Sleep Apnea Therapy
Sleep apnea is a potentially serious sleep disorder in which breathing repeatedly stops and starts. You may have sleep apnea if you snore loudly and you feel tired even after a full night’s sleep.
Sleep apnea occurs in two main types:
- Obstructive sleep apnea, the more common form that occurs when throat muscles relax
- Central sleep apnea, which occurs when your brain doesn’t send proper signals to the muscles that control breathing.
Causes of obstructive sleep apnea
Obstructive sleep apnea occurs when the muscles in the back of your throat relax. These muscles support the soft palate, the triangular piece of tissue hanging from the soft palate (uvula), the tonsils and the tongue.
When the muscles relax, your airway narrows or closes as you breathe in, and breathing momentarily stops. This may lower the level of oxygen in your blood. Your brain senses this inability to breathe and briefly rouses you from sleep so you can reopen your airway. This awakening is usually so brief that you don’t remember it.
You can awaken with a transient shortness of breath that corrects itself quickly, within one or two deep breaths, although this is rare. You may make a snorting, choking or gasping sound. This pattern can repeat itself five to 30 times or more each hour, all night long. These disruptions impair your ability to reach the desired deep, restful phases of sleep, and you’ll probably feel sleepy during your waking hours.
People with obstructive sleep apnea may not be aware that their sleep was interrupted. In fact, many people with this type of sleep apnea think they sleep well all night.
Sleep apnea may occur if you’re young or old, male or female. Even children can have sleep apnea. But certain factors put you at increased risk:
Obstructive sleep apnea
- Excess weight. Fat deposits around your upper airway may obstruct your breathing. However, not everyone who has sleep apnea is overweight. Thin people develop the disorder, too.
- Neck circumference. A neck circumference greater than 17 inches (43 centimeters) is associated with an increased risk of obstructive sleep apnea. That’s because a thick neck may narrow the airway and may be an indication of excess weight.
Your doctor may make an evaluation based on your signs and symptoms or may refer you to a sleep disorder center. There, a sleep specialist can help you decide on your need for further evaluation. Such an evaluation often involves overnight monitoring of your breathing and other body functions during sleep.
Tests to detect sleep apnea may include:
- Nocturnal polysomnography. During this test, 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.
- Portable monitoring devices. Under certain circumstances, your doctor may provide you with simplified tests to be used at home to diagnose sleep apnea. These tests usually involve measuring your heart rate, blood oxygen level, airflow and breathing patterns. If you have sleep apnea, the test results will show drops in your oxygen level during apneas and subsequent rises with awakenings. If the results are abnormal, your doctor may be able to prescribe a therapy without further testing. Portable monitoring devices don’t detect all cases of sleep apnea, so your doctor may still recommend a polysomnogram even if your initial results are normal.
If you have obstructive sleep apnea, your doctor may refer you to an ear, nose and throat doctor (otolaryngologist) to rule out any blockage in your nose or throat.
- High blood pressure (hypertension). Sleep apnea is more common in people with hypertension.
- A narrowed airway. You may have inherited a naturally narrow throat. Or, your tonsils or adenoids may become enlarged, which can block your airway.
- Being male. Men are twice as likely to have sleep apnea. However, women increase their risk if they’re overweight, and the risk also appears to rise after menopause.
- Being older. Sleep apnea occurs two to three times more often in adults older than 65.
- Family history. If you have family members with sleep apnea, you may be at increased risk.
- Use of alcohol, sedatives or tranquilizers. These substances relax the muscles in your throat.
- Smoking. Smokers are three times more likely to have obstructive sleep apnea than are people who’ve never smoked. Smoking may increase the amount of inflammation and fluid retention in the upper airway. This risk likely drops after you quit smoking.
- Prolonged sitting. Studies suggest that long periods of daytime sitting can cause fluids to shift from your legs when you recline at night, narrowing airway passages and possibly increasing the risk of obstructive sleep apnea.
For milder cases of sleep apnea, your doctor may recommend lifestyle changes, such as losing weight or quitting smoking. If these measures don’t improve your signs and symptoms or if your apnea is moderate to severe, a number of other treatments are available. Certain devices can help open up a blocked airway. In other cases, surgery may be necessary.
Treatments for obstructive sleep apnea may include:
- Continuous positive airway pressure (CPAP). If you have moderate to severe sleep apnea, you may benefit from a machine that delivers air pressure through a mask placed over your nose while you sleep. With CPAP (SEE-pap), the air pressure is somewhat greater than that of the surrounding air, and is just enough to keep your upper airway passages open, preventing apnea and snoring.
Although CPAP is a preferred method of treating sleep apnea, some people find it cumbersome or uncomfortable. With some practice, most people learn to adjust the tension of the straps to obtain a comfortable and secure fit. You may need to try more than one type of mask to find one that’s comfortable. Some people benefit from also using a humidifier along with their CPAP system.
Don’t just stop using the CPAP machine if you experience problems. Check with your doctor to see what modifications can be made to make you more comfortable. Additionally, contact your doctor if you are still snoring despite treatment or begin snoring again. If your weight changes, the pressure settings may need to be adjusted.
- Adjustable airway pressure devices. If CPAP continues to be a problem for you, you may be able to use a different type of airway pressure device that automatically adjusts the pressure while you’re sleeping. For example, units that supply bilevel positive airway pressure (BPAP) are available. These provide more pressure when you inhale and less when you exhale.
- Oral appliances. Another option is wearing an oral appliance designed to keep your throat open. CPAP is more effective than oral appliances and is the Gold Standard in treatment, but oral appliances may be easier for you to use. Some are designed to open your throat by bringing your jaw forward, which can sometimes relieve snoring and mild obstructive sleep apnea.A number of devices are available from your dentist. Dr. Bechtel utilizes two different types of appliances in treating mild to moderate OSA patients. You may need to try different devices before finding one that works for you. Once you find the right fit, you’ll still need to follow up with your dentist at least every six months during the first year and then at least once a year after that to ensure that the fit is still good and to reassess your signs and symptoms. If you suffer from this condition and are one of the approximately 50% of those who have a CPAP machine but refuse to use it please give our office a call. It could save your life!