What is Sleep Apnea?
Obstructive Sleep Apnea (OSA) is a potentially life-threatening condition that requires medical attention. The risks of undiagnosed OSA include heart attack, stroke, irregular heartbeat, high blood pressure, heart disease and decreased libido. In addition, OSA causes daytime drowsiness that can result in accidents, lost productivity and interpersonal relationship problems. The symptoms may be mild, moderate or severe.
Sleep apnea is fairly common. 1 in 5 adults has at least mild sleep apnea and 1 in 15 adults has at least moderate sleep apnea. OSA also affects 1% to 3% of children. During sleep, the upper airway can be obstructed by excess tissue, large tonsils and/or a large tongue. Also contributing to the problem may be the airway muscles, which relax and collapse during sleep, nasal passages, and the position of the jaw.
The cessation of breathing, or “apnea,” brought about by these factors, initiates impulses from the brain to awaken the person just enough to restart the breathing process. This cycle repeats itself many times during the night and may result in sleep deprivation and a number of health-related problems. Sleep apnea is generally defined as the presence of more than 30 apneas during a seven hour sleep. In severe cases, periods of not breathing may last for as long as 60 to 90 seconds and may recur up to 500 times a night.
There are two main types of sleep apnea:
Obstructive sleep apnea, the more common form that occurs when throat muscles relax
Central sleep apnea, which occurs when your brain doesn’t send proper signals to the muscles that control breathing
How does the doctor determine if I have Obstructive Sleep Apnea?
A sleep test, called polysomnography is usually done to diagnose sleep apnea. There are two kinds of polysomnograms. An overnight polysomnography test involves monitoring brain waves, muscle tension, eye movement, respiration, oxygen level in the blood and audio monitoring. (for snoring, gasping, etc.) The second kind of polysomnography test is a home monitoring test. A Sleep Technologist hooks you up to all the electrodes and instructs you on how to record your sleep with a computerized polysomnograph that you take home and return in the morning. They are painless tests that are usually covered by insurance.
How is Sleep Apnea treated?
Mild Sleep Apnea is usually treated by some behavioral changes. Losing weight, sleeping on your side is often recommended. There are oral mouth devices (that help keep the airway open) on the market that may help to reduce snoring in three different ways. Some devices (1) bring the jaw forward or (2) elevate the soft palate or (3) retain the tongue (from falling back in the airway and blocking breathing). Sleep Apnea is a progressive condition (gets worse as you age) and should not be taken lightly. Dr. Mueller does not recommend the appliances that position the jaw forward, as these can lead to TMJ pain and problems.
Moderate to severe Sleep Apnea is usually treated with a C-PAP (continous positive airway pressure). C-PAP is a machine that blows air into your nose via a nose mask, keeping the airway open and unobstructed. For more severe apnea, there is a Bi-level (Bi-PAP) machine. The Bi-level machine is different in that it blows air at two different pressures. When a person inhales, the pressure is higher and in exhaling, the pressure is lower. Your sleep doctor will “prescribe” your pressure and a home healthcare company will set it up and provide training in its use and maintenance.
Symptoms of Obstructive Sleep Apnea:
- Snoring with pauses in breathing (apnea)
- Excessive daytime drowsiness
- Gasping or choking during sleep
- Restless sleep
- Problem with mental function
- Poor judgment/can’t focus
- Memory loss
- Quick to anger
- High blood pressure
- Nighttime chest pain
- Problem with excess weight
- Large neck (>17″ around in men, >16″ around in women)
- Airway crowding
- Morning headaches
- Reduced libido
- Frequent trips to the bathroom at night
If collapse occurs at the tongue base, a hyoid suspension may be indicated. The hyoid bone is a U-shaped bone in the neck located above the level of the thyroid cartilage (Adam’s apple) that has attachments to the muscles of the tongue as well as other muscles and soft tissues around the throat. The procedure secures the hyoid bone to the thyroid cartilage and helps to stabilize this region of the airway.
Genioglossus Advancement (GGA)
GGA was developed specifically to treat obstructive sleep apnea, and is designed to open the upper breathing passage. The procedure tightens the front tongue tendon; thereby, reducing the degree of tongue displacement into the throat. This operation is often performed in tandem with at least one other procedure such as the UPPP or hyoid suspension. GGA by itself, however, is largely ineffective.
Maxillomandibular Advancement (MMA)
MMA is a procedure that surgically moves the upper and lower jaws forward. As the bones are surgically advanced, the soft tissues of the tongue and palate are also moved forward, again opening the upper airway. For some individuals, the MMA is the only technique that can create the necessary air passageway to resolve their OSA condition. When indicated, Dr. Mueller has completely cured patients with severe sleep apnea and removed them completely from their CPAP machines.
What is UPPP? The uvulo refers to the uvula, that fleshy part hanging in the back of your throat, palato refers to the soft palate, and pharyngoplasty means plastic surgery of the pharynx (the pharynx is the joint opening of the esophagus and the windpipe). The uvula is removed along with excess tissue. This surgery is usually done for patients who can’t tolerate nasal CPAP. This surgery has mixed reviews, it helps in around 50% who have the surgery and in others it does not help at all or it helps only partially and the patient may still need to use the C-PAP machine due to scar tissue.
Laser Assisted UvuloPalatoplasty (LAUP)
There is also the Laser assisted uvulopalatoplasty (LAUP), is a surgical procedure to remove the uvula and surrounding tissue to open the airway behind the palate. This procedure has been used to relieve snoring. It has been used somewhat successfully in treating sleep apnea. Always make sure you have a doctor who has done the procedure many times and is preferably extremely knowledgeable about sleep apnea. Ask lots of questions and do your homework!
Radio Frequency (RF) Procedure or Somnoplasty
The newest surgical procedure for snoring and sleep apnea is called somnoplasty. The U.S. Food and Drug Administration has approved a treatment for snoring that uses radio waves to shrink tissue in air passages to eliminate snoring. The procedure is called radiofrequency volumetric tissue reduction of the palate.
A new treatment for sleep apnea, Radiofrequency Volumetric Reduction of the Tongue has been approved by the FDA.
The radiofrequency treatment involves piercing the tongue, throat or soft palate with a special needle (electrode) connected to a radio frequency generator. The inner tissue is then heated to 158 to 176 degrees, in a procedure that takes approximately half an hour. The inner tissues shrink, but the outer tissues, which may contain such things as taste buds, are left intact. Several treatments may be required. This is performed with IV anesthesia. Unfortunately, at this time the procedure is so new that insurance companies are not covering it yet. It is still seen as an experimental procedure.