Sleep Apnea
Obstructive sleep apnea (OSA) is a common condition. It can have a severe effect on your health and lifestyle. Loud, frequent snoring is one of the most common signs of this problem. OSA often can cause excessive daytime sleepiness but can also harm both your performance at work and your quality of life. OSA has been linked to a number of medical conditions, including high blood pressure, stroke, heart attack, atrial fibrillation, gastroesophogeal reflux (GERD), diabetes, and glaucoma to name a few. Problems with controlling weight, mood and memory problems, as well as diminished libido and erectile dysfunction are also common symptoms associated with OSA.
OSA involves the partial or complete collapse of the airway during sleep. It can occur up to hundreds of times in one night. As you sleep muscles in the throat can start to relax which makes it more likely for the airway to collapse. A large neck or a retrusive jaw or large tonsils in children can all predispose someone to develop OSA. With the airway blocked, air cannot reach the lungs, and oxygen levels drop. Your brain slightly wakes up your body to restore your breathing. These brief, repeated arousals cause your sleep to be unrefreshing and puts stress on your heart and other organs. Proper diagnosis and treatment can prevent or reverse the serious effects of OSA.
LIFESTYLE CHANGES
Some behaviors or habits can make OSA worse. For some people, certain changes in behavior can reduce or end sleep apnea. Talk with your sleep specialist or another qualified healthcare professional. See if one of these options might work for you.
LOSING WEIGHT AND EXERCISING REGULARLY
Weight loss may be the most helpful treatment for overweight people who suffer from OSA. Consult your doctor before trying to lost weight. He or she can make sure that your weight loss program is both safe and effective. Your program should combine a healthy diet with regular exercise. A doctor should confirm that you no longer have OSA once you reach your desired weight. Then it is important to maintain that weight. Otherwise, snoring and breathing problems are likely to return when you gain weight again.
QUITTING SMOKING
Smoking irritates your mouth and throat. Recent evidence suggests that this might make snoring and sleep apnea worse. So “kicking the habit” may reduce snoring and sleep apnea problems during sleep. Talk with your doctor to find a safe and effective way to quit smoking.
AVOIDING ALCOHOL AND SEDATIVES
Even one glass of wine just before bed can worsen your snoring and sleep apnea. You should avoid drinking alcohol for at least four hours before bed. Alcohol and sedative medications can cause the muscles in your throat to relax more than usual. This can cause sleep apnea to occur. Alcohol and sedative drugs also make it harder for the brain to “wake up”. This means that episodes of sleep apnea will last longer and will be more dangerous. These are some examples of sedative drug include certain sleeping pills, muscle relaxants, anti-anxiety drugs, and narcotics.
SLEEPING ON YOUR SIDE OR STOMACH
Sleeping on your back allows gravity to pull on the soft tissues at the back of your throat and neck. This causes the airway to narrow or collapse completely. Sleeping on your side or stomach might improve your breathing. This change in behavior is called “sleep-position training.” Older techniques such as sewing tennis balls into the back of your pajamas or new strategies such as the SONA pillow can be effective for patients' whose prominent problem is apnea only while they are on thier back.
MEDICAL THERAPY:
POSITIVE AIRWAY PRESSURE DEVICES
Positive airway pressure (PAP) is the standard method of treating moderate to severe OSA. It keeps the airway open by providing a steady stream of air through a mask that you wear as you sleep. PAP machines work by pumping room air through a mask that you wear as you sleep. Masks either fit over the nose or over the nose and mouth. The mask is held in place with straps. Your sleep specialist determines the right level of air pressure for you during an overnight sleep study. This takes place in a sleep disorders center or laboratory.
Some people prefer using nasal pillows instead of a traditional mask. These are soft pieces of plastic that are placed directly into the nostrils. A nasal pillows system covers less of your face and may give you more freedom in your choice of sleeping positions. Several brands of PAP devices are available. Your sleep specialist can recommend for you the best combination of mask and PAP model. Most people do well with PAP therapy. Others may experience dryness in the nose or feelings of claustrophobia. You can overcome these problems with a few adjustments.
Some PAP models come with a humidifier. Others give you the option of connecting a humidifier to it. You may also be able to overcome nasal dryness by using a saline nasal spray. This solution is simply a mixture of salt and water. Taking a nasal decongestant or using a chin strap can also reduce nasal symptoms. A few people have feelings of claustrophobia from PAP treatment. This can be corrected by relaxation techniques. You can also try using a mask that covers less of the face. There are other methods to cope with this problem. Your sleep specialist can help you overcome these feelings.
ORAL APPLIANCES
These devices look much like sports mouth guards. They keep the airway open by holding the tongue or jaw forward. This can be effective for people who have mild to moderate OSA. A licensed dentist who is trained in dental sleep medicine can custom fit the oral appliance. This will give you the best results. Tongue-retaining devices—These devices create a slight suction that holds the tongue forward. This keeps the tongue from falling back into the throat and blocking the airway. Jaw-advancement devices—These appliances are made to fit the top and bottom teeth in a way that pulls the lower jaw slightly forward.
SURGERY
An operation may be an option if there is a physical cause for your OSA that surgery can correct. You may also want to consider surgery if more conservative treatments fail to control your sleep apnea. Make sure you have a realistic understanding of the expected success rate for any surgery you consider. Your sleep specialist should also inform you of all possible risks and side effects. An operation can be an effective treatment for some people. But it is not the right choice for everyone.
