Sleep Medicine

Sleep Apnea is a potentially serious disorder because of cessation of breathing while asleep.  Symptoms may include loud snoring, breath holds followed by a large gasping breath, and daytime tiredness. An apnea is defined as cessation of air exchange for at least 10 seconds, accompanied by a drop in oxygen level and by a brain wave “micro wakeup “when the patient rebreaths.  These pauses in breathing continue throughout the night, and may occur as often 1000 times during the night .    Those with sleep apnea usually have no problem falling asleep , and they are unaware that they are afflicted with the disorder. Bed partners frequently describe the symptoms accurately.

Sleep apnea occurs across all segments of the population , and if left untreated, can lead to increased risk of heart disease, high blood pressure,  stroke , increased chance of type 2 diabetes, cardiac arrhythmias and other illnesses.  Daytime tiredness also leads to increased chance of automobile accidents and may cause errors in judgment and concentration that may cause injury, job loss, relationship problems, depression and even death.

There are three main types of sleep apnea:

  • Obstructive sleep apnea. This is the most common form of apnea . It occurs because of a reduction in the opening of the breathing passage, behind the tongue . During sleep,  the throat muscles relax, and when the patient inhales,  there is a negative force which leads to collapse and closure of the airway, despite the fact that the patient is making an effort to breathe.
  • Central sleep apnea. This occurs when the brain fails to send proper signals to the muscles that control breathing. The airway is actually open, but there is no effort to breathe
  • Complex sleep apnea. This occurs when a person has both obstructive sleep apnea and central sleep apnea.

All forms of sleep apnea are treatable, and with proper treatment lead to a better quality of life.

Risk Factors

People that are obese have a much greater probability of developing sleep apnea.  Although many people of normal body mass index have sleep apnea as well due to a narrow airway, large tonsils or adenoids, or formation of the jaw that compromises the airway. Non obese people, however, also may have sleep apnea because of a narrow airway, or a large tongue, or a retro positioned tongue, and   children may have large tonsils or adenoids.

Other risk factors include being male, family history, smoking, use of alcohol, sedatives or tranquilizers, and nasal congestion.

Treatments and Therapies

Once tested and properly diagnosed with the correct type of sleep apnea, the disorder is very treatable.  Proper treatment can virtually eliminate the problems associated with sleep apnea.

Behavior Related Therapies

Some mild forms of sleep apnea are treatable by changes in lifestyle, such as losing weight, quitting smoking or drinking alcohol and proper sleep positions such as sleeping supine or with the head of the bed elevated.  Behavioral changes in combination with the therapies below tend to be the most effective methods to minimize the effects of sleep apnea.

CPAP

This the gold standard for therapy of sleep apnea. CPAP maintains an  open airway by  delivering  air pressure via a mask placed over the nose and/or mouth.  The air pressure inflates the airway , just enough to prevent the episodes of breath holding , thereby eliminating apnea events.  CPAP may require effort to determine the appropriate type of CPAP machine and the best fitting mask. CPAP  will eliminate virtually all the events and provide restful sleep and a better quality of life. Many patients describe CPAP therapy as “life changing”.

Oral Appliances

As determined by the physician and the sleep dentist , some patients will benefit by using   a custom fitted oral appliance. An oral appliance, that is worn during sleep, is adjusted so that the lower jaw protrudes forward, just enough to keep the airway open.  Dentists that are specially trained in the treatment of sleep medicine provide oral appliances.

Surgery

Surgery is also an option when CPAP and oral appliances fail.  Surgeries include the removal of the tonsils, adenoids and other tissue in the back of the throat.  More serious surgeries include advancing the jaw, in order to enlarge the area behind the tongue.  Surgical procedures do not guarantee the cessation of sleep apnea.  Most sleep medicine professionals recommend trying and CPAP and oral appliances before surgery.

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