By Sheila Dwyer, Body1 Staff
Approximately twenty million Americans have some degree of obstructive sleep apnea (OSA). Adults over age 60 commonly suffer this disorder, but it can affect anyone. Often people do not realize they have sleep apnea, because others must observe it and diagnose the condition in a sleep laboratory. The disorder is marked by long periods of ceased breathing during sleep. In fact, “apnea” is of Greek origin and literally means “without breath.”
The breath stoppage that defines OSA is due to tissues in the back of the mouth and throat constricting the airway for 10 seconds to two minutes at a time. As soon as the brain realizes that the body is suffocating from lack of oxygen, it rouses the person to a light sleep with an accompanying gasp, allowing air passage to resume. When the person falls back into a deep sleep, the cycle begins again. Over time, untreated sleep apnea can lead to high blood pressure, irregular heartbeat and even heart failure in patients.
Because a person cannot self-diagnose sleep apnea, a specialist performs a polysomnography test to identify the disorder. During this painless evaluation, sensors are attached to the subject. Electronic signals pass through these sensors and are recorded. These recordings monitor brain waves, heart function, leg motion, stage of sleep, and the level of oxygen in the blood. The specialist will also observe snoring, wake-up frequency, and body position to diagnose OSA.
Currently there are several options available to combat OSA, ranging from over the counter solutions to invasive surgery. The following are samples of treatments that aim to control OSA:
Behavioral Therapy
Behavioral modifications may eliminate OSA. Tobacco, alcohol, and sleeping pills leave the airway more susceptible to collapse during sleep, so they should be avoided. Overweight patients should lose around 10 percent of their body weight, because excess weight can also be carried in the throat. For patients who experience sleep apnea while on their backs, using extra pillows to support sleeping on one’s side is recommended.
Oral Appliances
Over-the-counter mouth guards can reposition a patient’s jaw or tongue during sleep to reduce the occurrence of OSA. Side effects include excess salivation, headache and skin irritation. Patients often find these dental devices uncomfortable but easy to use.
CPAP
The continuous positive airway passage (CPAP) system forcibly delivers oxygen to a sleeping patient. A mask straps over the nose and is attached by a tube to an oxygen-pumping machine. Notable drawbacks exist, however. CPAP may make patients feel claustrophobic and uncomfortable. Forced air delivery may cause its own side effects, including headaches and nasal congestion. CPAP, a nightly therapy, usually requires lifelong compliance.
Many patients oppose the use of a CPAP system because of the discomfort. Some companies are marketing equipment that is less obtrusive and fits more like headphones. Mallinckrodt Inc. has designed a system with this concern in mind. The mask hooks up to an automatically adjusting airway pressure system that translates into sounder sleep for the user.
Somnoplasty
Somnoplasty is an outpatient procedure that is less invasive than traditional surgical methods for treating sleep apnea. Doctors use radiofrequency energy to shrink excess tissue in a patient’s upper airway. The procedure boasts a short recovery period, and most patients resume normal activity the following day. One Somnoplasty study reveals that OSA patients experienced more than a 50 percent reduction in their sleep interruptions and an improvement in their quality of life.
Mandibular Advancement
This surgery involves moving the tongue or jaw forward to create a wider airway passage. Mandibular Advancement has a decent success rate for patients with mild to moderate cases of OSA.
Uvulopalatopharngoplasty (UPPP)
UPPP is one of the most common procedures performed in response to OSA. UPPP is a traditional surgical procedure that involves removal of the tonsils and trimming of the uvula and soft palate. Due to the nature of the surgery, the recovery period is usually painful and lasts one to two weeks. UPPP is effective on people with less severe cases of OSA; those with more severe cases rarely see positive results. Relapse of sleep apnea may occur five years after UPPP is performed.
Laser Assisted Uvulopalatoplasty (LAUP)
This procedure is used to treat mild cases of sleep apnea and snoring disorders. Laser light shrinks the size of the uvula and soft palate during several outpatient sessions at a doctor’s office. There is a fair amount of pain associated with this procedure, and a doctor will prescribe post-operative narcotics can be prescribed for as long as two weeks. Unfortunately, this procedure has no effect on more severe forms of OSA.
Tracheostomy
Tracheostomy is a highly invasive surgery mainly performed as a last resort to prevent OSA. In this procedure, a surgeon cuts a section out of the patient’s windpipe and fits the patient with a tube to aid breathing. After the tube is removed, the recovery period can last as long as two weeks. This procedure is highly effective in treating OSA but can be expensive and painful.
References:
www.somnoplasty.com
www.somnus.com
www.mallinckrodt.com
