Sleep Apnea in Neptune, Holmdel & Manahawkin, NJ
Sleep apnea is a common sleep disorder that involves repeated breathing interruptions during sleep. These interruptions may occur hundreds of times each night, and may be the result of structural abnormalities or brain malfunctions. During normal breathing, air passes through the nose, past the flexible structures in the back of the throat, including the soft palate, uvula and tongue. When a person is awake, the muscles hold this airway open. When they are asleep, these muscles relax and the airway usually stays open. Sleep apnea occurs when the upper airway and airflow are blocked, causing the oxygen levels to drop in both in the brain and the blood, resulting in shallow breathing or breathing pauses during sleep.
What Causes Sleep Apnea?
Sleep apnea occurs as a result of a partial or fully blocked airway passage in the throat. Certain factors may put certain people at risk for developing sleep apnea, which include:
- Enlarged tonsils or adenoids
- Cardiovascular problems
- Family history
- Nasal congestion
- Throat and tongue muscles that are more relaxed than normal
Adults over the age of 60 may be more at risk of developing sleep apnea because the aging process may limit the brain's ability to keep the throat muscles stiff during sleep. Heavy use of alcohol or sedatives may also contribute to sleep apnea because these substances may relax the muscles of the throat.
Types of Sleep Apnea
Obstructive Sleep Apnea
Obstructive sleep apnea is the most common form of sleep disorded breathing. Obstructive sleep apnea can occur when the soft tissues in the back of their throat — the tongue, tonsils, sidewalls of the throat — sag or slide backwards and block the airway. This can lead to episodes where a patient does not get enough oxygen or stops breathing. The brain senses that breathing has stopped and it awakens the person, making them take in air, often with a snorting sound. The interruption is so brief the person usually doesn’t remember this in the morning, and it can happen dozens, or even hundreds, of times each night.
Central Sleep Apnea
In patients with central sleep apnea the airway remains open but the brain does not send signals to the muscles involved in breathing. Patients with heart-related conditions may suffer from central sleep apnea.
Mixed Sleep Apnea
Mixed sleep apnea combines aspects of the obstructive and central types of apnea. A common warning sign of mixed sleep apnea is snoring, especially interspersed with gasps or lack of breathing.
Patients who are overweight, have high blood pressure, are older, smoke or have a family history of sleep apnea may have an increased risk of developing obstructive sleep apnea, while those with heart disease or a stroke are at an increased risk for central sleep apnea.
What are the Symptoms of Sleep Apnea?
Sleep apnea really has two sets of symptoms — those that occur while the disruption is happening at night and those that occur as a result of the disrupted sleep, usually the next day.
These symptoms are common with sleep apnea:
- Awakening with shortness of breath
- Episodes of breathing cessation witnessed by another person
- Loud snoring
- Abrupt awakenings from sleep, often with snorting sounds
- Waking up with a headache in the morning
- Excessive daytime sleepiness
- Waking up with a dry mouth or sore throat
- Difficulty staying asleep
- Attention problems
What Negative Effects Can Sleep Apnea Have On the Body?
Many people discount the seriousness of sleep apnea, thinking it’s just a little snoring. That’s a risky line of thinking. Untreated sleep apnea can lead to a number of very serious health concerns:
- High blood pressure — Because you wake up over and over during the night, this process places stress on your body, activating your hormone systems. This raises your blood pressure.
- Heart disease — People with obstructive sleep apnea are more likely to have heart attacks, strokes, and atrial fibrillation.
- Type 2 diabetes — Sleep apnea is common in people with type 2 diabetes. This is because when your body is tired it has trouble effectively processing insulin.
- Weight gain — Sleep apnea can make your body release more of the hormone ghrelin, which makes you crave carbs and sweets.
- Adult asthma — Adult asthma and sleep apnea combined tend to cause the patient to suffer from more asthma attacks.
How is Sleep Apnea Diagnosed?
