Sleep Apnea Evaluation and Treatment

sleep apnea

Dr. Boole is Board Certified in Sleep Medicine, a member of the American Academy of Sleep Medicine.  He is one of only a handful of Otolaryngologists in the country that is.

People with sleep apnea stop breathing while they sleep, sometimes hundreds of times per night, and sometimes for a minute or longer. With normal breathing, air passes through the nose and past the flexible structures, such as the soft palate, uvula and tongue, in the back of the throat. When awake, the muscles hold this airway open. When asleep, these muscles relax, but the airway should remain open. In those who suffer from sleep apnea, the upper airway is blocked, causing oxygen levels to drop in both the brain and the blood.

Causes:

While sleeping, the airway in the throat may become partially or fully blocked, which may be caused by the following:

  • Large tongue and tonsils compared to the opening in the windpipe
  • Obesity
  • Cardiovascular problems
  • Throat and tongue muscles that are much more relaxed than normal
  • Aging, which may limit the brain’s ability to keep throat muscles stiff during sleep

Diagnosis:

Sleep apnea may be diagnosed by a physical examination, review of family and medical history, and a sleep study.

Most patients are now able to be diagnosed with a Home Sleep Study.  A device is worn on the forehead while the patient sleeps in their own bed.

Occasionally, patients may be sent to a sleep lab for a formal polysomnogram (PSG).  A PSG records brain activity, eye movements, heart rate and blood pressure. It also records the amount of oxygen in the blood and air movement in the lungs during breathing and snoring.

Types Of Sleep Apnea

Obstructive Sleep Apnea

Obstructive sleep apnea (OSA) is the most common form of sleep apnea. It occurs when the soft tissue at the back of the throat closes, blocking or obstructing the airway.

Central Sleep Apnea

The airway remains open in central sleep apnea, but the brain does not send signals to the muscles involved in breathing.

Mixed Sleep Apnea

Mixed sleep apnea combines aspects of the obstructive and central types of apnea. A common warning sign of sleep apnea is snoring, especially when it is interspersed with gasps or lack of breathing.

Treatment

Continuous Positive Airway Pressure

A continuous positive airway pressure (CPAP) machine uses a mask that fits over the mouth and nose. The machine supports the airway with pressure and prevents collapse while the patient breaths normally.

Oral Appliance Therapy

A dentist may create a custom mouth piece that brings the jaw forward and thereby brings the base of tongue forward and opens the airway.  This is an alternative for some patients that do not tolerate CPAP or desire to avoid it if possible.  Because these appliances can be expensive, Dr. Boole produces customized diagnostic splints.  This is a quick process that allows for a trial of Oral Appliance Therapy with low expense.  A home sleep study may be performed with the diagnostic splint in place to be certain this form of therapy is effective.  If so, the patient may then proceed with a formal appliance with their dentist.

Surgery

There are some instances where surgery may be helpful.  Other times, surgery may improve nasal airflow in order to allow better tolerance of CPAP.

Weight loss

Most patients will either eliminate or significantly reduce their sleep apnea by reducing their weight.

Positional therapy

Occasionally, obstructive sleep apnea may be controlled with specialized body pillows that prevent the patient from sleeping on their back.

Complications:

The frequent drops in blood-oxygen levels and reduced sleep quality caused by sleep apnea can trigger the release of stress hormones that may cause serious complications. Left untreated, sleep apnea can cause headaches, daytime fatigue and memory problems. More serious complications may include:

  • High blood pressure
  • Heart arrhythmia
  • Heart attack
  • Stroke
  • Driving accidents and fatalities

Sleep apnea can be diagnosed and effectively treated. A doctor should be consulted for the best treatment option.

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