Sleep apnea is a potentially serious sleep disorder that occurs when a person’s breathing is interrupted during sleep. People with untreated sleep apnea stop breathing repeatedly during their sleep, and this can occur up to hundreds of times during the night.
There are two types of sleep apnea: obstructive and central. Obstructive sleep apnea (OSA) is more common, and is caused by episodes of complete or partial airway blockage during sleep. This usually happens when the soft tissue in the back of the throat collapses during sleep. In central sleep apnea (CSA), the airway is not blocked, but the brain fails to signal the muscles to breathe. This is caused by instability in the respiratory control center in the central nervous system.
What are the symptoms of sleep apnea? Often the first signs of OSA are recognized not by the patient, but by the bed partner. They may include snoring, daytime sleepiness or fatigue, restlessness during sleep, sudden awakenings with gasping or choking, dry mouth or sore throat upon awakening, trouble concentrating, forgetfulness, irritability, night sweats, sexual dysfunction and headaches. Those with CSA more often report recurrent awakenings or insomnia, although they also may experience choking or gasping with sudden awakenings. In children, the signs may not be as obvious and include poor school performance, hyperactivity, lack of focus, sleepiness, daytime mouth breathing, inward movement of the rib cage when inhaling, unusual sleeping positions, excessive nighttime sweating, learning and behavioral disorders, and bedwetting.
How is sleep apnea diagnosed? A physician will take a medical and sleep history and conduct a physical exam. An overnight sleep study, or polysomnogram (PSG), is required to make the diagnosis and grade its severity. Studies are tailored to address the individual’s symptoms and bedtimes. Sleep testing can be performed at the home of patients with high probability of moderate to severe obstructive sleep apnea and who do not have problems affecting the heart, lungs and/or nervous system. (See sidebar on Home Sleep Test for details.)
How is sleep apnea treated? Conservative treatment may be all that is needed for milder cases of sleep apnea. Lifestyle changes may include losing weight (if overweight), avoiding alcohol and sleeping pills, sleeping on your side, using nasal sprays or breathing strips, and avoiding sleep deprivation. Continuous positive airway pressure (CPAP) therapy is often necessary for those with OSA. Special appliances that are placed in the mouth can help those with mild-to-moderate sleep apnea. These appliances prevent the tongue from blocking the throat and help move the lower jaw forward during sleep.
Other non-CPAP methods of obstructive sleep apnea treatment include nasal expiratory positive airway pressure therapy and oral pressure therapy. Nasal expiratory therapy consists of mechanical valves placed at the nares. This allows for a low resistance when inhaling and a high resistance when exhaling, which ultimately keeps the airway clear. Oral pressure therapy uses a light oral vacuum that brings the throat tissues forward and stabilizes the tongue to open the airway. In some patients, surgical procedures effectively reduce sleep apnea in those who have too much soft tissue or malformed tissue that blocks the airflow through the nose or throat. Surgical options can range from nasal surgery to improve breathing to help adjust to CPAP, restructuring of the throat tissue to lessen collapse, or even a nerve stimulation implant to open the airway.
The nerve stimulation treatment involves a small, minimally invasive, implanted pacemaker-like system that monitors breathing while sleeping and delivers mild stimulation to certain airway muscles to keep the airway open. It is controlled via a handheld remote and consists of three implanted components: a small generator, which is implanted in the right chest area; a breathing sensor, which is placed in the thoracic region; and a stimulation lead, which is placed along a branch of the hypoglossal nerve. Of the patients that meet strict inclusion and exclusion criteria, this therapy has shown to reduce the severity of OSA and improve quality of life and daytime functioning.
What is CPAP? With continuous positive airway pressure (CPAP), patients wear a mask over their nose and/or mouth and an air blower forces air through the airway. The air pressure is constant and continuous, and adjusted so that it is just enough to prevent the upper airway tissues from collapsing during sleep.
CPAP prevents airway closure while in use, but apnea episodes return when CPAP is stopped or it is used improperly. Many types and styles of devices are available. Some patients are not able to adhere to CPAP due to pressure intolerance. Patients who cannot tolerate CPAP may benefit from other types of pressure delivery devices. The Ocean Sleep Medicine offers additional services including PAP Naps and SAM clinics for patients having challenges getting adjusted to PAP therapy.
PAP Nap is one tool used to help patients effectively use PAP therapy. A PAP Nap is a daytime study for patients who have anxiety about starting PAP therapy, are claustrophobic, or are having difficulty tolerating PAP therapy for their sleep-related breathing disorder. The patient works one-on-one with a sleep technologist, using relaxation, deep breathing and desensitization techniques to try to become more comfortable with PAP therapy. During the PAP Nap, patients have individual coaching and counseling by a sleep technologist to overcome any fears or discomforts they have about PAP therapy and to make them more comfortable with the mask and pressure sensations. Minimal bioelectrodes are used during