Your doctor at Coastal ENT will evaluate your symptoms and you’ll be asked to provide a sleep history/sleep diary. You’ll need help from a spouse or partner for this.
From there, evaluation will likely include overnight monitoring at a sleep center, or possibly a home sleep test will suffice. These are the two typical tests used to detect sleep apnea:
- Nocturnal polysomnography — At a sleep center, you are attached to equipment that monitors your heart, lung, and brain activity. It also records breathing patterns, arm and leg movements, and blood oxygen levels while you sleep.
- Home sleep tests — Testing may be able to be done at home by using portable monitoring devices. These devices provide simplified testing, usually of your heart rate, blood oxygen level, airflow, and breathing patterns.
How Is Sleep Apnea Treated?
For some of our patients at Coastal Ear, Nose & Throat, conservative treatment options could start with lifestyle changes, such as losing weight, limiting alcohol consumption, and quitting smoking. These could provide sufficient relief, but it is more likely that more involved treatments will be necessary. These are two common non-surgical treatments:
The next step up from oral appliance therapy would be continuous positive airway pressure (CPAP). CPAP is a breathing system that uses air pressure to keep the upper airway passages open. The patient wears a mask over his or her nose during sleep. The mask creates air pressure that is somewhat greater than the air pressure in the bedroom, and this difference in pressure keeps the airway open. The problem with CPAP, however, is that some people find it difficult to sleep with the tubes and mask. This can lead to a low compliance rate.
Oral Appliance Therapy
In some patients with mild to moderate obstructive sleep apnea, oral appliance therapy can be successful. This involves fitting and ordering a custom-made mouthpiece for the patient to wear while sleeping. The mouthpiece is similar to a sports mouth guard. It supports the jaw in a forward position to help keep the airway open. Currently, there are over 100 FDA-approved oral appliances, and we help our patients find the option that is best for them.
If conservative treatment is unsuccessful in treating sleep apnea, there are other options available. Individuals who suffer from severe cases of sleep apnea that may lead to serious medical conditions, may benefit from surgery. The goal of most surgical procedures is to remove the excess tissue from the nose or throat and open upper air passages to facilitate breathing.
Uvulopalatopharyngoplasty surgery treats obstructive sleep apnea by tightening the tissue in the throat and palate to expand the passageways. It may also include the removal of the tonsils and adenoids.
During a maxillomandibular advancement procedure, the upper and lower parts of the jaw are moved forward to create more space behind the tongue and soft palate and reduce the risk of obstruction during sleep. Breathing is restored as the path for airflow is cleared.
Often performed after other treatments have failed, a tracheostomy involves inserting a metal or plastic tube into the throat to help the patient breathe during sleep. The opening remains covered during the day but helps air pass directly in and out of the lungs during sleep. Tracheostomy is reserved for severe, life-threatening cases of sleep apnea.
Thermal Ablation Palatoplasty
Thermal ablation palatoplasty (TAP), is a group of procedures used to treat snoring and sleep apnea. During these procedures, electric current is used to cut away obstructive tissue in the airway and roof of mouth, or to shrink and stiffen obstructive areas in rear of the mouth and the uvula. Radio frequency ablation is used to emit energy to shrink excess tissue.
Genioglossus and Hyoid Advancement
Genioglossus and hyoid advancement procedures are frequently used to treat sleep apnea. The surgical procedure prevents the collapse of the lower throat by pulling the tongue muscles forward, which opens the obstructed airway.
Septoplasty and Turbinate Surgery
Nasal septoplasty reduces resistance to air flow through the nose. It repairs and straightens the bone and tissue separating the two nasal passages, as well as the layers of spongy horizontal bones, or turbinate, which are located inside the nasal cavity.
Custom made oral appliances may also be used to treat sleep apnea. Some devices are designed to open the throat by bringing the jaw forward, which can help to relieve snoring and mild obstructive sleep apnea. Left untreated, sleep apnea may cause serious problems. Patients with sleep apnea have a higher risk of developing high blood pressure, heart failure and stroke.