Sleep Apnea Treatment
As American society seems to take pride in working more and more and sleeping less and less, the health damage of this line of thinking is starting to become clear. Sleep is necessary for our bodies to do all kinds of repair work while we’re asleep.
Of course, getting less sleep than you need by choice is one thing; not getting enough sleep due to sleep apnea is another. And it’s not only costing our patients in how much they are able to sleep, it may actually be killing them.
The team at ENT Faculty Practice has extensive experience diagnosing and treating sleep apnea, helping our patients get the good night’s sleep they need.
What is sleep apnea?
We often have patients come to us in our Westchester County offices thinking their snoring is sleep apnea. It is true that most people who suffer from sleep apnea do snore, but snoring involves only interference with the airway when sleeping. That interference creates the rasping sounds that are snoring.
Sleep apnea involves partial or complete blockage of the airway dozens of times through the course of the night. This forces the person to wake up to regain muscle control in the throat to reopen the airway. Typically, the person doesn’t become fully conscious after these episodes, but this constant cycle of lack of oxygen and forced awakening results in poor sleep quality. This leads to fatigue, sleepiness, inability to concentrate, depression, and even greater health risks.
Most people with sleep apnea have no idea this is what is going on at night. Sleep apnea is the most under diagnosed medical condition in the U.S. It affects 4 percent of middle-aged men and 2 percent of middle-aged women, yet only a fraction of those people receive sleep apnea treatment.
What are the symptoms of sleep apnea?
These are the common symptoms of sleep apnea:
- Loud snoring
- Abrupt awakenings from sleep
- Awakening with shortness of breath (central sleep apnea)
- Episodes of breathing cessation witnessed by another person
- Waking up with a headache in the morning
- Excessive daytime sleepiness
- Waking up with a dry mouth or sore throat
- Difficulty staying asleep
- Attention problems
What negative effects can sleep apnea have on the body?
We have patients who discount the seriousness of sleep apnea, thinking it’s just a little snoring. That’s a risky line of thinking. Untreated sleep apnea can lead to a number of very serious health concerns:
- High blood pressure — Because you wake up over and over during the night, this process places stress on your body, activating your hormone systems. This raises your blood pressure.
- Heart disease — People with obstructive sleep apnea are more likely to have heart attacks, strokes, and atrial fibrillation.
- Type 2 diabetes — Sleep apnea is common in people with type 2 diabetes. This is because when your body is tired it has trouble effectively processing insulin.
- Weight gain — Sleep apnea can make your body release more of the hormone ghrelin, which makes you crave carbs and sweets.
- Adult asthma — Adult asthma and sleep apnea combined tend to cause the patient to suffer from more asthma attacks.
- Car accidents — People with sleep apnea are up to five times more likely than normal sleepers to have traffic accidents, and to even fall asleep at the wheel.
What causes sleep apnea?
Unlike common snoring, where there is some degree of interference with the patient’s airflow when sleeping, sleep apnea involves more pronounced blockage. Snoring can be linked to temporary causes, such as congestion or excess drinking. Sleep apnea isn’t usually a passing thing. The blockage is what we address at ENT Faculty Practice.
Sleep apnea can have varied causes:
- Throat and tongue muscles that are abnormally relaxed
- Enlarged tonsils or adenoids
- Cardiovascular problems
- Nasal congestion
- Family history
The obstructive form of sleep apnea occurs when the muscles in the back of the throat relax. These muscles support all of the surrounding tissues such as the tonsils and the side walls of the throat. When the muscles relax, the airway narrows or closes. Your brain senses this inability to breath and briefly wakes you from sleep to reopen the airway. These lapses in sleep can be so brief you don’t even remember them. These actions can involve a snorting, choking, or gasping sound and can repeat the pattern up to 30 times per hour all night.
In central sleep apnea, your brain doesn’t tell your breathing muscles to do their job. Consequently, you make no effort to breathe for a short period of time. You then awaken with shortness of breath or have difficulty even falling asleep.
Are there different types of sleep apnea?
There are different types of sleep apnea, defined by the causes.
- Obstructive sleep apnea (OSA) — This is the more common form, occurring when muscles in the throat relax, blocking airflow.
- Central sleep apnea (CSA) — This is caused when the brain doesn’t send proper signals to the muscles that control breathing.
