Sleep apnea is a condition in which people stop breathing for short periods during sleep. People who have sleep apnea are not aware they stop breathing while asleep but they may wake up startled or gasping for breath, and loved ones may tell them they snore.
There are two types of sleep apnea:
- Obstructive sleep apnea, in which people stop breathing because the throat narrows or closes (is obstructed)
- Central sleep apnea, in which people stop breathing because the brain is sending the wrong signals to the muscles responsible for breathing
Sleep apnea usually refers to obstructive sleep apnea.
While surgery is generally not the first-line treatment for sleep apnea, it may be recommended in cases of severe obstructive sleep apnea that does not respond to breathing devices such as a CPAP (Continuous Positive Airway Pressure) machine, or that is caused by visible obstruction to the upper airway.
Often, more than one type of surgery is performed at the same time to increase the success rate. In some cases, surgery can cure obstructive sleep apnea, but it is not always effective, and even when it is, the problem can recur. Surgical procedures used to treat obstructive sleep apnea include:
- UPPP, short for uvulopalatopharyngoplasty: removes excess tissue from the soft palate and pharynx
- The most common sleep apnea surgical procedure
- The tonsils are also removed if present
- Tonsillectomy: removal of the tonsils at the back of the throat
- Maxillary or jaw advancement: moves the upper jaw (maxilla) and lower jaw (mandible) forward, to enlarge the upper airway
- Tracheostomy: a hole is made through the front of the neck into the trachea (windpipe) and a breathing tube (trach tube), is placed through the hole and directly into the windpipe to help with breathing
- Nasal surgery: septoplasty to straighten the septum (the cartilage that separates the nostrils) and reduce the turbinates (structures inside the nose that help humidify, heat, and filter the air we breathe) to create more room in the nose to allow air to pass more smoothly
- Soft palate implants (the Pillar Procedure): involves the placement of three polyester rods into the soft palate to help slightly stiffen the soft palate, which makes it less likely to make contact with the back wall of the pharynx during deep stages of sleep as the muscles relax
- Hyoid advancement: the small bone in the neck where the muscles of the tongue base and pharynx attach (hyoid bone) is surgically repositioned to result in an expansion of the airway and to prevent collapse
- Tongue advancement: involves moving one of the main tongue muscles (the genioglossus muscle) forward, which limits the tongue’s backward fall during sleep
- Tongue base reduction: reduction of the amount of tissue from the tongue base
- Bariatric surgery (weight loss surgery): may improve sleep apnea in morbidly obese patients
In addition to surgery, other treatments for sleep apnea include:
- CPAP (Continuous Positive Airway Pressure) machine
- Patients wear a face mask or nose piece that fits over the mouth and nose with a hose connecting it to a motor that delivers a mild stream of air to help keep the airways open and facilitate breathing
- BiPAP is a bi-level positive airway pressure machine that alternates air pressure, delivering more pressure when you inhale, and less pressure when you exhale
- May be an option for patients who have difficulty tolerating the constant flow of forced air from a CPAP
- Mandibular advancement device (also called an oral appliance) that helps keep the airways open
- Not as effective as a CPAP
- Home remedies
- Stay off your back when sleeping if possible
- Lose weight if you are overweight
- Avoid alcohol
What Are Symptoms of Sleep Apnea?
Symptoms of sleep apnea include:
- Reduced or absent breathing (apnea events)
- Loud snoring
- Restless sleep
- Waking up choking or gasping
- Daytime sleepiness
- Feeling unrested after waking
- Morning headaches, dry mouth, or sore throat
- Frequently waking to urinate
- Difficulty thinking clearly or remembering things
- Decreased attention, vigilance, concentration, motor skills, and verbal and visuospatial memory
- Sexual dysfunction or decreased sex drive
What Causes Sleep Apnea?
Causes of obstructive sleep apnea include physical structure or medical conditions such as:
- Large tonsils
- About 2/3 of people who have obstructive sleep apnea are overweight or obese
- Large neck circumference
- Endocrine disorders
- Neuromuscular disorders
- Heart or kidney failure
- Certain genetic syndromes
- Small lower jaw and certain other facial configurations
- Premature birth
Risk factors for sleep apnea include:
- Unhealthy lifestyle habits and environments
- Family history of obstructive sleep apnea
- Race and ethnicity
- Male gender
- Alcohol consumption at bedtime
- Being post-menopausal
- Acromegaly (high levels of growth hormone)
How Is Sleep Apnea Diagnosed?
Sleep apnea is diagnosed with a physical examination to see if there is anything that is obstructing (blocking) the airways, and a patient history. The patient’s partner may be asked about a history of snoring or if the patient wakes up gasping for air during the night.
If sleep apnea is suspected, patients may be sent for a sleep study, which can sometimes be done at home, but is usually done in a sleep lab.
What Are Complications of Sleep Apnea?
If left untreated, obstructive sleep apnea can result in complications including:
- Heart attack
- Cognitive and behavioral disorders
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