Sleep apnea is a condition that causes the throat's air passage to close repeatedly during sleep, stopping breathing and disrupting the normal stages of sleep. The results of Sleep Apnea can be serious illness or even death caused by lack of oxygen. Symptoms include snoring, daytime sleepiness, gasping for air at night, irritability, personality changes, depression, chronic fatigue, insomnia and morning headaches.

The best way to test and diagnose sleep apnea is through an overnight polysomnography or sleep study in our sleep diagnostic laboratories. The studies provide valuable information about how you breathe and sleep. This information enables your doctor to determine the type and severity of sleep apnea you may have and how it should be treated.

OBSTRUCTIVE SLEEP APNEA (OSA)

OSA causes people to struggle for breath because the passage in the back of the throat falls shut during sleep. This can cause loud snoring. Sleep apnea has been shown to contribute to:

  • Weight gain
  • High blood pressure
  • Heart disease
  • Stroke
  • Accidents caused by sleepiness

Treatments can generally be divided into three types:

1. Prosthetic Devices

CPAP/BIPAP - The most frequently used treatment for sleep apnea in this category is nasal continuous positive airway pressure, referred to as nasal CPAP. In this therapy, a prosthetic device consisting of an airflow generator, a flexible hose and a nasal mask is attached to you while you sleep. It uses room air, under pressure, to splint your airway passage open and prevents both snoring and obstruction of airflow in and out of the lungs. To obtain this device, one must sleep in a Sleep Center, under observation in order to determine the amount of pressure necessary to keep the airway freely open during sleep. It is available by prescription following the test.

Nasal CPAP has the following advantages:
  • Being able to eliminate both snoring & apnea
  • Being effective on almost all patients
  • Being available quickly
  • Being non-invasive
  • Being used in conjunction with weight loss
Nasal CPAP has the following disadvantages:
  • Being a nuisance
  • Providing symptomatic relief, but not a cure
  • Possibly causing nasal dryness or nasal irritation
  • Oral dental appliances. They re-position the upper and lower jaw relationship in an effort to bring the tongue forward and increase the posterior airway space.
  • A tongue retaining device. It moves the tongue forward independently and increases the posterior airway space.
  • Cervical collars or pillows. They have been reported to relieve sleep apnea, but there are no studies that validate this claim.

2. Surgical Intervention

Nasal surgery - This usually involves correction of a deviated septum, repair of a broken nose, reduction of turbinate bones which project from the sidewalls of the nasal passage and/or the removal of nasal polyps. In general, any chronic obstruction of the nasal passage is likely to worsen or induce obstructive sleep apnea.

Plastic surgery of the palate, uvula, and pharynx- This is referred to as uvulopalatopharyngoplasty. In this procedure, the soft palate and the associated uvula which is the dependent portion of this in the throat, is reduced in size. Any redundant tissue in the posterior pharyngeal wall is removed along with tonsils and/or adenoids.
Recommendations for either nasal or soft palate surgery should be obtained from an Ear-Nose-Throat (ENT) specialist, sometimes referred to as an Otorhinolaryngologist.

3. Other Surgical Procedures

Some patients have has their lower jaw surgically relocated, portions of the back of the tongue removed or other types of facial surgery. These surgeries remain experimental and are recommended only in unusual cases.

Tracheostomy: This is a very effective procedure, but is seldom used. An opening from the surface of the trachea is made just below the Adam's apple (larynx). It is closed during the day and opened at night to prevent apnea.

Lifestyle Changes

  • Weight reduction. Weight loss, in addition to providing other benefits, often reduces the severity of sleep apnea. The only way to determine if weight reduction is beneficial is to be tested for sleep apnea after ideal body weight is achieved.
  • Avoidance of alcohol and sleeping aids. These substances reduce the body's ability to arouse when the occlusion occurs. They also increase the likelihood of occlusion by further relaxing the throat muscles and lowering the threshold for airway collapse. Lastly, once the collapse occurs, these sedating compounds make it more difficult to correct the obstruction of the airway. This makes the associated changes both in terms of oxygen loss and carbon dioxide build up more severe and worsen the effects of the sleep apnea.
  • Avoidance of extreme fatigue, sleep deprivation and use of caffeine late in the day.

Who is at Risk For Developing Obstructive Sleep Apnea

A typical sleep apnea patient can be described as falling into a risk group characterized by predictive factors.

Loud Snoring

This is snoring which is socially objectionable and usually makes the bed partner unhappy. It is often punctuated by snorts and gasps. The snoring is made worse by fatigue, sleep deprivation, use of alcohol or hypnotic medications and weight gain.
Male Predominance

80 to 90% of sleep apnea patients are males. This would appear to be hormonally related. Injections of male hormone into males makes the condition worse or may induce sleep apnea in some cases. The taking of female hormones by men appears to lessen the symptoms of obstructive sleep apnea.
Age

Most sleep apnea patients are over the age of 35, however, sleep apnea may develop at any age, including infancy.

Weight Gain

  • With weight gain, snoring usually worsens and sleep apnea is also aggravated. This becomes a positive feedback loop. The more weight one gains, the worse the sleep apnea becomes. The worse the sleep apnea, the more you slow down and become inactive, which results in further weight gain.
  • Most sleep apnea patients have a neck size of 16½ inches or greater. Weight gain appears to be associated with deposits of fat inside the neck which press on the airway and further restrict the size of the airway passage.

Genetics

The tendency for snoring and sleep apnea is often inherited.

Alcohol and sleeping pills

Use of alcohol or sleeping pills can cause or worsen sleep apnea in a susceptible patient. If you snore, the drugs can induce or worsen sleep apnea.

Related Doctors