Obstructive Sleep Apnea
Sleep apnea is a form of Sleep Disordered Breathing. It is a very common disorder where you have one or more pauses in breathing or shallow breaths while you sleep which causes your oxygen level to decrease. Sleep apnea is one of the leading causes of excessive daytime sleepiness or fatigue and can occur 5 to 30 times or more an hour. Pauses in breathing can last from just a few seconds to several minutes and depending on the frequency and the duration of the apnea events, may be a precursor to heart attack and stroke due to a decrease in oxygen level (below 88%). Normally, breathing will start again with a choking sound or a loud snort. It is not uncommon however, to have no signs or symptoms of Sleep Disordered Breathing.
Major Signs and Symptoms of Obstructive Sleep Apnea (OSA)
Most people with obstructive sleep apnea don’t know their breathing starts and stops during the night. Look for these signs and symptoms:
- Choking, snorting, snoring, grunting or gasping during sleep
- Long pauses in breathing
- Daytime sleepiness or fatigue
- Throat weakness or hoarseness
Other symptoms may include:
- Waking up with a dry mouth or sore throat
- Morning headaches
- Restless or fitful sleep
- Going to the bathroom frequently during the night
- Waking up feeling out of breath
- Forgetfulness and difficulty concentrating
Activity Modification to Treat Obstructive Sleep Apnea
In mild cases of sleep apnea, activity modification may be all that is needed to get a restful night’s sleep. These methods may include:
- Losing weight (though not all patients with Sleep Disordered Breathing are overweight)
- Avoiding alcohol and sleeping pills including those over the counter
- Changing sleep positions to promote regular breathing. Avoid sleeping on your back.
- Stop smoking. Smoking can increase the swelling in the upper airway which may worsen both snoring and apnea.
If additional treatment is required, there are several options. These include:
Continuous positive airway pressure (CPAP)
CPAP, or continuous positive airway pressure, is often the best treatment for obstructive sleep apnea and is considered the Gold Standard. The CPAP machine increases air pressure in your airway so that your airway doesn’t collapse when breathing. Treatment involves a CPAP machine, which sits at the side of your bed and is usually smaller than a tissue box. It has four main parts:
- An interface or other device that fits over your nose or your nose and mouth with soft straps that keep the mask in place while you’re wearing it. Nasal pillows are also an option and are good for folks that are claustrophobic.
- A tube that connects the mask or interface to the CPAP unit.
- A water chamber that humidifies the pressurized room air.
- The CPAP unit itself.
Automatic positive airway pressure (APAP or AutoPAP)
AutoPAP machines function much the same as a CPAP as it delivers pressurized room air, via a mask or interface, to keep your airways free of obstructions as you sleep. The air pressure delivered from the machine acts as a splint, keeping your throat from collapsing in on itself so that you can breathe freely through the night an acceptable number of apnea events. The pressure setting on an AutoCPAP self adjusts within parameters established by your sleep physician.
Bilevel positive airway pressure (BiPAP)
BiPAP provides two different levels of pressure into the airway. A higher level of pressure is delivered when you breath in (inspiration)and a lower level of pressure when you breath out (expiration), allowing you to breathe easily and regularly throughout the night.
An oral appliance may be used for patients that snore and have no obstructive sleep apnea or very mild Sleep Disordered Breathing. They work by jutting the lower part of the patient’s’ jaw forward. These appliances that are worn at night are usually fitted by a dentist that specializes in Oral Appliances for OSA and are usually not covered by insurance. Oral appliances are rarely effective for correcting Obstructive Sleep Apnea.
Surgery Options for Obstructive Sleep Apnea
When all conservative measures listed above have failed, surgery may be needed to correct sleep apnea. Several surgical procedures performed are:
In this surgical procedure, the base of the tongue is pulled forward to help increase the size of the airway due to a sleep breathing disorder or a physical deformity. During the procedure, a small incision is made in the lower jaw allowing the surgeon to place a device that will pull the tongue down and forward. This procedure helps to maximize airway airflow and longterm improvement of snoring and obstructive sleep apnea symptoms. This procedure is effective with success rates of about 50 percent.
This procedure anchors the hyoid bone in place to help reduce airway blockage that leads to obstructive sleep apnea. During this operation, the epiglottis and tongue base are moved forward, opening the breathing passageway. Using a small incision in the upper neck, two tendons on the upper part of the hyoid bone are detached and also some of the muscle on the lower surface, allowing the hyoid to be moved over the “Adam’s apple” and secured into position. The voice remains unaffected during this procedure and is usually completed in less than an hour. There is significant recovery time and it is not always effective in correcting Sleep Disordered Breathing.
This procedure is used to reduce or eliminate snoring. During the procedure, a topical anesthetic is used to numb the area at back of the throat. Once numb, a sclerosing agent is injected into the palate, which causes stiffening of the roof of the mouth, thus reducing the fluttering of the palate and reducing or eliminating snoring. The procedure involves little pain, virtually no recovery time and is considered very effective. This procedure does not correct Obstructive Sleep Apnea.
In this procedure, tissue of the uvula and soft palate are removed using very low levels of radiofrequency heat energy. As healing occurs, the tissue begins to shrink, creating more space in the breathing passageway and thereby reducing the symptoms of snoring.