How is Sleep Apnea Diagnosed?

Sleep apnea is usually diagnosed by combining a person’s symptoms and medical history with a sleep study (polysomnography). A doctor may ask about snoring, witnessed pauses in breathing, morning headaches, daytime sleepiness and difficulty concentrating, while information from a bed partner can also be helpful. A sleep study records breathing, oxygen levels, heart rate and other body signals during sleep and may be performed at home or in a sleep centre.

Some other common tests to diagnose sleep apnea include a home sleep apnea test, pulse oximetry, sleep history and a physical examination. These help identify breathing problems and other factors, such as nasal obstruction or changes in the throat and mouth anatomy.

Types of Sleep Apnea and Their Treatment

Sleep apnea treatment differs based on each type of the condition. Here is a summary of treatment options:

Type of Sleep Apnea Treatment
Obstructive Sleep Apnea Continuous positive airway pressure (CPAP), oral appliances, lifestyle measures, positional therapy and selected procedures.
Central Sleep Apnea Treatment of the underlying cause and selected forms of positive airway pressure.
Complex or Mixed Sleep Apnea Individualised positive airway pressure treatment and specialist monitoring.

How is Sleep Apnea Treated Based on Stages?

The following are sleep apnea treatment based on different stages:

Stage Treatment
Mild Sleep Apnea Lifestyle changes such as losing weight or quitting smoking, may help reduce symptoms. Nasal sprays, nasal strips or dental devices may also be recommended to help keep the airway open.
Moderate Sleep Apnea A CPAP machine may be recommended.
Severe Sleep Apnea Surgery may be considered to correct structural problems, reduce swollen tissue, remove enlarged tonsils or widen the airway.

Topical Medications for Sleep Apnea

The two main intranasal (topical nasal) medications used to relieve sleep-disrupted breathing are as follows:

    1. Nasal corticosteroids Sprays such as fluticasone or budesonide can reduce swelling inside the nose and may help improve sleep apnea symptoms, particularly when nasal congestion is present.

    2. Decongestant sprays Sprays like oxymetazoline can help open blocked nasal passages for a short time, making it easier to breathe at night. However, these sprays are meant for short-term use (no more than 3 consecutive nights) and do not address the root cause of the blockage.

Note: Nasal treatments may improve nasal breathing but should not be considered a substitute for CPAP or other prescribed sleep-apnea treatment.

Other Treatments for Sleep Apnea

The following non-surgical treatment options might also be suitable for sleep apnea:

  1. Continuous Positive Airway Pressure (CPAP) CPAP uses a mask to send a steady flow of air that helps keep the upper airway open while you sleep. It is a well-known treatment for moderate to severe obstructive sleep apnea.

  2. Bi-level Positive Airway Pressure (BiPAP) Therapy Bi-level positive airway pressure provides different pressure levels during inhalation and exhalation. It may be useful for selected patients who require different pressure support levels or have specific breathing disorders.

  3. Oral Appliance Therapy (OAT) A custom-fitted oral appliance can reposition the jaw or tongue to help keep the airway open during sleep. It may be considered for selected people with mild to moderate obstructive sleep apnea or those who cannot tolerate CPAP.

  4. Positional Therapy Some people experience significantly more apnea when sleeping on their backs. Positional therapy uses techniques or devices to encourage side sleeping and may be helpful in suitable cases.

  5. Surgery Surgery may be considered when enlarged tissues, jaw structure or other anatomical factors contribute significantly to airway obstruction and non-surgical treatment has not provided adequate control. The procedure depends on the specific source of obstruction.

Oral Appliances for Sleep Apnea Treatment

Oral appliances used in the treatment of sleep apnea are:

  • Mandibular Advancement Devices (MADs): Mandibular advancement devices are the most common oral appliances used to treat obstructive sleep apnea (OSA). They move the lower jaw and tongue forward, creating more space for airflow through the throat. These devices fit over the upper and lower teeth and come in different designs.

  • Tongue-Stabilizing Devices (TSDs): Tongue-stabilizing devices use gentle suction to hold the tongue forward while you sleep. This helps move the base of the tongue away from the airway and improve airflow. They may be an option for people who cannot use mandibular advancement devices.

