Sleep Apnea
Sleep apnea is a serious condition that can affect a person's ability to safely perform normal daily activities and can affect long-term health. Approximately 25 percent of adults are at risk for sleep apnea of some degree. Normally during sleep, air moves through the throat and in and out of the lungs at a regular rhythm. In a person with sleep apnea, air movement is periodically diminished or stopped. There are two types of sleep apnea: obstructive sleep apnea and central sleep apnea. In obstructive sleep apnea, breathing is abnormal because of narrowing or closure of the throat.
In central sleep apnea, breathing is abnormal because of a change in the breathing control and rhythm. We will focus on the most common type of sleep apnea: obstructive sleep apnea.
How Sleep Apnea Occurs
The throat is surrounded by muscles that control the airway for speaking, swallowing, and breathing. During sleep, these muscles are less active, and this causes the throat to narrow. In most people, this narrowing does not affect breathing. In others, it can cause snoring, sometimes with reduced or completely blocked airflow. A completely blocked airway without airflow is called an obstructive apnea. Partial obstruction with diminished airflow is called a hypoapnea. A person may have apnea and hypoapnea during sleep. Insufficient breathing due to apnea or hypoapnea causes oxygen levels to fall and carbon dioxide to rise. Because the airway is blocked, breathing faster or harder does not help to improve oxygen levels until the airway is reopened. Typically, this requires the person to awaken to activate the upper airway muscles. If the person falls back to sleep quickly, he or she will not remember the event. Many people with sleep apnea are unaware of their abnormal breathing in sleep, and all patients underestimate how often their sleep is interrupted.
Sleep Apnea Causes
- Small upper airway
- Obesity
- Tonsil enlargement
Sleep Apnea Risk Factors
- Increasing age-greater in middle and older age adults
- Male sex-2 times greater in men
- Obesity
- Sedation from medication or alcohol
- Abnormality of the airway
Sleep Apnea Complications
Daytime sleepiness and difficulty concentrating, which can lead to increased risk of accidents and errors in daily activities.
Increased risk of cardiovascular problems such as high blood pressure, heart attack, abnormal heart rhythms, or stroke.
Sleep Apnea Diagnosis
A full sleep study is called a polysomnogram. The polysomnogram measures the breathing effort and airflow, blood oxygen level, heart rate and rhythm, duration of the various stages of sleep, body position, and movement of the arms/legs. We have a full sleep laboratory in our office, with trained sleep specialist to make your experience the most beneficial and comfortable as possible.
Sleep Apnea Treatment
The goal of treatment is to maintain an open airway during sleep. Effective treatment will eliminate the symptoms of sleep disturbance; long-term health consequences are also reduced. Most treatments require nightly use. The challenge for the physician and the patient is to select an effective therapy that is appropriate for the patient's problem and that is acceptable for long-term use.
Continuous positive airway pressure (CPAP) — The most effective treatment for sleep apnea uses a mechanical device to keep the upper airway open during sleep. A CPAP device uses an air-tight attachment to the nose, typically a mask, connected to a tube and a blower which generates the pressure. Devices that fit comfortably into the nasal opening, rather than over the nose, are also available. CPAP should be used any time the person sleeps (day or night).
Adjust sleep position — Adjusting sleep position (to stay off the back) may help improve sleep quality in people who have OSA when sleeping on the back. However, this is difficult to maintain throughout the night and is rarely an adequate solution.
Weight loss — Weight loss may be helpful for obese or overweight patients. Weight loss may be accomplished with dietary changes, exercise, and/or surgical treatment. However, it can be difficult to maintain weight loss; the five-year success of non-surgical weight loss is only 5 percent, meaning that 95 percent of people regain lost weight.
Avoid alcohol and other sedatives — Alcohol can worsen sleepiness, potentially increasing the risk of accidents or injury. People with OSA are often counseled to drink little to no alcohol, even during the daytime. Similarly, people who take anti-anxiety medications or sedatives to sleep should speak with their healthcare provider about the safety of these medications.
Dental devices — A dental device, called an oral appliance or mandibular advancement device, can reposition the jaw, bringing the tongue and soft palate forward as well. This may relieve obstruction in some people.
Surgical treatment — Surgery is generally reserved for patients who cannot tolerate or do not improve with non-surgical treatments such as CPAP or oral devices. Surgical procedures can reshape structures in the upper airways or surgically reposition the facial bones. Uvulopalatopharyngoplasty (UPPP) is one of the most commonly performed surgical procedures; it removes the uvula and excessive tissue in the throat, including the tonsils, if present. However, this surgery and other surgeries of the soft palate have a poor rate of success (less than 50 percent) and have a high rate of relapse. As a result, throat surgery is only recommended in a minority of patients and should be considered with caution.