What is Sleep Apnea?

Effects

This roller coaster sleep pattern leads to a loss of energy, concentration, productivity and an inability to stay awake during less active tasks like reading, watching television and driving. In serious cases, the continuous oxygen deprivation caused by sleep apnea can lead to high blood pressure, heart attacks, strokes and even sudden death. There may be a genetic component to this disorder as it often occurs within families.

What can be done to treat sleep apnea? In less severe cases, weight loss and a reduction in alcohol and other sedative use before bedtime has been a very successful remedy. Sleep experts also recommend that most people with sleep apnea should not sleep on their backs. Sometimes sewing a tennis ball into the back of a nightshirt or use of a backpack filled with foam rubber can eliminate back sleeping. In more serious cases continuous positive airway pressure (CPAP) machines blow air through a mask into the body during sleep. Although this treatment helps most people, some cannot tolerate this method and may benefit from oral devices that change the position of mouth structures during sleep.

Seeking treatment for sleep apnea usually involves visiting a sleep laboratory where heart, blood oxygen levels and other vital signs are monitored by professionals. For more information on sleep apnea and resources, you can write the National Sleep Foundation, 1367 Connecticut Avenue, NW, Washington, D.C. 20036.

Is It Sleep Apnea?

For many sleep apnea patients, their spouses are the first ones to suspect that something is wrong. It’s usually noticed from their heavy snoring and apparent struggle to breathe. Co-workers or friends of the sleep apnea victim may notice that the individual falls asleep during the day at inappropriate times (such as while driving a car, working or talking). The patient often does not know he or she has a problem and may not believe it when told. It is important that the person see a doctor for evaluation of the sleep problem.

How Is It Diagnosed?

Primary care physicians, pulmonologists, neurologists or other physicians with specialty training in sleep disorders may be involved in make a definitive diagnosis and in initiating treatment. Diagnosis of sleep apnea is not simple as there can be many different reasons for disturbed sleep. Several tests are available for evaluating a person for sleep apnea.

Polysomnography is a test that records a variety of body functions during sleep, such as the electrical activity of the brain, eye movement, muscle activity, heart rate, respiratory effort, air flow and blood oxygen levels. These tests are used both to diagnose sleep apnea and to determine its severity.

The multiple sleep latency test (MSLT) measures the speed of falling asleep. In this test, patients are given several opportunities to fall asleep during the course of a day when they would normally be awake. Time to fall asleep is measured at each opportunity. People without sleep problems usually take an average of 10 to 20 minutes to fall asleep. Individuals who fall asleep in less than 5 minutes are likely to require some treatment for sleep disorders. MSLT may be useful to measure the degree of excessive daytime sleepiness and to rule out other types of sleep disorders.

Diagnostic tests usually are performed in a sleep center, but new technology may allow some sleep studies to be conducted in the patient’s home.

Treatment Options

The specific therapy for sleep apnea is tailored to the individual patient based on medical history, physical examination and the results of polysomnography. Medications are generally not effective in the treatment of sleep apnea. Oxygen administration may safely benefit certain patients, but does not eliminate sleep apnea or prevent daytime sleepiness; therefore, the role of oxygen in the treatment of sleep apnea is controversial and it is difficult to predict which patient will respond well. It is important that the effectiveness of the selected treatment be verified. This is usually accomplished by polysomnography.

Behavioral Therapy

Behavioral changes are an important part of the treatment program and in mild cases behavioral therapy may be all that is needed. The individual should avoid the use of alcohol, tobacco and sleeping pills which makes the airway more likely to collapse during sleep and prolong the periods of disrupted breathing. Overweight people can benefit from losing weight. Even a 10% reduction in body wieght can cut the AHI in half. Breathing pauses for some patients with mild sleep apnea only when they sleep on their backs. In such cases, using pillows and other devices that help them sleep on their sides is often helpful.

Physical or Mechanical Therapy

Nasal continuous positive airway pressure (PAP) is the most effective treatment for sleep apnea. In this procedure, the patient wears a mask over the nose during sleep and pressure from an air blower forces air through the nasal passages. The air pressure is adjusted so that it is just enough to prevent the throat from collapsing during sleep. The pressure is constant and continuous. Nasal (PAP) prevents airway closure while in use, but apnea episodes return when (PAP) is stopped or used improperly.

Variations of the (CPAP) device attempt to minimize side effects that sometimes occur, such as nasal irritation and drying, facial skin irritation, abdominal bloating, mask leaks, sore eyes and headaches. Some versions of (CPAP) vary the pressure to coincide with the person’s breathing pattern, and others start with low pressure slowly increasing it to allow the person to fall asleep before the full prescribed pressure is applied.

Dental appliances that reposition the lower jaw and the tongue have been very helpful to some patients with mild to moderate sleep apnea or who snore but do not have apnea. A specially trained dentist is the best provider to fit the patient with such a device.

Surgery

Some patients with sleep apnea may need surgery. Although, several surgical procedures are used to increase the size of the airway, none of them is completely successful or without risks. More than one procedure may need to be tried before the patient realizes any benefits.

Some of the more common procedures include removal of adenoids and tonsils (especially in children), nasal polyps or other growths, or other tissue in the airway and correction of structural deformities. Younger patients seem to benefit from these surgical procedures more than older patients.

Uvulopalatopharyngoplasty (UPPP) is a procedure used to remove excess tissue at the back of the throat (tonsils, uvula and part of the soft palate). The success of this technique is less than 30 percent. The long-term side effects and benefits are not known and it is difficult to predict which patients will do well with this procedure.

Laser-assisted uvulopalatoplasty (LAUP) is done to eliminate snoring, but has not been shown to be effective in treating sleep apnea. This procedure involves using a laser device to eliminate tissue in the back of the throat. Like UPPP, LAUP may decrease or eliminate snoring but not sleep apnea itself. Elimination of snoring, the primary symptom of sleep apnea, without influencing the condition may carry the risk of delaying the diagnosis and possible treatment of sleep apnea in patients who elect LAUP. To identify possible underlying sleep apnea, sleep studies are usually required before LAUP is performed.

Tracheostomy is used in people with severe life threatening sleep apnea. In this procedure, a small hole is made in the windpipe and a tube is inserted into the opening. This tube stays closed during waking hours and the person breathes and speaks normally. It is opened for sleep so that air flows directly into the lungs by-passing any upper airway obstruction. This procedure is highly effective and is an extreme measure that is poorly tolerated by patients and rarely used.

Other procedures: When sleep apnea is due to jaw deformities, patients may benefit from surgical reconstruction. Also, surgical procedures to treat obesity are sometimes recommended for sleep apnea patients who are morbidly obese. For more information on surgical options for adults, see www.sleepapneasurgery.com.

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