Why Am I so Tired? How to Diagnose and Treat Sleep Apnea

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When was the last time you had a good night’s sleep? If you’ve been struggling to sleep at night and constantly find yourself waking up still feeling tired from the night before, it could be a sign that you suffer from sleep apnea. Sleep apnea is a sleep disorder that results in interrupted breathing while sleeping. If left untreated, sleep apnea can disrupt more than just your sleep cycle; it can also cause hypertension, heart disease, elevated blood sugar, and even a stroke. Fortunately, there are many diagnostic and treatment options available.

Who is at Risk

Sleep apnea tends to be more common in men, and the bed partner often has sleep issues because of the snoring or gasping. In fact, it is often the wife who nudges her husband to seek treatment for this disorder, according to Ronald Barnett, MD, pulmonologist and sleep medicine specialist at Penn Medicine Valley Forge.

A woman’s risk of developing sleep apnea increases after menopause. Women appear to be protected from sleep apnea during their child-bearing years, but the risk increases once they enter perimenopause, and the risk for post-menopausal women is three times greater compared to premenopausal women.

What to Look for

Has your partner been complaining about your constant snoring keeping them up all night? Loud, ongoing snoring is one of the most common signs of sleep apnea. Another common sign of sleep apnea is frequent sleepiness especially during the day. Patients with sleep apnea often report falling asleep during quiet and inactive times of day. Some other less common signs of sleep apnea are morning headaches, the inability to focus or concentrate, memory loss, depression, mood swings, insomnia, and waking up with a dry mouth or sore throat.

Sleep studies are often recommended for patients who are overweight and have a history of hypertension and cardiac arrhythmias because of the link between sleep apnea and heart disease, according to Theodhor Diamanti, MD, Penn cardiologist. “Sleep apnea causes the oxygen levels to drop and low oxygen levels can lead to life-threatening cardiac arrhythmias,” said Dr. Diamanti.

Keep in mind that just because an individual snores or experiences difficulty with sleeping does not necessarily mean that they have sleep apnea. They could be suffering from another sleep disorder or health issue. It is important to see your doctor if you suspect you may have sleep apnea or another medical condition to receive proper diagnosis.

How to Receive a Diagnosis

When a patient suffers from sleep difficulties and suspects that they may have sleep apnea, a doctor will recommend that they receive a sleep evaluation. This evaluation reviews all aspects of a person’s sleep habits, physical characteristics, and associated medical conditions to help physicians make a diagnosis of sleep apnea. These evaluations can take place overnight in a sleep laboratory, but it is becoming more common for physicians to allow patients to perform the evaluation in the comfort and convenience of their own home using home sleep monitors. According to Dr. Barnett, approximately 80% of the patients tested end up being diagnosed with sleep apnea.

Treatment Options Available

The most common, and most successful treatment for sleep apnea is CPAP — continuous positive airway pressure. The positive airflow blows into the nose and/or mouth and keeps the airway open so that breathing is not interrupted. The treatment works for about 90% of patients.

However, CPAP is not the only treatment option available for those who are diagnosed with sleep apnea. Bert W. O’Malley, Jr., MD and Gregory S. Weinstein, MD, FACS both of Penn Medicine worked together to develop one of the latest options, which uses minimally invasive robotic surgery to treat sleep apnea patients who have problems with excess tissue at the base of the tongue.

The muscles that hold the airway open relax during sleep. When the loose tissue vibrates, someone snores. If the tissue in the back of the throat collapses, it blocks the airway and results in sleep apnea. Uvulopalatopharyngoplasty is the most common procedure for removing the excess tissue in the throat.

“In surgical management of sleep apnea we can remove the tonsils and trim the uvula and palate,” said Erica Thaler, MD, Penn otorhinolaryngologist. “Now with the introduction of transoral robotic surgery (TORS) we can also help patients who have issues with the tissue at the base of the tongue.”

Although the procedure has only been around for slightly more than a decade, Penn has already offered clinical trials to more than 400 patients with good results. This is a new procedure so we are continuing to follow these patients through sleep studies,” Dr. Thaler said, “but so far our outcomes have been positive.”

To learn more about transoral robotic surgery (TORS), visit the Department of Otorhinolaryngology-Head and Neck Surgery.

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