- Upper airway resistance syndrome (UARS) — This syndrome differs from OSA in that there aren’t pauses in breathing or decreases in breathing. Patients with UARS simply require greater effort in breathing to get past obstructions.
- Complex sleep apnea syndrome — This sleep apnea is categorized as a person having both OSA and CSA.
How is sleep apnea treated?
At ENT Faculty Practice, we start with conservative treatment options and progress from there. Lifestyle changes, such as losing weight, limiting alcohol consumption, or quitting smoking — those types of changes are the first treatment steps. From there, the next options are breathing systems such as CPAP or oral appliance therapy. Severe cases may require surgery as the patient is in danger of developing serious medical conditions such as high blood pressure and heart problems.
What is CPAP?
The most popular treatment for obstructive sleep apnea is called continuous positive airway pressure (CPAP). This is a breathing system that uses air pressure to keep the upper airway passages open. The patient wears a mask over his or her nose during sleep. The mask delivers air pressure that is somewhat greater than the air pressure in the bedroom. This difference in pressure keeps the airway passages open, preventing snoring and apnea.
What is oral appliance therapy?
Oral appliance therapy uses what is akin to a sports mouth guard or an orthodontic retainer. Worn only during sleep, the oral appliance supports the jaw in a forward position to help maintain an open upper airway. At ENT Faculty Practice, we have dozens of different options for custom-made appliances.
If a patient’s sleep apnea is moderate to severe and is impacting their quality of life adversely, surgery may be necessary to remove the blockage and improve the patient’s airflow. Surgery is usually an option if other sleep apnea treatments have failed to improve the patient’s symptoms. These are three surgeries that may be used.
- UPPP/Uvulopalatopharyngoplasty — This surgical procedure removes excess tissue in the throat, widening the airway. UPPP also seeks to improve the movement of the soft palate to help the airway remain open during sleep. We go into more detail about this surgical option below.
- Nasal Valve Reconstruction — The nasal valve forms the bridge between the bone of the upper nose and the nasal tip. Cartilage on each side of the nose may weaken and collapse on one or both sides when a person is breathing in. This is known as nasal valve collapse. Nasal valve reconstruction surgery corrects this problem and returns proper airflow.
- Septoplasty — The septum is the structure in the nose that separates the two nostrils. For some patients, their septum can become crooked or misaligned, making one nostril larger than the other. This can inhibit proper airway function. Septoplasty evens out both nostrils by repositioning the septum. This places both nostrils in the proper position and improves airflow.
Who is a candidate to have UPPP?
This procedure isn’t something to consider to simply correct snoring, as it involves some risks of damage to muscles in the throat. It should be as a last option, of sorts, for treating obstructive sleep apnea that is seriously impacting the patient’s health and overall life.
We may suggest UPPP if you:
- Have excess tissue in your nose, mouth, or throat that is blocking your airway
- If you cannot tolerate CPAP
- If you are not improving with CPAP
What are the benefits of UPPP?
When successful, UPPP opens the airway and stops the patient’s sleep apnea. It will invariably stop snoring, but the overall goal is larger than that.
What are the results with UPPP?
This surgery improves sleep apnea in roughly half of the people who have it. It is best suited for people with abnormalities in their soft palate. In some cases, the benefits of this procedure will wear off or slacken and the blockage returns.
How is UPPP done?
In UPPP, your ENT Faculty Practice surgeon removes soft tissue at the back of the throat to make the airway wider. This is generally what is removed:
- All or part of the uvula (the soft flap of tissue that hangs down at the back of the throat)
- Parts of the soft palate
- Tissue at the sides of the throat
- Tonsils and adenoids (if the patient still has them)
- If an enlarged tongue is a factor, a small part of it may be removed
What are the risks of UPPP?
In addition to the typical risks involved with any surgery, such as infection, excessive bleeding, blood clot formation, and poor wound healing, UPPP has specific risks for the patient:
- Problems swallowing (usually temporary)
- Problems keeping liquids from coming up through the nose when drinking (usually temporary)
- Speech problems
- Surgery may give the patient’s voice a nasal tone
- Changes in food taste
- Narrowing of the airway
Schedule a Consultation
Not only is it important to see a doctor to decide which kind of treatment you need, if any, but it is recommended for your sleep apnea condition. Contact our office today at (914) 693-7636 to schedule an appointment with one of our experienced doctors.