Obstructive sleep apnea is an unsuccessful attempt to breathe through the nose and mouth, caused by obstruction involving the soft palate, uvula, nose, tonsils, adenoids, or base of the tongue. It is estimated that at least ten million Americans have unrecognized sleep apnea. When obstructive sleep apnea occurs, the airway is temporarily blocked, and air flow stops. When the oxygen level in the brain becomes low enough, the sleeper partially awakens, which clears the obstruction, and the flow of air starts again, usually with a loud gasp. This can occur numerous times throughout the night.
The characteristic rattling sound of snoring is the vibration of the soft palate and uvula or other structures in the upper airway. This is the result of the airway being constricted by one or more of these physical conditions:
- Poor muscle tone in the soft palate when muscles are relaxed by consumption of alcohol or drugs, or by smoking
- Enlarged uvula, tonsils, and adenoids
- Blocked nasal air passages, common with a cold or allergies
- Obstructed nasal airways, caused by polyps, cysts, or a deviated septum
- Excessive weight, causing tissues in the neck to be bulky and flaccid
- An underdeveloped upper or lower jaw
- Hypothyroidism and other glandular disorders
Obstructive sleep apnea can deprive you of oxygen. If you suffer from obstructive sleep apnea, you are probably also being deprived of the deep sleep stages you need. You may stay drowsy much of the day, and may even fall asleep while driving or on the job. Without treatment, the sleep deprivation and lack of oxygen caused by sleep apnea increases health risks, such as cardiovascular disease, high blood pressure, stroke, diabetes, depression, weight gain, and obesity.
Our surgeons are experienced in the diagnosis and treatment of obstructive sleep apnea, and can help you assess the severity of your condition. The best treatment option for your obstructive sleep apnea depends upon the severity of your sleep apnea, the physical structure of your upper airway, and other aspects of your medical history.
Weight loss: Sleep apnea can be weight-related. Additional fat around the neck may make the airway more narrow, making obstructions more likely to occur. For some overweight people, losing weight can be an effective treatment.
Avoiding alcohol and other CNS depressants: Alcohol and medications that act as central nervous system (CNS) depressants, such as pain killers, sedatives, and muscle relaxants can worsen sleep apnea by relaxing the airway muscles further and/or by reducing the respiratory drive. Avoiding alcohol and CNS depressants close to bedtime may be helpful.
Oral appliances: Oral appliances, sometimes called dental appliances, are intended to treat apnea by keeping the airway open in one of three ways: by pushing the lower jaw forward (a mandibular advancement device or MAD), by preventing the tongue from falling back over the airway (a tongue-retaining device), or by combining both mechanisms.
Continuous Positive Airway Pressure (CPAP): CPAP works by gently blowing pressurized room air through the airway at a pressure high enough to keep the throat open. This pressurized air acts as a “splint.” The pressure is set according to the patient’s needs at a level that eliminates awakening and sleep fragmentation.
Surgery: The intention of surgery is to create a more open airway so obstructions are less likely to occur, which include several different procedures, as follows:
- Nasal surgery, including turbinectomy (removal or reduction of a nasal turbinate), or straightening of the nasal septum, in patients with nasal obstruction or congestion.
- Tonsillectomy and/or adenoidectomy in an attempt to increase the size of the airway.
- Removal or reduction of parts of the soft palate and uvula, such as uvulopalatopharyngoplasty (UPPP) or laser-assisted uvulopalatoplasty (LAUP).
- Genioglossus advancement, in which a small portion of the lower jaw that attaches to the tongue is moved forward, to pull the tongue away from the back of the airway.
- Maxillomandibular advancement (MMA) simultaneously moves the upper (maxilla) and lower (mandible) jaws forward, opening the airway at the back of the throat. This movement opens the upper airway in three dimensions, giving a significant reduction in obstruction. MMA is the most effective sleep apnea surgical procedure currently available. The success rate is usually above 90%.