11 percent of children.
Interestingly, one study suggests that although the prevalence of sleep apnea increases with age, its health consequences decline. In the study, apnea was shown to pose more of a threat to a person’s health before age 45 than afterwards. African Americans face a higher risk for sleep apnea than any other ethnic group in the United States. Obesity, and particularly people with fat around the abdomen (the so-called apple shape), is a particular risk factor for sleep apnea, even in adolescents and children. Many people, however, with sleep-disordered breathing, particularly women and small children, are not obese.
Physical Characteristics
Large neck (17" male) (15" female)
Facial characteristics:
- A long lower part of the face
- A narrow upper jaw
- A receding chin
- Overbites
- Larger tongues
- Longer and stiffer soft palates
Characteristics in the throat
- The soft palate (roof of the mouth) and the walls of the throat collapse easily
- The soft palate is stiffer and/or longer than normal
Body position
Often, body position greatly affects the number and severity of episodes of obstructive sleep apnea. At least twice as many apneas occur when a person lies supine (face upward) than when the person lies on their side. This may be due to the effects of gravity, which cause the throat to narrow and the tongue to slide posteriorly (fall back) when a person lies on their back.
Smoking and alcohol use
Smokers are at higher risk for apnea, with heavy smokers (more than two packs a day) having a risk 40 times greater than nonsmokers. Alcohol use has also been associated with apnea, although studies are mixed. One survey reported that 53 percent of people who use alcohol to facilitate sleep, experience symptoms of sleep apnea.
Polycystic ovary syndrome
In one 2000 study, women with polycystic ovary syndrome (PCO) were 30 times more likely than other premenopausal women to have obstructive sleep apnea and excessive daytime sleepiness. PCO is a disorder in which women produce high amounts of androgens (male hormones), particularly testosterone. The elevated levels of male hormones can cause obesity, facial hair and acne. About half of PCO patients also have diabetes. (Obesity and diabetes are both associated with sleep apnea and may be the common factors, although some researchers believe that hormonal imbalances and insulin resistance may actually be causes of apneas.)
A 2001 Swedish study found that people with respiratory tract disorders, including asthma, chronic bronchitis or seasonal allergic rhinitis, reported symptoms of sleep apnea more often than those without any of these ailments.
How serious is sleep
apnea?
Higher Risk of Accidents
As many as 200,000 automobile
collisions in the United States and 1,500 deaths that result are caused by sleepiness.
Studies support that drowsy driving is as risky as alcohol-impaired
driving.
- Estimates on fatigue
as a cause of automobile crashes may be as high as 56 percent.
- An extensive 1997 survey
indicated that accidents involving motor vehicles or machine tools occurred
twice as often in people with moderate or severe daytime sleepiness, compared
with those without daytime sleepiness.
- In a 1995 poll,
33 percent of those surveyed said they had fallen asleep while driving, and
10 percent were in collisions due to fatigue.
Sleep Apnea as a Cause of
Obesity
Obesity and sleep apnea
have a chicken and egg relationship. It is not always clear which condition is responsible
for the other. For example, obesity is often a risk factor and possibly a cause
of sleep apnea, but it is also likely that sleep apnea increases the risk for
weight gain.
- Some studies indicate
that sleep apnea disrupts rapid-eye movement (REM) sleep, which, in turn,
increases the risk of obesity.
- Research indicates that
animals deprived of REM sleep tend to eat more.
- People with apnea may
also become too tired to exercise and gain weight as a result.
Mental Functioning
One study found that older
people with sleep apnea and daytime sleepiness have lower scores on tests for
cognitive functions. Another researcher suggests that treating sleep apnea in older
patients may correct some cases of dementia that are caused by sleep disturbances.
Elderly people with sleep apnea may also be more prone to depression.
Headache
A few studies strongly suggest
that sleep disorders, including apnea, may be the underlying causes of chronic
headaches. Many patients with Sleep Apnea wake up with headaches. Treating the Sleep Apnea may alleviate the headaches.
What are the serious
health effects of sleep apnea?
The effects of sleep apnea
on major health conditions are currently under debate. Problems associated with
this sleep disorder include:
- High blood pressure
- Stroke
- Heart attack
- Heart failure
- Pulmonary hypertension
- Diabetes
- Kidney failure
Other Effects of
Sleep Apnea
Irregular menstrual periods
accompany apnea in about 40 percent of premenopausal women. It is not clear
how they are related, but one study reported that treating apnea helped normalize
periods.
Patients with sleep apnea
also appear to be at higher risk of glaucoma, a serious eye condition related
to damage in the optic nerve. The drop in blood oxygen that occurs during apneas may either damage the nerve directly or increase pressure in the eye, a cause of glaucoma.
Emotional Effects of Sleep
Apnea
Studies report an association
between severe apnea and psychological problems. In one study, 32 percent of
patients were found to have symptoms of depression. Certainly, daytime sleepiness
interferes with quality of life.
Effects on Bed Partner
Because sleep apnea so often
includes noisy snoring, the condition can also adversely affect the sleep quality
of a patient’s bed partner. Spouses or partners may also suffer from sleeplessness
and fatigue. In some cases the snoring can even disrupt relationships.
