CCENT offers diagnostic and treatment options for sleep disorders. Our physicians and staff are highly qualified and ready to assess your sleep concerns. Below is some information on Obstructive Sleep Apnea and Snoring. If you feel you are in need of a physician for your sleep concerns, please contact our office.
Obstructive sleep apnea, or OSA, is a serious condition affecting more than twelve million Americans. This condition is due to blockage of air flow through the throat while sleeping. OSA leads to decreased oxygen delivery to the body, termed oxygen desaturation.
If gone untreated, sleep apnea can cause:
DEFINITION OF OBSTRUCTIVE SLEEP APNEA
The term apnea describes a complete stop or pause in breathing, while hypopnea describes a slowdown in breathing. Apnea can be further defined as central or peripheral. In central apnea, the nervous system fails to adequately control breathing, thus leading to irregular sleep patterns and decreased oxygen levels. In contrast, peripheral apnea is due to the tissues (tongue, tonsils, and palate) blocking the airway leading to decreased oxygen levels. This blockage, or obstruction, is the cause of obstructive sleep apnea.
The character and severity of your obstructive sleep apnea can be determined via a sleep study. The sleep study yields information regarding sleep cycles, oxygen levels, and the number and length of the apneic and hypopneic episodes. This information is used to determine the Respiratory Distress Index, or RDI, and the degree of oxygen desaturation.
Obstructive sleep apnea is thus defined as peripheral obstruction leading to decreased oxygen levels, and is defined by abnormalities in the RDI and percentage of oxygen saturation.
WHO GETS OBSTRUCTIVE SLEEP APNEA, AND WHAT ARE THE SYMPTOMS?
Obstructive sleep apnea is most commonly seen in middle-aged men. While the condition is made worse with obesity, it can occur in thin people. Most people with OSA state they are tired in the morning when awakening. They have trouble making it “through the day” and are very tired in the afternoon. While not all patients who snore have obstructive sleep apnea, almost all patients with obstructive sleep apnea are very loud snorers. The spouse or partner of the OSA patient will have observed the apneic episodes, and often report needing to shake or nudge the patient to “get them to breathe.”
OSA patients will frequently wake up throughout the night. They may get out of bed to get a drink or go to the bathroom multiple times. They may also have six or seven awakenings in which they do not get out of bed. Finally, patients with OSA often report having trouble at work. They may have decreased memory and concentration. They may have trouble operating machinery, and in particular have trouble driving the car secondary to fatigue.
CAUSE OF OBSTRUCTIVE SLEEP APNEA
The exact cause of OSA is not known. While OSA is made worse with obesity, certainly not all obese people have obstruction. A long palate, large tonsils, and a large or high-riding tongue are commonly found in patients with OSA and contribute to the obstruction. Furthermore, people whose chins do not protrude or project may have tongues positioned farther back in the throat, leading to OSA.
DETERMINATION OF OBSTRUCTIVE SLEEP APNEA
If the patient has symptoms consistent with obstructive sleep apnea, then a sleep study, or polysomnogram, is performed. This study can be carried out either in a sleep lab or at home. The study determines the number of apnea episodes, hypopnea episodes, and the degree of oxygen desaturation. It will look at changes in brain waves and the various sleep cycles. It will determine if you have significant leg movements or spasms, which may cause irregularity of sleep. It will also determine whether abnormal brain waves occur, as some patients’ apparent sleep deprivation may actually be caused by nighttime seizures.
I’VE BEEN TOLD I HAVE OBSTRUCTIVE SLEEP APNEA – NOW WHAT?
If you have been examined and a sleep study has shown that you have OSA, then treatment is available. If the degree of OSA is mild and you are overweight, then a weight loss program may be of great benefit. If the degree of OSA is moderate to severe, however, then Continuous Positive Airway Pressure (CPAP) or surgical intervention may be offered.
CPAP. CPAP is a padded mask worn while sleeping which fits over the mouth or nose. The machine senses each time you stop breathing and provides a breath of air. There are multiple kinds of CPAP machines, masks, and settings. Once a sleep study has determined that you have obstruction, a “CPAP titration study” is carried out. This repeat sleep study is performed with the CPAP mask in place to determine the optimal mask settings to overcome your obstruction.
