Sleep Apnea
The word “apnea” is Greek, and means “to stop breathing.” Sleep apnea describes a sleep disorder during which a patient repeatedly stops breathing in his sleep, and it can have dire consequences on your overall health if not treated successfully. Breathing cessation can occur for a number of reasons, and different causes account for different forms of 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.
Our oral surgeons can treat extreme cases of obstructive sleep apnea, the most common form of the disorder, when all other treatments have failed, and help you achieve the deep sleep your mind and body need.
The Different Forms of Sleep Apnea
Central sleep apnea occurs when the brain fails to send the appropriate signals to the chest muscles and diaphragm; essentially, your body forgets how to breathe in your sleep. Obstructive sleep apnea, or OSA, occurs when your airway is physically blocked by collapsed oral tissues.
Most OSA patients exhibit some form of abnormal oral tissue, like enlarged tonsils or base of the tongue. During sleep, these tissues relax and collapse into the airway, causing excessive snoring as air is forced through an increasingly smaller space. The sound grows louder as the airway continues to close, and then silence ensues as the patient stops breathing. After a few moments, the mind panics and wakes the body with a gasp or choking sound, but only enough to start breathing again.
Treating OSA
The first step in treatment resides in recognition of the symptoms and seeking appropriate consultation. Oral and maxillofacial surgeons offer consultation and treatment options.
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. To confirm the amount of cardiovascular compromise and decreased oxygenation levels, a sleep study may be recommended to monitor an individual overnight.
Treating obstructive sleep apnea focuses on preventing airway obstruction. Some patients find relief from obstructive sleep apnea simply by losing weight.
In many cases, the condition is successfully treated with a custom-fitted oral appliance, or sleep guard, designed to keep the lower jaw in a forward position at night.
The mandibular support helps prevent oral tissues from collapsing and blocking the airway. For more severe cases, a continuous positive airway pressure (CPAP) machine is often prescribed to maintain air pressure and keep the airway open.
When Oral Surgery Is Required
Though many OSA patients find successful treatment with CPAP or a sleep guard, the treatments may not always work. In extreme cases, OSA patients are referred to an oral surgeon. Surgical OSA treatment involves soft tissue surgery to minimize the source of the obstruction, followed by jaw and orthognathic surgery to reposition the upper and lower jaw (both procedures are performed during the same visit). By changing the landscape of your oral tissues and airway, surgical treatment can eliminate the cause of obstructive sleep apnea when all other treatments have failed.
There are several treatment options available. An initial treatment may consist of using a nasal CPAP machine that delivers pressurized oxygen through a nasal mask to limit obstruction at night. One of the surgical options is an uvulo-palato-pharyngo-plasty (UPPP), which is performed in the back of the soft palate and throat. A similar procedure is sometimes done with the assistance of a laser and is called a laser assisted uvulo-palato-plasty (LAUPP). In other cases, a radio-frequency probe is utilized to tighten the soft palate. These procedures usually performed under light IV sedation in the office.
In more complex cases, the bones of the upper and lower jaw may be repositioned to increase the size of the airway (orthognathic surgery). Procedures like Maxillomandibular Advancement, Hyoid suspension, Genioglossus Advancement are done in the hospital under general anesthesia and requires a one- to two-day overnight stay in the hospital.
OSA is a very serious condition that needs careful attention and treatment. Most major medical plans offer coverage for diagnosis and treatment
Consequences of Untreated Sleep Apnea
Patients with obstructive sleep apnea typically aren’t aware of the condition until an annoyed sleeping partner points out their extremely loud snoring. The disruptive cycle can occur hundreds of times a night, and while the body and mind are constantly woken up by the lack of air, the patient is not typically roused from consciousness. Aside from snoring and a complaining sleeping partner, other symptoms of sleep apnea include signs of sleep deprivation, such as :
- Daytime fatigue
- Blurred vision
- Trouble concentrating/remembering
- Irritability
- Depression
- Reduced ability to tolerate stress
- Dramatic change in appetite
- Weak immune system (more frequent infections/illnesses