SLEEP APNEA AFFECTS AT LEAST TWENTY-FIVE MILLION ADULTS IN THE U-S.
THE CONDITION CAUSES THE UPPER AIRWAY TO COLLAPSE FREQUENTLY WHILE SLEEPING, ROBBING SUFFERERS OF A GOOD NIGHT’S SLEEP AND LEADING TO DAYTIME SLEEPINESS AND DROWSY DRIVING.
NOW, NEW CLEVELAND CLINIC RESEARCH SUPPORTS A GROWING BODY OF EVIDENCE THAT SHOWS TREATING SLEEP APNEA WITH A C-PAP (SEE-PAP) MACHINE REDUCES SLEEPINESS BEHIND THE WHEEL.
CG: Dr. Harneet Walia /Cleveland Clinic “There was a significant reduction in the drowsy driving episodes and this reduction was more pronounced in patients who were CPAP adherent. This is a very important finding because drowsy driving poses a very important public health risk.” [:14]
RESEARCHERS ANALYZED SELF-REPORTED QUESTIONNAIRES FROM NEARLY TWO THOUSAND PEOPLE WITH SLEEP APNEA. THEY ASSESSED DROWSY DRIVING INCIDENTS BEFORE AND AFTER PARTICIPANTS USED A C-PAP MACHINE.
C-PAP STANDS FOR CONTINUOUS POSITIVE AIRWAY PRESSURE AND IS WORN AT NIGHT WHEN SOMEONE IS SLEEPING.
IT’S DESIGNED TO INCREASE AIR PRESSURE IN THE THROAT TO PREVENT THE AIRWAY FROM COLLAPSING AND THEREFORE RESULT IN A BETTER NIGHT’S SLEEP.
RESULTS SHOW A SIGNIFICANT IMPROVEMENT IN REPORTED ACCIDENTS AND NEAR-MISS-ACCIDENTS AFTER USING A C-PAP MACHINE. FOLKS WHO USED IT REGULARLY AND COMPLIED WITH TREATMENT GUIDELINES SAW THE GREATEST IMPROVEMENT.
IN ADDITION TO DROWSY DRIVING AND DAYTIME SLEEPINESS, DOCTOR WALIA (WALL-EE-UH) SAYS SLEEP APNEA CAN ALSO HAVE CARDIOVASCULAR CONSEQUENCES, SO IT’S IMPORTANT TO BE PROPERLY DIAGNOSED AND TREATED.
CG: Dr. Harneed Walia /Cleveland Clinic “If you think you have obstructive sleep apnea, or you have signs of obstructive sleep apnea such as loud snoring, having pauses in breathing, or you feel excessively tired throughout the day please seek medical attention.” [:14]
DOCTOR WALIA SAYS SLEEP APNEA CAN BE EASILY DETECTED DURING AN OVERNIGHT SLEEP STUDY AND THAT USING A C-PAP MACHINE IS OFTEN THE FIRST LINE OF TREATMENT. COMPLETE RESULTS WERE PRESENTED AT THE AMERICAN ACADEMY OF SLEEP MEDICINE IN BOSTON.
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Dr. Charles Bae says, “Depending on how serious the sleep apnea is that would determine when you need the machine, but it really, oftentimes, doesn’t matter. Someone with severe sleep apnea may not be sleepy, but they definitely need the machine. Someone with mild sleep apnea may be super sleepy, so certainly, that would be the time to consider it.”
DR. BAE ALSO SAYS IF YOU’RE GETTING 8 HOURS OF SLEEP, BUT STILL FEEL TIRED, OR ARE WAKING UP FOR UNKNOWN REASONS, TALK TO YOUR DOCTOR. For more information, visit: www.clevelandclinic.org
Mount Sinai is one of only a few programs in the world to use transoral robotic surgery (TORS) to remove excess tissue or fix a collapsed airway that causes sleep apnea.
Through the robotic procedure, a laser removes the extra tissue in the throat that contributes to the airway obstruction in sleep apnea patients.