Ayurvedic and Alternative Treatments for Sleep Apnea

Some supportive and Ayurvedic options for sleep apnea include:

  • Ashwagandha: Supports relaxation, eases stress, and promotes more comfortable, restful sleep. Its calming properties make it a commonly used Ayurvedic herb for managing stress-related sleep difficulties.

  • Shankapushpi: Promotes mental calmness, eases restlessness and supports better sleep and concentration. It is valued for supporting a relaxed mind and healthy nervous system function.

  • Sarpagandha: Encourages relaxation and restful sleep while traditionally supporting healthy blood pressure and circulation. Its calming effects have made it a long-standing herb in Ayurvedic practices.

  • Jatamansi: Calms nervous tension, supports deeper sleep and promotes relaxation during the night. It is used to help settle the mind and encourage a more peaceful sleep routine.

  • Nirgundi: Supports clearer breathing and respiratory comfort, particularly when congestion affects sleep quality. It is used in Ayurveda to support breathing and promote comfortable nighttime rest.

Note: Ayurvedic treatments are complementary to the medical recommendations made by the doctor. Do not stop CPAP or another prescribed treatment in favour of an alternative remedy without discussing it with your doctor.

Home Care for Managing Sleep Apnea

The home care tips below can help during sleep apnea recovery:

  • Maintain a healthy weight to avoid fat accumulation around neck and upper body

  • Remember to keep your mask and equipment clean.

  • Try to sleep on your side.

  • Consider singing or playing a wind instrument to help strengthen your airway muscles.

  • Using a humidifier can make breathing more comfortable at night.

  • Try to keep nasal passages clear.

  • Avoid alcohol and sedatives before bed.

  • Elevate the head of your bed 4–6 inches to keep your airway open.

Latest Treatment for Sleep Apnea in India

There are now new ways to treat sleep apnea besides the usual CPAP therapy. Medications such as tirzepatide (a weight-management drug) have been shown to significantly reduce sleep apnea severity by treating underlying obesity, which reduces excess tissue surrounding the upper airway. Another investigational oral pill, AD109, is being studied to find out if it can help by changing how the muscles in the upper airway work.

Newer approaches also include oral devices such as the CARE device, which works by repositioning the jaw and expanding the airway, and continuous negative external pressure (cNEP), which uses gentle negative pressure around the neck to help prevent airway collapse. These emerging treatments may provide additional options for people who cannot tolerate or do not respond well to conventional therapy.

Other oral appliances, such as mandibular advancement devices (MADs), can also help keep the airway open by moving the lower jaw forward during sleep. They may be suitable for some people with mild to moderate sleep apnea.

Some latest approaches also include neurostimulation therapy (such as Hypoglossal Nerve Stimulation, which uses an implantable pulse generator to keep the tongue from blocking the airway).

How Long Does Sleep Apnea Treatment Take?

The treatment duration and recovery period differ with the type of treatment prescribed for sleep apnea. Here is a quick overview:

Treatment Approximate Duration
CPAP Therapy Improvement starts in 1-7 days after therapy.
Oral Appliance Improvement may occur within 2 to 4 weeks.
Uvulopalatopharyngoplasty or MMA (maxillomandibular advancement) Surgery Improvement may take several weeks and months.

Sleep Apnea Treatment Side Effects

Some possible side effects of sleep apnea treatment include:

  • Nasal dryness

  • Aerophagia (swallowing air, which leads to bloating and gas)

  • Nasal congestion

  • Skin irritation from the mask

  • Air leakage

  • Dry mouth

  • Claustrophobia

  • Jaw discomfort with some oral appliances

  • Recurrent sinus infections

  • Excessive salivation

  • Temporary or permanent numbness in the lower lip, chin, or tongue

Lifestyle Changes for Managing Sleep Apnea

Lifestyle measures mentioned below can support recovery and overall well-being during sleep apnea treatment:

  • Maintain a healthy body weight.

  • Exercise regularly.

  • Try not to drink alcohol right before bed.

  • It is best to avoid smoking.

  • Go to bed and wake up at the same time each day.

