What is Sleep Apnea?
The Greek word "apnea" literally means "without breath." There are three types of apnea: obstructive, central, and mixed; of the three, obstructive is the most common. Despite the difference in the root cause of each type, in all three, people with untreated sleep apnea stop breathing repeatedly during their sleep, sometimes hundreds of times during the night and often for a minute or longer.
Sleep apnea is a condition that can be life-threatening. It is a disorder distinguished by short pauses in breathing during sleep and is often characterized by a loud snoring and choking sensation. There are two different types of sleep apnea, central and obstructive. Central sleep apnea is less common and happens when the brain does not send the correct signals to the breathing muscles. Obstructive sleep apnea is more common and occurs when the airflow through a person’s upper airway is blocked, even though the person is still trying to breathe. People who have sleep apnea can experience early morning headaches, daytime sleepiness and, sometimes, insomnia.
The number of unintentional pauses in breathing, in a given night, can be as high as 100 or more an hour. These pauses are frequently accompanied by snoring, but not everyone with sleep apnea snores. It is important that sleep apnea is recognized early because it has been linked with an irregular heartbeat, high blood pressure, heart attacks, and strokes.
There are many reasons for interrupted sleep and sleep apnea cannot be diagnosed by just the symptoms or complaints of the patient. There are a number of tests that are available for assessing a person for sleep disorders. The most accurate of all tests that exist is a polysomnograph, or a “sleep study.” Sleep studies record an assortment of body functions during sleep. These functions can include eye movement, electrical activity of the brain, muscle activity, heart rate, respiratory effort, airflow, and blood oxygen levels. Polysomnographs are used to diagnose sleep apnea and to determine its severity. Another test is the Multiple Sleep Latency Test (MSLT). This test is done the day after a sleep study and measures the speed of falling asleep; this test may be used to rule out other sleep disorders.
Treatment of sleep apnea is determined by the patient's medical history, physical examination, and results from the sleep study. In most cases, medications are not effective in the treatment of sleep apnea. One of the ways to treat sleep apnea is through behavioral therapy. In some mild cases, changing some behaviors is all the person needs to get rid of his/her sleep apnea. The use of alcohol, tobacco, and sleeping pills make the airway more likely to collapse during sleep and they extend pauses in breathing. People who are overweight can profit from losing weight; even a ten percent drop in weight can reduce the severity of the disease.
Nasal continuous positive airway pressure (nCPAP) is the most common and effective treatment for sleep apnea. Nasal CPAP controls airway closure while the person uses it; pauses in breathing come back when a person removes the CPAP or uses it incorrectly.
Dental appliances are another method of treatment; these ‘orthotics’ reposition the lower jaw and tongue to open the collapsed airway similar to CPR (cardiopulmonary resuscitation). Orthotics are most effective in patients with mild to moderate sleep apnea, or a person who snores but does not have apnea.
There are numerous surgeries used in the treatment of sleep apnea, although no procedure is without risks or totally successful. Common procedures include the removal of adenoids and tonsils (most effective in children), nasal polyps or other tissue blocking the airway as well as correction of structural deformities. Younger patients seem to benefit more than older people when undergoing surgical procedures.
The most common procedure is uvulopalatopharyngoplasty (UPPP), which removes excess tissue at the back of the throat, like the tonsils, uvula, and part of the soft palate. The long-term success of this procedure ranges from 30 to 50 percent. Long-term side effects and benefits are not known and it is difficult to predict which patients will do well with an individual surgical procedure.
Other surgical interventions are done with lasers or radio ablation (e.g. somnoplasty™), but these are less effective treatments than those done in an operating room. A procedure used to people with severe, life-threatening sleep apnea is tracheostomy. The surgeon makes an opening the windpipe from the outside of the neck and a tube is inserted into the opening. The tube is opened at night so that air flows directly into the lungs; during the person’s waking hours, the hole is plugged so the patient can breathe and speak normally. This procedure is effective but is rarely used because it is an extreme measure and can be poorly tolerated by patients. Extremely obese patients might be recommended for surgical procedures to treat obesity.
No one treatment is effective for every patient. It is important that all physicians treating obstructive sleep apnea be well versed in all of the different modes of treating this disease and help the patient receive appropriate information and care.