Sleep Medicine

Sleep Apnea is a potentially serious disorder because of cessation of breathing while asleep.  Symptoms may include loud snoring, breath holds followed by a large gasping breath and daytime tiredness. An apnea is defined as a cessation of air exchange for at least 10 seconds, accompanied by a drop in oxygen level and by a brain wave “micro wakeup “when the patient breaths.  These pauses in breathing continue throughout the night and may occur as often as 1000 times during the night.    Those with sleep apnea usually have no problem falling asleep, and they are unaware that they are afflicted with the disorder. Bed partners frequently describe the symptoms accurately.

Sleep apnea occurs across all segments of the population, and if left untreated, can lead to increased risk of heart disease, high blood pressure, stroke, increased chance of type 2 diabetes, cardiac arrhythmias and other illnesses.  Daytime tiredness also leads to an increased chance of automobile accidents and may cause errors in judgment and concentration that may cause injury, job loss, relationship problems, depression, and even death.

Other conditions we treat:

  • Restless Leg Syndrome
  • Periodic Limb Movements
  • Narcolepsy
  • Idiopathic Hypersomnia

There are three main types of sleep apnea:

  • Obstructive sleep apnea. This is the most common form of apnea. It occurs because of a reduction in the opening of the breathing passage, behind the tongue. During sleep,  the throat muscles relax, and when the patient inhales,  there is a negative force that leads to collapse and closure of the airway, even though the patient is making an effort to breathe.
  • Central sleep apnea. This occurs when the brain fails to send proper signals to the muscles that control breathing. The airway is actually open, but there is no effort to breathe
  • Complex sleep apnea. This occurs when a person has both obstructive sleep apnea and central sleep apnea.

All forms of sleep apnea are treatable, and proper treatment lead to a better quality of life.

Risk Factors

People that are obese have a much greater probability of developing sleep apnea.  Although many people of normal body mass index have sleep apnea as well due to a narrow airway, large tonsils or adenoids, or formation of the jaw that compromises the airway. Non-obese people, however, also may have sleep apnea because of a narrow airway, or a large tongue, or a retro positioned tongue, and children may have large tonsils or adenoids.

Other risk factors include being male, family history, smoking, use of alcohol, sedatives or tranquilizers, and nasal congestion.

Treatments and Therapies

Once tested and properly diagnosed with the correct type of sleep apnea, the disorder is very treatable.  Proper treatment can virtually eliminate the problems associated with sleep apnea.

Behavior Related Therapies

Some mild forms of sleep apnea are treatable by changes in lifestyle, such as losing weight, quitting smoking or drinking alcohol and proper sleep positions such as sleeping supine or with the head of the bed elevated.  Behavioral changes in combination with the therapies below tend to be the most effective methods to minimize the effects of sleep apnea.


This the gold standard for therapy of sleep apnea. CPAP maintains an open airway by delivering air pressure via a mask placed over the nose and/or mouth.  The air pressure inflates the airway, just enough to prevent the episodes of breath-holding, thereby eliminating apnea events.  CPAP may require an effort to determine the appropriate type of CPAP machine and the best fitting mask. CPAP  will eliminate virtually all the events and provide restful sleep and a better quality of life. Many patients describe CPAP therapy as “life-changing”.

Oral Appliances

As determined by the physician and the sleep dentist, some patients will benefit by using a custom-fitted oral appliance. An oral appliance, that is worn during sleep, is adjusted so that the lower jaw protrudes forward, just enough to keep the airway open.  Dentists that are specially trained in the treatment of sleep medicine provide oral appliances.


Surgery is also an option when CPAP and oral appliances fail.  Surgeries include the removal of the tonsils, adenoids and other tissue in the back of the throat.  More serious surgeries include advancing the jaw, to enlarge the area behind the tongue.  Surgical procedures do not guarantee the cessation of sleep apnea.  Most sleep medicine professionals recommend trying and CPAP and oral appliances before surgery.

Multiple Sleep Latency Test (MSLT)

This daytime sleep study measures how sleepy you are. It typically is done the day after a PSG (an overnight sleep study). You relax in a dark, quiet room for about 30 minutes while a technician checks your brain activity. The MSLT records whether you fall asleep during the test and what types and stages of sleep you’re having. Sleep has two basic types: rapid eye movement (REM) and non-REM. Non-REM sleep has three distinct stages. REM sleep and the three stages of non-REM sleep occur in regular cycles throughout the night. The types and stages of sleep you have can help your doctor diagnose sleep disorders such as narcolepsy, idiopathic hypersomnia (id-ee-o-PATH-ick HI-per-SOM-ne-ah), and other sleep disorders that cause daytime tiredness.

An MSLT takes place over a full day. This is because of your ability to fall asleep changes throughout the day.

Maintenance of Wakefulness Test

This daytime sleep study measures your ability to stay awake and alert. It’s usually done the day after a PSG and takes most of the day. Results can show whether your inability to stay awake is a public or personal safety concern. Results also can show how you’re responding to treatment.

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