Sleep Apnea and Snoring

What Is Obstructive Sleep Apnea (OSA)?

Sleep apnea an extremely common sleep disorder which affects millions of Americans. The most common type is obstructive sleep apnea, often simply called OSA. Obstructive sleep apnea is the periodic cessation of breathing during sleep due to a blockage of the airway, resulting in disruption of quality sleep and a drop in oxygen levels. This puts significant stress on the cardiovascular system.

The brain signals the body that it needs oxygen, causing the OSA sufferer to wake up enough to gasp for air and begin breathing normally again. This may occur repeatedly, with anywhere from a few to several hundred apneic episodes in one night. Most people with obstructive sleep apnea have severely disrupted sleep and do not go through the normal stages of sleep.

Symptoms of Sleep Apnea

Symptoms of sleep apnea are commonly ignored or attributed to something else, so it often goes undiagnosed and untreated.

Sufferers don’t remember their many awakenings during the night.  It is usually a sleep partner who witnesses the snoring, pauses in breathing, and the gasping for air throughout the night.

Symptoms of OSA include:

  • Loud Snoring
  • Choking or Gasping for Air While Sleeping
  • Witnessed Pauses in Breathing While Asleep
  • Frequent Urination During the Night
  • Daytime Sleepiness
  • Morning Headaches

Health Problems Caused by Sleep Apnea

The consequences of untreated sleep apnea are far reaching, going well beyond poor quality sleep.

Conditions that have been associated with OSA if left untreated include daytime sleepiness, forgetfulness, morning headaches, depression, anxiety, heart disease (heart attack, heart failure, heart rhythm problems), stroke, diabetes, high blood pressure, and memory loss, among others.

Without proper sleep, many people develop a weakened immune system, and many complain of worsened symptoms of acid reflux.

Sufferers commonly have trouble concentrating during the day and OSA has often been found to be at the root of many driving and workplace accidents.

Causes of Sleep Apnea

When a person suffers from snoring and OSA, what occurs is repeated episodes in which the airway obstructs while the person continues to try to breathe. This results in the noisy breathing associated with snoring and the pauses in breathing associated with the apnea. While this process is similar among all patients, it’s important to recognize that how the obstruction occurs is different in every individual. This is a result of different sites of airway collapse.

Common sites of obstruction include:

  • Nose
  • Soft palate (the floppy tissue in the back of the throat)
  • Base of tongue
  • Epiglottis (top of the voice box)
To make things even more complicated, each of these sites may have a different mechanism by which collapse may occur. For example, at the level of the palate, collapse may occur from the palate falling backwards or from the sides of the throat collapsing in on themselves. As a result, an individualized approach needs to be used for every patient.

The good news is that there is almost always a treatment solution that can be offered but it will differ from patient to patient.

 

Treatment for Sleep Apnea

While most patients positively diagnosed with OSA will be offered CPAP (Continuous Positive Airway Pressure), many patients simply cannot tolerate this device for treatment.

Because sleep apnea has many health related consequences that extend beyond poor sleep, it is critical that patients find a treatment solution.  The good news is that there are multiple treatment options available and there is always help to find relief.

Some of these options include:

  • Oral appliances
  • Provent Therapy
  • Weight Loss
  • Weight Loss Surgery (in some cases)
  • Surgery

 

Surgery for Sleep Apnea

There are many different surgical procedures to treat the different mechanisms of airway collapse. In the last 10 – 15 years, many new procedures have been developed that have shifted away from removal of tissue to operations that reconstruct the airway. These limit some of the complications of past procedures that that were commonly seen. Dr. Boon is a strong advocate of these newer and more functional procedures.

It’s critical for any patient who is undergoing surgery to treat sleep apnea or snoring to have adequate diagnosis for proper treatment. While this can be accomplished in some patients with an office examination, many patients are best assessed with a sleep endoscopy. This is a brief and painless procedure in which patients are given limited sedation to produce sleep and a fiber-optic camera is used to examine the airway while the individual snores and obstructs their airway.

Drug-Induced Sleep Endoscopy

Many patients are best assessed with a minor diagnostic procedure called a sleep endoscopy. Done while the patient is under sedation, a sleep endoscopy makes it possible to examine the upper airway, including the back of the tongue, behind the palate, epiglottis, uvula, voice box, and the walls of the throat. Any one of these areas might collapse and cause snoring or obstruction. This brief and painless procedure helps the surgeon identify an optimal treatment plan.

Inspire Therapy

For patients with moderate to severe obstructive sleep apnea who are unable to tolerate CPAP (continuous positive airway pressure), there is a new FDA-approved alternative available called Inspire Therapy upper airway stimulation.

Dr. Boon is one of the first surgeons nationally to use upper airway stimulation to treat OSA.  He’s been performing the Inspire Therapy procedure in Philadelphia since 2014 with superior results. This outpatient procedure involves implanting a small device that gently stimulates the airway muscles to limit airway collapse.