SLEEP APNEA
SIMPLY SNORING OR
SOMETHING MORE
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SLEEP APNEA SIMPLY SNORING OR |
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If you snore it is likely you are familiar with nightly jab in the ribs, grumbling from your bed partner and maybe sleeping in separate bedrooms. Snoring happens when air does not flow through the passage in the throat. The resulting rasp and rattle can disrupt your sleep as well as those around you. You may not know that snoring can also be a sign of a serious condition called sleep apnea.
SLEEP APNEA IS SERIOUS
When a person has sleep apnea, the throat becomes blocked during the night, stopping breathing for short periods of time. If you have sleep apnea, your partner may hear you alternate between snoring loudly and being quiet. You may even gasp or snort in your sleep. Other symptoms are: waking up tired after a full night's sleep, waking up with a headache, feeling sleepy or falling asleep at inappropriate times (at work or while driving a car), irritability and a short temper, problems with concentration. Not only can sleep apnea leave you feeling constantly tired, it is also associated with health problems, such as high blood pressure, heart attack and stroke. Your doctor can help. Snoring and Sleep Apnea rarely go away on their own but they can be treated. I will evaluate you and recommend a treatment plan to help you sleep quietly and breathe safely. This plan may involve changes in sleeping position, the use of medical and oral devices to open the air passages, or surgery.
| Breathing During Sleep Breathing often seems like the easist thing in the world. Most of the time, you don't even think about it. But if you've ever had a stuffed-up nose, you know the feeling of trying to breathe through a very narrow passageway. This is what happens in your throat when your snore. While your sleep, stuctures in your throat partially block your air passage, making the passage narrow and hard to breathe at all, you have sleep apnea. |
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The soft palate is the
tissue at the back of the roof of your mouth. It helps block off your nose when you
swallow. The uvula is a long flap of tissue that hangs from your soft palate. Tonsils are balls of tissue in the throat. They may play a small role in helping your body defend itself against illness. The tongue helps you talk, chew, and swallow. |
| Breathing Normally When you breath in, air passes through your throat on it's way to your lungs. The air travels past soft, flexible structures in the throat such as the soft palate, uvula, tonsils, and tongue. During the day, muscles surrounding each structure tighten to hold the structure in place so it doesn't block the air passage. During sleep, these muscles relax, but the passage in your throat still stays clear enough for air to flow freely into and out of your lungs. |
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Although breathing seems like the easiest thing in the world and most of the time we do not think about it, if you have ever had a stuffed-up nose you know the feeling of trying to breathe through a narrow passageway. This is what happens in your throat when you snore. While you sleep, the structures in the throat partially block your air passage, making it narrow and difficult to breathe through. Entire passages can be blocked and you may have sleep apnea.
SNORING
If the throat structures are too large or the muscles relax too much during sleep, the air passages may be partially blocked. As air from the nose or mouth passes around this blockage, the throat structures vibrate and rattle against each other. At times this sound can be so loud that snorers wake up others or even themselves. Snoring gets worse as more and more of the air passage is blocked.
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SLEEP APNEA
If the structures completely block the throat, air flow cannot flow to the lungs. This is called apnea, meaning "no breathing." Since the lungs are not getting fresh air, the brain tells the body to wake up just enough to tighten the muscles and unblock the air passage -- with a loud gasp, breathing begins again. This process may be repeated over and over throughout the night, making your sleep fragmented. The lack of sleep and fresh air strains the heart, lungs and other organs, leading to problems such as high blood, heart attack or stroke.
NASAL DISORDERS CAN MAKE THINGS WORSE
Problems that make it hard to breathe through your nose can make snoring worse and may even cause snoring to become sleep apnea. If the dividing wall in the nose is crooked (deviated septum) or you have growths (polyps) in the nasal passages, air flow through the nose can be blocked. Colds, allergies that affect your nose, smoking and other things that make nasal tissue swell can increase stuffiness.
EVALUATION/HISTORY
I will take your history to gather information and ask facts about your life that may be affecting your breathing during sleep. My questions will include information about your sleeping and waking habits, medical problems and a history of medical problems in the family. Sometimes it is a good idea to bring a sleep partner because you are probably not aware of what you are doing while you sleep.
QUESTIONS TO THINK ABOUT
How often do you snore?
How loud is your snoring?
Can it be heard from other rooms?
Does the snoring stop for periods of time while you sleep?
Does it sound like you stop breathing?
Do you gasp or snort in your sleep?
Are you a restless sleeper?
What is your usual sleep position?
Does the snoring get better or worse if you change positions?
Do you drink alcohol in the evenings?
Do you take antihistamines, sleeping pills or sedatives?
How many hours do you usually sleep?
When you wake up, do you feel refreshed?
Are you often tired?
Do you fall asleep easily?
Have you ever fallen asleep during the day when you did not mean to?
Have you ever fallen asleep while driving?
Do you have problems breathing through your nose?
Are you overweight?
Do you smoke?
PHYSICAL EXAMINATION
During the examination I will look into your mouth and throat for enlarged or crowded structures. I will look into the area of your trachea and larynx (voice box). I will evaluate your nose and the area behind your nose for signs of allergies or obstruction. I may order laboratory tests or x-rays, including a special scan of the sinus or an x-ray of the throat or jaw.
