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Sleep Apnea

Introduction to Sleep Apnea

Sleep apnea occurs when the airway becomes partially or fully blocked during sleep, stopping air from successfully reaching the lungs, causing the patient to wake up gasping for breath. The majority of those with sleep apnea are unaware that they suffer from the condition. People with severe apnea can stop breathing hundreds of times every night.  

Data from 2014-2015 indicates that approximately 1 in 4 Americans have sleep apnea and 75% are yet to be diagnosed.  This is the most common sleep disorder and hence why sleep apnea is often considered in the differential diagnosis when addressing a patient's sleep issue(s).  Furthermore, data from 2014 indicated that ~40% of patients with moderate-to-severe obstructive sleep apnea are not overweight thus indicating that weight is not the single most important risk factor but rather anatomy of the airway.  

Overview of Sleep Apnea

Sleep apnea is a disorder where individuals stop breathing repeatedly while sleeping, decreasing oxygen levels in the body. There are two types of sleep apnea:

  • Obstructive Sleep Apnea: A tissue in the back of the throat collapses during sleep, blocking the airway. This is the more common cause of sleep apnea.

  • Central Sleep Apnea: The brain falters in sending a message to the muscles of the respiratory system during sleep. This typically occurs in those with neuromuscular disease or congestive heart failure.

Symptoms of Sleep Apnea

There are multiple reasons why the airway can become blocked during sleep. Causes of blocked airway may include: The soft tissue structures collapsing as they relax during sleep and block the airway, the airway itself may be smaller than usual because of large tonsils or a small jaw, or gaining extra body weight causing the airway to become blocked when the heavier throat tissues fall into the airway.

Surgery

Surgical therapy for obstructive sleep apnea has been deemed to be ineffective as of the American Academy of Sleep Medicine 2010 Update Recommendations for surgical therapy for OSA.  

The newest therapy includes a new surgical implanted device called, Inspire, that is indicated for severe OSA with a BMI of less than 32 kg/m2 but despite this device the treatment is not 100% effective and in fact the Phase III clinical trials presented to the FDA indicated ~50-60% effectiveness.

Symptoms of Sleep Apnea include:
  • Frequent silences during sleep due to breaks in breathing

  • Choking or gasping during sleep to get air into the lungs

  • Loud snoring

  • Sudden awakenings

  • Daytime sleepiness and feeling unrefreshed by a night’s sleep

  • Sleep deprivation

  • Oxygen depravation

  • Nocturnal heart burn symptoms

  • Morning headaches

  • Night sweats

  • Frequent nighttime urination

*These symptoms are often noticed first by a parent or bed partner.

For those suffering from sleep apnea, despite the fact that they had been in bed all night long, and they may not recall waking up even once during that time, they will likely feel exhausted. Some trickle-down effects of sleep deprivation include a compromised immune system, poor mental and emotional health, irritability, and an increased likelihood of vehicular or workplace accidents.

Treatment of Sleep Apnea

Sleep apnea has serious health consequences and can even be life-threatening if it remains untreated. If you, or someone that you know, has signs of sleep apnea, schedule an appointment with your doctor or sleep specialist immediately. As obstructive sleep apnea is a common and well-understood disease, treatments exist that can relieve most, if not all, of the symptoms.

Continuous Positive Airway Pressure (CPAP)

CPAP is the most widely recommended treatment for moderate to severe obstructive sleep apnea. CPAP entails wearing a mask-like device while you sleep, which provides pressurized air to prevent the airway from collapsing.  It is in essence an air splint that gently supports the airway thus eliminating snoring and sleep apnea.  For those patients that have had difficulty adjusting to CPAP therapy there are alternatives that may be considered such as Bi-level PAP therapy that is much more physiologic to our inherent breathing patterns and hence much more comfortable to breathe with.

Dental Appliances

Most dental devices are acrylic and fit inside your mouth to reposition the lower jaw. These devices open your airway by dropping the jay and bringing the tongue forward. Oral appliances are only effective for mild to moderate sleep apnea but even then these devices are ~50-60% effective, i.e., ~50-60% of patients with mild-to-moderate OSA will be successfully treated.  Oral appliances are not equivalent to CPAP therapy but can offer a potential alternative to those patients that have significant difficulty adjusting to CPAP.