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What is sleep apnea?
- Sleep apnea occurs when your breathing is disrupted during sleep.
- There are two main problems associated with it.
- The loss of sleep causes you to have diminished brain function.
- Secondly, when sleep apnea is not treated, it is one of the promoters of heart disease. People who have untreated sleep apnea have much more hypertension, heart attacks, and strokes that are preventable if sleep apnea is taken care of early in life.
What are the symptoms?
- Pauses in breathing
- Broken sleep and fatigue
Treatment Options Include:
Continuous Positive Air Pressure
CPAP uses gentle air pressure to hold the airway open. CPAP is often the most effective treatment for sleep apnea and severe snoring.
The more weight lost, often the less severe the sleep apnea. Obese patients should use PAP while losing weight. This will actually help by improving metabolism, alertness and energy. Weight loss is sufficient when a sleep study finds the patient no longer has sleep apnea. A return of snoring or drowsiness requires a re-evaluation by the sleep specialist.
Positional Therapy means avoiding sleeping on the back. Sleepers change position many times during sleep, so attach a tennis ball to the back of the night-clothes to discourage back-sleeping. Hip and shoulder problems may rule out this approach.
Mandibular Advancement Devices (MADs)
Mandibular Advancement Devices are oral appliances that resemble sports guards. They hold the lower jaw forward, expanding the airway. Non-obese patients with mild/moderate apnea whose apnea occurs mostly sleeping on their back will have the best results. MADs are custom fit by dentists. Ask your sleep center to suggest an experienced dentist. Insurance may cover the cost.
Provent consists of a pair of small plastic valves that attach with adhesive to the nasal openings. They restrict air flow during exhalation, increasing air pressure inside the upper airway and holding the airway open.
Before deciding on surgery, ask your healthcare provider to help you weigh the potential benefit versus risk. (Anesthetic can be risky for sleep apnea patients.) Surgery to treat sleep apnea may combine two or more procedures. The results may not be curative or permanent. After surgery, a sleep study must verify that sleep apnea is gone.
Patients with significant nasal obstruction may need nasal surgery in order to use a PAP or MAD device successfully.
The most common treatment in children, and may be part of a surgical approach for adults.
Uvulopalatopharyngoplasty involves removing by scalpel the uvula and excess tissue in the airway. Postoperative pain is very significant. Complications can include problems swallowing.
Palatal Stiffening Procedures (Somnoplasty,LAUP, CAPSO, Pillar)
These techniques may reduce snoring but none of them alone is recommended to treat sleep apnea. They use various energy sources or implants to scar and/or stiffen the soft palate. Usually they are an outpatient procedure with local anesthetic. Several sessions may be required. Tongue Base Reduction has been done by both scalpel and somnoplasty.
Suture Suspension of Tongue (Repose)
Prevents the base of the tongue from dropping backward during sleep. A polypropylene thread passes through the tongue base and attaches to a screw in the base of the lower jaw. Effectiveness for the treatment of sleep apnea is not yet established.
Moves both the upper and the lower jaws, thereby bringing the tongue forward, enlarging the space for the airway. When done by an experienced surgeon this is the most effective surgical treatment for obstructive sleep apnea. Dental work may also be required, to realign the bite.
Weight loss in morbidly obese patients with obstructive sleep apnea can be effective provided it is sufficient and permanent. PAP is required until weight loss is complete. Sleep apnea may return in future, even if weight gain does not occur.