Getting a Diagnosis
If you suspect that you have sleep apnea, the usual first step is to discuss your suspicions with your primary care physician. If you don't have a primary care physician, you can go directly to a clinician who is a sleep specialist. But check your health care insurance coverage first. Some policies require you to see a primary care physician first, and some policies limit the sleep centers and testing facilities whose services they will pay for. Unfortunately, you may discover that your policy offers limited or no coverage for the diagnosis and treatment of sleep apnea, in which case you may wish to switch insurers if and when you can.
Whichever kind of physician you consult initially, it can be helpful for you to prepare in advance a detailed account of your medical history as it may be relevant to sleep apnea. The ASAA is collaborating with Arbor Medicus to offer you a free interactive online HistoryTaker that will help you do just that. Here are the details.
Sleep specialists come from a variety of medical backgrounds. They may be pulmonologists (lung specialists), otolaryngologists (ears, nose, and throat), neurologists (brain and nerves), psychiatrists (mental health), or primary care physicians--internists and family practitioners. Some dentists also have special training in the treatment of sleep disordered breathing, which includes sleep apnea. You can check the credentials of specialists at the web sites of the American Board of Internal Medicine and the American Board of Sleep Medicine. You should feel free to ask any doctor you see about his or her credentials and the diagnostic procedures to be followed.
A definitive diagnosis of sleep apnea can be made only with a sleep study conducted during a visit to a sleep lab, usually overnight, or a home study performed with special equipment. Some sleep centers are accredited by the American Academy of Sleep Medicine and you can find them listed here. Others that are just as qualified, however, may choose not to pay the cost of accreditation or may be in the process of obtaining it.
A sleep study generates several records of activity during several hours of sleep, usually about six. Generally, these records include an electroencephalogram, or EEG, measuring brain waves; an electroculogram, or EOG, measuring eye and chin movements that signal the different stages of sleep; an electrocardiogram, EKG, measuring heart rate and rhythm; chest bands that measure respiration; and additional monitors that sense oxygen and carbon dioxide levels in the blood and record leg movement. None of the devices is painful and there are no needles involved. The testing procedure as a whole is known formally as "polysomnography," and the technician who supervises it is usually a "registered polysomnographic technologist," or RPT. Usually the bedroom where the test is conducted is more like a comfortable hotel room than a hospital room.
Your doctor might prescribe a "split-night study," in which the first hours are devoted to diagnosis. If obstructive sleep apnea is found, the patient is awakened and fitted with a positive airway pressure device. The remainder of the patient's slumber is then devoted to determining how well he or she responds to PAP therapy.
A substantial amount of data is generated by a sleep study, but the most crucial is the apnea-hypopnea index, or AHI. An apnea is a complete cessation of breathing for 10 seconds or longer. A hypopnea is a constricted breath (more than one-fourth, less than three-fourths) that lasts 10 seconds or longer. The index number is the number of apneas and hypopneas the sleeper experiences each hour. An AHI of 5 to15 is classified as mild obstructive sleep apnea; 15 to 30 is moderate OSA; 30 or more is severe OSA. Here is more information about understanding the results of your sleep study. If you are diagnosed with OSA, its severity is one of the factors you and your sleep specialist will weigh as you explore your treatment options.
While polysomnography in a fully equipped sleep lab is regarded as the "gold standard" for sleep apnea diagnostics, your sleep specialist may decide that given your circumstances and your symptoms the findings produced in a home study will be sufficient to make an accurate diagnosis. A home study, especially if it is self-administered (as most are), is definitely cheaper, and some patients are unable to conform to the sleep lab's procedures. Home studies are coming into steadily wider use.
The cost of diagnosing and treating sleep apnea is significant, generally well over $1,000, and if PAP therapy is prescribed, charges will be ongoing. If you are uninsured or underinsured, you may be tempted to delay action. Be aware, though, that the consequences of untreated sleep apnea, described elsewhere on this web site, could lay a heavy cost on you as well. Diagnosis and, if necessary, treatment may be well worth the price.