Sleep Apnea

Obstructive Sleep Apnea (OSA) is a potentially serious medical condition characterized by brief interruptions of breathing while sleeping. OSA is caused when soft tissues in the back of the throat relax and block the passage of air. When breathing stops, blood oxygen levels drop, which increases blood pressure and strains every system in the body. These episodes make restorative sleep impossible. OSA can occur in children, seniors, or anyone at any age. The obstruction or narrowing of the airway results in repetitive arousals – signals from the body and brain that disrupts you out of sleep. The body intermittently fights to keep the airway open, eventually causing a chronic state of low-grade stress throughout the night. When the upper airway gets blocked or collapses, the body can’t get enough oxygen in the blood. The brain senses you can’t breathe and briefly wakes you so you can open the airway to start breathing again. People with OSA are often unaware of these episodes. In mild cases of OSA your breathing stops 5-15 times per hour throughout the night.  In severe cases it happens 30 times or more per hour. According to the CDC, more than one-third of Americans are not getting enough sleep and an estimated 50 to 70 million Americans have chronic sleep-related disorders.

• Loud snoring
• Fatigue
• Poor sleep quality
• Morning headaches
• Difficulty staying asleep (insomnia)
• Awakening with a dry mouth
• Excessive daytime sleepiness (hypersomnia)
• Difficulty concentrating, impaired cognitive function
• Mood disorders, Irritability, depression
• Gasping for air during sleep

*These declines in daytime function can result in higher rates of job-related and motor vehicle accidents.

• A narrowed airway – Tonsils or adenoids also can enlarge and block the airway, particularly in children.
• Age – As we age the muscles of the throat weaken.
• Family History –  Having family members who have had sleep apnea may increase your risk.
• Use of medications, alcohol or sedatives which may relax the muscles in the throat.
• Smoking
• Excessive weight
• Medical Conditions- Cognitive heart failure, type 2 diabetes, high blood pressure, prior stroke, hormonal disorders, chronic lung disease are some of the co-morbidities that increase risk.
• Nasal obstruction
• OSA is more likely to occur in men than women. However, women who have gone through menopause or are overweight have an increased risk.

Sleep apnea is a chronic and progressive condition. Over time, it is common for sleep apnea to slowly get worse. It is best treated as early as possible. If left untreated, sleep-related disorders may lead to significant adverse health consequences.

• Heart problems – Repeated cycles of decreased oxygenation can lead to very serious cardiovascular problems such as increased risk of heart attacks, coronary heart disease, heart failure, and irregular heartbeat. In studies people with untreated sleep apnea have a 2-3 times increased risk of dying from cardiovascular causes compared to people without the condition.
• Difficult to control high blood pressure
• Stroke
• Liver problems – people with OSA have a greater risk of nonalcoholic fatty liver disease
• Metabolic dysregulation affecting glucose control. People with untreated sleep apnea are 2-3 times more likely to develop type II diabetes than people without OSA.
• Excessive weight – people with untreated sleep apnea are more likely to become obese.
• Migraines or headaches
• Sexual dysfunction
• Increased risk of Alzheimer’s Disease
• Frequent nighttime urination
• Mood disorders including anxiety and depression

A sleep test (polysomnography) can diagnose and confirm the severity of OSA. A polysomnogram records how many apneas, hypopneas, or respiratory effort-related arousals (RERA) occur per hour while a person is asleep.

• Apnea – When airflow stops for a period of 10 seconds or longer.
• Hypopnea – A period of shallow breathing that lasts for at least 10 seconds and causes a drop in the oxygen level in your blood or a brief arousal from sleep.
• Respiratory effort-related arousal (RERA) –  RERAs occur when breathing is restricted more subtly than a hypopnea but is still associated with a brief arousal from sleep.

Dr. Malan’s office can refer you to get a sleep study test from the comfort of your own home.

Although there is no cure for OSA, there are several effective treatments. The severity of OSA determines which treatment is best. OSA is classified as either mild, moderate or severe.

Mild to Moderate OSA:

A custom made mandibular advancement device can adjust the jaw forward opening the upper airway. Dr. Malan is trained to provide oral appliance treatment. This is a cost effective, non invasive treatment.

Severe OSA:

The most common treatment for severe OSA is continuous positive airway pressure (CPAP) therapy. A CPAP device has a mask that is worn over the nose and mouth during sleep. The mask is connected by a hose to a small machine that pumps pressurized air through the hose and mask to open your airway. If this effective treatment does not work for you, oral appliance therapy can help alleviate symptoms and decrease the number of apneas throughout the night.

Surgical Procedures:

Removal of tonsils or adenoids

Surgery to modify the structure of mouth or nose

Surgery to implant a device that stimulates the tongue to move forward

Lifestyle changes are also often encouraged as a form of treatment. Losing weight, sleeping on your side rather than on your back, and not drinking alcohol before bed can all be beneficial. If vitamin D or B deficiencies are a health problem it is wise to eat a healthy diet and take supplements as needed. While ongoing treatment usually alleviates symptoms, stopping treatment will cause the condition to come back.

OSA is a serious medical condition that needs careful attention and treatment. Most major medical plans offer coverage for diagnosis and treatment.