Understanding Sleep Apnea
People with obstructive sleep apnea have disrupted sleep and low blood oxygen levels. When obstructive sleep apnea occurs, the tongue is sucked against the back of the throat, blocking the upper airway and stopping airflow. When the oxygen level in the brain becomes low enough, the sleeper partially awakens, the obstruction in the throat clears, and the flow of air starts again, usually with a loud gasp.
Repeated cycles of decreased oxygenation can lead to serious cardiovascular problems, as well as excessive daytime sleepiness, depression, and loss of concentration.
In less severe cases, called upper airway resistance syndrome, individuals suffer many of the same symptoms.
The First Step in Getting Relief
The first step in treatment is recognizing symptoms and seeking a consultation. During a consultation, a detailed history is taken, along with an assessment of the anatomic relationships in the maxillofacial region. This can include cephalometric (skull X-ray) analysis, nasopharyngeal exam with a flexible fiber-optic camera if indicated, and a sleep study to confirm the level of cardiovascular compromise and decreased oxygenation levels.
There are several treatment options available, and they are usually performed under light IV sedation in the office.
- CPAP machine is often a first course of treatment. Used while sleeping, this continuous positive air pressure machine delivers pressurized oxygen through a nasal mask to limit obstruction.
- Uvulopalatopharyngoplasty (UPPP) is a procedure performed in the back of the soft palate and throat to remove extra tissue that could be causing obstruction.
- Laser-assisted uvulopalatoplasty (LAUP), a procedure similar to the one above, uses a laser to remove and tighten tissue.
- Radio-frequency probe can tighten the soft palate.
In complex cases, repositioning of the bones of the upper and lower jaw to increase the size of the airway (orthognathic surgery) is performed. The procedure is done in the hospital under general anesthesia and requires one to two nights in the hospital.
Obstructive sleep apnea is a serious condition that needs careful attention and treatment. Most major medical plans offer coverage for diagnosis and treatment.