Diagnosis

Your doctor may make an evaluation based on your signs and symptoms and a sleep history, which you can provide with help from someone who shares your bed or your household, if possible.

You're likely to be referred to a sleep disorder center. There, a sleep specialist can help you determine your need for further evaluation.

An evaluation often involves overnight monitoring at a sleep center of your breathing and other body functions during sleep. Home sleep testing also might be an option. Tests to detect sleep apnea include:

• Nocturnal polysomnography. During this test, you're hooked up to equipment that monitors your heart, lung and brain activity, breathing patterns, arm and leg movements, and blood oxygen levels while you sleep.

• Home sleep tests. Your doctor might provide you with simplified tests to be used at home to diagnose sleep apnea. These tests usually measure your heart rate, blood oxygen level, airflow and breathing patterns.

• If the results are abnormal, your doctor might be able to prescribe a therapy without further testing. Portable monitoring devices don't detect all cases of sleep apnea, however, so your doctor might still recommend polysomnography even if your initial results are normal.

If you have obstructive sleep apnea, your doctor might refer you to an ear, nose and throat doctor to rule out blockage in your nose or throat. An evaluation by a heart doctor (cardiologist) or a doctor who specializes in the nervous system (neurologist) might be necessary to look for causes of central sleep apnea.

Treatment

• Continuous positive airway pressure (CPAP)

For milder cases of sleep apnea, your doctor may recommend only lifestyle changes, such as losing weight or quitting smoking. If you have nasal allergies, your doctor will recommend treatment for your allergies.

If these measures don't improve your signs and symptoms or if your apnea is moderate to severe, a number of other treatments are available.

Certain devices can help open up a blocked airway. In other cases, surgery might be necessary.

Therapies

• Continuous positive airway pressure (CPAP). If you have moderate to severe sleep apnea, you might benefit from using a machine that delivers air pressure through a mask while you sleep. With CPAP (SEE-pap), the air pressure is somewhat greater than that of the surrounding air and is just enough to keep your upper airway passages open, preventing apnea and snoring.

• Although CPAP is the most common and reliable method of treating sleep apnea, some people find it cumbersome or uncomfortable. Some people give up on the CPAP machine, but with practice, most people learn to adjust the tension of the straps on the mask to obtain a comfortable and secure fit.

• You might need to try more than one type of mask to find one that's comfortable. Don't stop using the CPAP machine if you have problems. Check with your doctor to see what changes can be made to increase your comfort.

• Additionally, contact your doctor if you're still snoring or begin snoring again despite treatment. If your weight changes, the pressure settings of the CPAP machine might need to be adjusted.

• Other airway pressure devices. If using a CPAP machine continues to be a problem for you, you might be able to use a different type of airway pressure device that automatically adjusts the pressure while you're sleeping (auto-CPAP). Units that supply bilevel positive airway pressure (BPAP) also are available. These provide more pressure when you inhale and less when you exhale.

• Oral appliances. Another option is wearing an oral appliance designed to keep your throat open. CPAP is more reliably effective than oral appliances, but oral appliances might be easier to use. Some are designed to open your throat by bringing your jaw forward, which can sometimes relieve snoring and mild obstructive sleep apnea.

• A number of devices are available from your dentist. You might need to try different devices before finding one that works for you.

• Once you find the right fit, you'll need to follow up with your dentist repeatedly during the first year and then regularly after that to ensure that the fit is still good and to reassess your signs and symptoms.

Surgery

Surgery is usually only an option after other treatments have failed. Generally, at least a three-month trial of other treatment options is suggested before considering surgery. However, for a small number of people with certain jaw structure problems, it's a good first option.

Surgical options might include:

• Tissue removal. During this procedure (uvulopalatopharyngoplasty), your doctor removes tissue from the rear of your mouth and top of your throat. Your tonsils and adenoids usually are removed as well.

• This type of surgery might be successful in stopping throat structures from vibrating and causing snoring. It's less effective than CPAP and isn't considered a reliable treatment for obstructive sleep apnea.

• Removing tissues in the back of your throat with radiofrequency energy (radiofrequency ablation) might be an option if you can't tolerate CPAP or oral appliances.

• Tissue shrinkage. Another option is to shrink the tissue at the rear of your mouth and the back of your throat using energy (radiofrequency ablation). This procedure might be used for mild to moderate sleep apnea. One study found this to have effects similar to that of tissue removal, but with fewer surgical risks.

• Jaw repositioning. In this procedure, your jaw is moved forward from the remainder of your face bones. This enlarges the space behind the tongue and soft palate, making obstruction less likely. This procedure is known as maxillomandibular advancement.

• Implants. Plastic rods are surgically implanted into the soft palate after you've received local anesthetic. More research is needed to determine how well implants work.

• Nerve stimulation. This requires surgery to insert a stimulator for the nerve that controls tongue movement (hypoglossal nerve). The increased stimulation helps keep the tongue in a position that keeps the airway open. More research is needed.

• Creating a new air passageway (tracheostomy). You may need this form of surgery if other treatments have failed and you have severe, life-threatening sleep apnea. In this procedure, your surgeon makes an opening in your neck and inserts a metal or plastic tube through which you breathe.

• You keep the opening covered during the day. But at night you uncover it to allow air to pass in and out of your lungs, bypassing the blocked air passage in your throat.

Other types of surgery may help reduce snoring and contribute to the treatment of sleep apnea by clearing or enlarging air passages:

• Surgery to remove enlarged tonsils or adenoids

• Weight-loss (bariatric) surgery