What is Obstructive Sleep Apnea?

This is a condition that occurs in sleep and is characterized by repetitive episodes of obstruction to air flow into the lungs. The level of obstruction is usually at the level of the soft palate, however the obstruction can be at different levels in the throat.

The oropharynx is the principle site of obstruction in the upper airway, in people with obstruction sleep apnea syndrome. The soft palate can be enlarged, thickened, and elongated. The uvula can be swollen. The base of the tongue can protrude backwards and block the airway. The posterior pharyngeal lining can go into folds of redundant tissue. The pillars of fauces may be prominent and close to the midline. The tonsils can also be enlarged causing obstruction to airflow.

What are the signs and symptoms?

• Loud snoring
• Dry mouth in the morning
• Unrefreshing sleep and morning grogginess
• Headaches on awakening
• Night sweats
• Indigestion during the night
• Problems with memory and concentration
• Increased urination at night
• Daytime sleepiness
• Irritabilty and/or fatigue during the day
• Depression
• Decreased libido

Persons with sleep apnea may stop breathing hundreds of times per night, and consequently, sleep is very disturbed. The brain repeatedly awakens the person so that breathing can resume. The normal sleep cycle is inhibited. This can make the person fatigued and sleepy throughout the daytime hours.

The typical scenario is:

• The person drifts off to sleep.
• The tongue, excess throat tissue, or relaxed throat muscles block the airway during sleep.
• Breathing stops or is reduced for least 10 seconds, and sometimes for up to several minutes.
• The body struggles for air, the oxygen level in the blood drops --- and the brain says, "Wake Up!"
• Breathing resumes for four or five breaths until the oxygen levels rise.
• The person drifts into deeper sleep - and the whole process repeats itself.

What are the risks to my health?

You are at an increased risk for:

• High blood pressure
• Heart attack
• Congestive heart failure
• Strokes 

How is Sleep Apnea diagnosed?

The diagnosis is made by an overnight sleep study. During the study various bodily parameters are monitored, including brain waves, eye movements, oxygen levels, heart rate, and breathing patterns. This data is then interpreted by the physician to make the diagnosis. The study is painless!

What are the treatments available?

Nasal CPAP (Continuous Positive Airway Pressure)
Nasal CPAP is a device that can be placed in your home to treat obstructive sleep apnea. The CPAP device works during sleep by gently blowing air from a machine into a mask applied over the person's nose. The air pressure keeps the airway open, thus eliminating the apnea and frequent awakenings. Nasal CPAP is the most reliable treatment method for sleep apnea.

Weight Loss
Even a small weight loss may make a difference in obstructive sleep apnea. Reversing severe sleep apnea usually requires weight loss of at least 20%, however. Some doctors think that patients lose weight more easily and naturally if their sleep apnea is treated first. Weight loss may also decrease the level of nasal CPAP pressure needed for treatment.

Positioning
Sleeping only on one's sides may reduce the severity of sleep apnea. It is difficult to do this voluntarily, but special garments and/or pillows may help you to train yourself to stay off your back during sleep.

Dental appliances
These are used to help keep the tongue and lower jaw from falling backwards during sleep. They are most likely to be effective in patients who snore without apnea or who have relatively mild obstructive sleep apnea. In some people, these devices may cause temporomandibular joint (TMJ ) pain or excessive salivation during sleep

Surgery
Surgery on the soft palate, tongue, or jaws is sometimes used to widen the airway. These operations are not always effective, however. The failure rate is as high as 80% for some procedures, and there are potential complications. Tracheotomy (an opening in the windpipe below the vocal cords) is effective, but there are many of complications.