Sleep apnea is a common sleep disorder characterized by brief interruptions of breathing during sleep. These episodes usually last 10 seconds or more and occur repeatedly throughout the night. People with sleep apnea will partially awaken as they struggle to breathe, but in the morning they will not be aware of the disturbances in their sleep. The most common type of sleep apnea is obstructive sleep apnea (OSA), caused by relaxation of soft tissue in the back of the throat that blocks the passage of air. Central sleep apnea (CSA) is caused by irregularities in the brain’s normal signals to breathe. Most people with sleep apnea will have a combination of both types. The hallmark symptom of the disorder is excessive daytime sleepiness. Additional symptoms of sleep apnea include restless sleep, loud snoring (with periods of silence followed by gasps), falling asleep during the day, morning headaches, trouble concentrating, irritability, forgetfulness, mood or behavior changes, anxiety, and depression. Not everyone who has these symptoms will have sleep apnea, but it is recommended that people who are experiencing even a few of these symptoms visit their doctor for evaluation. Sleep apnea is more likely to occur in men than women, and in people who are overweight or obese. Untreated, sleep apnea can be life threatening. Excessive daytime sleepiness can cause people to fall asleep at inappropriate times, such as while driving. Sleep apnea also appears to put individuals at risk for stroke and transient ischemic attacks (TIAs, also known as “mini-strokes”), and is associated with coronary heart disease, heart failure, irregular heartbeat, heart attack, and high blood pressure. Although there is no cure for sleep apnea, recent studies show that successful treatment can reduce the risk of heart and blood pressure problems.
To diagnose the condition doctors at BRAINS will evaluate your signs and symptoms followed by examination and tests. Physical examination will centre around the back of your throat, mouth and nose for extra tissue or abnormalities. The doctor may also measure your neck and waist circumference and check your blood pressure.A sleep specialist may conduct additional evaluations to diagnose your condition, determine its severity and plan your treatment. The evaluation may involve overnight monitoring of your breathing and other body functions as you sleep. There are several tests to detect obstructive sleep apnea like polysomonography, oximetry and portable monitoring (See: Technology & procedures).
For milder cases of obstructive sleep apnea, your doctor may recommend lifestyle changes like physical exercise aimed at weight reduction (if you are overweight), moderate drinking (if you must drink), kicking addictions like smoking, use of nasal decongestant and not sleeping on your back. If these measures are not effective then your specialist at BRAINS may recommend other steps like devices that open blocked airways and in some cases, surgery.
Positive airway pressure: If you have obstructive sleep apnea, you may benefit from positive airway pressure wherein a machine delivers air pressure through a piece that fits into the nose or is placed over the nose and mouth while you sleep.Positive airway pressure reduces the number of respiratory events that occur as you sleep, reduces daytime sleepiness and improves your quality of life.
Mouthpiece (oral device): Though positive airway pressure is often an effective treatment, oral appliances are an alternative for some people with mild or moderate obstructive sleep apnea. These devices may reduce your sleepiness and improve your quality of life.These devices are designed to keep your throat open. Some devices keep your airway open by bringing your jaw forward, which can sometimes relieve snoring and obstructive sleep apnea. Other devices hold your tongue in a different position.
Medications: If you continue to experience daytime sleepiness after treatment for your obstructive sleep apnea, your doctor may prescribe medications to reduce sleepiness.
Surgery or other procedures: The goal of surgery for obstructive sleep apnea is to prevent blockage of the upper airway during sleep. Surgery is usually considered only if other therapies haven’t been effective or haven’t been appropriate options for you. Surgical options may include removal of tissue from the back of your mouth and top of your throat as well as your tonsils and adenoids through a process called UPPP. Doctors at BRAINS often do this with a laser (laser-assisted UPPP) or with radiofrequency energy (radiofrequency ablation) to treat snoring. These procedures don’t treat obstructive sleep apnea, but they may reduce snoring.
Jaw surgery: In this procedure, called maxillomandibular advancement, the upper and lower parts of your jaw are moved forward from the rest of your facial bones. This enlarges the space behind the tongue and soft palate, making obstruction less likely.
Surgical opening in the neck: You may need this form of surgery if other treatments have failed and you have severe, life-threatening obstructive sleep apnea. In this procedure, called a tracheostomy, your surgeon makes an opening in your neck and inserts a metal or plastic tube through which you breathe. Air passes in and out of your lungs, bypassing the blocked air passage in your throat.
Implants: The Pillar procedure is a minimally invasive treatment that involves placement of three tiny polyester rods in the soft palate. These inserts stiffen and support the tissue of the soft palate and reduce upper airway collapse and snoring. This treatment is recommended only for people with mild obstructive sleep apnea.
Polysomnography: During this sleep study, you’re hooked up to equipment that monitors your heart, lung and brain activity, breathing patterns, arm and leg movements, and blood oxygen levels while you sleep. You may have a full-night study, in which you’re monitored all night, or a split-night sleep study.
In a split-night sleep study, you’ll be monitored during the first half of the night. If you’re diagnosed with obstructive sleep apnea, staff may wake you and give you continuous positive airway pressure for the second half of the night.
This test can help your doctor diagnose obstructive sleep apnea and adjust positive airway pressure therapy, if appropriate. This sleep study can also help rule out other sleep disorders, such as periodic limb movements of sleep or narcolepsy, which also can cause excessive daytime sleepiness, but require different treatment.
Oximetry: This test monitors and records your blood oxygen level while you’re asleep and can be used as a screening test for obstructive sleep apnea. If you have obstructive sleep apnea, the results of this test will often show drops in your blood oxygen level during apneas and subsequently rises with awakenings.
If the study reveals temporary drops in oxygen compatible with obstructive sleep apnea, a polysomnogram may follow to formally diagnose obstructive sleep apnea and determine appropriate therapy.