If you have snoring problems, you are not alone. Snoring is literally heard all over the world and occurs in all age groups and both genders. Snoring can be a natural part of sleep, but it may also be a symptom of Obstructive Sleep Apnea.

Of people 50 years or older, 25% experience abnormal breathing at night. Approximately 10% to 30% of adults snore and have hypertension.  It is estimated that as many as 18 million Americans suffer from Sleep Apnea, yet up to 95% of these cases go undiagnosed and untreated. For 30% of adults, snoring is the first indication of Obstructive Sleep Apnea. Approximately 60% to 80% of people who have tried CPAP (Continuous Positive Airway Pressure) to relieve Sleep Apnea continue using it with benefit.

It is time to see a doctor with special training in sleep medicine when you have had trouble sleeping for more than a month, if you awaken unrefreshed or if you are tired during the day for unknown reasons. If you have trouble falling asleep or staying asleep, it is important to have the cause evaluated. You should not assume that you just have “Insomnia.” Recent studies show that a high percentage (30% to 50%) of people diagnosed with Insomnia actually have another sleep disorder such as Obstructive Sleep Apnea. Also, it is very important to have your nighttime breathing patterns evaluated before starting any sleep aids since these types of medications can decrease your spontaneous breathing.

Our board-certified sleep medicine physician will perform an extensive review of your medical history with a concentrated focus on sleep and will perform an examination aimed at uncovering common causes of sleep disruption. The doctor will evaluate you for one of the more than 80 sleep disorders that are currently known. Some sleep disorders may be treated without requiring a sleep study, while others require a sleep study to determine which type of sleep disorder you may have. This visit not only ensures that we are providing you with the best possible service, but it is also preferred by the Sleep Diagnostic & Treatment Center to meet the high standards of our accreditation by the American Academy of Sleep Medicine.

There are two types of Sleep Apnea: Obstructive Sleep Apnea and Central Sleep Apnea.

Obstructive Sleep Apnea (OSA) OSA occurs when the soft tissue at the back of the throat collapses and partially or completely blocks the airway during sleep. This keeps the air from getting into the lungs. This is a very common sleep disorder. It happens because the muscles inside the throat relax as you sleep. Blockage of the airway can happen a few times a night or several hundred times per night.

Central Sleep Apnea (CSA) CSA occurs when the brain fails to tell the lungs to breathe during sleep. As this signal is lost, the lungs do not take in the oxygen that your body needs. CSA is less common than OSA.

Medical professionals and insurance carriers recognize Sleep Apnea as life threatening. For a person with Sleep Apnea breathing stops from 10 to 60 seconds at a time and these events can occur up to 120 times an hour during sleep.

What are the risk factors for Obstructive Sleep Apnea?

• Being male
• Older age
• Being overweight
• Large neck
• Large tonsils and/or adenoids
• Family history of sleep apnea
• Smoking
• Nasal Congestion

What are risk factors for Central Sleep Apnea:

• Being male
• Older age
• Heart disease
• Stroke
• Brain tumor

• Loud, irregular snoring
• Daytime sleepiness
• Morning headaches
• Weight gain
• Frequent nighttime urination
• Obesity
• High blood pressure
• Memory problems
• Falling asleep while driving
• Fatigue and loss of energy
• Anxiety or depression

Untreated Sleep Apnea is associated with memory problems, daytime sleepiness and fatigue, irritability, increased risk of traffic accidents, high blood pressure, heart attack, stroke, diabetes, poor job performance, anxiety, depression and other factors that can contribute to disability or death. The National Commission on Sleep Disorders attributes 38,000 cardiovascular deaths a year to Sleep Apnea.

Sleep apnea is diagnosed by performing a sleep study (or polysomnogram) to monitor your sleep and record events of sleep apnea or other sleep disturbances.

A sleep study is a non-invasive, painless evaluation of your sleep.  A sleep study (or polysomnogram) helps us see how you sleep at night. It involves spending the night at our sleep center. The test begins at night and lasts until the morning, as would a normal night of sleep. Every patient will have their own private, clean and home-like bedroom with bathroom. Each bedroom comes with a large screen television. For the study, electrodes are attached with paste to monitor your brain waves, stages of sleep, breathing patterns, oxygen levels, muscle tone, leg movements, and heart rhythm. You are able to move from side to side and get up to go to the bathroom. Our friendly sleep technologists make every effort to make your stay with us as comfortable as possible.

