A serious medical condition where a patient has decreased breathing or pauses in breathing while they are sleeping. This results in decreased oxygen levels getting into our lungs which in turn causes multiple acute and chronic damaging effects on all parts of our body. It is estimated that 80 million people in the United States have some degree of sleep apnea with up to 80-90% percent of people undiagnosed. While most people with sleep apnea also snore, this is not always the case. In addition, people may snore but not have sleep apnea – however this scenario is rare. The social, individual wellbeing, financial and societal impact of sleep apnea would be impossible to fully determine given the widespread negative impact it has.

SYMPTOMS: Gasping or choking at night, waking up suddenly at night with a choking feeling, fatigue, excessive daytime sleepiness, memory loss, dementia, restless sleep, snoring, depression, irritability, mood swings, headaches, erectile dysfunction, decreased libido, diabetes, weight gain, trouble losing weight, high blood pressure, stroke, atrial fibrillation, acid reflux, decreased immune system, mouth breathing, dry mouth, sore throat, waking up at night to urinate, falling asleep in public or when sitting around and insomnia.

CAUSES: Obstruction of the nasal airway (deviated nasal septum, turbinate hypertrophy, nasal polyps, sinus disease), obstruction of the upper oral airway (large tonsils, large tongue, loose palate), jaw abnormalities, oral cavity / teeth abnormalities, obstruction of the lower airway (voice box disorders, pharyngeal collapse), being overweight and gaining weight. Central sleep apnea is not caused by obstruction of the airway but rather occurs due to our brain sending improper signals to the muscles that help us breathe at night – it is not as common as obstructive sleep apnea.

DIAGNOSIS: A through medical history and physical exam are the first step in diagnosing sleep apnea. The nasal airway can be checked for blockage with Nasal Endoscopy and the upper / lower airway can be examined with Flexible Laryngoscopy. Next a sleep quality survey like the Epworth Sleepiness Scale is taken to further evaluate for the presence of sleep apnea. If the exam and survey indicate a likelihood of sleep apnea, then a sleep study is done next. This can be done in a sleep lab (PSG – polysomnography) or at home with a Home Sleep Study. If sleep apnea is diagnosed, then a comprehensive treatment plan will be developed and executed. If the sleep apnea has been ruled out, then further evaluation will be done to evaluate for other sleep disorders like hypersomnia.

TREATMENT: Sleep apnea is graded as mild, moderate and severe and this will guide treatment plans. Other parameters like the AHI (apnea-hypopnea index), RDI (respiratory distress index), RERA (respiratory event related arousal), amount of REM and deep sleep, sleep position, presence or absence of snoring, associated medical conditions, airway anatomy and patient weight are all considered when determining treatment options for a patient. Options include CPAP, Septoplasty, Turbinoplasty, Tonsillectomy, Palate Surgery, Tongue base nerve stimulators {link to ASPIRE website}, mandible / jaw surgery, dental surgery and Oral Airway Appliances. All patients benefit from weight loss, improved sleep habits and sleeping in positions that keep the airway open. It is very important to not just treat the sleep apnea – a comprehensive team of health experts including cardiologists, endocrinologists, psychiatrists, nutritionists, acupuncturists, physical therapists and holistic practitioners should be involved to ensure that all aspects of a sleep apnea patient’s wellbeing are addressed to resolution.