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Q&A: What Is Sleep Apnea, And How Should It Be Treated?

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Dr. Agarwal is board-certified in family medicine and
sleep medicine, and is a member of the American
Academy of Family Medicine, the American Academy
of Sleep Medicine, the American Medical Association
and the American Association of Physicians of Indian
Origin.// Photo by Luigi Ciuffetelli

Why is sleep needed?

Sleep is a biological requirement that energizes and restores our brain and body.  Good quality sleep is vital to health and overall quality of life.  It is as essential as the water we drink, air we breathe and food we eat. Sleep Apnea (SA) is the most common type of sleep disorder and can impact the ability to reenergize and function optimally.

 

What is sleep apnea?

Obstructive Sleep Apnea restricts breathing during sleep. This occurs when soft tissue collapses at the base of the tongue – typically due to anatomy and/or genetics. The airway repeatedly becomes blocked and often results in snoring, snorting, and gasping for air.  These pauses in breathing, known as apneas, last for at least 10 seconds and are associated with reduced oxygen levels and arousals.  Central Sleep Apnea (less common) occurs when your brain sends improper signals to the muscles – so there is no effort to breath.  This is commonly seen in patients with heart failure, stroke, and chronic narcotic use.

 

Why is increased awareness of sleep apnea important?

Over 80 percent of the population remains undiagnosed. Symptoms include excessive daytime sleepiness, concentration difficulties, insomnia, morning headaches, morning dry mouth, nocturia, mood changes, deceased sexual desire, and changes in cognitive function. Untreated SA may increase the risk of: heart attack, high blood pressure, heart failure, irregular heartbeats, depression, obesity, stroke, diabetes, and accidents.

 

How is sleep apnea diagnosed?

A Sleep Specialist can diagnose SA using an in-lab polysomnogram (PSG) or a home sleep apnea test (HSAT).  A PSG, the gold standard for diagnosis, entails wearing sensors that provide detailed information on sleep stages, breathing effort, and blood oxygen abnormalities. HSAT screening cannot identify important sleep stages or objectively confirm if sleep is achieved.  HSAT’s can underestimate sleep apnea severity and demonstrate high false negative diagnostic rates.

 

How is sleep apnea treated?

The primary treatment for sleep apnea is positive airway pressure (PAP) therapy. The pressure from air flow keeps the airway open, reducing the severity and number of sleep apnea episodes.

Other treatments include oral appliance therapy (provided by a certified dentist) which protrudes the jaw forward and opens the airway.

Surgical options include: Uvulopalatopharyngoplasty (removing tonsils, adenoids, and remodeling soft tissue), Maxillomandibular Advancement (moving the upper and lower jaws forward), and Hypoglossal Nerve Stimulation (implanting of a sensor that stimulates the nerve in the tongue to move it forward when obstructions occur).

Proper diagnosis and treatment for sleep disorders requires a multidisciplinary approach encompassing cardiology, pulmonology, neurology, otolaryngology, dentistry, and psychiatry.


Dr. Kunal Agarwal is board certified in Sleep Medicine and oversees pediatric and adult sleep patients. The Nanticoke Sleep Disorder Centers provides patients with readily available access to proper diagnosis and management of common sleep disorders. Accreditation by the American Academy of Sleep Medicine ensures highly qualified care, which is recognized on the national level. The Nanticoke Sleep Disorder Centers are directed by Kunal Agarwal, MD. 

Office location • 100 Rawlins Drive, Seaford, Delaware. 
Center Locations

  • 801 Middleford Road, Seaford, Delaware
  • 26744 John J. Williams Hwy, Suite 7, Millsboro, DE

Kunal Agarwal, MD
2017-2018 Delaware Today Top Docs

Dr. Agarwal received his Bachelor of Arts in Neuroscience from Johns Hopkins University in Baltimore, Maryland and his Doctor of Medicine from Ross University School of Medicine in Portsmouth, Dominica. He completed his residency in Family Medicine at Western Michigan University School of Medicine in Kalamazoo, Michigan and a fellowship in Sleep Medicine at Henry Ford Hospital in Detroit, Michigan.

Dr. Agarwal serves as the Medical Director of the Nanticoke Sleep Disorders Center, where he is available to see adult and pediatric sleep patients at both locations in Seaford and Millsboro.

To learn more, visit www.nanticoke.org/sleep.

­­­­­­­­­­­­­­­­­­­­­­­Affiliated with Health Services – Nanticoke Memorial Hospital, Provider in the Nanticoke Physician Network
100 Rawlins Drive, Seaford DE 19973 • 302-990-3300

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