From the electrodes that are placed on different points of your body, up to 16 different physiologic parameters are measured, simultaneously, by the attached computers. These include the following:

Brain Waves or EEG: Usually 6 electrodes are attached to your scalp with a water-soluble paste or adhesive. Your hair is not cut or shaved. Needles are not used. The adhesive is removed when your sleep study is over. Measuring brain waves allows us to determine your different stages of sleep.

Eye Movements: Usually 2 or 3 electrodes are attached with tape near your right and left eyes. They do not touch your eye in any way. Eye movements help us to determine if you are in REM sleep (one of the stages of sleep).

Muscle Activity: Usually 2 or 3 electrodes are attached with tape to your chin or under your chin. Muscle tone plays a large role in determining your sleep stage throughout the night.

Electrocardiogram (ECG): Usually 3 electrodes are attached with tape to your upper chest to record your heart's rhythm and activity.

Leg Movements: Usually a small belt or cuff is placed around each ankle to record leg movements. Occasionally, 2 electrodes are attached with tape to your lower legs to measure leg muscle activity.

Breathing: Your breathing is measured in several ways. First, a sensor is attached with tape to your upper lip to measure airflow. Second, lightweight belts are placed around the chest and abdomen to measure how much effort you are using to breathe. These belts are not tight and are sensitive to the motion of your breathing.

Oxygen Level: A sensor is attached to one of your fingers or your ear with tape to measure the oxygen levels in your blood.

Other sensors: Depending on your particular problem, other types of sensors may be used. Please feel free to ask the sleep technologist about any of the equipment used for the sleep study.

Yes, Medicare and most private health insurance companies cover office visits, sleep studies, and CPAP services. We accept most insurance plans. A complete list of accepted insurance providers is provided on our “Forms & Insurance” menu tab, or contact the Sleep Diagnostic & Treatment Center at 703-876-2850.

Yes, an order is required from your doctor to schedule a sleep study. Generally, you can call your referring doctor or your primary care doctor and ask him/ her to fax us an order for a sleep study.

Many insurance companies require an insurance referral and approval before a sleep study can be performed. Our staff is available to assist you in obtaining the appropriate referrals for your needed studies. Please call us at 703-876-2850 if you have questions about your referral.

Any physician may refer a patient directly for a sleep study if it is for suspected Obstructive Sleep Apnea and the patient is in very good health. If your physician has questions about your referral, have him/her contact Dr. Richard L. Cho at the Sleep Diagnostic & Treatment Center, 703-876-2850 or at 703-876-0800.

You should discuss altered sleep patterns such as shift work with the Sleep Center staff when you schedule your study.

Continuous Positive Airway Pressure (CPAP) is the “gold standard” treatment for Obstructive Sleep Apnea. This highly effective therapy uses air pressure to keep your upper airway open during sleep to prevent the airway from collapsing. CPAP machines work by pressurizing filtered room air through a very quiet compressor which is connected to a hose and mask. The mask is worn over the nose and sometimes over the mouth during sleep. The newer masks are softer, smaller and more comfortable than the older masks. CPAP prevents snoring, airway obstruction and decreased oxygen levels in the blood. This allows the patient to go through the normal stages of sleep and awaken feeling refreshed and alert in the morning.

The CPAP equipment consists of a nasal mask (or full-face mask) with headgear, a flexible hose, and the CPAP machine itself. The current CPAP models are smaller, lightweight and portable making travel with the machine easy.

During the CPAP study, the sleep technologist will monitor your breathing patterns, oxygen levels, heart rhythm, and sleep stages. If you show continuing signs of Sleep Apnea, the CPAP pressure will be adjusted until the breathing abnormalities resolve. Following your CPAP study, the data from your study is reviewed in detail by our board-certified sleep specialist to determine the most effective CPAP pressure for you.

No, there are many types of CPAP masks and devices. At the beginning of the study, you will be able to choose the mask you find most comfortable. As the study progresses, you can try on different masks to find the one you like best.

People usually breathe through their noses when they sleep.  However, it can sometimes be difficult to breathe out when first using the CPAP mask. You should resist the temptation to breathe through your mouth. If mouth breathing is a problem, a chinstrap or full-face mask may need to be used.

Your physician will prescribe a CPAP unit for you to use at home.  A prescription order is sent to a Durable Medical Equipment (DME) company contracted with your insurance company. After they receive the order, the DME company will contact you to arrange for you to receive your CPAP machine and all related supplies. Most DME companies offer the convenience of bringing your CPAP machine and all related supplies to your home where a knowledgeable service representative will provide instructions to you on how to operate your CPAP equipment.

Questions about the CPAP machine and its operation should be directed to the Durable Medical Equipment (DME) company.

