Don’t Lose Sleep Over Obstructive Sleep Apnea

Sleep apnea is more common than people think.

According to the American Sleep Apnea Association, sleep apnea affects more than 18 million Americans. But because of a lack of awareness, many people with sleep apnea go undiagnosed, despite the potentially significant consequences.

Let’s set the record straight.

What is Obstructive Sleep Apnea (OSA)?

OSA is a sleep disorder that causes your breathing to repeatedly stop and start while you sleep, due to a blockage in your throat. When this happens, your breathing muscles have to work harder to open your airway and pull air into your lungs. Your breath becomes very shallow or interrupted. When you start to breathe again, it may be with loud gasping, snores, or body jerk. A noticeable sign of obstructive sleep apnea is snoring.

It’s a potentially serious disorder that can cause:

• Sleepiness during the day and trouble concentrating
• Cardiovascular problems such as heart attack, high blood pressure, unusual heart rhythms, or stroke
• Eye problems such as glaucoma and dry eye
• Metabolic disorders like type 2 diabetes
• Problems during pregnancy

“While obesity is the most common cause of sleep apnea, it’s not the only one,” says Dr. Alejandro Chediak, Interim Chief of Pulmonary, Critical Care, and Sleep Medicine at the University of Miami Miller School of Medicine. “Sometimes it has to do with the brain’s over-sensitivity to under or over-breathing or to lowering of a person’s arousal threshold. There are also anatomical blockages, such as a small jaw or a large uvula.”

Breathe easier. You have options

Regardless of the cause, or phenotype, he says 95% of people with OSA will find relief with a positive airway pressure (PAP) machine. Many who use a PAP machine and mask to help them prevent these episodes while they sleep.

A PAP machine uses a hose attached to a mask that fits over the nose and mouth or just the nose or uses a pronged nasal pillow piece to deliver air pressure to the throat. The majority of patients prefer the two nasal options, but mask choice is often a matter of your preference.

What you may not realize is that there are many types of PAP machines to fit individual situations and lifestyles. “We have CPAP, APAP, and BPAP, each with individual options for how the air is delivered,” says Dr. Chediak.

• CPAP (Continuous positive airway pressure) therapy is a common treatment for OSA. With CPAP, the pressure is continuous, like it sounds, and doesn’t adjust.
• APAP (Automatic positive airway pressure) looks at the pattern of breathing and automatically adjusts to the person’s breath. It exerts less pressure overall and is sometimes more comfortable, but equally effective.
• BPAP (bi-level positive airway pressure): BPAP makes it easier to breathe out because there is a lower pressure for exhaling. It comes in fixed and automatic pressure versions.

Dr. Chediak says there are PAP devices designed for use wherever you sleep, at home, or away. Several manufacturers make small PAP devices for frequent travelers.

Is there an alternative to the PAP mask?

For people with a low arousal threshold, a sleeping pill like Lunesta can be helpful. Because about 70% of people with obstructive sleep apnea are overweight or obese, losing weight has been reported to produce striking improvements in both OSA and snoring.

Upper Airway Stimulation (UAS) therapy

Some people with moderate to severe OSA who are unable to use PAP therapy now have a new treatment recently approved by the FDA. UAS has four components. Three of them are implanted during an outpatient procedure:

• Small impulse generator the size of a cardiac pacemaker implanted beneath the collar bone
• Breathing sensing lead placed between the muscle layers of the ribs
• Implanted stimulation lead attached to the branch of the hypoglossal (tongue) nerve that produces tongue protrusion when stimulated.

The fourth component is a small remote control that turns the system on when you go to bed and off when you get up.

UAS therapy works by continuously monitoring your breathing during sleep and delivering mild stimulation to the tongue muscles to keep the airway open. When the sensing lead detects breath inward, the impulse generator sends a signal to the hypoglossal nerve, which pushes the tongue slightly forward. The battery lasts about ten years, and the latest version is compatible with MRI.

In clinical trials, it was 65 to 70% effective in keeping oxygen levels up and restoring daytime wakefulness. Your doctor will evaluate your airway anatomy and overall health status to determine if UAS therapy is right for you.

What else can I do to fight Obstructive Sleep Apnea?

Oral appliances can be effective for some people with mild or moderate sleep apnea, says Dr. Chediak. Still, you should consult with your doctor about whether the probable cause of your OSA would benefit from an oral appliance. For some people with severe OSA, combination therapy (wearing PAP and an oral appliance together) can help reduce the pressure in a PAP machine, making it more comfortable to use.

Oral appliances are worn in the mouth during sleep, just like a sports mouthguard or an orthodontic appliance. They hold the lower jaw forward just enough to keep the airway open and prevent the tongue and tissues in the upper airway from collapsing and blocking the airway.

If they fit your mouth accurately, they can be helpful, but they should be custom-made by a dentist specially trained making and adjusting oral appliances for OSA. Over-the-counter, self-administered, devices only work in 20% of cases.

Surgery may help as well. The challenge is determining what part of the upper airway is causing the obstruction to airflow.

Historically, says Dr. Chediak, removing the soft palate and uvula will cure 45 to 55% of people. If that surgery and a procedure to bring the lower part of the jaw forward are done together, the effectiveness rate goes to 85 to 95%, but these are major operations. Other options, like PAP therapy or upper airway stimulation, are less intrusive.

For most children with snoring or sleep apnea, it is due to enlarged tonsils or adenoids.

In 75% of those cases, removing these tissues with a simple surgical procedure typically takes care of the problem.

The bottom line? If your significant other complains about your snoring or you feel exhausted all day, talk to your physician.

Most important? Get evaluated by a physician knowledgeable in OSA who will order the right type of testing to confirm the diagnosis.

Mary Jo Blackwood, RN, MPH, is a contributing writer for UMiami Health News.

Tags: APAP, BPAP, CPAP, Dr. Alejandro Chediak, obstructive sleep apnea, oral appliance, Therapy Upper Airway Stimulation (UAS) Therapy