Obstructive Sleep Apnea

People with obstructive sleep apnea (OSA) have disrupted sleep and low blood oxygen levels. When obstructive sleep apnea occurs, the tongue is sucked against the back of the throat. This blocks the upper airway and airflow stops. When the oxygen level in the brain becomes low enough, the sleeper partially awakens, the obstruction in the throat clears, and the flow of air starts again, usually with a loud gasp.

Repeated cycles of decreased oxygenation lead to very serious cardiovascular problems. Additionally, these individuals suffer from excessive daytime sleepiness, depression, and loss of concentration.

Some patients have obstructions that are less severe called Upper Airway Resistance Syndrome (UARS). In either case, the individuals suffer many of the same symptoms.

Diagnosis

The first step in treatment resides in recognition of the symptoms and seeking appropriate consultation.  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.  Home sleep testing is gaining in popularity, because it’s often easier for you and less expensive.  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 lood oxygen levels while you sleep.  These are most often done at a certified sleep center.

Home sleep tests. In some cases, 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 polysomnography even if your initial results are normal.

In addition to a detailed history, the doctors will assess the anatomic relationships in the maxillofacial region. With cephalometric (skull x-ray) analysis, the doctors can ascertain the level of obstruction. Sometimes a naso-pharyngeal exam is done with a flexible fiber-optic camera.  

 Treatment

Sleep apnea is treated with lifestyle changes, oral appliances, breathing devices, and surgery.  Medicines typically aren’t used to treat the condition.  The goals of treating sleep apnea are to restore regular breathing during sleep and relieve symptoms such as loud snoring and daytime sleepiness.

Treatment may improve other medical problems linked to sleep apnea, such as high blood pressure.  Treatment can also reduce your risk for heart disease, stroke, and diabetes.

Treatment options include:

Lifestyle Changes

If you have mild sleep apnea, some changes in daily activities or habits might be all the treatment you need.

  • Avoid alcohol and medicines that make you sleepy.  They make it harder for your throat to stay open while you sleep.
  • Lose weight if you overweight or obese.  Even a little weight loss can improve your symptoms.
  • Sleep on your side instead of your back to help keep your throat open.  You can sleep with special pillows or shirts that prevent you from sleeping on your back.
  • If you smoke, quit.  Talk with your doctor about programs and products that can help you quit smoking.

Oral Appliances

An oral appliance, sometimes called a mouthpiece, may help some people who have mild to moderate sleep apnea.  Severe apnea may require combination therapy (an oral appliance used with CPAP).  Your doctor may also recommend an oral appliance if you snore loudly but don’t have sleep apnea.

Dr. Roscher has extensive training in the diagnosis and treatment of obstructive sleep apnea and is a member of the American Academy of Dental Sleep Medicine (AADSM).  He is not currently practicing sleep medicine but can refer you to a specialist he has found to be a true expert in the field. 

CPAP

  • CPAP (continuous positive airway pressure) is the most common treatment for moderate to severe sleep apnea in adults.  A CPAP machine uses a mask that fits over your mouth and nose, or just over your nose.  The machine gently blows air into your throat.  The pressure from the air helps keep your airway open while you sleep.
  • Treating sleep apnea may help you stop snoring.  But not snoring doesn’t mean that you no longer have sleep apnea or can stop using CPAP.  Your sleep apnea will return if you stop using your CPAP machine or don’t use it correctly.
  • CPAP treatment may cause side effects and/or discomfort in some people. Oral appliances are an excellent alternative to CPAP in many cases.

In some extremely severe cases, surgery may be required to correct the problem but should be considered as a last resort in most cases.

OSA is a very serious condition that needs careful attention and treatment. Most major medical plans offer coverage for diagnosis and treatment.