Reimbursement for the CPAP machine and related supplies varies by insurance company and insurance plan. We suggest that you contact your insurance company and inquire about your Durable Medical Equipment (DME) benefits.

First call your DME company to come to your home to check the machine and make any adjustments. If problems persist, then make an appointment to see your Sleep Medicine Physician.

When you travel, take your CPAP machine with you in your carry-on luggage. The airport screeners are familiar with CPAP machines. A travel case comes with the CPAP machine. Most CPAP machines available today come equipped with transformers which allow them to be used with international voltage (220v) when you travel to foreign countries. A battery power option is available for those who camp. High altitudes can affect the performance of your CPAP machine. You should consult with your physician if your travel plans include sleep at altitudes much higher or lower than those at home.

Bi-level Positive Airway Pressure (BiPAP) is similar to CPAP, except that it delivers two different pressures; a higher pressure for breathing in, and a lower pressure for breathing out. BiPAP therapy can be used to treat a different type of Sleep Apnea known as Central Sleep Apnea. Patients with COPD are often candidates for BiPAP therapy; this may help them minimize CO₂ (carbon dioxide) retention during sleep, evaluated during CPAP study.

Weight Loss is strongly encouraged. There is a strong correlation between weight gain and the development of Obstructive Sleep Apnea. Even modest increases in weight can greatly increase the severity of Sleep Apnea. Conversely, weight loss of as little as 20 pounds can substantially decrease the severity of Sleep Apnea. Therefore, patients with Obstructive Sleep Apnea are encouraged to pursue healthy weight loss. Once the quality of sleep improves with CPAP treatment, weight loss often becomes a more realistic and obtainable goal. Many patients lose enough weight that they are eventually able to discontinue CPAP treatment.

Oral Appliances open the airway by bringing the tongue and jaw forward. These devices may help reduce snoring and mild Sleep Apnea in certain individuals.

Surgery is the most effective treatment for snoring but is less effective for treating Sleep Apnea in adults. Surgery may help control the volume of snoring but can make Sleep Apnea "silent" by removing the site of the obstruction. Specific anatomic problems which may be corrected with surgery include: enlarged tonsils or adenoids, nasal polyps, deviated nasal septum, and malformation of the jaw. In the case of children, tonsil and adenoid surgery is usually curative.

Radio Frequency Ablation (Somnoplasty) is an outpatient procedure which uses low temperature radio frequency to shrink soft tissues which may be obstructing the nasal or oral airways. This may include the turbinates (for those with chronic allergies), soft palate, uvula, and base of the tongue.

Laser Assisted Uvulopalatoplasty is an outpatient laser procedure which may reduce snoring in people who have a large uvula or long soft palate.

Uvulopalatopharyngoplasty (UPPP) is a surgical technique that is appropriate for a small percentage of people. During this procedure, excess soft tissue at the back of the throat (i.e. tonsils, adenoids, uvula) is removed thereby enlarging the airway of the patient. Some negative side effects of this procedure have been reported and include nasal-sounding speech and transient nasal reflux.

Some patients are scheduled to stay the next day after their sleep study for a Multiple Sleep Latency Test. This test evaluates daytime sleepiness. When you wake up in the morning from your sleep study, the technologist will remove the breathing sensors and leg electrodes but will leave the head and EKG electrodes attached. These will stay on all day.

At two-hour intervals beginning at 8:00 a.m., you will be asked to lie down in bed and close your eyes for twenty minutes. These naps will continue throughout the day at approximately the following intervals: 8 a.m., 10 a.m., 12 p.m., 2 p.m. and 4 p.m. When each nap is over, you will be asked questions about your sleep and how sleepy or alert you feel. Between the napping periods, you will be able to watch television, read, or use your computer, but you will not be allowed to lie down or take additional naps. After the last nap, the technologist will remove the electrodes and you will be allowed to leave sometime around 5:00 p.m.

All sleep studies contain 1,000 pages or more of data that must be analyzed and interpreted. Analyzing a sleep study is a time-consuming process. Each 30-second interval is carefully examined for multiple variables including sleep stage, breathing patterns, heart rhythm, muscle tone, movements, and awakenings. The sleep technologist must review the same page of data 3 or 4 times to correctly identify all events. The fully analyzed data is then reviewed by our board-certified sleep specialist who will provide the final interpretation. A final sleep study report, and your CPAP recommendation if you had a CPAP study performed, is then prepared and sent to your referring physician and to your primary care physician. This process usually takes 10 to 14 days. Please allow at least 2 weeks before you schedule your follow-up visit with your physician to review these results and for treatment recommendations. The Sleep Center technologist and the scheduling staff will not be able to provide your test results to you.