For all of you that are suffering from poor quality sleep and have read our earlier blog piece on Sleep Apnea and why you should get tested for it , we thought we would follow up with some useful information on how it is typically treated in a step-wise manner:
#1 Sleep Study (Polysomnography)
The first step in treating sleep apnea is figuring out if you actually have sleep apnea! A sleep study is a test used to to record what happens while you sleep and is used to identify the root cause of any sleeping problems. The most common sleep study is a polysomnogram which records several body functions during sleep such as brain activity, heart rates, oxygen saturation levels, muscle movements, eye movements, air flow through the mouth and nose, etc. Since breathing-related disorders are a common cause of sleep problems, this test is usually an essential part of the ENT specialty and results can often be interpreted by ENT doctors. How it’s done: This test is conducted overnight. The patient is wired up with a number of sensors from head to toe which are all taped on to the body. A light sleep aid might be administered to put the patient to sleep. A technician often monitors the data feeds received from the sensors. If sleep apnea is suspected, the patient might be made to sleep with a CPAP machine at some point during the test to see whether this leads to an alleviation of symptoms. This is a painless procedure but can be uncomfortable for some. The ultimate metric stemming from the sleep study that doctors use to determine whether you have Sleep Apnea or not is called the Apnea-Hypopnea Index (AHI). This actually measures the number of times per hour that you stop breathing. An AHI under 5 is considered normal.
# 2 Weight Loss
Being overweight is considered a high risk factor for sleep apnea. Fat tissue accumulation in the neck area can constrict the upper airway, thereby leading to sleep apnea. For those apnea patients that are overweight or obese, doctors will often first recommend weight loss to alleviate sleep apnea. However, except in those cases where the patient is drastically overweight, weight loss is used to supplement other forms of treatment such as CPAP therapy.
# 3 CPAP Therapy
Once the sleep study has confirmed that you have sleep apnea (AHI Index > 5) Continuous Positive Airway Pressure (CPAP) Therapy is considered universally to be the “gold standard” in treatment of Sleep Apnea. It does not involve surgery, carries minimal risks if any and has a high success rate. The patient wears a mask while sleeping that is connected via a tube to a CPAP machine. The CPAP machine basically pumps air to maintain a positive pressure in the patient’s respiratory tract — this positive pressure ensures that the tongue and soft palate do not fall back and clog the upper respiratory tract. While wearing a mask and going to bed might take some getting used to, most people generally get accustomed to it over time and the results are usually dramatic — most patients with Sleep Apnea report a huge improvement from the very first day of using the CPAP in terms of sleep quality and how refreshed they feel the following day.
# 4 Sleep Apnea Surgery
Obstructive sleep apnea is usually treated through non-surgical means such as weight loss, use of a CPAP machine, etc. Surgery is only performed when these methods have proven not be effective. Since obstructive sleep apnea can be caused by a number of structural factors along the upper respiratory airway, there are multiple methods or procedures used as follows: Uvulopalatopharyngoplasty (UPPP): This is the most common surgery to treat sleep apnea. It removes excess tissue in the throat to widen the airway. Tonsilectomy / Adenoidectomy: This is usually the preferred surgical option for children since their sleep apnea is usually caused by enlarged tonsils or adenoids. Tracheostomy: This is usually the option of last resort in surgical treatment of sleep apnea. It is effective but risky and hence is only performed when other surgical options are found to be ineffective. In this procedure a permanent hole is made in the next, leading into the trachea or windpipe and then a tube with a valve is inserted into this hole to allow air to enter when the valve is open. This valve is kept closed during the day and opened at night during which the air can directly bypass its normal route into your trachea and thereby get around the structural obstruction that is causing apnea. Radiofrequency ablation (RFA): This involves using radiofrequency to reduce the size of the tongue and surrounding tissue that might be blocking airflow into the lungs Maxillo-mandibular advancement (MMA): This procedure moves the jaws forward to increase the size of the airway. Palatal implants: This method places small plastic rods into the soft palate to stiffen it. This prevents the tissue from getting flappy and blocking the airway.
If you think you might be suffering from Sleep Apnea and would like to get it investigated and treated, check out this list of Medisetter partner hospitals that are specialized in treatment of Sleep Apnea.