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Sleep apnea is a condition that occurs when your breathing stops while you are asleep. The most common kind of sleep apnea is obstructive sleep apnea (OSA). OSA occurs when your throat closes off when you try to breathe while asleep. This happens because the muscles that usually keep your throat open are relaxed during sleep. People who are overweight or have certain face shapes are at risk for OSA because they have a narrower throat. When the throat closes off, there is a pause in breathing and blood oxygen levels drop. Eventually, the person wakes up briefly, which gets the throat muscles working again and opens the throat so breathing can resume. This can cause a gasping for air or a full awakening in the middle of the night. If the breathing stoppages occur frequently through the night, they can prevent one from getting into deeper stages of sleep and so make their sleep less restful.

Restless legs syndrome (RLS) is a condition marked by an uncontrollable urge to move the legs, often with an uncomfortable feeling in the legs that occurs around bedtime. It can feel like something is creeping or crawling on your skin, an electrical sensation, or a need to stretch. This feeling gets better when you move your legs even for a few seconds but starts to come back when you stop moving. It is different from muscle cramps or charley horses that some people also frequently get at night. The uncomfortable sensations can be bothersome enough that it is difficult to fall asleep.

Insomnia means different things to different people, but generally it refers to difficulty falling asleep, staying asleep, or poor quality sleep. Insomnia can be normal in the short term, but can be an issue if experienced over a longer period of time. Many things can contribute to insomnia, including depression, anxiety, medications, a poor sleep routine, and other sleep disorders such as sleep apnea and RLS. Stress and worry are also frequent causes of insomnia. Sometimes, after not having slept well for a few nights, the worry and anxiety about not sleeping well and feeling like you really need to get a good night’s sleep can lead to a vicious cycle preventing sleep and worsening the insomnia.

A sleep study usually takes place in a special sleep lab set up like a hospital room with a lot of monitors and equipment. You will go to the sleep lab in the evening and be given a private room where a sleep technician will place sensors all over your body. There will be monitors on your head to measure your brain activity to see when you are sleeping and what stages of sleep you are in. There will be monitors over your nose and mouth to measure the air you breathe in and out. Monitors on your chest measure your breathing efforts and your heartbeat, while monitors on your legs measure twitching or movements in your legs. A clip on your finger or ear measures the oxygen level in your blood.

Once the technician finishes applying all the monitors, they will have you get into bed. All of the wires coming from the sensors will be bundled together in to one thick cable to make it easier to disconnect things if you need to get up in the night to use the bathroom. After some tests to make sure everything is recording correctly, you will be asked to go to sleep. The technician will be watching all of the recordings on a computer next door, and may come in to adjust things if there is a problem during the night. In the morning, the technician will wake you up and remove the monitoring equipment.

Recently, devices have been developed that can be used to do a sleep study in your own home. These devices measure breathing but don’t have the sensors on your head to measure sleep. They are used mostly to test for sleep apnea. If you get a home sleep test, you will receive instructions on how to put on the monitors – usually plastic tubing goes in your nose, some bands go around your chest and stomach, and a clip goes on your finger. You will put the device on when you get ready to go to sleep and turn it on. When you wake up in the morning, you will turn it off, take the monitors off, and then return the device. The information about your sleep will have been recorded through the night and will be downloaded from the device to be reviewed by your doctor.

The most common treatment for sleep apnea is a machine called “continuous positive airway pressure” (CPAP). CPAP consists of a machine that blows air under pressure through a hose that attaches to a mask. Patients with sleep apnea wear the CPAP mask at night when they go to sleep and the air blown by the device keeps their throat from closing, allowing them to breathe normally. This treatment works very well in normalizing breathing, but it can be difficult for patients to get used to sleeping with a mask on their face. Masks come in different styles – some just cover the nose, some the nose and mouth, and some go in the nostrils. Another common treatment option is called an “oral appliance.” Oral appliances are typically made by a dentist based on a mold of your teeth. The most common style of oral appliance uses your upper teeth as a brace to pull your lower jaw forward. By pulling your lower jaw, your tongue moves forward and opens up the back of your throat.

In cases of mild sleep apnea, treatment can include weight loss and positional therapy. Positional therapy is a method of avoiding sleeping on your back (the position in which sleep apnea is worst). This can be accomplished by wearing something that makes it uncomfortable if you are on your back. For example, some people sew a tennis ball into the back of their pajama shirt.