Sleep apnea is a condition where a person repeatedly stops breathing multiple times during sleep.

There are 3 different types of sleep apnea: Obstructive sleep apnea, central sleep apnea and mixed sleep apnea.

Obstructive sleep apnea (OSA) is caused by the upper airway collapsing and blocking the throat. Central sleep apnea happens when the brainstem that controls breathing malfunctions. Mixed sleep apnea is a mixture of both.

What Are The Characteristics and Symptoms of Sleep Apnea?

• frequent episodes of obstructed breathing during sleep. (The patient may be unaware of this symptom -- usually the bed partner is extremely aware of this).
• loud snoring
• morning headaches
• unrefreshing sleep
• excessive daytime sleepiness
• a dry mouth upon awakening
• chest retraction during sleep in young children (chest pulls in)
• high blood pressure
• obesity
• irritability
• change in personality
• depression
• difficulty concentrating
• excessive perspiring during sleep
• heartburn
• reduced libido
• insomnia
• frequent nocturnal urination (nocturia)
• restless sleep
• nocturnal snorting, gasping, choking (may wake self up)
• rapid weight gain
• confusion upon awakening

The upper airway can be obstructed by excess tissue in the airway, large tonsils, a large tongue, and the disorder is usually characterized by the airway muscles relaxing and collapsing when asleep. Another site of obstruction can be the nasal passages. Sometimes the structure of the jaw and airway can be a factor in sleep apnea.

Patients with sleep apnea can have hundreds of cycles of interrupted breathing per night.

Many people with sleep apnea may are unaware of this repeating sleep-snore-apnea-wake pattern, it is very disruptive to normal sleep patterns, and very hard on partners. Fatigue throughout the day can be attributed to a frequent disrupted sleep pattern.

Who Is Most Likely To Have Sleep Apnea?

Sleep apnea is more common in:

• Males (2-4 times more likely than females)
• African-Americans
• Hispanics of Mexican origin
• Pacific Islanders

Risk factors for sleep apnea include:

• Smoking
• Heavy alcohol use
• Sedative/CNS depressant use
• Obesity
• Family history of sleep apnea
• Pregnancy
• Diabetes
• Polycystic ovary syndrome
• High blood pressure
• Facial deformities
• Hypothyroidism
• Esophageal reflux (GERD)
• Enlarged tonsils or adenoids
• Chronic respiratory tract conditions, such as:
• Asthma
• Allergies
• Chronic bronchitis
• Chronic obstructive pulmonary disease

Treatment for Sleep Apnea:

Lifestyle Modifications:

• Quitting smoking
• Weight loss
• Eliminating alcohol
• Eliminating sedative/central nervous system depressant use

Physical Intervention:

The most commonly employed physical therapeutic method is known as positive airway pressure (PAP): a breathing machine pumps a controlled stream of air through a mask worn over the nose, mouth, or both. The additional pressure holds open the relaxed muscles, just as air in a balloon inflates it. There are several types of PAP:

• CPAP (Continuous Positive Airway Pressure) – This is the gold standard for sleep apnea treatment: a controlled air compressor generates an airstream at a constant pressure. This pressure is prescribed by the patient's physician, based on an overnight test or titration. Newer CPAP models are available which slightly reduce pressure upon exhalation to increase patient comfort and compliance.
• VPAP (Variable Positive Airway Pressure), also known as BiPAP, uses an electronic circuit to monitor the patient's breathing, and provides two different pressures - a higher one during inhalation and a lower pressure during exhalation. This system is more expensive, and is sometimes used with patients who have other coexisting respiratory problems and/or who find breathing out against an increased pressure to be uncomfortable or disruptive to their sleep.
• APAP (Automatic Positive Airway Pressure) is the newest type of PAP treatment. An APAP machine incorporates pressure sensors and a computer which continuously monitors the patient's breathing performance. It adjusts pressure continuously, increasing it when the user is attempting to breathe but cannot, and decreasing it when the pressure is higher than necessary.

Surgical Intervention:

When patients do not want to use a method like CPAP, surgery is usually the best option. There are several types of surgeries, detailed below:

What Does Surgery for Sleep Apnea Involve?

Tracheostomy:

This is a much less-frequently used surgery for sleep apnea nowadays. A surgeon makes an incision in the trachea and inserts a tube to let air in. A valve in the tube keeps the opening of the tube closed during the day, allowing you to speak and breathe normally. At night, the valve is opened so that air can go around the blockage in your throat and into your lungs while you sleep.

Tonsillectomy/Adenoidectomy:

Removal of the tonsils and adenoids creates a larger airway. This is accomplished using standard, “cold knife” dissection, electrocautery, or radiofrequency (RF ablation).

CO2 Lasers can also be used to quickly and easily vaporize and remove tonsil tissue.

Uvulopalatopharyngoplasty (UPPP)/Laser Assisted Uvuloplasty (LAUP):

This surgery refers to the removal or reduction of parts of the soft palate and some or all of the uvula.

Somnoplasty:

This is a procedure which uses a minimally invasive technique called radiofrequency (RF) ablation to reduce excess soft tissue volume in the upper airway, including the base of the tongue, thereby opening the airway.

Under local anesthesia, a handheld RF device with a needle electrode is applied to the affected areas of soft tissue (uvula, soft palate, base of tongue). The heat generated produces coagulative lesions, which are naturally reabsorbed by the body, resulting in decreased tissue volume and renewed airway patency.

Are You A Candidate?

You may be a good candidate for these surgeries if:

• You have mild to severe obstructive sleep apnea (OSA) where CPAP is unsuccessful or you don’t wish to use CPAP

What Are The Advantages Of Surgery for Sleep Apnea?

This is a largely-permanent solution to the problem. There is substantial reduction of excess tissue, which is the cause of obstructive sleep apnea. Patients report significant and lasting relief from the problem post-surgery.

How Long Does It Take?

Depends on the individual procedure.

How Many Treatments Are Required?

Tracheeostomy: one. Sometimes UPPP or LAUP requires several treatments.

What Are My Alternatives If I Have Sleep Apnea?

• CPAP
• Theophylline

Will I Have Pain?

There may be minor pain and swelling for a few days; a short course of pain relievers is usually given.

When Can I Go Back To Work Or School?

Usually about two weeks for UPPP and LAUP; slightly less for tracheostomy.

Who Will Perform My Sleep Apnea Surgery?

The surgery will be performed by one of our highly-trained specialists in the field.

How Much Does It Cost?

Depends upon particular procedure utilized. Please call TopSurgeons at 800-506-8084 for more information.

Will My Insurance Cover?

Insurance companies should cover this procedure.