Sleep Apnea Overview
Most people should be getting about eight hours of sleep a night. This sleep repairs the body and prepares the brain for a new day. Unfortunately, an estimated 10 percent of women and 25 percent of men have a serious disorder that keeps them from getting the sleep they need for good health. Obstructive sleep apnea affects millions of Americans, and as many as 80 percent of those who have it are not diagnosed.
What is Sleep Apnea?
Sleep apnea is a sleep disorder that occurs when the tongue or other soft tissues in and near the mouth obstruct the airway during sleep. This blocks the oxygen flow to the rest of the body, and when the brain senses the decreased oxygen levels, it will partially awaken the sleeper. The brief awakening enables the person to clear the obstruction in the airway and begin to breathe again.
The pauses in breathing can last just a few seconds or up to minutes each time they occur, and they can happen dozens of times every hour, significantly disrupting sleep. When breathing restarts, it may be accompanied by a loud gasp, snort or choking sound. Snoring is common. Obstructive sleep apnea is chronic and can lead to severe health problems.
Each time breathing stops, it puts stress on the cardiovascular system. Over time, this increases the risk of high blood pressure and cardiovascular disease. The repeated cycles of waking up can lead to excessive daytime sleepiness, depression, decreased concentration and a higher incidence of workplace or roadway accidents.
Sleep Apnea Risk Factors
Obstructive sleep apnea can affect both males and females of any age. However, several controllable and uncontrollable risk factors can affect the risk of suffering from sleep apnea.
Known risk factors for sleep apnea include:
A family history of snoring or sleep apnea
- Being overweight or obese
- Having a large neck
- Having large tonsils
- Having a small lower jaw
- Excess alcohol consumption especially at night
Symptoms and Diagnosis
Obstructive sleep apnea often goes unrecognized because the symptoms occur during sleep. Being aware of daytime symptoms and seeking appropriate medical advice is the first step to getting relief. Oral and maxillofacial surgeons offer consultations and treatment options to those who are suffering from sleep apnea symptoms.
Along with snoring and daytime sleepiness, the symptoms of sleep apnea often include:
- Memory problems
- Depression, irritability and mood swings
- A dry mouth or a sore throat when waking up
- Morning headaches
- Frequently urinating at night
At a consultation, an oral and maxillofacial surgeon will take a detailed medical history and may request a sleep diary to better understand the patient’s symptoms. Then, the doctor will evaluate the various anatomic relationships in the maxillofacial region to determine the nature and the degree of the obstruction. A flexible fiber-optic camera might be used to perform a nasopharyngeal exam. A sleep study will often be recommended to confirm the diagnosis and determine the severity of the apnea and its effects on the body.
Several noninvasive treatment options are available for patients with sleep apnea. One common first-line treatment is called CPAP therapy. With CPAP therapy, the airway is kept open by pressurized oxygen that is delivered through a nasal mask. Nasal dilators, mouth pieces and lifestyle changes can also be helpful for some patients. Unfortunately, nonsurgical treatments only offer temporary relief. The source of the obstruction remains, and symptoms will return as soon as the patient stops using the treatment.
Surgical treatments are designed to address the underlying cause of sleep apnea. Excess or loose tissue around the throat or soft palate is a common cause of obstructive sleep apnea. It is often treated with a procedure called the uvulo-palato-pharyngo-plasty. Also known as UPPP, this procedure focuses on the soft palate and the back of the throat and widens the airway for easier breathing. It can be performed traditionally or with a laser. The doctor might also use a radio-frequency probe to tighten loose tissues in the soft palate area. These are outpatient procedures and can be performed in the office under light sedation.
In other cases, the size of the airway may be abnormally narrow or small. For these patients, orthognathic surgery can be necessary. Orthognathic surgery is a type of jaw surgery. It is performed in the hospital under general anesthesia, and patients will need to stay overnight in the hospital for one to two days depending on their needs. Orthognathic surgery is a highly effective procedure for sleep apnea because it enlarges the entire airway in those with sleep apnea. It can be appropriate for those with moderate to severe obstructive sleep apnea and for those who have jaw deformities that contribute to their sleep apnea.
There is no single treatment that is right for every patient. The best way to find the right treatment for your sleep apnea symptoms is to visit an experienced oral and maxillofacial surgeon who can evaluate your airway and recommend the best approach to a healthier night’s sleep. Dr. Jamali is a board-certified oral and maxillofacial surgeon who completed extensive training in plastic surgery, otolaryngology and anesthesia during his residency. He completed a fellowship in orthognathic surgery. Contact his New York, NY, office today by calling 212-480-2777 to schedule your appointment.
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Author: Martin Olivos