  • Take care of any nasal allergies or congestion you might have.

  • Only use sedative medicines if your doctor prescribes them.

  • Sleep on your side (lateral positioning).

Factors That Can Worsen Symptoms of Sleep Apnea

Certain habits and conditions can make nighttime breathing interruptions more frequent or severe. Such factors that worsen sleep apnea symptoms are:

  • Excess body weight

  • Sleeping on your back

  • Drinking alcohol before bedtime

  • Smoking

  • Having nasal congestion

  • Having an irregular sleep schedule

  • Taking certain sedative medicines

  • Having untreated nasal allergies

Sleep Apnea Treatment Cost

The cost of treating sleep apnea in India varies based on the type of treatment and how serious the condition is. Visiting a sleep specialist typically costs ₹500 to ₹2,000 per appointment. A polysomnography ranges from ₹1,600 to ₹25,000. For long-term care, a basic CPAP machine costs around ₹18,000 to ₹1.5 lakh, and a BiPAP machine can range from ₹50,000 to ₹1.5 lakh or more.

Surgical treatments and other procedures are generally more expensive. Radiofrequency ablation costs between ₹90,000 and ₹1.5 lakh. UPPP surgery ranges from ₹1.25 lakh to ₹1.85 lakh, while maxillomandibular advancement surgery costs about ₹3 lakh to ₹3.85 lakh. Other options, such as septoplasty, tonsillectomy, or adenoidectomy, usually cost ₹80,000 to ₹1.25 lakh, depending on the procedure and hospital.

Does Health Insurance Cover Sleep Apnea Treatment in India?

Yes, health insurance does cover sleep apnea treatment if the condition is medically necessary or leads to severe complications. Inpatient treatment, including eligible hospitalisation and surgeries, may be covered under standard health plans. Cost of diagnostic tests such as in-lab polysomnography (PSG) or home sleep apnea tests (HSAT), and CPAP or BiPAP treatment may also be covered depending on the policy terms.

In case you already have sleep apnea, your insurance might have a waiting period of up to 3 years, as it will be considered a pre-existing disease.

FAQs

  • Q1. Can children have sleep apnea?

    Ans: Yes, children can develop obstructive sleep apnea, often because of enlarged tonsils or adenoids, obesity or other airway-related problems. Snoring, restless sleep, mouth breathing and daytime behavioural changes can be warning signs.

  • Q2. What are the treatment options for sleep apnea?

    Ans: CPAP is one of the most established treatments, particularly for moderate to severe obstructive sleep apnea. Some other treatment options include oral appliances, positional therapy, lifestyle changes, surgery and other specialised approaches.

  • Q3. When should I see a doctor for sleep apnea?

    Ans: If you often snore loudly, notice breathing pauses, wake up gasping or choking, feel very sleepy during the day, or have frequent morning headaches, it is a good idea to see a doctor for sleep apnea.

  • Q4. Can sleep apnea resolve on its own?

    Ans: Sleep apnea usually does not resolve on its own. Getting the right diagnosis and treatment can help you manage the condition and lower the risk of problems.

  • Q5. Is sleeping on the side good for sleep apnea?

    Ans: Sleeping on your side (lateral positioning) can help reduce breathing interruptions, especially if your sleep apnea is worse when you lie on your back. However, this position does not work for everyone.

  • Q6. Can sleep apnea be cured permanently?

    Ans: Some people can greatly improve or even get rid of obstructive sleep apnea by treating the main cause, like losing weight or fixing a physical issue. But many people still need ongoing treatment to keep their airway open while they sleep.

  • Q7. Can sleep apnea cause daytime tiredness?

    Ans: Yes. Sleep apnea can interrupt your breathing repeatedly during sleep, breaking up your sleep and preventing you from getting enough rest. This can make you feel tired during the day, lower your focus, and reduce how alert you feel.

  • Q8. Can weight loss reduce sleep apnea?

    Ans: Yes. Weight loss can reduce the severity of obstructive sleep apnea in people whose condition is associated with excess body weight. It does not mean that prescribed treatment should be stopped without reassessment.

  • References

    • https://www.ncbi.nlm.nih.gov/books/NBK459252/

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