Surgery. Surgery is reserved only for patients who are absolutely intolerant of CPAP therapy. Surgery is a “protocol” or series of well-defined surgical steps to open up the airway. The protocol is comprised of uvulopalatopharyngoplasty, or UPPP, in addition to temperature controlled radiofrequency ablation of the tongue base, or TCRFA. Note that TCRFA is not carried out in one treatment, but is delivered in four treatments spaced eight weeks apart.
CPAP vs UPPP/TCRFA
In contrast, surgery is reserved for patients who cannot tolerate CPAP. The surgical protocol is only 70-80% effective in treating OSA, and therefore some patients completing the entire protocol may still have significant obstructive sleep apnea. It is important, therefore, to understand that not all patients respond to surgery. Surgery is also time consuming and expensive. The protocol is comprised of four surgeries conducted under general anesthesia, with the first surgery (UPPP with TCRFA) requiring an overnight hospital stay. The first surgery also requires you to be off work at least two weeks. The three additional tongue treatments (TCRFA alone) will require at least a few days off for each procedure. There are also potential serious risks to these procedures, as is the case with all operations. Furthermore, the effects of surgery are not reversible, unlike the mask. Therefore, for the above reasons, an earnest attempt at the use of CPAP is highly advocated.
Doctor, Please Explain Snoring
Insight into sleeping disorders and sleep apnea
Forty-five percent of normal adults snore at least occasionally, and 25 percent are habitual snorers. Problem snoring is more frequent in males and overweight persons, and it usually grows worse with age. Snoring is an indication of obstructed breathing. Therefore, it should not be taken lightly. An otolaryngologist can help you to determine where the encumbrance may be and offer solutions for this noisy and often embarrassing behavior.
The noisy sounds of snoring occur when there is an obstruction to the free flow of air through the passages at the back of the mouth and nose. This area is the collapsible part of the airway where the tongue and upper throat meet the soft palate and uvula. Snoring occurs when these structures strike each other and vibrate during breathing.
In children, snoring may be a sign of problems with the tonsils and adenoids. A chronically snoring child should be examined by an otolaryngologist, as a tonsillectomy and adenoidectomy may be required to return the child to full health.
People who snore may suffer from:
Also, deformities of the nose or nasal septum, such as a deviated septum (a deformity of the wall that separates one nostril from the other) can cause such an obstruction.
What is obstructive sleep apnea?
When loud snoring is interrupted by frequent episodes of totally obstructed breathing, it is known as obstructive sleep apnea. Serious episodes last more than ten seconds each and occur more than seven times per hour. Apnea patients may experience 30 to 300 such events per night. These episodes can reduce blood oxygen levels, causing the heart to pump harder.
The immediate effect of sleep apnea is that the snorer must sleep lightly and keep his muscles tense in order to keep airflow to the lungs. Because the snorer does not get a good rest, he may be sleepy during the day, which impairs job performance and makes him a hazardous driver or equipment operator. After many years with this disorder, elevated blood pressure and heart enlargement may occur.
Is there a cure for heavy snoring?
Heavy snorers, those who snore in any position or are disruptive to the family, should seek medical advice to ensure that sleep apnea is not a problem. An otolaryngologist will provide a thorough examination of the nose, mouth, throat, palate, and neck. A sleep study in a laboratory environment may be necessary to determine how serious the snoring is and what effects it has on the snorer's health.
Treatment depends on the diagnosis. An examination will reveal if the snoring is caused by nasal allergy, infection, deformity, or tonsils and adenoids.
Snoring or obstructive sleep apnea may respond to various treatments now offered by many otolaryngologist—head and neck surgeons:
If surgery is too risky or unwanted, the patient may sleep every night with a nasal mask that delivers air pressure into the throat; this is called continuous positive airway pressure or "CPAP".
Do you recommend the use of over-the-counter devices?
More than 300 devices are registered in the U.S. Patent and Trademark Office as cures for snoring. Some are variations on the old idea of sewing a sock that holds a tennis ball on the pajama back to force the snorer to sleep on his side since snoring is often worse when a person sleeps on his back. Some devices reposition the lower jaw forward; some open nasal air passages; a few others have been designed to condition a person not to snore by producing unpleasant stimuli when snoring occurs. But, if you snore, the truth is that it is not under your control. If anti-snoring devices work, it is probably because they keep you awake.
Self-help for the light snorer
Adults who suffer from mild or occasional snoring should try the following self-help remedies:
Reprinted with permission of the American Academy of Otolaryngology-Head and Neck Surgery Foundation, copyright © 2006. All rights reserved.