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Sleep Apnea

Question: What is Sleep Apnea?

Answer: Have you been told that you snore loudly? Do you wake up with a headache? Are you sleepy during the day? If so, you may have sleep apnea. Sleep apnea is a potentially serious disorder in which breathing stops and starts during sleep.

There are two types of sleep apnea: obstructive and central. Obstructive sleep apnea is the more common of the two. If you have this condition, the muscles in the walls of your throat (pharynx) relax while you sleep so that the walls collapse on themselves and obstruct the flow of air. After 10 to 30 seconds or more of no exchange of air, you rouse to a lighter level of sleep or brief wakefulness. The muscles then regain their normal tone (tenseness), the obstruction is relieved and you breathe. If you have obstructive sleep apnea, you may not be aware that your sleep was interrupted. In fact, many people with this type of sleep apnea think they sleep well all night.

In central sleep apnea, the brain fails to send proper signals to the muscles that control breathing. When breathing is interrupted, the level of carbon dioxide in the blood rises, which may cause you to wake up. People with central sleep apnea are more likely to remember waking up than people with obstructive sleep apnea.

More than half of all cases of sleep apnea are diagnosed in people 40 years of age or older. The condition also is more common in men than women and is a major contributor to daytime drowsiness. Thirty percent to 60 percent of people with severe daytime sleepiness have sleep apnea.

Question: How do you treat Sleep Apnea?

Answer: Sleep apnea rarely goes away on its own, but it can — and should — be treated. Self-care measures such as losing weight and varying the position in which you sleep (generally avoiding sleeping on your back) may be sufficient to ease the problem in some cases. Certain devices that can help open up a blocked airway also may be recommended. In more severe cases, surgery may be needed.

Therapies

Dental devices designed to open the throat by bringing the jaw forward can sometimes relieve mild apnea.

If you have moderate or severe sleep apnea, you may be taught how to use a machine that delivers air — at a pressure somewhat greater than that of the surrounding air — through a mask placed over your nose. This is called continuous positive airway pressure (CPAP). The pressure is just enough to keep your upper airway passages open, preventing apnea and snoring.

Surgical or Other Procedures

Uvulopalatopharyngoplasty (UPPP) is the most common type of surgery used to treat snoring and sleep apnea. During this procedure, tissue from the rear of the mouth and top of the throat is removed. Tonsils and adenoids are usually removed as well. This type of surgery is often successful in stopping throat structures from rattling and causing snoring. It may be less successful in treating sleep apnea, however, because tissue farther down the throat may still block your air passage. UPPP usually is performed in a hospital and requires you to be put to sleep with a general anesthetic. After the procedure, you may have a severe sore throat for several weeks and be able to eat only soft foods. Full recovery takes about a month.

Other types of surgery may help improve snoring and sleep apnea by clearing or enlarging air passages. They include:

• Nasal surgery to remove polyps or straighten a deviated septum
• The removal of enlarged tonsils or adenoids
• Jaw surgery to move the jaw and tongue forward

Another form of surgery, known as a tracheostomy, may be necessary if other treatments have failed and you have severe, life-threatening sleep apnea. In the procedure, an opening is made in the breathing tube in your neck (trachea). The opening is kept covered during the day. But at night it is uncovered to allow air to pass in and out of the lungs, bypassing the blocked air passage in your throat.

Self Care

In many cases self-care may be the most appropriate means of dealing with obstructive sleep apnea. Self-care for sleep apnea includes:

• Losing excess weight. Even a 10 percent loss may help by relieving constriction of the windpipe.
• Avoiding alcohol and medications such as tranquilizers and sleeping pills. These relax the muscles in the back of the throat, interfering with breathing.
• Sleeping on your side or stomach rather than your back. Sleeping on your back can cause your tongue and soft palate to rest against the back of your throat and block your airway.

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