Sleep Apnea

  • Approximately 30 million Americans are victims of a sleep disorder called sleep apnea.
  • Many millions more are pre-disposed and have a high risk of developing the illness.
  • “Apnea” is a Greek word meaning “without breath”.
  • Those with apnea literally stop breathing in their sleep often hundreds of times during the night.

How does it Occur?

  • During normal sleep, throat muscles relax.
  • If the throat is crowded due to obesity, the airway collapses during sleep. Airflow stops and
    the blood oxygen level drops, which causes the brain to wake up.
  • If you have sleep apnea, this cycle may repeat hundreds of times during the night while you
    have no idea it is happening.

What are the Common Symptoms?

Man Sleeping

  • Fatigue and Tiredness During the Day.
  • Loud snoring.
  • Waking up with choking or gasping.
  • Not feeling rested in the morning or satisfied with a night’s sleep.
  • A strong desire to take a daily afternoon nap.
  • Unexplained accidents or errors.

Other Common Features are:

  • Obesity
  • Small jaw, thick neck.
  • High blood pressure.
  • Restless sleep; the repeated struggle to breathe can be associated with a great deal of movement.
  • Depressed mood and/or irritability.
  • Reduced sex drive and impotence.
  • Snorting, gasping, choking during sleep.

How Serious is it?

  • Sleep apnea is a potentially life-threatening condition.
  • Undiagnosed severe sleep apnea can cause irregular heartbeats, unstable high blood pressure,
    leg swelling, heart attack, stroke, cardiac arrest during sleep, or a harmful accident.
  • Increased daytime sleepiness poses a serious risk of automobile accidents, impaired functioning
    in the workplace and in personal relationships.
  • Untreated sleep apnea tends to progressively worsen and can cause partial or complete disability and death.

How is it Diagnosed?

  • An overnight sleep study, called polysomnography, is usually done to diagnose sleep apnea.
  • The sleep study measures your heart rate, brain waves, chest movement, air flow and blood oxygen levels while you sleep.
  • Other sleep disorders that cause unrestful sleep may be detected with a sleep study as well.
  • The test involves no pain and is covered by insurance.

Non-Surgical Treatment of Sleep Apnea

Continuous Positive Airway Pressure
The most common nonsurgical treatment for sleep apnea is Continuous Positive Airway Pressure or CPAP, which is applied through a nasal or facial mask worn while the patient is sleeping. It creates a flow of air pressure when the patient inhales that is strong enough to keep air passages open. Once the otolaryngologist determines that CPAP is the right treatment, CPAP should be used on a nightly basis.

What Are the Advantages of CPAP?
CPAP is an effective means of treating sleep apnea and snoring. It keeps airway passages open which prevents pauses in breathing and helps patients get better sleep. This, in turn, reduces daytime sleepiness, fatigue and other sleep apnea-related health problems such as high blood pressure, heart disease, diabetes, and stroke.

What Are the Disadvantages Of CPAP?
The CPAP device needs to be used every night. Some patients complain of mask discomfort, nasal congestion, and nose and throat dryness when using CPAP. Others find the device to be too constrictive and cumbersome, particularly when traveling. Unfortunately, these complaints sometimes lead to inconsistent use or abandonment of the device altogether

What Are the Alternative Treatments For Sleep Apnea?

Lifestyle change including weight loss and exercise can help to improve sleep apnea and its related health problems. Sleep positioning and oral appliances have also been found to be effective. In cases when non-invasive treatments fail, a surgical solution might be necessary. These alternative methods also provide the same benefits as CPAP, such as reduction in daytime sleepiness and fatigue, high blood pressure, heart disease, diabetes and stroke. Your otolaryngologist will be able to advise you on the treatment options.

Oral Appliance
Oral appliances are one of the treatment options for snoring and obstructive sleep apnea (OSA). These devices are similar to mouth guards or orthodontic retainers that are worn in the mouth during sleep. They are designed to prevent soft tissue in the airway from collapsing and causing obstruction. Oral appliances work by repositioning the lower jaw to a more forward position and/or pulling the tongue forward. These appliances can be used alone or in combination with Continuous Positive Airway Pressure (CPAP) or surgery.
These appliances are less cumbersome than CPAP and patients are typically more compliant with use. However, they can cause problems with excessive salivation, dry mouth and temporomandibular joint disorder.

