Testing for Sleep Problems
It’s impossible to know what’s really happening when you’re sleeping, which can make it difficult to realize that you have a sleep problem. Maybe you wake up feeling fine, yet your bed partner says you choke and gasp for air in the night, your body jerks and shudders in bed or you rattle the house with your snoring. To determine if there really is a problem with your sleep, you can be tested in a sleep laboratory or use portable monitoring for home sleep testing.
What is a Sleep Lab?
During an overnight study in the lab, your brain activity and body physiology are monitored while you sleep. Recording EEG brain waves, eye movements and muscle tone as you drift between non-REM and REM sleep permits scoring of sleep architecture and the full investigation of sleep-related medical disorders of which there are over 100. By recording your heart EKG, airflow plus breathing efforts, snoring, oximetry blood oxygen levels, body movements and arousals, a sleep medicine physician can detect a variety of problems. These include sleep-related breathing disorders such as sleep apnea, the upper airway resistance syndrome, restless leg syndrome, periodic limb movement disorder and REM sleep behavior disorder.
If your snoring is simply a loud, disruptive rattling in the night rather than an indicator of a more serious health condition, several treatment options could be considered:
- Physical examination including ENT assessment by your physician
- Practise good sleep hygiene and obtain adequate rest
- Avoid sleeping on your back
- Refrain from alcohol and sedating substances in the hours before bedtime
- Weight loss
- Oral appliance
The most effective treatment for sleep apnea is Continuous Positive Airway Pressure (CPAP). During sleep, air gently blows from the CPAP machine into your nose and throat through a hose and mask. This constant air flow holds your airway open so that it remains unobstructed during the night, allowing you to breathe normally.
In some instances, an oral appliance can effectively reposition the lower jaw so that the airway stays open during sleep. Sometimes lifestyle changes can reduce the severity of your apnea. These include good sleep hygiene, weight loss, avoiding alcohol and sedating substances around bedtime and quitting smoking. Surgical therapy includes a variety of procedures that are often site-directed and may be done in stages. This is a consideration for some patients, especially if other treatments such as CPAP and oral appliance therapy have been poorly tolerated.
Upper Airway Resistance Syndrome (UARS)
It is believed that the UARS represents a progression of disease bridging the transition from “benign snoring” to obstructive sleep apnea. The soft tissue of the throat relaxes, reduces the size of the airway, and there may be snoring with respiratory effort related arousals (RERAs) and brief awakenings, resulting in disturbed sleep. Classic symptoms include daytime tiredness and fatigue, daytime sleepiness, insomnia and mood changes such as depression.
The treatment options for snoring also apply to UARS, and a trial of CPAP is warranted if significant symptoms persist.