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... e Multiple Sleep Latency Test (MSLT) measures the speed of falling asleep. In this test, patients are given several opportunities to fall asleep during the course of a day when they would normally be awake. For each opportunity, time to fall asleep is measured. People without sleep problems usually take an average of 10 to 20 minutes to fall asleep. Individuals who fall asleep in less than 5 minutes are likely to require some treatment for sleep disorders.
The MSLT may be useful to measure the degree of excessive daytime sleepiness and to rule out other types of sleep disorders (Mayo Foundation). Oximetry is a test that uses a small machine that monitors and records oxygen levels. A clip fits onto the finger and information is collected during a normal 8 -hour sleep cycle. This device can be taken home to record the sleep cycle, as some believe that patients sleeping at a sleep clinic do not sleep the same way they would at home. If the result of the Oximetry test comes back abnormal the physician would then prescribe a polysomnogram (Holten 202). A Nocturnal Polysomnography Test monitors heart, lung, and brain activity, breathing patterns, arm, and leg movements, and blood oxygen levels while the patient sleeps (Holten 202).
As this is a more involved test they are done in sleep clinics for proper monitoring of equipment and patient sleep cycle. Treatment for OSA is widely available and for some that have very mild cases of OSA it may be as simple as a few lifestyle changes such as sleeping on their side, losing a few pounds or limiting alcohol, tobacco and drug use before bed. For those with mild to moderate OSA there are a few dental appliances, oral devices, and lower jaw adjusters that can help reduce sleep apnea episodes. Oral devices work by bringing the lower jaw forward during sleep. Most of the products fit inside the mouth, but some products are worn around the head and chin to adjust the position of the lower jaw. Two examples of dental appliances are Mandibular Repositioning Device (MRD) and the Tongue Restraining Device (TRD).
The Mandibular Repositioning Device works by bringing the lower jaw forward during sleep. If the lower jaw and tongue remain forward during sleep, the air passage of the throat opens up. This is the most commonly used device (Figure 3) 3. There is also a Tongue Retaining Device (TRD), or a splint, that keeps the tongue in place while you sleep, so that it does not fall back and block the airway. (Figure 4) 4 Figure 3 Figure 4 For the patients that are at high risk there are several treatment options available. Continuous Positive Airway Pressure (CPAP) is one of the most common long-term treatments for severe sleep apnea. It is a machine that regulates airflow and keeps airway passages open by way of a mask worn during sleep. (Figure 5) 5 This treatment by far is the most popular and when worn nightly, a full restful nights sleep is obtained.
The machine itself can sit on a table next to the bedside and a long tube fastened to the machine has a face mask attachment (Figure 6) 6, that must be worn to cover the nose. The patient must sleep with their mouth closed. Some use a chinstrap (Figure 7) 7. For those patients that either have little success with the CPAP or cannot tolerate the mask since it must be worn every night have several surgical options available if they qualify. Figure 5 Figure 6 Figure 7 Uvulopaltopharyngoplasty (UPPP) is the process of removing the uvula along with excess tissue. The surgery has mixed reviews, it helps 50 % while in others it provides no relief, or some have partial success but still may be forced to use the CPAP due to scar tissue.
There is also Laser Assisted Uvuloplasty (LAUP). Mandibular Myotomy involves cutting a rectangular piece of bone in the front part of the jaw where the tongue muscles are attached. The piece of bone is then pulled outward, rotated 90 degrees and attached to cover over where the bone was cut. This pulls the tongue forward 6 to 10 mm and almost always eliminates the sleep-related obstruction. One of the newest treatments is Radio Frequency (RF) procedure. This procedure uses radio waves to shrink tissue in air passages.
The treatment involves piercing the tongue, throat, or soft palate with a special electrode connected to a radio frequency generator. The inner tissue is then heated to 158 to 179 degrees in a procedure that takes approximately half an hour. The inner tissues shrink and the larger outer tissues maintain their normal size. Several treatments may be required. The Food and Drug Administration (FDA) has approved this procedure for snoring and now for OSA.
Medical insurance companies are not covering the procedure; since it is so new it is still considered experimental procedure. Lastly soft palate implants are the very latest procedure. It is new in the United States but has been used in Europe for several years. The FDA approved it in 2003 for snoring and has now approved it in 204 for OSA (Sullivan 52). The procedure which takes anywhere from 8 to 16 minutes to complete involves inserting 3 tiny woven cords into the soft palate adjacent to the hard palate. The firmness of the implants and the fibrosis that develops stiffens the tissue, which then reduces the opportunity for collapse.
There has been moderate success with this new procedure in some instances the cords have come out and need to be replaced. It is still too new to determine the long-term effects, it will have on people with OSA. People have been suffering with sleep disorders for years without knowing or understanding why. Thanks to the doctors that have dedicated their careers to answering those questions there is now a more heightened awareness of sleep disorders. There are almost 700 sleep clinics in the US offering diagnosis and treatment for OSA As studies continue to highlight the harmful effects sleep disorders can have on a person's quality of life, as well as connections to other physical ailments such as congestive heart failure and obesity, the study of sleep has become a more common practice.
Development of new procedures to improve or eliminate sleep apnea is continuing. There is hope that diagnosing and treating OSA early on will circumvent a more serious condition in the future. This is a very treatable disorder, the physician's reluctance to recognize sings and symptoms seem to be a thing of the past. Works Cited Alonso-Fernandez, Alberto, et al. 'Cardiac rhythm disturbances and ST-segment depression episodes in patients with OSA-Hypopnea syndrome and its mechanisms. ' Chest 127 (2005): 15 - 23. Dement, William C.
The Promise of Sleep. New York: Dell, 2000. 167 - 193. Dreher, H. Michael, and Regina M.
Willard. 'Wake up call for sleep apnea. ' Nursing 2005 Mar. 2005: 46. Holten, Keith B. 'How should we diagnose and treat obstructive sleep apnea?' Journal of Family Practice 53 (2004): 202. Melville, Nancy A. 'Sleep apnea's O 2 disruption has diverse effects. ' Family Practice News 34 (2004): 52 - 53. Parnell, D... 'Sleep on it: fitful slumber tied to diabetes risk. 's cience News 25 Sept. 2004: 195 - 196. 'Risk factors in sleep disorder breathing. ' Internal Medicine Alert 23 (2003): 97 - 100. Sleep Apnea screening and diagnosis. 21 July 2004. Mayo Foundation for Medical Education and Reasearch. 22 Mar. 2005.
Sullivan, Michele G. 'Palatal implants decrease snoring, may lessen obstruction. ' Family Practice News 34 (2004): 52.
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Research essay sample on Sleep Apnea Sleep Disorders
