Sleep apnea

Dear Very Tired Indeed,

You’re not alone in your experience of this condition: In the United States, about four percent of middle-aged men and two percent of middle-aged women experience collapsing mouth and throat muscles that block the intake of air during sleep, referred to as sleep apnea. Some good news, though: there are a variety of approaches to treating sleep apnea ranging from lifestyle changes to surgical intervention (more on those in a bit). It may just take trying a number of strategies before a successful treatment is determined. Having a conversation with your health care provider about additional options may help you find a treatment option that works best for you.

For those unfamiliar with the condition, one of the primary tip-offs to sleep apnea's presence is a very pronounced snore — more like a loud and sudden snort. This "gasp for air" as the person abruptly wakes up is literally a lifesaver when blood pressure and pulse have fallen to dangerous levels; the mouth and throat muscles tense up to allow air back into the body. Risk factors that increase the chance of developing the condition include being older than 45, being overweight, and/or having: enlarged tonsils, a small jaw, or small, soft palate. Sleep apnea is frequently not treated directly because its symptoms are often associated first with depression, stress, or plain old loud snoring. Additionally, most sleepers are unaware of this occurrence, although it often shakes their bed partners, roommates, and even neighbors, to the core. When people with sleep apnea fall back asleep, relaxing muscles once again cause airway blockage. As you noted, this vicious cycle is repeated over and over again each night. This roller coaster sleep pattern often leads to a loss of energy, concentration, and productivity, and an inability to stay awake during less active tasks, such as reading, watching television, and driving. In serious cases, the continuous oxygen deprivation caused by sleep apnea can lead to high blood pressure, heart attacks, strokes, and even sudden death.

What can be done to better manage or treat sleep apnea? In less severe cases, weight loss and a reduction in alcohol, caffeine, large meals, and sleeping pills before bedtime have shown to be successful remedies. Sleep experts also recommend that people with sleep apnea not sleep on their back; sometimes sewing a tennis ball into the back of a nightshirt can prevent this from occurring. In more severe cases, positive airway pressure devices (PAP) — machines that blow air through a mask into the body during sleep — are the standard treatment. As you mentioned, continuous positive airway pressure (CPAP) is one type, but other options include bilevel positive airway pressure (BiPAP), and variable positive airway pressure (VPAP). Although this treatment has also helped many people, some cannot tolerate this method, and may benefit from oral devices that change the position of mouth structures during sleep. These oral appliances that hold the lower jaw forward to force the airway to stay open, and have been shown to be extremely effective in preventing snoring — but only help in some, not all, cases.

Surgery can also be an option, but it’s successful in only about half of all cases. Some surgical procedures reconstruct the nasal passages or remove tissue from the back of the throat to create a larger airway. Other procedures move the bones or tissues in the mouth forward, again opening the airway. In most cases, more than one surgical procedure is needed to ensure complete success due to the challenge of removing all of the obstructive tissue. A newer approach recently approved for use, is an upper airway stimulation (UAS) device. It works somewhat like a pacemaker.  A small generator and breathing sensor is implanted to monitor sleep patterns, and stimulate muscles to contract in order to open the airway. This is not for everyone, but can be a helpful alternative for some who are unable or unwilling to use PAP devices or undergo surgery.

For more information on sleep apnea and resources for help, you can contact the National Sleep Foundation and the American Sleep Apnea Association. It’s good to hear that the use of the CPAP is helping, but your discomfort and fears are certainly understandable. Consider discussing new treatment options — such as an oral appliance, UAS, and/or surgery — or even your feelings related to CPAP with your health care provider to potentially find a more agreeable option.