What is sleep apnea?
Sleep apnea is a condition in which the patient stops breathing during sleep. The classic type of sleep apnea is called obstructive sleep apnea. The obstruction occurs in the upper airway at the level of the back of the throat at the base of the tongue. The resulting blockage causes the person to increase the inspiratory effort, resulting in the snore or ìsnort.î This obstruction happens many times per hour throughout the night. If the patient were just snoring, then it is not a problem for the patient, but only for the people who have to listen. If the person blocks the airway and stops breathing, then sleep is disrupted and the oxygen level drops. At that point it becomes a problem for the patient.
There is a less common form of sleep apnea known as central apnea. This is a cyclic waxing and waning of oneís respiratory drive.
What are the symptoms of sleep apnea?
- Snoring
- Witnessed apneas by the spouse or spouse equivalent
- Nocturnal gasping or choking
- Excessive daytime sleepiness, particularly during activities that require high levels of concentration, such as driving
- Urination at night
- Restless legs and thrashing in sleep.
What are the long term consequences of sleep apnea?
- Low oxygen
- Hypertension
- Edema (swollen legs)
- Snoring that disturbs the household
- Fragmented sleep with chronic sleep deprivation
- Chronic fatigue and impaired thinking
- Motor vehicle accidents
- Chronic muscle aches
- Heart failure
- Heart arrhythmias
How is the diagnosis of sleep apnea made?
- Examination by a physician specializing in sleep medicine
- Pulmonary function tests
- Blood tests of thyroid function, blood count, chemistry
- The patient keeps a sleep log to evaluate his sleep habits
- Sleep study
What is involved in a sleep study?
- The patient spends a night sleeping in the sleep laboratory. Whilethe patient sleeps the following is monitored
- Sleep activity and stages
- Respiratory function
- Breathing effort
- Oxygen level
- Airflow
- Heart rate and rhythm
- After the study is completed the data is analyzed by computer and reviewed by the physician and sleep technician. Based on the data, therapy is prescribed or recommended. Sometimes the study has to be repeated to:
- Perform a trial of a therapy called CPAP or continuous positive airway pressure.
- To permit the patient to sleep again if a diagnosis may have been suggested, but the data was not definitive.
- In very positive cases the trial of CPAP or BiPAP can be done during the later part of the night on the initial study.
How is sleep apnea treated?
The following therapy is used either alone or in combination, depending on severity.
- Nasal CPAP (continuous positive airway pressure) A mask is applied over the nose and a continuous flow of air keeps the airway open. Another version that provides better control of airflow is called BiPAP (bilevel pressure)
- Uvulopalatopharyngoplasty (UPP) - Surgical removal of excess tissue in the back of the throat to make the airway larger, and removal of part of the soft palate.
- Mandibular advancement devices that prevent the jaw and/or tongue from falling back during sleep so the airway does not become blocked.
- Mandibular advancement reconstructive procedures that are done by oral surgeons to move the jaw forward, thereby making more room in the back of the throat and a larger airway
- Weight loss
- Relief of nasal obstruction, either medically or surgically.
Sleep apnea is a serious medical problem that can be diagnosed and treated.