WHAT HAPPENS NEXT
After the examination I will decide upon a plan of action. I may prescribe medication for a simple problem or recommend a sleep study done in a testing laboratory that will evaluate. During this study, sensors will record the activity of your heart, lungs and brain, the movement of your muscles, airflow from your nose and mouth, and the level of oxygen in your blood. In addition, your body movements will be videotaped and snoring, talking or other noises you make while you are asleep will be recorded. A technician watches the recording on monitors all night to observe you and make sure that there are no problems with the equipment. If you have severe sleep apnea, the technician or I may provide a device called CPAP that keeps the air passage open and helps you breathe. After the sleep study the results will be analyzed and interpreted. I will make recommendations based upon things I learned about your sleep, whether your air passages are blocked, or whether you have sleep apnea.
CHANGES YOU CAN MAKE
Whether or have sleep apnea or not, your snoring may get better if you make a few simple changes in your life in your sleeping and waking habits.
1. Sleep on your side.
This will prevent the throat structures from sliding back and blocking the air passage. It will also relieve pressure on the passage caused by extra weight in the stomach, chest or neck. Here is a simple trick: sew a pocket into or safety pin a sock on the back of your tee-shirt or pajama top. Place two or three tennis balls into the pocket or sock and then wear this to bed. The tennis balls will prevent you from rolling on your back.
2. Lose weight.
Being overweight makes snoring worse; in fact, sleep apnea occurs most often in people who are overweight. Talk to a doctor about a weight loss program. If you lose enough weight to come close to your ideal weight, your snoring and sleep apnea may be cured (although this is unlikely).
3. Avoid alcohol and certain medications.
Alcohol and medications such as sleeping pills or sedatives make breathing slower and shallower and make the muscles relax of the throat so that the structures of the throat are more likely to block. If you snore, it is best to avoid alcohol.
4. Exercise regularly.
Exercise can help you lose weight, tone muscles and make the lungs work better. Walking is a good exercise for almost anyone. Any exercise through the day that can you help you lose weight may be of benefit in this condition.
5. Unblock your nose.
If you have allergies, polyps or other problems that block your nose, treating them may improve snoring or sleep apnea. I will recommend medications for allergies or sinus problems. If you smoke, try to quit. Smoking irritates the nasal passages and makes a stuffy nose even worse, causing more snoring and sleep apnea.
DEVICES FOR SLEEP APNEA AND SNORING
AIR PRESSURE DEVICES
The most common air pressure device is called CPAP. Adjustments are necessary to make CPAP comfortable. A small air blower is connected by a flexible hose to a plastic mask. The blower sends a gentle, steady stream through the nose into the throat which keeps the structures from collapsing and blocking the air passage. The pressure is customized to the patient's needs and it may take some adjusting before it is right. The air pressure may also need to be adjusted if the patient loses weight.
TIPS FOR USING CPAP
CPAP does not cure underlying conditions that cause sleep apnea so it should be used all night every night. Many styles of masks are available. If the mask is uncomfortable, try to get a custom mask. A vaporizer or humidifier may combat any dryness of the nose. Salt water spray may also help. CPAP works when the nose is clear. If you have allergies or other problems that block the nose, get those treated first. If the CPAP is uncomfortable or ineffective, do not stop using it. Ask the doctor for additional tips that might help it work for you.
ORAL DEVICES
Oral devices worn in the mouth at night help quiet snoring and treats mild apnea. These devices come in many shapes and styles. Adjustments may be necessary when selecting and fitting dental devices. Work with your doctor or dental professional to find the right device for you.
HOW THESE DEVICES WORK
Some hold the tongue forward to keep it from blocking the throat. Some hold the jaw forward moving the throat structures with it. Others lift the uvula and soft palate, keeping them from blocking the throat. After the device is fitted, periodic follow-ups including a complete sleep study will insure that the device is working properly. Oral devices do not permanently cure underlying conditions that cause snoring or sleep apnea; therefore, they should be used all night and every night. Ultimately, if they have fail, one should give consideration to a permanent solution for the problem, such as surgery.
SURGERY FOR SLEEP APNEA
If the above treatments have not been successful in stopping snoring and sleep apnea, several types of procedures are available.
1.UPPP (or uvulopalatopharyngoplasty)
It is the most common operation for snoring. It involves removing the uvula part of the palate, the tonsils and the side walls of the throat. It is helpful in stopping the throat structures from rattling and causing snoring. It is less successful in treating sleep apnea because tissues farther back in the throat may still block the air passage.
DURING AND AFTER AN UPPP
The procedure is done in a hospital under an anesthetic which may require a one or two day stay. You may have a severe sore throat for several weeks and you will only eat soft foods during this time. Full recovery takes a month.
RISKS AND COMPLICATIONS OF THE UPPP
2.LAUP
A newer procedure used to treat snoring is called the Laser Assisted Uvulopalatoplasty (or LAUP). A laser is used to remove part or all of the uvula and some of the soft palate. A similar procedure is done with electric current. Either of these may quiet snoring and sometimes may be appropriate for treating mild apnea. A sleep study is done before this procedure is performed to determine whether or not the patient has sleep apnea. The procedure is done in the physician's office with the patient awake under a local anesthetic. One or more repeated operations may be necessary until the correct amount of tissue is removed and the patient stops snoring. After each session there may be some discomfort for a few days to a week. Eating may be restricted to soft foods for several days.
RISKS AND COMPLICATIONS OF THE LAUP
3.OTHER PROCEDURES
Nasal surgery can remove polyps and straighten a deviated septum. Surgery may be needed to remove enlarged tonsils or adenoids. Jaw surgery can move the jaw and tongue forward to make the air passage larger. A tracheostomy is necessary if one has severe life-threatening apnea when other treatments have failed.
