Sleep Apnea

Sleep apnea and insomnia

Sleep apnea is the pausing of breathing, lasting between a few seconds to a minute or more that occurs between 1 and 100 times an hour during sleep. It is caused by low muscle tone around the airways, sleep position and general body condition. People most at risk are the elderly, obese, smokers and men, though it also affects women and children. Most notably it causes snoring, and daytime fatigue. Sleep apnea is difficult to diagnose due to its occurring while a sufferer is asleep, and is usually noticed only by a bed partner.

Sleep apnea reduces oxygen intake and therefore blood oxygen levels become low. This signals the brain to disrupt sleep in order to resume breathing, thereby creating a broken sleep pattern. Broken sleep patterns prevent the body and mind from getting the daily amount of required sleep and this causes daytime fatigue.

Untreated sleep apnea can increase the risk of high blood pressure, heart attack, stroke, obesity, and diabetes, as well as heart failure and irregular heartbeats.

There are a variety of treatments for sleep apnea, which include:

• Lifestyle changes
  • Reducing weight
    • Being overweight is a major cause of sleep apnea
  • Quitting smoking
  • Avoiding alcohol at least 4 hours before sleep
  • Avoiding sedatives and sleeping medications

• Sleep position
  • Sleeping on one’s back increases the likelihood of sleep apnea significantly. Sleeping on one’s side can reduce or eliminate sleep apnea.

• Specialized mouth pieces
  • Known as a Mandibular Advancement Device (MAD), a MAD is a mouthpiece that looks similar to those that a boxer wears. It has breathing holes and a system for holding the tongue in place. It is designed to keep the lower jaw forward and airways open.

• Specialized breathing devices
  • Known as a Continuous Positive Airway Pressure machine (CPAP), a CPAP device pushes air through a mask that covers the nose and mouth in order to keep the throat and airways open. CPAP devices are usually more effective than MAD devices.

• Surgery
  There are several surgical operations for treating sleep apnea, depending on the specific condition. These include:

• Uvulopalatopharyngoplasty (UPPP)
  • Removal of excess throat tissue, including:
    • Uvula
    • Roof of the mouth
    • Parts of the tongue
• Tonsillectomy and/or adenoidectomy
  • Removal of tonsils and/or adenoids
  • Done to treat apnea, not snoring
  • Usually for children, not adults
• Tracheostomy
  • A surgical operation that creates a permanent opening in the neck (trachea) with a valve that is closed during the day and open during sleeping hours
  • A tracheostomy is usually only done as a last resort
• Maxillo-mandibular advancement (MMA)
  • A surgical operation that moves both the upper jaw (maxilla) and lower jaw (mandible) forward in order to enlarge the airway. It is a highly effective treatment for obstructive sleep apnea, but usually done as a last resort.
• Radiofrequency ablation (RFA)
  • This procedure involves several treatments (usually 10 or more) of placing an electrode, that emits radio waves and heat, at the base of the tongue to reduce excess tissue there. The reduction of tongue tissue opens the airways and reduces apnea. It is effective for obstructive sleep apnea.
• Palatal implants
  • Palatal (or pillar) implants involve inserting 1 to 3 cylindrical polyester rods into the soft palate (upper back area of the roof of the mouth). The inserted rods trigger the healing of tissue around them, which stiffens the soft palate and reduces relaxation and vibration there. This procedure is effective for reducing snoring and can be beneficial in reducing obstructive sleep apnea.
• Nasal septoplasty
  • Nasal septoplasty is a surgical procedure that straightens a crooked (deviated) septum (the cartilage that runs the length of the nose and separates the two nostrils). A deviated septum impairs breathing and smell, and can cause snoring, nasal drip, headaches and sinusitus. This procedure can also happen in combination with repairs to nasal bone.
• Nasal polypectomy
  • This is a surgical procedure that removes or reduces the size of soft tissue polyps in the nasal passages. When polyps in the nasal passages become too large, they can block air flow.
• Bariatric surgery
  • Bariatric surgery involves changing (decreasing in size) the structure of the stomach and upper small intestine in order to reduce the calorie intake of an individual as a means to enact weight loss. This type of surgery is almost always only performed on the morbidly obese. There remain questions about using this procedure to reduce sleep apnea, as sleep apnea can be caused by factors other than obesity.