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Obstructive Sleep Apnea

Apnea literally means without breath, in which an individual stops breathing. Obstrutive sleep apnea occurs at night because an individual has a physical obstruction, often in the nose, tongue or throat, which prevents an individual from breathing by mouth at night. Obstructive Sleep Apnea is characterized by significant and prolonged interruptions of breathing and airway obstructions at night.

Obstructive sleep apnea prevents someone from obtaining restful sleep. Individuals with sleep apnea may complain of

  • Constant “tired” feeling
  • Sensation of never fully being rested
  • Need to take daytime naps
  • Sleepiness during the day
  • Lack of energy
  • Mood changes
  • Lack of libido

Obstructive sleep apnea not only affects the quality of life of individuals, but when uncontrolled by may be harmful to one’s health. Obstructive sleep apnea may be associated with

  • Low oxygen levels
  • Cardiac arrhythmias, or irregularities in the heart's normal beating pattern
  • High blood pressure
  • Rarely, sudden death.

It is well established that obstructive sleep apnea is a a serious disorder which may become a major risk to one's health, causing significant lung and heart problems over time.

Obstructive sleep apnea may occur in those who snore. However, not all people who snore have sleep apnea

Overview

Individuals who snore loudly may also suffer from obstructive sleep apnea (OSA). There are a variety of treatments for each disorder (and some patients have both). Dr. Crumley has performed over 1,500 procedures in treating patients who suffer from snoring, OSA, or both. This information comes from his 25 years of experience in dealing with sleep disorders at UCI Medical Center.

Many people snore. It has been estimated that anywhere from 30 - 50% of the United States population snore at some time or another. Significant snoring is sometimes described as "heroic" snoring, in which the snoring loudness may be heard more than two bedrooms away. Such snoring may cause several problems:

  • Marital Discord
  • Sleep disturbances (from spousal prodding)
  • Waking episodes (from one's own snoring)
  • Frequent association with OSAS

Snoring is not sleep apnea, and sleep apnea is not snoring. Snoring (noisy breathing during sleep) is a social problem, as indicated above, and may be associated with significant sleep disturbance, waking episodes, etc. without OSAS. However, many patients with loud snoring do have significant obstructive sleep apnea (possibly 2/3’s or more).

Obstructive Sleep Apnea

Obstructive Sleep Apnea (OSA) is characterized by significant interruptions of breathing (airway obstructions) during the night. These cessations of breathing may be associated with a substantial decrease in blood oxygen levels, high blood pressure, cardiac arrhythmias (irregularities in the heart's normal beating pattern) and may in fact be a cause of sudden death. OSAS is a serious disorder and can become a major risk to one's health, causing significant lung and heart disease over time.

Since this condition is often found in people who snore loudly (“Snoring with Sleep Apnea”), such snorers should be aware of this association and their spouses should monitor their sleeping patterns for apneic episodes (where breathing stops for a short period of time -- 10 - 20 seconds). If breathing stops for more than 10 seconds, significant OSA may be present.

Symptoms of sleep apnea can include:

  • Excessive daytime tiredness
  • Napping during work hours
  • Falling asleep while driving
  • Sore throats
  • Unexplained hypertension (high blood pressure)
  • Headaches

Most loud snorers should have a polysomnogram (PSG) or sleep test performed. This is an overnight test that is usually performed in a sleep laboratory, where one simply falls asleep for a number of hours. During this sleeping time, the lab monitors and tests a number of important processes in the sleeper's body, including the heart rhythm (EKG), blood oxygen levels, number and duration of apneic spells.

Treatment

Based on the results of the PSG, you will be classified as having “primary snoring”, (snoring only), or a person with snoring and OSA. People who suffer from loud snoring but not OSA have a number of treatment options, as do those with OSA.

Primary snoring treatment can include non-surgical or surgical approaches. Non-surgical treatment methods include weight loss and positional changes (keeping the snorer off his/her back). Other treatments include Radio Frequency (RF) procedures, such as Somnoplasty, and Coblation RF, Palatal Implants, Injection Snoreplasty, and CAPSO (Cautery Assisted Palatal Stiffening Operation).

Somnoplasty and Coblation are radio frequency treatments aimed at mild-to-severe snorers (without apnea). This technology utilizes radio frequency techniques to accomplish palatal stiffening. We have had experience with over 450 RF procedures. These are outpatient treatments and are performed in our Department's outpatient area (Head & Neck Disorders Center.)

(Snoring, continued) Radiofrequency procedures of the palate are not covered by medical insurance since they are performed to reduce snoring (snoring being a non-reimbursable disorder by most medical insurance companies.)

Treatment of OSA

For those suffering from OSAS, treatment options generally include:

  • Weight Loss
  • Sleeping prone or on the side only (avoiding supine position)
  • Continuous Positive Airway Pressure (CPAP)
  • Uvulopalatopharyngoplasty (UPPP or UP3)
  • Upper and/or lower jaw advancement procedures

CPAP is the first line of defense in management of OS, and has the highest cure rate. In CPAP, pressurized air is delivered by a face mask which is worn during sleep. The pressure of the air is adjusted in order to maintain adequate pressure to overcome airway obstruction. In this way, most of the apneic episodes are eliminated. Many patients find that while wearing this device, they experience a much improved sleep pattern with an overall better night's sleep. Some patients find, however, that the CPAP device is cumbersome and difficult to use. Some patients, in fact, will use CPAP for a year or two and then opt for surgical therapy. CPAP, however, remains the best non-surgical treatment for OSAS.

UPPP, introduced by Fujita in the late 1970's, for 2 decades has been the mainstay in the surgical treatment of OSAS and severe snoring. Thousands of patients have been effectively treated with this technique. It should be noted, however, that UPPP does not cure all OSAS. It does, though, significantly reduce the degree of OSAS in well over 50 - 60% of patients, and typically eliminates or significantly reduces snoring. There are a few patients who do not experience a significant correction of the OSAS, and they may need to undergo other surgical methods. Most people do, however, experience an improvement in their sleep patterns and overall daily life.

The UPPP is performed in the main surgical suites at UCI Medical Center, under general anesthesia, and typically requires an overnight hospital stay for observation. Postoperatively, patients typically experience a sore throat and some difficulty swallowing which may last as long as 10 - 14 days, although most patients find they can return to work after only a few days' recuperation. Of course, improvements in our management of postoperative pain have made this procedure much less traumatic than what their experience may have been even a few years ago.

If you are interested in pursuing any of these treatment modalities, contact your family physician or contact our Department calling 714-456-7017.