WHAT IS SLEEP APNEA?
If you snore, first of all you should rule out if you suffer from a more serious health problem called sleep apnoea.
People with sleep apnea actually stop breathing for brief periods of time (usually 10-20 seconds) while asleep.
Sleep apnea often results in feelings of excessive tiredness during the day since the ability to reach deep, restorative sleep stages is impaired. Other warning signs of sleep apnea are often noticed by bed partners and include loud snoring and making snorting or choking sounds at night.
What are the types of sleep apnea?
There are three types of sleep apnea, central sleep apnea (CSA), obstructive sleep apnea (OSA), and mixed sleep apnea (both central sleep apnea and obstructive sleep apnea).
1. What is central sleep apnea and what causes it?
Central sleep apnea (CSA) occurs when the brain does not send the signal to breathe to the muscles of breathing.
This usually occurs in adults with heart disease, cerebrovascular disease, or congenital diseases but also can be caused by some medications and high altitudes. In adults with central sleep apnea, the apneas are treated by treating the underlying heart disease, medication interaction, high altitude, or other primary problem.
If you suffer from CSA you should visit your GP asap.
2. What is obstructive sleep apnea and what causes it?
This is the most common category of sleep-disordered breathing.
Obstructive sleep apnea (OSA) is estimated to affect about 4% of men and 2% of women. It is probably more common than that because the population is becoming more obese, and obesity worsens obstructive sleep apnea.
An apnea event has four components.
1. First, the airway collapses.
2. Second, an effort is made to take a breath, but is unsuccessful.
3. Third, the oxygen level in the blood drops.
4. When the amount of oxygen reaching the brain decreases, the brain signals the body to wake up and take a breath. (This is what the bed partner hears as a silence followed by a gasp for air.)
Airflow can become diminished for a variety of reasons, for example if a person has a deviated septum. If the palate and uvula (the thing that hangs in the back of your throat) are long or floppy, they can fall backwards and close the area for breathing. The back of the tongue can also fall backwards and obstruct breathing especially when laying flat on your back. Finally the side walls of the throat can fall together to narrow or close the airway.
What are obstructive sleep apnea symptoms?
Common symptoms include loud snoring, restless sleep, and sleepiness during the daytime. Thus, people with obstructive sleep apnea have a greater risk of a car accident and accidents in the work place than the general population.
Sleep apnea causes high blood pressure and sufferers have a 30% higher risk of heart attack.
Unfortunately it is estimated that only 10% of people with obstructive sleep apnea seek medical attention.
How is diagnosed and evaluated?
The Epworth Sleepiness Scale is a common test to establish the severity of sleepiness and to assess whether a person is affected by sleep apnea.
At The Private Clinic, during your free consultation, we will perform a medical assessment and we will help you with fill in your Epworth questionnaire to assess whether or not you may be suffering from OSA.
Non-surgical treatments for obstructive sleep apnea
- Some treatments involve lifestyle changes, such as avoiding alcohol or muscle relaxants, losing weight, quitting smoking or changing sleeping position.
- Some people require the use of a breathing machine called CPAP - continuous positive airway pressure. CPAP delivers the air through a nasal or face-mask under pressure. When adjusted properly and tolerated, it is nearly 100% effective in eliminating or reducing obstructive sleep apnea. Unfortunately only 60% of people with CPAP machines report that they use them and only 45% of them actually use them more than 4 hours per night.
The use of CPAP mask can be impaired when a patient has nasal congestion or a septal deviation; it is important to have these evaluated since they can be treated (see below under surgical treatments).
- Another non-surgical method is a dental appliance to hold the jaw and tongue forward and holds the palate up thus preventing closure of the airway. This small increase in airway size sometimes is enough to control the apneas. A dental appliance requires natural teeth to fit properly and it must be worn every night.
- Finally many medications have been studied for obstructive sleep apnea; however, because obstructive sleep apnea is due to an anatomic airway narrowing, it has been difficult to find a medication that will help.
Surgical treatments for obstructive sleep apnea
There are many surgical options to treat obstructive sleep apnea. The type of surgery that is chosen is dependent on an individual’s specific anatomy and severity of sleep apnea.
Surgery should be considered only after all the risks, benefits, and alternatives to surgery are understood.
At The Private Clinic we offer three possibilities, two to target the excess vibration of the soft palate and uvula (the stalactite of flesh at the back of the throat). The third treatment unblocks the nose. We will be able to advise on which is most suitable for you at your free consultation.
Laser Assisted Uvulopalatoplasty (LAUP)
A simple procedure performed under local anaesthetic. You sit in a chair as if at the dentist while the ENT surgeon uses a laser to remodel the excess vibrating soft tissue at the back of your throat. LAUP is a long established procedure in the UK with over 20,000 procedures performed to date.
Bipolar Radiofrequency Thermotherapy (RFITT)
A radio frequency to tighten the muscle within the soft palate so that it vibrates far less during sleep. The procedure involves numbing the back of the throat with a local anaesthetic and targeting it with a slim pen that emits a high frequency. The heat causes the muscle to tighten - which it continues to do so in the weeks following treatment, with the maximum benefit being achieved after six months.
Unblocking the nose:
The nasal cavity can be obstructed by swelling of the turbinates and septal deviation. We use a minimally invasive procedure to reduce enlarged fleshy ridges or ‘turbinates’ at the entrance of the sinuses, or to correct a deviated septum (a buckled partition between the two nostrils). Nasal obstruction makes CPAP difficult if not impossible to tolerate. Surgery to open the nasal passages markedly improves tolerance to CPAP.
Sleep apnea can be a very serious condition. If you are a loud snorer, you may suffer from sleep apnea.
You can book your free consultation online or call 0800 599 9911
