sleep disorders
brain, spinal cord, and nerve disorders
Snoring
For doctors, the main goal of evaluation is identifying people who are at high risk of obstructive sleep apnea (OSA). Not all people who snore have OSA. However, most people with OSA do snore. The following symptoms are cause for concern: Episodes of not breathing or of choking during sleep (as witnessed by a bed partner) Headaches when waking up in the morning Sleepiness during the day Obesity None Very loud, constant snoring High Blood Pressure None These symptoms may suggest sleep apnea. People with warning signs should see a doctor soon because testing may be needed. People without warning signs are unlikely to need testing and may wish to try General measures to help reduce snoring before they call a doctor. If these measures are unsuccessful and snoring is very bothersome to their bed partner, people should see their doctor. Doctors first ask questions about the snoring and other symptoms and then about the person's other medical history. Because several important findings are noticed mainly by others, doctors try to interview the bed partner or roommates when possible. Doctors then do a physical examination. What they find during the history and physical examination helps them decide whether tests for OSA need to be done. Doctors ask how severe the snoring is. For example, they may ask the bed partner Whether the person snores every night and, if not, how many nights Whether the person snores all night long and, if not, how much of the night How loud the snoring is The person and bed partner are also asked to describe How often the person seems to wake up during the night Whether the person has stopped breathing or had episodes of gasping or choking Whether sleep seems unrefreshing or the person has morning headaches How sleepy the person is during the day Doctors also ask about disorders that may be associated with Obstructive sleep apnea (OSA), particularly During the physical examination, doctors measure the person's height and weight in order to calculate Body Mass Index (BMI) (BMI). The higher the person's BMI, the greater the risk of OSA. Doctors may measure neck size. OSA is more likely when the neck is larger than about 16 inches for women and about 17 inches for men. Doctors also inspect the nose and mouth for signs of airway obstruction and risk factors for snoring—for example, nasal polyps, a deviated septum, chronic nasal congestion, a high and arched palate, a jaw that is small or farther back than normal, and an enlarged tongue, tonsils, or uvula (the structure that hangs down at the back of the throat). Doctors measure blood pressure because OSA is more likely when blood pressure is high. Although doctors are not able to predict risk precisely, the more risk factors and warning signs people have, the greater their risk of OSA. When doctors suspect obstructive sleep apnea (OSA), they typically do tests to confirm the diagnosis. Testing consists of Testing . For this test, people sleep overnight in a sleep laboratory while their breathing and other functions are monitored. A sleep laboratory may be located in a hospital, clinic, hotel room, or other facility that is equipped with a bed, bathroom, and monitoring equipment. Polysomnography can be done in the home (home sleep study) if people who snore do not have many other coexisting disorders. However, because snoring is so common and polysomnography is costly and time-consuming, doctors may not recommend polysomnography for everyone who snores. Testing people who have warning signs (particularly those with episodes of not breathing witnessed by another person) and those with several risk factors is particularly important.. If people without warning signs do not appear to have any sleep disturbance other than snoring, they typically do not need tests. However, they should schedule regular follow-ups so that their doctor can check for the development of such problems. 