In Office Tongue Base Reduction
The most up-to-date office treatment for obstructive sleep apnea (OSA) is in-office submucosal radiofrequency ablation of the tongue base. This is a technique in which plasma energy (which treats the tissue with lower heat intensity than lasers and electrocautery) is delivered to the base of the tongue. This is done in the office under local anesthesia. Patients may experience a mild to moderate sore throat and resume normal activities within a day. Multiple treatments are necessary to achieve optimal results.

Research studies have shown that this technique is effective in treating mild, moderate and severe obstructive sleep apnea. Studies have also shown that this treatment is equally as effective as continuous positive airway pressure (CPAP). The advantage of this treatment is that there is no need for lifelong use of a CPAP machine.

Surgical Treatments

Nasal Surgery
Increased nasal congestion has been shown to cause or contribute to snoring, disrupted sleep, and even sleep apnea. It is also a leading cause of failure of medical treatments for OSA, such as CPAP or an oral appliance. Nasal obstruction may result from many causes including allergies, polyps, deviated septum, enlarged adenoids, and enlarged turbinates. Medical treatment options, such as a nasal steroid spray or allergy management, may be helpful in some patients. Structural problems, such as a deviated septum, often benefit from surgical treatment. One surgical option, known as radiofrequency turbinate reduction (RFTR), can be performed in the office under local anesthesia. RFTR uses radiofrequency to shrink swollen tissues in each side of the nose. Some patients may require nasal surgery to straighten the septum, shrink turbinates or remove polyps.

Tonsillectomy and Adenoidectomy
The tonsils and adenoids may be the sole cause of snoring and sleep apnea in some patients, particularly children. In children, and in select adults, with OSA and enlarged tonsils/adenoids, tonsillectomy/adenoidectomy alone can provide excellent resolution of snoring, sleep apnea, and associated symptoms.

Uvulopalatopharyngoplasty (UPPP)
In many patients with OSA, airway narrowing and collapse occur in the area of the soft palate (back part of the roof of the mouth), tonsils, and uvula. In this case, patients may benefit from uvulopalatopharyngoplasty (UPPP). This is a surgery that is aimed at preventing collapse of the tissues at the back of the upper throat. UPPP is most successful in patients who have large tonsils, a long uvula (the most posterior, central part of the palate that hangs down in the back of the throat), or a long, wide palate. A UPPP operation is performed under general anesthesia (the patient is completely asleep). The tonsils and uvula are removed and the palate is trimmed. UPPP usually requires an overnight stay in the hospital to monitor breathing. Many patients return to school/work in approximately one week and return to normal diet and activity at two weeks. Throat discomfort, particularly with swallowing, is common in the first two weeks and usually managed with medications for pain and inflammation.

Hyoid Suspension
The hyoid bone helps support the larynx (voice box) and tongue in the neck. It is located below the jaw, but above the laryngeal cartilages. It is not directly attached to any other bones, but rather is attached to muscles above and below. These strap muscles are important for swallowing. In general, the hyoid bone is sutured up closer to the mandible. This pulls the tongue forward and up. This is usually performed with other surgical procedures such as UPPP or genioglossus advancement. Like other surgical procedures for obstructive sleep apnea, hyoid suspension has a good success rate when performed in an appropriately selected patient.

Tracheostomy
A tracheostomy is a procedure that bypasses the narrowed upper airway. The trachea (commonly referred to as the “windpipe”) connects the larynx (voice box) to the lungs. It can be felt in the lowest part of the neck in most people. If the obstruction to airflow is occurring above the larynx, a tracheostomy can be inserted to channel airflow directly into the trachea. The tracheostomy tube is passed through the skin of the lower neck directly into the trachea. This surgery is performed under general anesthesia and requires admission to the hospital. Tracheostomy generally is reserved for morbidly obese patients with severe obstructive sleep apnea who are not candidates for other treatments. Patients with tracheostomies can speak and eat normally.

A tracheostomy can be a temporary procedure, and is kept in place only as long as it is needed. It is easy to remove the tube, and the body will usually heal the skin and close the opening rather quickly. Tracheostomy has close to a 100% rate of cure for obstructive sleep apnea because it bypasses the problem in the upper airway. Studies have shown improvements in sleepiness, hypertension, and cardiac risks following tracheostomy.

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