What is Sleep Apnea?
Obstructive sleep apnea (OSA) is common sleep disorder which affects your breathing at night. During sleep, the airway becomes blocked, resulting in an ‘apnea’ or a suspension of breathing. These pauses typically last 10 to 20 seconds or longer.Â According to theÂ American Sleep Apnea Association, OSA affects more than 18 million people in the United States andÂ is widely believed to be the most common chronic condition in the U.S. today.
Diagnosis and Treatment
Sleep apnea is a common cause of insomnia and often goes undiagnosed for years. Even with so many sufferers undiagnosed, it is still the most common complaint seen in sleep clinics. Because so many sufferers remain undiagnosed, it is hard to get accurate figures.Â The physical effects of sleep apnea are thought to be responsible for approximately 50,000 deaths each year associated with conditions that sleep apnea causes or exacerbates, such as heart attacks, strokes and accidents. The toll that sleep apnea takes on personal, professional and family lives of sufferers is immense. However, once diagnosed, sleep apnea is quite amenable to treatment.
Continuous Positive Airway Pressure (CPAP)
CPaP is the most common treatment for sleep apnea. Sufferers wear a mask over their nose and mouth that generates a slight positive air pressure during sleep, preventing the characteristic airway collapse of the condition. Modern CPAP machines even come in “smart” versions that can adjust the pressure as needed in order to deal with changing conditions as well as offering a variety of types of masks aimed at creating the most comfortable fit possible.
Although they are incredibly useful, CPAP machines do have some downsides. Sleeping with a mask on is difficult for most people and can be nearly impossible for some. As people change positions in their sleep, adjustments in air pressure are needed in order to maintain open airways, which the less expensive non-“smart” machines find difficult to do. The continuous flow of air also tends to dry out the nose, mouth and throat.
One of the most popularÂ CPAP alternatives is the oral appliance. These are custom-fit mouthpieces created by dental specialists that increase the opening in the back of the throat in order to allow optimal airflow. They do this by either moving the tongue or the lower jaw forward.
When the alternative is sleeping with a CPAP for life, many patients will elect to have a single surgical procedure and hopefully be done with it. Tracheostomies are sometimes performed, but most cases call for other options. Older surgical procedures that involved removing the uvula, tonsils and other soft tissue at the back of the throat are not commonly used anymore, thanks to the relatively low success rate.
This original surgical treatment for sleep apnea was called uvulopalatopharyngoplasty or UPPP. It was pioneered in the 1980s and the initial outcome was often favorable. However, much of the tissue that is removed in a UPPP procedure will grow back given time. This, in addition to scarring that regrowth creates, can actually make the condition worse.
The modern surgical options for sleep apnea sufferers are essentially permanent versions of the oral appliance. One surgery moves the tongue forward in the mouth to increase the space at the back of the throat. This option has a 60-70 percent success rate.
A more drastic procedure called the maxillomandibular osteotomy, or MMO, has a 90 percent success rate. However, it is a major surgery that involves physically advancing both the upper and lower jaws. The jaws must both be cut free, moved forward, and then fixed back into place with metal plates and screws.
Radio Frequency Options
A non-invasive treatment option for sleep apnea is radio frequency reduction of tissue volume. This treatment involves placing needle electrodes, about the size of ordinary hypodermic needles, into the tissue that is to be shrunk. The radio waves heat the needles and destroy small amounts of tissue around them. The immediate effect is moderate inflammation and swelling, but the longer-term effect is a reduction in the amount of tissue in the treated areas. This increases the size of the airway and helps reduce sleep apnea problems.
Because of the way the treatment works and the delicacy of preventing damage to other functions, radio frequency treatments produce smaller gains of function than some other options. In the future, radio frequency techniques will probably be fine-tuned and become more effective. The proccess has the major advantage of being an outpatient and minimally-invasive procedure that can be done relatively quickly, all of which are essential in treating one of the most common chronic conditions in the U.S