NASAL OPERATIONS
Nasal surgery removes blockages in the nose. It can also repair a deviated septum. The septum is the bony divider between the two nostrils. A bent septum can block the flow of air through your nose. These operations may be one part of an overall plan to treat sleep apnea. They tend to be used along with other forms of treatment or other operations. Nasal surgery by itself rarely cures OSA.
LASER-ASSISTED UVULOPALATOPLASTY (LAUP)
This procedure is used mainly for the treatment of snoring. The surgeon uses a laser to remove part of the soft palate and uvula. The uvula is the soft lump of tissue that hangs down in the back of the throat. The surgery takes place during several sessions in a doctor’s office. This technique may be helpful for snoring. You need to be aware that it rarely succeeds in treating OSA.
UVULOPALATOPHARYNOGOPLASTY (UPPP)
This operation involves removing the uvula, the tonsils, and part of the soft palate. It is helpful for about 50% of people who undergo the operation. But not all of them are cured. Side effects may include throat pain, nasal speech, and liquid backing up into the nose when swallowing.
INFERIOR SAGITAL MANDIBULAR OSTEOTOMY (ISO) & GENIOHYIOD ADVANCEMENT (GA) WITH HYOID MYOTOMY
The ISO and GAHM are surgeries that involve cutting the bones of the face. They are more aggressive procedures to enlarge the airway. They target the lower part of the airway that collapses. The goal is to enlarge the opening as much as possible. The effectiveness of these operations can depend on a person’s weight and bone structure. Your surgeon should consult with your sleep specialist before operating.
MAXILLOMANDIBULAR ADVANCEMENT(MMO)
This surgery involves cutting the upper and lower bones of the jaws. This moves them both forward. General anesthesia is used for the operation. The surgery requires a hospital stay of a few days. After the operation, the jaw is wired shut to hold it in and weight loss often results. Once the wires are removed, you may need orthodontic work to realign the teeth so they fit together properly. This treatment is time-consuming and expensive, but its results are positive for many people. It works best for people who are born with a jaw that is either smaller than normal or that is set too far back.
SOMNOPLASTY
This procedure uses radio frequency energy waves, or microwaves. It enlarges the airway by shrinking upper airway tissues. A prove is placed into the airway tissues to deliver the energy. Somnoplasty can reduce snoring and may improve sleep apnea. Studies have not yet determined which people may benefit from this procedure. You should talk with a sleep medicine specialist to see if it might help you.
LASER MIDLINE GLOSSECTOMY (LMG) & LINGULPLASTY
These operations are rarely used. They enlarge the airway by removing a portion of the back half of the tongue.
TRACHEOSTOMY
This surgery is rarely used to treat sleep apnea. It is performed only in severe cases of OSA when all other options have failed. It involves the creation of a small surgical opening in the throat. The opening is located in the windpipe below the larynx. The tracheostomy bypasses any obstructions in the throat. This allows air to flow freely into the lungs while you are sleeping. The opening is covered during the day and normal breathing and speech resume.
MEDICATIONS & ALTERNATIVE TREATMENTS
Using only medications to treat snoring and OSA has limited benefits. They may be most useful for treating mild sleep apnea. They may also be one part of an overall treatment program. Research is currently looking at weight loss regimens that could improve sleep apnea.
NASAL SPRAYS
Over the counter nasal sprays that help clear the nasal passages can be habit forming. They should be used for only a few days. Prescription anti-allergy nasal sprays might improve OSA by helping to unblock the nose. You should be aware that it takes days or weeks for the spray to work. By themselves, nasal sprays do not fully control OSA. Nasal sprays tend to be ineffective if there is a permanent nasal blockage. This may be caused by a deviated septum or other abnormality.
DECONGESTANTS
Oral medications to relieve nasal congestion may help you breathe better through your nose. But they area rarely a successful treatment for sleep apnea. They also can make it hard for you to fall asleep and stay asleep.
OXYGEN
This treatment can help correct the low oxygen levels in the blood that sleep apnea causes. But oxygen treatment rarely prevents sleep apnea from occurring. It is sometimes used along with PAP therapy.
ALERTNESS PROMOTING MEDICATIONS
Modafinil is a medicine that stimulates the brain to help you stay awake. It is used to treat some causes of excessive daytime sleepiness. Some people with OSA may remain sleepy during the day even if their PAP treatment is successful. If there is no other identifiable cause for this sleepiness, then taking modifinil is an option to improve alertness. Some people with OSA have mild elevations in their blood pressure when taking modafinil. It is important to monitor you blood pressure while you are taking the medication.
FOLLOW- CARE
A sleep specialist can help you achieve long-term success with your OSA treatment. This will improve your health and overall quality of life. It is important for you to have regular follow-up appointments with your sleep doctor. This will allow him or her to confirm the ongoing success of your treatment. OSA may become either more severe or milder as you age. A change in your weight can also affect your sleep apnea. Even if surgery has corrected OSA, the problem may return later. Snoring or struggling with daytime sleepiness again may indicate that your sleep apnea has returned. If you are using PAP to treat your OSA, then your first follow-up appointment should be shortly after you start using PAP at home. This will help ensure that you get off to a good start. Ongoing follow-up will then help you maintain this success.