Patients typically return home the next day, and are back to work in 10 days, sleeping and breathing normally.
During sleep apnea, a person’s breathing is blocked and then restored when the brain sends a signal that awakens the patient to a lighter level of sleep.
This process can happen hundreds of times each night, leaving the patient exhausted during the day and at risk for many health complications, including cardiovascular disease and hypertension.
Many patients opt for a treatment called continuous positive airway pressure (CPAP), delivered through a mask that the patient wears at night to force his or her airway open for the duration of sleep.
However, some feel the mask hinders their quality of life, and look for better options.
“Over time many patients grow frustrated with CPAP or stop using the device, causing their sleep apnea to return and leaving them anxious for a better solution,” said Fred Lin, MD, Assistant Professor of Otolaryngology and Director of the Mount Sinai Sleep Surgery Center.
“In the past, surgery had been a last resort. Now, using robotic surgery, we can remove the tissue that contributes to the airway blockage in a brief procedure with no external incisions and have patients home the next day, sleeping healthfully.”
During the robotic procedure, a surgeon sits at a console directly controlling a robotic arm that extends a small surgical instrument through the patient’s mouth. Using a high-powered 3-D camera, he or she has a clear view of the surgical field.
The previous surgical technique was less precise and potentially less effective because the surgeon was only able to use one hand, and had limited maneuverability.
“Mount Sinai is one of the original adopters of robotic surgery and we have seen first-hand the dramatic quality of life improvements it provides our head and neck cancer patients,” said Eric Genden, MD, Professor and Chair of Otolaryngology, Mount Sinai School of Medicine.
There are three types of respiratory events:
Obstructive apnea—caused by a temporary, partial, or complete blockage of the airway
Central apnea—caused by a temporary failure to make an effort to breathe
Mixed apnea—combination of the first two types
These factors increase your chance of developing sleep apnea. Tell your doctor if you have any of these risk factors:
Large neck circumference
Age: middle to older age
Family history of apnea
Structural abnormalities of the nose, throat, or other part of the respiratory tract. Examples include:
There are a number of treatment options for sleep apnea, including:
Lose weight if you are overweight.
Avoid using sedatives, sleeping pills, alcohol, and nicotine, which tend to make the condition worse.
Try sleeping on your side instead of your back.
Place pillows strategically so you are as comfortable as possible.
For daytime sleepiness, practice safety measures, such as avoiding driving or operating potentially hazardous equipment.
Continuous positive airway pressure (CPAP) entails wearing a mask over your nose and/or mouth during sleep. An air blower forces enough constant and continuous air through your air passages to prevent the tissues from collapsing and blocking the airway. In some cases, dental appliances that help keep the tongue or jaw in a more forward position may help.
In some cases, surgery may be recommended. It is most often beneficial in pediatric patients.
Types of surgery that may be done to treat severe cases of sleep apnea include:
Uvulopalatopharyngoplasty—The doctor removes excess soft tissue from the nose and/or throat.
Maxillomandibular advancement—The jawbone is repositioned forward.
Tracheotomy—For life-threatening cases of sleep apnea, an opening is made in the windpipe to allow for normal breathing.
Bariatric surgery may help with weight loss in some people who are obese. This surgery may reduce many of the complications that are related to obesity, including sleep apnea.
Only used in central apnea, acetazolamide (Diamox) may help improve the ability to regulate breathing. Overall, there is not a lot of evidence to support the use of medicines to treat sleep apnea.
Supplemental oxygen may be given if blood levels of oxygen fall too low during sleep, even after opening the airway.
You may be able to prevent the onset of sleep apnea by maintaining a healthy weight . Avoid alcohol, nicotine, and sedatives, which may contribute to airway obstruction.
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Morgenthaler TI, Kapen S, Lee-Chiong T, et al. Practice parameters for the medical therapy of obstructive sleep apnea. Sleep. 2006;29:1031-1035.
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Last reviewed September 2011 by Marjorie Bunch, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.